APEA ONLY Flashcards
Which of the following symptoms would be a clinical manifestation noted during the tertiary stage of syphilis?
a. A single painless lesion, chancre, on the genital area
b. Absence of symptoms
c. Rash marked by red or reddish-brown, penny-sized lesions over the palms and soles
d. Poor muscle coordination
d. Poor muscle coordination
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Which stage of syphilis includes findings of a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles of the feet?
a. Primary
b. Secondary
c. Latent
d. Tertiary
b. Secondary
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Which type of virus causes oral and genital lesions through sexual contact?
a. Chancroid
b. Herpes simplex virus (HV-1)
c. Herpes zoster
d. Syphilis
b. Herpes simplex virus (HV-1)
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Which sexually transmitted disease (STD) is caused by infection with a protozoan parasite?
a. Chlamydia
b. Genital herpes
c. Trichomoniasis
d. Syphilis
c. Trichomoniasis
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Which stage of syphilis is described as having serologic proof of infection without symptoms of disease?
a. Primary
b. Secondary
c. Latent
d. Tertiary
c. Latent
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A chancre is defined as a:
a. group of small scattered vesicles
b. painless ulceration
c. papule of many shapes
d. non-tender penile indurated nodule
b. painless ulceration
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Which gynecological assessment finding includes a fish-like odor with white vaginal discharge on physical presentation and clue cells on microscopic exam?
a. Chlamydia
b. Gonorrhea
c. Trichomoniasis
d. Bacterial vaginosis (BV)
d. Bacterial vaginosis (BV)
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Which sexually transmitted disease (STD) in men causes a yellowish discharge from the penis, accompanied by itching and burning?
a. Chlamydia
b. Gonorrhea
c. Trichomoniasis
d. Syphilis
b. Gonorrhea
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Which sexually transmitted disease (STD) can lead to serious neurological conditions if left untreated?
a. Chlamydia
b. Gonorrhea
c. Trichomoniasis
d. Syphilis
d. Syphilis
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What is the most commonly reported sexually transmitted disease (STD) in the United States?
a. Human immunodeficiency virus (HIV)
b. Syphilis
c. Chlamydia
d. Gonorrhea
c. Chlamydia
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Which of the following is NOT considered a sexually transmitted disease (STD)?
a. Chlamydia
b. Gonorrhea
c. Trichomoniasis
d. Bacterial vaginosis (BV)
d. Bacterial vaginosis (BV)
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Which is NOT a type of diagnostic test for human immunodeficiency virus (HIV)?
a. Antibody test
b. Combination antibody and antigen test
c. Cluster of differentiation 4 (CD4)
d. Nucleic acid tests (NATs)
c. Cluster of differentiation 4 (CD4)
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Which sexually transmitted disease (STD) is known as a ‘silent’ infection and often lacks abnormal physical examination findings?
a. Syphilis
b. Chlamydia
c. Trichomoniasis
d. Bacterial vaginosis
b. Chlamydia
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Hairy leukoplakia may be associated with:
a. Acquired immunodeficiency syndrome (AIDS)
b. Addison’s disease
c. Cushing’s disease
d. Diabetes
a. Acquired immunodeficiency syndrome (AIDS)
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What is the sexually transmitted disease (STD) caused by infection with Haemophilus ducreyi and characterized by painful necrotizing genital ulcers?
a. Herpes simplex virus
b. Chancroid
c. Syphilis
d. Herpes zoster
b. Chancroid
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When examining the external genitalia of a female patient, excoriations and itchy, small, red maculopapulares were noted. These lesions may be suggestive of:
a. Genital herpes
b. Pediculosis pubis
c. Chlamydia trachomatis
d. Genital warts
b. Pediculosis pubis
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What type of cells are found on the wet mount slide of a patient with bacterial vaginosis (BV)?
a. Lactobacilli
b. Yeast cells
c. Clue cells
d. White blood cells
c. Clue cells
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What cluster of differentiation 4 (CD4) lab result suggests that a patient with human immunodeficiency virus (HIV) has developed acquired immunodeficiency syndrome (AIDS)?
a. 150 cells/mm3
b. 300 cells/mm3
c. 500 cells/mm3
d. 650 cells/mm3
a. 150 cells/mm3
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What is the gold standard method for diagnosing bacterial vaginosis (BV)?
a. Bimanual examination
b. Urine culture
c. Gram stain
d. Rectal examination
c. Gram stain
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Which genital infection can cause cervicitis, pelvic inflammatory disease (PID), tubal factor infertility, and ectopic pregnancy in women if untreated?
a. Chlamydia
b. Syphilis
c. Trichomoniasis
d. Bacterial vaginosis (BV)
a. Chlamydia
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Which of the following signs and symptoms are consistent with genital warts?
a. Pain or itching in the genital area and the presence of small, red papules or vesicles
b. Small, flesh-colored or grey lesions and itching in the genital area
c. Presence of vaginal or penile discharge
d. Painful bowel movements, anal itching, and painful or swollen testicles or abnormal menstrual bleeding.
b. Small, flesh-colored or grey lesions and itching in the genital area
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Which of the following signs and symptoms are consistent with genital warts?
a. Pain or itching in the genital area and the presence of small, red papules or vesicles
b. Small, flesh-colored or grey lesions and itching in the genital area
c. Presence of vaginal or penile discharge
d. Painful bowel movements, anal itching, and painful or swollen testicles or abnormal menstrual bleeding.
b. Small, flesh-colored or grey lesions and itching in the genital area
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During palpation of the abdomen, right lower quadrant pain is elicited by applying pressure to the left side of the abdomen. This technique elicited a positive:
a. Psoas sign.
b. Rovsing’s sign.
c. Murphy’s sign
d. Obturator sign
b. Rovsing’s sign.
**APEA Gastroenterology
Examination of the abdomen reveals a small midline protrusion in the linea alba. This finding is consistent with an:
a. Incisional hernia
b. Epigastric hernia
c. Umbilical hernia
d. Inguinal hernia
b. Epigastric hernia
**APEA Gastroenterology
Indicators of oropharyngeal dysphagia include all of the following symptoms except:
a. Drooling
b. Nasopharyngeal regurgitation
c. Cough
d. Vomiting
d. Vomiting
**APEA Gastroenterology
A feeling of constantly needing to pass stool is termed:
a. Constipation
b. Tenesmus
c. Obstipation
d. Acholic
b. Tenesmus
**APEA Gastroenterology
Sarcopenia is:
a. Cancer of the muscle sheath
b. Loss of lean body mass and strength with aging
c. Atrophy of voluntary muscles
d. Loss of bone production
b. Loss of lean body mass and strength with aging
**APEA Gastroenterology
On auscultation of the abdomen, rushes of high-pitched sounds are audible and coincide with abdominal cramps. These findings are most consistent with:
a. An adynamic ileus
b. Intestinal obstruction
c. Peritonitis
d. Ulcerative colitis
b. Intestinal obstruction
**APEA Gastroenterology
A patient visits the nurse practitioner for complaints of passing bloody stools over the past few weeks. He denies abdominal pain or fever. Further questioning reveals that when he passes stool, he notices blood dripping in the toilet. These symptoms could be consistent with:
a. Hemorrhoids
b. Colon cancer
c. Ischemic colitis
d. Adenomatous polyps
a. Hemorrhoids
**APEA Gastroenterology
Of the five percussion notes, which one produces a drum-like sound heard over air filled structures during the abdominal examination?
a. Tympany
b. Dullness
c. Flatness
d. Hyperresonance
a. Tympany
**APEA Gastroenterology
When performing a rectal exam, a purulent bloody discharge mixed with fecal matter is oozing from the rectum. This finding is most consistent with a:
a. Rectal carcinoma
b. Anorectal fistula
c. Anal abscess
d. Genital wart
b. Anorectal fistula
**APEA Gastroenterology
When performing a rectal exam, if a tender, purulent, reddened mass is palpated, consider an anal abscess, especially in the presence of fever and chills. Abscesses tunneling to the skin surface from the anus or rectum may form a clogged or draining anorectal fistula. Fistulas may ooze blood, pus, or feculent mucus. Rectal carcinoma may present with pain along with bleeding from the rectum and changes in bowel habits. Genital warts present as tiny growths and may increase in size to that of a pea. They are usually non-tender and are not associated with rectal discharge.
A 55-year-old patient visits with the nurse practitioner for an annual exam. Stool sample revealed hematochezia. The patient is otherwise asymptomatic. This finding could be associated with:
a. Hemorrhoids
b. Pancreatic cancer
c. Ischemic colitis
d. Adenomatous polyps
d. Adenomatous polyps
**APEA Gastroenterology
Blood in the stools, hematochezia, is often the only symptom seen with adenomatous polyps. Although adenomatous polyps are benign, they are the most common cause of colorectal cancer. Lower abdominal pain accompanied by fever or shock in older adults could be consistent with ischemic colitis. Generally, the abdomen is soft on palpation. Hemorrhoids typically present with noticeable blood on the tissue paper, surface of stool, or dripping in the toilet. Colon cancer can cause bloody stool but usually presents with changes in bowel habits and weight loss.
Bowel sounds may be decreased in the presence of:
a. Diarrhea
b. Early intestinal obstruction
c. Peritonitis
d. Ulcerative colitis
c. Peritonitis
**APEA Gastroenterology
Pain of duodenal or pancreatic origin may be referred to the:
a. Right shoulder
b. Retrosternal area
c. Right posterior chest
d. Back
Back
**APEA Gastroenterology
Referred pain of duodenal or pancreatic origin may be perceived in the back. Referred pain from the biliary tree may be perceived in the right shoulder or the right posterior chest. Heartburn may be associated with retrosternal pain.
When examining the buttocks and rectum, a small tuft of hair surrounded by a halo of erythema was observed at the sacral area. This finding is most likely:
a. An external hemorrhoid
b. A pilonidal cyst
c. A genital wart
d. A normal finding
b. A pilonidal cyst
**APEA Gastroenterology
Pilonidal cyst is a fairly common, probably congenital, abnormality located in the midline superficial to the coccys or the lower sacrum. The opening may exhibit a small tuft of hair surrounded by a halo of erythema. Although Pilonidal cysts are generally asymptomatic, they may drain, form abscesses, or secondary sinus tracts.
An enlarged liver with a smooth tender edge may suggest:
a. Cirrhosis
b. Right-sided heart failure
c. Hepatocellular carcinoma
d. Hematochromatosis
b. Right-sided heart failure
**APEA Gastroenterology
An enlarged liver with a smooth, tender edge suggests inflammation, as in hepatitis, or venous congestion, as in right-sided heart failure. Cirrhosis, hematochromatosis (increased amount of iron in the blood), and lymphoma produce an enlarged liver with a firm, non-tender edge. An enlarged liver that is firm or hard and has an irregular edge or surface suggests hepatocellular carcinoma
Palpation of the liver reveals an enlargement that is firm with an irregular edge. This finding may be suggestive of:
a. Cirrhosis
b. Hepatocellular carcinoma
c. A normal variation in the shape of the liver
d. A downward displacement of the liver by a low diaphragm
b. Hepatocellular carcinoma
**APEA Gastroenterology
An enlarged liver that is firm or hard and has an irregular edge or surface suggests hepatocellular carcinoma. There may be one or more nodules. The liver may or may not be tender. With cirrhosis, the liver is enlarged with a firm, non-tender edge.
Helminths can be transmitted by:
a. The bite of a blood-sucking insect
b. Venom injected through a stinger
c. Casual contact
d. Body fluids
a. The bite of a blood-sucking insect
**APEA Gastroenterology
Helminths are worm-like organisms living in and feeding on living hosts, receiving nourishment and protection while disrupting their hosts’ nutrient absorption, causing weakness and disease. They are transmitted via fecal-oral ingestion, ingestion of infected pork, via sexual contact, and through skin penetration. Examples of helminths are tapeworms, pinworms, and hookworms. Venom is transmitted by arachnids and insects. Casual contact and body fluids are not modes of transmission for helminths
An infant weighed 8 pounds at birth. According to the principles of normal growth and development, how much should he weigh at 12 months of age?
a. 16 pounds
b. 24 pounds
c. 29 pounds
d. 32 pounds
b. 24 pounds
**APEA Gastroenterology
Normal infants double their birth weight at 6 months and triple their birth weight at one year of age.
A 9-month-old who has been a healthy, thriving infant presents with poor appetite, two episodes of vomiting, three bloody stools with mucus and knees drawn to the abdomen with screaming. These are clinical manifestations of:
a. Celiac disease
b. Intussusception
c. Pyloric stenosis
d. Intestinal parasites
b. Intussusception
**APEA Gastroenterology
Intussusception generally occurs in children without a history of chronic GI problems. Pain progresses from colicky-like, intermittent discomfort to a more constant, intense pain. Vomiting may occur and the child may pass “currant jelly-like” stools due to the blood/mucus from inflammation secondary to intussusception. These are classic signs of intussusception. The other choices do not present with these symptoms.
When performing a rectal exam, a reddish, moist, protruding mass is noted at the anal opening. This finding is most likely a(n):
a. A prolapsed internal hemorrhoid
b. An external hemorrhoid
c. A rectal polyp
d. An anal abscess
a. A prolapsed internal hemorrhoid
**APEA Gastroenterology
Internal hemorrhoids are enlargements of the normal vascular cushions located above the pectinate line. They are not usually visible but may become visible if prolapse occurs after defecation. They would appear in the anal canal as reddish, moist, protruding masses. External hemorrhoids are dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. They present as tender, swollen, bluish, ovoid masses at the anal margin. A tender, purulent, reddened mass palpated in the rectum would be consistent with an anal abscess, especially in the presence of fever and chills. Rectal polyps are typically located in the rectum and, if palpated, feel soft to touch.
Stool that appears bloody, mucoid, or with pus, may indicate:
a. Constipation
b. A lesion in the sigmoid colon
c. Hemorrhoid
d. Crohn’s disease
d. Crohn’s disease
**APEA Gastroenterology
Crohn’s disease usually presents with blood, mucus, or puss in the stool. Thin, pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid colon. Constipation produces hard, dry stool. In the presence of hemorrhoids, the stool may appear blood streaked.
Which type of hepatitis is most commonly transmitted from infected mothers to infants at the time of birth?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
b. Hepatitis B
**APEA Gastroenterology
Hepatitis A is typically contracted via ingestion of food or water contaminated with the virus. Hepatitis C and D usually occur as a result of parenteral contact with body fluids infected with the virus. Hepatitis B can be transmitted from mothers to infants at time of birth or from a family member to the infant early in childhood.
Spider angiomas, palmar erythema, and Terry’s nails can be associated with:
a. Chronic renal failure
b. Leukemia
c. Liver disease
d. Infective endocarditis
c. Liver disease
**APEA Gastroenterology
Jaundice, spider angiomas and other telangiectasias, palmar erythema, Terry’s nails, pruritis, purpura, and caput medusae are skin conditions associated with liver disease.
A patient is experiencing a dull achy pain in the epigastric area with eating. This type of pain is consistent with:
a. A gastric ulcer
b. A duodenal ulcer
c. Pancreatitis
d. Dumping syndrome
a. A gastric ulcer
**APEA Gastroenterology
Pain associated with peptic ulcers is dull and achy and usually occurs with eating. With a duodenal ulcer, the pain is relieved by eating. Dumping syndrome is usually seen following gastric surgery when the pylorus is bypassed. Depending on the time following ingestion of food, symptoms can include GI cramping, diarrhea, syncope, tachycardia, sweating, and high-pitched bowel sounds. Pancreatitis pain is caused by edema and inflammation and may be referred posteriorly because of its retro peritoneal position
When percussing the right upper quadrant of the abdomen, a dull medium-pitched sound is heard. The area being percussed is probably the:
a. Spleen
b. Liver
c. Right kidney
d. Bladder
b. liver
**APEA Gastroenterology
The liver is located in the RUQ below the right costal margin. The five percussion notes include: tympany, dullness, flatness, resonance, and hyperresonance. Tympanic or tympanitic, are drum-like sounds heard over air-filled structures during the abdominal exam. Hyperresonant (pneumothorax) sound similar to percussion of puffed up cheeks. Normal resonance/resonant is the sound produced by percussing a normal chest. A dull (consolidation) sound is similar to percussion of a mass such as a liver. Stony dull or flat sounds are produced on percussion from the pleximeter with no contribution from the underlying area.
If a patient describes his stool as thin and “pencil-like”, this could be associated with:
a. Constipation
b. A lesion in the sigmoid colon
c. Hemorrhoids
d. Crohn’s disease
b. A lesion in the sigmoid colon
**APEA Gastroenterology
Peritoneal inflammation produces abdominal pain and tenderness. What technique can be used to assess a tender abdomen suspected to be secondary to peritoneal inflammation?
a. Gentle palpation over the painful area
b. Ask the patient to cough prior to palpation
c. Listen for a bruit prior to palpation
d. Listen for normal bowel sounds after percussing the abdomen
b. Ask the patient to cough prior to palpation
**APEA Gastroenterology
Abdominal pain and tenderness are usually associated with muscle spasms and suggest inflammation of the peritoneum. Before palpating the abdomen, ask the patient to cough because if coughing increases the abdominal pain this suggests inflammation. Deep palpation is not recommended with inflammation. When assessing for rebound tenderness, do it firmly and quickly. A bruit would not denote inflammation but it would denote arterial obstruction. Bowel sounds would be decreased and eventually absent in the presence of peritonitis or in an adynamic ileus.
Stools that appear black, tarry, and sticky are referred to as:
a. Acholic
b. Melena
c. Hematochezia
d. Steatorrhea
b. Melena
**APEA Gastroenterology
Acholic refers to pale or clay-colored stools. A term used to describe red blood in the stool is hematochezia. Steatorrhea refers to the presence of excess fat in the stool.
A patient presents with complaints of black, tarry stools for the last week. This symptom is seen in conditions related to the:
a. Descending colon
b. Ascending colon
c. Rectum
d. Transverse colon
b. Ascending colon
**APEA Gastroenterology
If blood occurs in the stool in right-sided colon cancers or gastric ulcers, the stool will be black and tarry. Bright red blood is more characteristic of left-sided colon cancer or rectal hemorrhoids.
A 30-year-old male presents with generalized abdominal pain. With flexion of the legs at the hip, an increase in his abdominal pain is noted. This finding elicited a positive:
a. Psoas sign
b. Rovsing’s sign
c. Murphy’s sign
d. Obturator sign
a. Psoas sign
**APEA Gastroenterology
Flexion of the leg at the hip causes the psoas muscle to contract. If there is an increase in abdominal pain, this is a positive psoas sign. This is consistent with an inflamed appendix.
Pain in the right lower quadrant during left-sided pressure is a positive Rovsing’s sign. This can be positive with appendicitis.
A sharp increase in tenderness is a positive Murphy’s sign, and consistent with acute cholecystitis.
Right hypogastric pain constitutes a positive obturator sign, from irritation of the obturator muscle by an inflamed appendix.
An enlarged liver with a firm, non-tender edge may be suggestive of:
a. Cirrhosis
b. Right-sided heart failure
c. Hepatocellular carcinoma
d. Hepatitis
a. Cirrhosis
**APEA Gastroenterology
A 30-year-old patient complains of frequent belching, pain in the area below the sternum mostly after earing, and increased salivation. These symptoms are often seen in patients who have:
a. Peptic ulcers
b. Cancer of the stomach
c. Esophageal varices
d. Gastroesophageal reflux
d. Gastroesophageal reflux
**APEA Gastroenterology
GERD symptoms include dyspepsia, frequent belching with a sour taste, chest pain after eating or lying down, straining or lifting, increased salivation, and history of high stress levels.
A patient presents with right upper quadrant and upper abdominal pain. Acute cholecystitis is suspected because the pain radiates to the:
a. Epigastric area
b. Lower abdomen
c. Back
d. Right scapula area
d. Right scapula area
**APEA Gastroenterology
Acute cholecystitis presents with right upper quadrant and upper abdominal pain radiating to the right scapular area. It is usually steady and aching. Pain in the epigastric area could be associated with peptic ulcer or dyspepsia. Cancer of the stomach can present with epigastric pain. Acute mechanical colon obstruction presents with pain in the lower abdomen.
Risk factors associated with Hepatitis B include all of the following except:
a. Having multiple sex partners
b. Body piercing with unclean equipment
c. Travelers to endemic areas
d. Being incarcerated
c. Travelers to endemic areas
**APEA Gastroenterology
Exposure to infected blood in ANY situation can be a risk. International travelers to endemic areas is consistent with risk factor for Hepatitis A, not Hepatitis B.
When performing a rectal exam, a tender, purulent, reddened mass was noted at the anal opening. This finding is most consistent with a:
a. Rectal carcinoma
b. Anorectal fistula
c. Anal abscess
d. Genital wart
c. Anal abscess
**APEA Gastroenterology
If a tender, purulent, reddened mass is palpated, consider anal abscess, especially in the presence of fever and chills.
Abscesses tunneling to the skin surface from the anus or rectum may form a clogged or draining anorectal fistula. Fistulas may ooze blood, pus, or feculent mucus.
Rectal carcinoma may present with pain but is not usually accompanied by fever. Other symptoms may include bleeding from the rectum and changes in bowel habits.
Genital warts present as tiny growths and may increase in size to that of a pea. They are usually non-tender.
The most appropriate position for the patient when performing a rectal exam and one that allows for optimal examination is the:
a. Knee-chest position
b. Lateral decubitus position
c. Right side lying position
d. Supine position
b. Lateral decubitus position
**APEA Gastroenterology
Left side-lying position (Lateral decubitus) is satisfactory for rectal exam and allows good visualization of the perianal and sacrococcygeal areas.
Abdominal percussion is performed to assess:
a. Local inflammation
b. Generalized tenderness
c. Density of tissues and organs
d. Size and placement of the kidneys
c. Density of tissues and organs
**APEA Gastroenterology
A patient was instructed to point to the location of his pain. He pointed to just below the sternoclavicular notch which likely indicates:
a. Diabetic gastroparesis
b. Esophageal dysphagia
c. Oropharyngeal dysphagia
d. Esophageal varices
b. Esophageal dysphagia
**APEA Gastroenterology
Pain associated with diabetic gastroparesis is located in the upper abdomen. The pain associated with oropharyngeal dysphagia is usually located in the cervical neck region. Esophageal varices may be retrosternal.
A patient complains of severe epigastric pain that radiates to the posterior trunk and entire abdomen. This type of pain can be suggestive of:
a. Appendicitis
b. Stomach cancer
c. Acute pancreatitis
d. Biliary colic
c. Acute pancreatitis
**APEA Gastroenterology
Inflammation of the pancreas is poorly localized in the abdomen, therefore can be epigastric and may radiate to the posterior trunk.
Biliary colic, sudden obstruction of the cystic or common bile ducts by a gallstone is characterized by pain in the epigastric or right upper quadrant and may radiate to the right scapula or shoulder.
Pain in the periumbilical area that radiates to the right lower quadrant is usually seen in patients who have appendicitis. Stomach cancer presents with pain in the patient’s epigastric area.
When percussing a protuberant abdomen, tympany is audible. This is consistent with all of the following conditions except:
a. Intestinal obstruction
b. Increased intestinal gas production
c. A large solid tumor
d. A paralytic ileus
c. A large solid tumor
**APEA Gastroenterology
A solid mass gives a dull sound on percussion.
Atypical respiratory symptoms associated with gastroesophageal disease (GERD) may include all of the following except:
a. Coughing
b. Wheezing
c. Aspiration pneumonia
d. Rhinitis
d. Rhinitis
**APEA Gastroenterology
Respiratory symptoms associated with GERD may include coughing, wheezing, asthma, aspiration pneumonia.
When performing an examination of the rectal area, a linear tear at the anal opening was observed. This could be indicative of:
a. A hemorrhoid
b. An anal fissure
c. A syphilitic chancre
d. A genital wart
b. An anal fissure
**APEA Gastroenterology
A linear crack or tear suggests an anal fissure from large hard stools, inflammatory bowel disease, or sexually transmitted diseases.
When performing a rectal exam, a firm mass with an irregular border is palpated approximately two inches inside the rectum. This finding could be indicative of:
a. Rectal carcinoma
b. A syphilitic chancre
c. Rectal abscess
d. Genital wart
a. Rectal carcinoma
**APEA Gastroenterology
Syphilitic chancre appears as a firm, painless ulcer and suggests the chancre of primary syphilis. A tender, purulent, reddened mass palpated in the rectum would be consistent with an anal abscess, especially in the presence of fever and chills. Genital warts present as tiny growths and may increase in size to that of a pea and are usually non-tender and not associated with anal discharge.
Risk factors associated with Hepatitis A include all of the following except:
a. Travelers to endemic areas
b. Male-male partners
c. Persons with chronic liver disease
d. Exposure to needle sticks
d. Exposure to needle sticks
**APEA Gastroenterology
Risk factors for Hep A: Traveling internationally to endemic areas, eating food or drinking water contaminated with HAV, male-male partners, and persons with chronic liver disease.
Being exposed to needlesticks on the job is a risk usually associated with Hepatitis B
A patient presents with complaints of burning sensation in the sternal area. He states it is aggravated by alcohol, chocolate, and coffee. This finding is:
a. Odynophagia
b. Dyspepsia
c. Dysphagia
d. Heartburn
d. Heartburn
**APEA Gastroenterology
Heartburn is a rising retrosternal burning pain or discomfort. Can be aggravated by chocolate, coffee, alcohol, onions, tomato sauce, or bending over or lifting.
Dyspepsia is chronic or recurrent discomfort or pain centered in the upper abdomen.
Odynophagia is pain on swallowing and could be associated with esophagitis, peptic strictures, or Barrett’s esophagus.
Dysphagia is difficulty swallowing and can be associated with some of the same conditions as odynophagia
Signs and symptoms associated with diabetic gastroparesis may include all of the following except:
a. Vomiting of undigested food
b. Weight loss
c. Diarrhea
d. Erratic glucose levels
c. Diarrhea.
**APEA Gastroenterology
Diabetic gastroparesis occurs as a result of damage to the vagus nerve (controls the movement of food through the digestive system). Signs and symptoms associated with diabetic gastroparesis may include vomiting of undigested food, weight loss, erratic glucose levels, and gastroesophageal reflux. Diarrhea is not associated with this condition.
A 35-year-old male visits the nurse practitioner for complaints of a fullness in his lower abdomen. He states that he noticed it a few days ago when he was working out at the gym. At times it feels like a round lump in his groin. Examination reveals a protrusion under the skin near the right groin area. This finding could be suggestive of:
a. Incisional hernia
b. Epigastric hernia
c. Umbilical hernia
d. Inguinal hernia
d. Inguinal hernia
**APEA Gastroenterology
When there is a sudden obstruction caused by a gallstone in the common bile duct or the cystic duct, the pain is usually felt in the:
a. Epigastric area with radiation to the back.
b. The periumbilical area with radiation to the right lower quadrant
c. Epigastric or right upper quadrant with radiation to the right scapula and shoulder.
d. Left lower quadrant
c. Epigastric or right upper quadrant with radiation to the right scapula and shoulder.
**APEA Gastroenterology
A is more indicative of peptic ulcers or dyspepsia. B is more indicative of appendicitis. D is more indicative of diverticulitis.
Which one of the following symptoms is seen in infants with pyloric stenosis?
a. Gross distension of the abdomen
b. Distended superficial veins
c. Ascites
d. Visible peristalsis
d. Visible peristalsis
**APEA Gastroenterology
In pyloric stenosis, visible peristalsis is seen because the stomach works to empty itself but the lumen is obstructed by the hyperplasia and hypertrophy of the pyloric muscle. The stomach is empty, not distended, due to repeated vomiting of feedings. Distended superficial veins and ascites have no relationship with pyloric stenosis, they are observed in biliary atresia.
When assessing a preschooler’s mouth, the number of deciduous teeth seen should be:
a. Up to 10
b. 11 to 15
c. 16-20
d. Up to 32
c. 16-20
**APEA Gastroenterology
Children get their first 20 deciduous teeth between the ages of 6 months and 5 years. Permanent teeth begin to erupt around 6 years of age when the deciduous teeth begin to fall out. All 32 permanent teeth usually erupt by late adolescence.
A patient presents with chest pain and moves his hand from the neck to the epigastrium. This gesture could be suggestive of:
a. Costochondritis
b. Angina pectoris
c. Gastroesophageal reflux
d. Bronchitis
c. Gastroesophageal reflux
**APEA Gastroenterology
Patient gestures may indicate the etiology of some types of chest pain. A clenched fist over the sternum may suggest angina pectoris. A finger pointing to a tender area on the chest wall may suggest musculoskeletal pain. A hand moving from the neck to the epigastrium may suggest GERD.
A patient complains of an unpleasant abdominal fullness after a light meal. This complaint may be consistent with:
a. Diabetic gastroparesis
b. Peptic ulcer
c. Gastritis
d. Gastrocolic fistula
a. Diabetic gastroparesis
**APEA Gastroenterology
Complaints of unpleasant abdominal fullness after a light or moderate meal, or the inability to eat a full meal is often seen in patients with diabetic gastroparesis, gastric outlet obstruction, gastric cancer, early satiety in hepatitis, or those taking anticholinergic medications.
Which of the following symptoms are indicators of dehydration in a four-year-old child?
a. Weight gain and absence of tears
b. Thirst and urine specific gravity of 1.038
c. Heart rate of 120 bpm and sunken fontanels
d. Urine specific gravity of 1.010 and clear, yellow urine
b. Thirst and urine specific gravity of 1.038
**APEA Gastroenterology
A patient presents with complaints of bright red stools over the past weeks. This symptom could be consistent with:
a. Cancer of the ascending colon
b. Cancer of the sigmoid colon
c. Gastric ulcers
d. Small bowel obstruction
b. Cancer of the sigmoid colon
**APEA Gastroenterology
A positive obturator sign would elicit pain in the:
a. right hypogastric area
b. left lower quadrant
c. flank area
d. right lower quadrant
a. right hypogastric area
**APEA Gastroenterology
Assessment of the obturator sign is performed by flexing. By flexing the patient’s right thigh at the hip with knees bent, rotating the leg internally at the hip. If this causes pain in the right epigastric area, then the obturator sign is positive. Hypogastric pain occurs as the obturator muscle rubs an inflamed appendix.
Which of the following assessment findings is a result of the presence of a stone in the common bile duct?
a. Elevated cholesterol levels
b. Right upper quadrant pain
c. Steatorrhea
d. Jaundice
d. Jaundice
**APEA Gastroenterology
Obstruction of the common bile duct results in reflux of bile into the liver, thus, producing jaundice. Although nausea and right upper quadrant pain would occur, jaundice is the result of the obstruction. Steatorrhea is the presence of excessive fat in the stool and can be seen in patients with Crohn’s disease but is not present in cholelithiasis. Elevated cholesterol levels are not indicative of an obstructed common bile duct.
Lower abdominal pain accompanied by fever or shock in older adults could be consistent with:
a. Hemorrhoids
b. Colon cancer
c. Ischemic colitis
d. Adenomatous polyps
c. Ischemic colitis
**APEA Gastroenterology
When examining the abdomen, which of the following symptoms would be suggestive of appendicitis?
a. Pain localized halfway between the umbilicus and the right iliac crest
b. Pain in the left lower quadrant
c. Presence of borborygmus sounds
d. Pain radiating from the mid abdomen to the back.
a. Pain localized halfway between the umbilicus and the right iliac crest
**APEA Gastroenterology
A positive response over McBurney’s point, the area located halfway between the umbilicus and the right iliac crest, would be highly suspicious for appendicitis. Positive rebound tenderness may also be present. Pain in the left lower quadrant could be suggestive of diverticulitis. Pain radiating from the abdomen to the back could be related to a peptic ulcer, perforation, or even pancreatitis.
A 40-year-old female presents with generalized abdominal pain and nausea. During the abdominal exam she exhibits inspiratory arrest with deep palpation of the upper right quadrant of the abdomen. This maneuver exhibits a positive:
a. psoas sign
b. Rovsign’s sign
c. Murphy’s sign
d. Obturator sign
c. Murphy’s sign
**APEA Gastroenterology
Inspiratory arrest with deep palpation of the RUQ constitutes a positive Murphy’s sign and is consistent with acute cholecystitis.
Flexion of the leg at the hip resulting in increased abdominal pain is positive psoas sign and is consistent with inflamed appendix
Pain in RLQ that occurs with palpation of the RLQ is Rovsing’s sign and is consistent with appendicitis.
A positive obturator sign occurs when the obturator muscle rubs inflamed appendix and produces right hypogastric pain.
Percussion of the abdomen should be avoided when:
a. Trying to determine if the bladder is full
b. Trying to detect the size of an abdominal organ
c. Assessing for feces-filled intestines
d. An abdominal aneurysm is suspected.
d. An abdominal aneurysm is suspected
**APEA Gastroenterology
Bowel sounds may be increased in the presence of:
a. An adynamic ileus
b. Early intestinal obstruction
c. Peritonitis
d. Constipation
b. Early intestinal obstruction
**APEA Gastroenterology
Bowel sounds may be increased in the presence of diarrhea or early intestinal obstruction
Bowel sounds are decreased, then absent in adynamic ileus and peritonitis.
They are decreased in constipation.
Ecchymosis of the abdominal wall is usually seen with persons with:
a. Cushing’s disease
b. Hepatic cirrhosis
c. Colorectal cancer
d. Intraperitoneal hemorrhage
d. Intraperitoneal hemorrhage
**APEA Gastroenterology
Ecchymosis of the abdominal wall is seen in intraperitoneal or retroperitoneal hemorrhage.
Pink-purple striae may indicate Cushing’s syndrome.
Dilated veins may indicate hepatic cirrhosis or inferior vena cava obstruction.
Colorectal cancer does not exhibit ecchymosis.
Pain of biliary tree origin may be referred to the:
a. Right shoulder
b. Retrosternal area
c. Left posterior chest
d. Back
a. right shoulder
**APEA Gastroenterology
When performing a digital rectal exam, a soft, pedunculated lesion is palpated. This finding is most likely:
a. A prolapsed internal hemorrhoid
b. An external hemorrhoid
c. A rectal polyp
d. An anal abscess
c. A rectal polyp
**APEA Gastroenterology
Rectal polyps are typically located in the rectum and if palpated, feel soft to touch and may be pedunculated (attached to the base tissue by means of a stalk).
When inspecting the abdomen of a 60-year-old male, dilated veins were noted especially in the mid and upper abdomen. This condition is associated with:
a. Cushing’s disease
b. Hepatic cirrhosis
c. Colorectal cancer
d. Intraperitoneal hemorrhage
b. Hepatic cirrhosis
**APEA Gastroenterology
When the scrotum is transilluminated in a 4-month-old boy, it lights up brightly. This finding may be consistent with:
a. Normal scrotal findings
b. An inguinal hernia
c. Cryptochidism
d. A hydrocele
d. A hydrocele
A hydrocele is defined as swelling in the scrotum that lights up on transillumination. Inguinal hernia and cryptorchidism are diagnosed using palpation of the scrotum and testicle and are not associated with fluid collection. Swelling of the scrotum and collection of serous fluid are not normal findings.
**APEA Men’s Health
What is the most common non-skin cancer in America?
a. Uterine cancer
b. Bladder cancer
c. Cervical cancer
d. Prostate cancer
d. Prostate Cancer
**APEA Men’s Health
A 26-year-old man with a past medical history of sickle cell disease arrives at the office with complaints of a penile erection that has lasted 4 hours. He is experiencing symptoms of:
a. Low flow priapism
b. Peyronie disease
c. Acute balanitis
d. Side effect of opioids
a. Low flow priapism
**APEA Men’s Health
Low flow priapism is common in sickle cell patients. Priapism is a penile erection lasting more than 4 hours without stimulation. Peyronie disease, acute balanitis, and opioid side effects result in an inability to achieve or difficulty maintaining an erection.
During assessment of a 3-month-old boy, an incomplete descent of the left testicle into the scrotum is noted. The practitioner understands that:
a. Testicles should descend by 6 months of age
b. Testicles will not spontaneously descend
c. An abdominal ultrasound should be ordered.
d. A referral to a pediatric urologist is indicated.
a. Testicles should descend by 6 months of age
**APEA Men’s Health
Male infants with cryptorchidism experience incomplete descent of one or both testicles into the scrotum. Urology evaluation should be considered if the testicle is not descended by 6 months of age. Orchiopexy surgery is not performed until symptoms persist after 1 year. 75% of full-term and 95% of premature cryptorchid testes descent spontaneously by 1 year of age.
A 30-year-old man is seen in the clinic for complaints of scrotal irritation, bilateral testicular pain, and enlarged lymph nodes in the groin that began 2 weeks after having unprotected intercourse. The subjective history describes:
a. Epididymitis
b. Testicular torsion
c. Urinary tract infection
d. Idiopathic sacral edema
a. Epididymitis
**APEA Men’s Health
Epididymitis is commonly caused by a sexually transmitted infection (STI) and presents as scrotal irritation, bilateral testicular pain, and enlarged lymph nodes. Urinary tract infections (UTIs) include symptoms associated with urination and do not usually feature testicular or scrotal involvement. Testicular torsion causes acute, unilateral testicular pain. Idiopathic sacral edema presents as swelling of the scrotum with fluid accumulation. It presents as unilateral erythema of the scrotal skin.
A 40-year-old male states that he felt “something” above his left testis. On examination, a painless cyst is noted above the left testicle. Transillumination is positive. This is consistent with a:
a. Varicocele of the spermatic cord
b. Spermatocele of the epididymis
c. Torsion of the spermatic cord
d. Prostatitis
b. Spermatocele of the epididymis
**APEA Men’s Health
A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate and are difficult to distinguish clinically.
An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. Additionally, the scrotum may be reddened and the vas deferens inflamed. Coexisting urinary tract infection, or prostatitis, supports the diagnosis.
Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” upon palpation of the scrotum.
Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection.
When screening for bladder cancer in a primary care setting, the test that would be LEAST appropriate is:
a. Microscopic urinalysis
b. Urine cytology
c. Cystoscopy
d. Dipstick for hematuria
c. Cystoscopy
**APEA Men’s Health
Cystoscopy would be completed by a urologist, not in the PCP setting.
A 30-year-old man who has a history of heart disease will present with which symptom related to the development of arteriosclerosis?
a. Hypogonadism
b. Erectile dysfunction
c. Enlarged prostate
d. Urinary incontinence
b. Erectile dysfunction
APEA Men’s Health
Hypogonadism is caused by changes in testosterone. Prostate enlargement occurs in most older men and is not specifically related to heart disease. Urinary incontinence is a symptom associated with enlarged prostate and is not specific to atherosclerotic changes.
Which examination finding is defined as a congenital ventral displacement of the meatus on the penis?
a. Balanitis
b. Posthitis
c. Phimosis
d. Hypospadias
d. Hypospadias
**APEA Men’s health
Balanitis is an inflammation of the glans of the penis.
Posthitis is an inflammation of the foreskin.
Phimosis is a congenital narrowing of the opening of the foreskin so that it cannot be retracted
When examining the scrotum in a young male child, test the cremasteric reflex by:
a. Scratching the medial aspect of the thigh
b. Having the child lie down and palpate the femoral pulse
c. Gently pulling the penis downward
d. Palpating the area above the symphysis pubis
a. Scratching the medial aspect of the thigh
**APEA Men’s Health
To elicit the cremasteric reflex: examine child when he is relaxed and have him sit crossed legged on the table. Palpate the scrotum. The child can also blow into a balloon, this would cause an increase in intra-abdominal pressure and stimulate the reflex. The cremasteric reflex can be tested by scratching the inside of the child’s thigh.
When assessing for the presence of a direct inguinal hernia in a man, the practitioner should palpate for a distinct bulge while instructing the patient to:
a. Hold a breath
b. Lift one leg
c. Cough
d. Bear down
c. Cough
**APEA Men’s Health
The prostate is assessed by:
a. A digital rectal examination (DRE)
b. A formal urinalysis
c. Testicular palpation and cough
d. Palpation of the left lower quadrant
a. A digital rectal examination (DRE)
**APEA Men’s Health
A 33-year-old male presents for examination because of a scrotal complaint. The exam reveals the presence of 2 testicles and palpable tissue resembling a “bag of worms” over the left testicle. When in the supine position with the scrotum elevated, the “bag of worms” disappears. This condition is suggestive of a:
a. Varicocele of the spermatic cord
b. Spermatocele of the epididymis
c. Torsion of the spermatic cord
d. Prostatitis
a. Varicocele of the spermatic cord
**APEA Men’s Health
Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” upon palpation of the scrotum.
An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. The scrotum may be reddened and the vas deferens inflamed. Epididymitis occurs usually in adults, who are infected with Chlamydia. Coexisting UTI or prostatitis support the diagnosis.
A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate.
Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection.
When examining the prostate gland, the examiner should inform the patient that this procedure may:
a. Cause him to urinate
b. Prompt an urge to defecate
c. Prompt an urge to urinate
d. Cause him to cough
c. Prompt an urge to urinate
**APEA Men’s Health
When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, “boggy” and warm. This finding is consistent with:
a. A normal prostate gland
b. Acute bacterial prostatitis
c. Benign prostatic hyperplasia
d. Carcinoma of the prostate
b. Acute bacterial prostatitis
**APEA Men’s Health
As palpated through the anterior rectal wall, the normal prostate is a rounded, heart-shaped structure, somewhat rubbery and non-tender. It measures approximately 2.5 cm long.
In a patient with BPH, the gland feels enlarged and increases with age. BPH is present in more than 50% of men by 50 years of age.
Carcinoma of the prostate gland is suggested by an area of hardness in the gland. A distinct hard nodule that alters the contour of the gland may or may not be palpable. However, as the cancer enlarges, the prostate feels irregular and may extend beyond the confines of the gland.
Undescended testicle(s) in a young male is termed:
a. Testicular torsion
b. Epispadias
c. Hydrocele
d. Cryptorchidism
d. Cryptorchidism
**APEA Men’s Health
Epispadias is present when the urethral orifice is located on the dorsal surface of the glans or shaft of the penis.
A hydrocele denotes fluid in the scrotal sac.
Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, reducing the testicle’s blood supply resulting in ischemia of that testicle. This is a medical emergency.
When palpating the prostate gland during the rectal exam, the prostate feels enlarged and non-tender. This finding is consistent with:
a. A normal prostate gland
b. Acute bacterial prostatitis
c. Benign prostatic hyperplasia
d. Carcinoma of the prostate.
c. Benign prostatic hyperplasia
**APEA Men’s Health
As palpated through the anterior rectal wall, the normal prostate is a rounded, heart-shaped structure, somewhat rubbery and non-tender. It measures approximately 2.5 cm long.
In a patient with BPH, the gland feels enlarged and increases with age. BPH is present in more than 50% of men by 50 years of age.
Carcinoma of the prostate gland is suggested by an area of hardness in the gland. A distinct hard nodule that alters the contour of the gland may or may not be palpable. However, as the cancer enlarges, the prostate feels irregular and may extend beyond the confines of the gland.
During pregnancy, which hormone promotes endometrial growth that supports the early embryo?
a. Progesterone
b. Human chorionic gonadotropin (HCG)
c. Estrogen
d. Human placental lactogen
c. Estrogen
**APEA Pregnancy
Estrogen promotes endometrial growth that supports the early embryo. This hormone appears to stimulate prolactin output in the anterior lobe of the pituitary gland, which readies breast tissue for lactation. Estrogen also contributes to the hypercoagulable state that puts pregnant women at higher risk for thromboembolic events.
During pregnancy, as the skin over the abdomen stretches to accommodate the fetus, this purplish mark may appear. This finging is:
a. Hegar’s sign
b. Chadwick’s sign
c. Striae gravidarum
d. Linea nigra
c. Striae gravidarum
**APEA Pregnancy
As the skin over the abdomen stretches to accommodate the fetus, purplish striae gravidarum “stretch marks” may appear.
Linea nigra is a brownish black pigmented vertical stripe along the midline skin.
Hegar’s sign is the palpable softening of the cervical isthmus, the portion of the uterus that narrows into the cervix.
Increased vascularity throughout the pelvis during pregnancy gives the vagina a bluish color, known as Chadwick’s sign.
A form of milk produced by the mammary glands during the late pregnancy is referred to as:
a. Witch’s milk
b. Colostrum
c. Breast milk
d. Lactating milk
b. Colostrum
**APEA Pregnancy
After 24 weeks gestation, auscultation of more than one fetal heart tone (FHT) in different locations with varying rates suggests:
a. Decelerations
b. Fetal distress
c. Intrauterine growth restriction
d. Multiple gestation
d. Multiple gestation
**APEA Pregnancy
When performing a pelvic exam on a pregnant woman, a larger speculum may be needed because of:
a. Increased vascularity of the vagina
b. Vaginal wall relaxation
c. Increased vascularity of the cervical structures
d. Swelling in the vaginal cavity
b. Vaginal wall relaxation
**APEA Pregnancy
During pregnancy, which hormone results in increased blood viscosity?
a. Human chorionic gonadotropin (HCG)
b. Estrogen
c. Progesterone
d. Erythropoietin
d. Erythropoietin
**APEA Pregnancy
Erythropoietin increases during pregnancy, which raises erythrocyte mass resulting in increased blood viscosity
When should an oral glucose tolerance test be performed during pregnancy?
a. Initially, when the pregnancy is confirmed
b. 8 weeks
c. 24 weeks
d. 30 weeks
c. 24 weeks
**APEA Pregnancy
Oral glucose tolerance test is used to screen for gestational diabetes between 24-28 weeks of pregnancy. It may also be used when the disease is suspected, even though fasting blood glucose level is normal.
During pregnancy, which hormone is responsible for increasing insulin resistance and hyperglycemia associated with gestational diabetes?
a. Progesterone
b. Human chorionic gonadotropin (HCG)
c. Estrogen
d. Human placental lactogen
d. Human placental lactogen
**APEA Pregnancy
Normal changes in the breast and nipples during pregnancy include all of the following except:
a. A marked venous pattern on the breast
b. Darkened nipples
c. Mastitis
d. Darkened areola
c. Mastitis
**APEA Pregnancy
When might fundal height in a pregnant woman most accurately predict gestational age?
a. 10 weeks gestation
b. 14 weeks gestation
c. 18 weeks gestation
d. 40 weeks gestation
c. 18 weeks gestation
**APEA Pregnancy
Uterine fundal height measured in centimeters correlates with gestational age between 18-34 weeks. Fundal height is measured in centimeters from symphysis pubis to top of uterus. This is known as McDonald’s rule.
Upon cervical examination of the pregnant woman, cervical erosion, erythema, and irritation are noted. These findings could be suggestive of:
a. Cervical cancer
b. A non-pregnant state
c. Cervicitis
d. Bacterial vaginosis
c. Cervicitis
**APEA Pregnancy
Cervical erosion, erythema, discharge, or irritation might suggest cervicitis and warrants investigation for sexually transmitted infections (STIs).
A pink cervix suggests a non-pregnant state.
B/P readings greater than 140 mm HG systolic and greater than 90 mm HG diastolic prior to pregnancy, before 20 weeks gestation, or beyond 12 weeks postpartum is:
a. Gestational hypertension
b. Preeclampsia
c. Chronic hypertension
d. Primary hypertension
c. Chronic hypertension
**APEA Pregnancy
Chronic HTN occurs when systolic BP >140 or diastolic BP >90 documented prior to pregnancy, before 20 weeks gestation, or beyond 12 weeks postpartum.
Gestation HTN refers to elevated BP detected after 20 weeks gestation in the absence of proteinuria.
Pre-eclampsia occurs in a woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage.
Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause.
During pregnancy, what sound may be auscultated at the second or third intercostal space at the sternal border due to increased blood flow through the vessles?
a. Diastolic murmur
b. Systolic murmur
c. Venous hum
d. Bruit
c. Venous hum
**APEA Pregnancy
A venous hum, or continuous mammary souffle, that occurs during pregnancy is due to increased blood flow through normal vessels. The mammary souffle is commonly heard during late pregnancy or lactation. It is heard loudest in the second or third intercostal space at the sternal border, and is typically both systolic and diastolic, though only the systolic component may be audible.
Inaudible fetal heart tones (FHT) may indicate:
a. Extra amniotic fluid
b. Severe fetal morbidity
c. Earlier gestation than expected
d. Intrauterine growth restriction
c. Earlier gestation than expected
**APEA Pregnancy
Lack of audible fetal heart tones (FHT) may indicate earlier gestation than expected, fetal demise, false pregnancy, or observer error.
Inability to locate the FHT should always be investigated with ultrasound.
When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the:
a. Vertical lie
b. Transverse lie
c. Face presentation
d. Vertex presentation
d. Vertex presentation
**APEA Pregnancy
When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the vertex or cephalic presentation. Additionally, if the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back, then the head is extended and the fetus is in face presentation. The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie.
If regular uterine contractions occur prior to 37 weeks gestation, this could be:
a. A normal finding
b. Preterm labor
c. Preeclampsia
d. Supine hypotensive syndrome
b. Preterm labor
**APEA Pregnancy
Before 37 weeks, regular uterine contractions with/without pain and bleeding are abnormal findings and may suggest preterm labor.
During the examination of a pregnant woman, knee and ankle deep tendon reflexes appear hyperreflexic. This finding could be suggestive of:
a. Hypertension
b. Gestational diabetes
c. Preeclampsia
d. An embolus
c. Preeclampsia
**APEA Pregnancy
During the vaginal examination of a pregnant woman in her first trimester, an adnexal mass with tenderness is palpated. This finding could be consistent with:
a. Multiple gestation
b. A fibroid tumor
c. An ectopic pregnancy
d. A false pregnancy
c. An ectopic pregnancy
**APEA Pregnancy
Adnexal tenderness or masses identified early in gestation require ultrasound evaluation to rule out ectopic pregnancy.
An enlarged uterus may indicate multiple gestation or a fibroid tumor.
During pregnancy, which hormone is secreted by the corpus luteum and placenta to promote ligamentous laxity in the sacroiliac joint and pubic symphysis for passage of the fetus?
a. Human chorionic gonadotropin (HCG)
b. Estrogen
c. Human placental lactogen
d. Relaxin
d. Relaxin
**APEA Pregnancy
Inflamed and overgrown gingiva during pregnancy is:
a. A common finding during pregnancy
b. Suggestive of anemia
c. Suggestive of periodontal disease
d. Indicative of poor nutrition
a. A common finding during pregnancy
**APEA Pregnancy
Gingival inflammation and swelling is common during pregnancy because of hormonal shifts that occur. Consequently, meticulous oral hygiene is important in pregnant women.
Adequate daily dietary intake of folic acid in pregnancy is:
a. 300 mcg
b. 400 mcg
c. 800 mcg
d. 1000 mcg
b. 400 mcg
**APEA Pregnancy
The daily suggested intake levels of folic acid are as follows:
Men older than 13 years = 400 mcg.
Women older than 13 years = 400-600 mcg.
Pregnancy all ages = 400-600 mcg.
Breastfeeding women of all ages = 500 mcg.
The cervical opening or shortening noted during a bimanual examination prior to 37 weeks gestation, may indicate:
a. Ectopic pregnancy
b. Preterm labor
c. Leiomyomata
d. Cervical erosion
b. Preterm labor
**APEA Pregnancy
When examining the pregnant patient, conjunctival pallor may indicate:
a. Leukemia
b. Anemia
c. Preeclampsia
d. Hypertension
b. Anemia
**APEA Pregnancy
Which substance used during pregnancy accounts for one third of all low-birth-weight infants, placental abruption, and preterm labor?
a. Illicit drugs
b. Alcohol
c. Tobacco
d. Prescription drugs
c. Tobacco
**APEA Pregnancy
When should all pregnant women be screened for human immunodeficiency virus (HIV)?
a. Routine screening is not recommended
b. At the first prenatal visit
c. During the second trimester
d. During the third trimester
b. At the first prenatal visit
**APEA Pregnancy
The CDC recommends screening all pregnant women for HIV at the first prenatal visit. During the third trimester, women at high risk for acquiring HIV infection should be rescreened.
Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is <18.5, the total weight gain should be:
a. 11-20 lbs
b. 15-25 lbs
c. 25-35 lbs
d. 28-40 lbs
d. 28-40 lbs
**APEA Pregnancy
Weight gain should be closely monitored during pregnancy, as both excessive and inadequate weight gain are associated with poor birth outcomes. BMI of <18.5 should gain 28-40 lbs.
BMI of 18.5-24.9 should gain 25-35 lbs
BMI of 25-29.9 should gain 15-25 lbs
BMI >30 should gain 11-20 lbs
During pregnancy, dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concerns of:
a. Preeclampsia
b. Hypertension
c. Peripartum cardiomyopathy
d. Cocaine use
c. Peripartum cardiomyopathy
**APEA Pregnancy
These symptoms raise concerns of possible infection, asthma, pulmonary embolus, or peripartum cardiomyopathy.
Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is 30, the total weight gain should be:
a. 11-20 lbs
b. 15-25 lbs
c. 25-35 lbs
d. 28-40 lbs
a. 11-20 lbs
**APEA Pregnancy
Weight gain should be closely monitored during pregnancy, as both excessive and inadequate weight gain are associated with poor birth outcomes. BMI of <18.5 should gain 28-40 lbs.
BMI of 18.5-24.9 should gain 25-35 lbs
BMI of 25-29.9 should gain 15-25 lbs
BMI >30 should gain 11-20 lbs
In pregnant women, between 10-18 weeks gestation, fetal heart tones (FHT) can be auscultated along the:
a. Woman’s back
b. Woman’s upper left quadrant
c. Midline of the woman’s lower abdomen
d. Upper left quadrant
c. Midline of the woman’s lower abdomen
**APEA Pregnancy
After 18 weeks, the FHT are best heard over the back or chest and depends on fetal position
Pregnant women should avoid unpasteurized dairy products such as soft cheese, raw eggs, and delicatessen meats because of the risk of:
a. Ingesting large amounts of mercury
b. Ingesting large amounts of vitamin A
c. Contracting toxoplasmosis
d. Contracting botulism
c. Contracting toxoplasmosis
**APEA Pregnancy
These foods should be avoided in pregnancy due to the risk of Listeria, Salmonella, and toxoplasmosis
What is the standard instrument used to auscultate fetal heart tones?
a. Stethoscope
b. Doppler
c. Prenatal monitor
d. Ultrasound
b. Doppler
**APEA Pregnancy
When should a vaginal swab for Group B streptococcus be obtained in a pregnant woman?
a. Initially, when the pregnancy is confirmed
b. 12-18 weeks
c. 24-30 weeks
d. 35-37 weeks
d. 35-37 weeks
**APEA Pregnancy
A vaginal swab for group B streptococcus should be done between 35-37 weeks gestation. Group B streptococcus can normally be found in 15-45% of all healthy adult women. It can commonly be found in the intestine, vagina, and rectal area. Most women who are carriers will not have any symptoms. However, under certain circumstances, infection of both the mother and/or the newborn can develop.
Normal findings of the vaginal wall of a pregnant woman include all of the following except:
a. Bluish color
b. Deep rugae
c. Leukorrhea
d. Lochia
d. Lochia
**APEA Pregnancy
Lochia is a term given to the substance that is discharged from the uterus, through the vagina after childbirth. It consists of blood, mucus, and placental tissue.
The normal fetal heart rate (FHR) range is:
a. 60-90 bpm
b. 90-110 bpm
c. 120-160 bpm
d. 140-180 bmp
c. 120-160 bpm
**APEA Pregnancy
New onset hypertension with proteinuria or end-organ damage is:
a. Gestational hypertension
b. Preeclampsia
c. Chronic hypertension
d. Primary hypertension
b. Preeclampsia
**APEA Pregnancy
Chronic HTN occurs when systolic BP >140 or diastolic BP >90 documented prior to pregnancy, before 20 weeks gestation, or beyond 12 weeks postpartum.
Gestation HTN refers to elevated BP detected after 20 weeks gestation in the absence of proteinuria.
Pre-eclampsia occurs in a woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage.
Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause.
Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is 25-29.9, the total weight gain should be:
a. 11-20 lbs
b. 15-25 lbs
c. 25-35 lbs
d. 28-40 lbd
b. 15-25 lbs
**APEA Pregnancy
Weight gain should be closely monitored during pregnancy, as both excessive and inadequate weight gain are associated with poor birth outcomes. BMI of <18.5 should gain 28-40 lbs.
BMI of 18.5-24.9 should gain 25-35 lbs
BMI of 25-29.9 should gain 15-25 lbs
BMI >30 should gain 11-20 lbs
Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is 18.5-24.9, the total weight gain should be:
a. 11-20 lbs
b. 15-25 lbs
c. 25-35 lbs
d. 28-40 lbs
c. 25-35 lbs
Weight gain should be closely monitored during pregnancy, as both excessive and inadequate weight gain are associated with poor birth outcomes. BMI of <18.5 should gain 28-40 lbs.
BMI of 18.5-24.9 should gain 25-35 lbs
BMI of 25-29.9 should gain 15-25 lbs
BMI >30 should gain 11-20 lbs
Which of the following sexually transmitted disease (STD) screening tests is NOT routinely recommended during pregnancy?
a. Syphilis
b. Gonorrhea
c. Hepatitis B
d. Genital herpes (HSV-2)
d. Genital herpes (HSV-2)
**APEA Pregnancy
Evidence does not support routine genital herpes (HSV-2) serologic testing among asymptomatic pregnant women. The CDC recommends screening for syphilis, gonorrhea, and hepatitis B at the first prenatal visit for all pregnant women.
During pregnancy, if fundal height is 4 centimeters larger than expected, consider all of the following except:
a. Large for gestational age infant
b. Extra amniotic fluid
c. Uterine leiomyoma
d. Fetal anomaly
d. Fetal anomaly
**APEA Pregnancy
If fundal height is >4 cm larger than expected, consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma.
If fundal height is >4 cm smaller than expected, consider low level of amniotic fluid, missed abortion, intrauterine growth restriction, or fetal anomaly.
All of these conditions should be investigated by ultrasound.
If fetal movement cannot be perceived after 24 weeks gestation, all of the following may be considered except:
a. Fetal demise
b. False pregnancy
c. An error in calculating gestational age
d. A normal finding
d. A normal finding
If fetal movement cannot be perceived after 24 weeks, consider error in calculating gestational age, fetal death or severe morbidity, or false pregnancy.
Confirm fetal health and gestational age with an ultrasound.
Facial edema in a pregnant woman after 20 weeks gestation could be:
a. A normal finding
b. Suggestive of preeclampsia
c. Renal failure
d. Heart failure
b. Suggestive of preeclampsia
A five percent weight loss during the first trimester due to vomiting would be considered:
a. Normal weight loss
b. Mild weight loss
c. Moderate weight loss
d. Excessive weight loss
d. Excessive weight loss
**APEA Pregnancy
Weight loss in excess of 5% of pre-pregnancy weight is considered excessive, representing hyperemesis gravidarum, and may lead to adverse pregnancy outcomes.
When performing a third Leopold maneuver on a pregnant woman, the cephalic prominence is on the same side as the back. This finding is referred to as the:
a. Vertical lie
b. Transverse lie
c. Face presentation
d. Vertex presentation
c. Face presentation
**APEA Pregnancy
When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the vertex or cephalic presentation. Additionally, if the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back, then the head is extended and the fetus is in face presentation. The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie.
Which substance used during pregnancy accounts for the leading cause of preventable intellectual disability?
a. Illicit drugs
b. Alcohol
c. Tobacco
d. Prescribing drugs
b. Alcohol
**APEA Pregnancy
Fetal alcohol syndrome, the neurodevelopmental sequela of alcohol exposure during fetal development, is the leading cause of preventable intellectual disability in the United States.
When performing the first Leopold maneuver on a pregnant woman, if the fetal buttocks and head are not easily palpated at the fundus, the fetus is said to be in:
a. Vertical lie
b. Transverse lie
c. Face presentation
d. Vertex presentation
b. Transverse lie
**APEA Pregnancy
When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the vertex or cephalic presentation. Additionally, if the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back, then the head is extended and the fetus is in face presentation. The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie.
In the third trimester of pregnancy, which position affords the greatest comfort by reducing the weight of the uterus on the abdominal vessels?
a. Left side lying
b. Right side lying
c. Supine
d. Semi-sitting with knees bent
d. Semi-sitting with knees bent
**APEA Pregnancy
Murmurs audible during pregnancy may suggest:
a. Preeclampsia
b. Hypertension
c. Anemia
d. Pulmonary embolus
c. Anemia
**APEA Pregnancy
Murmurs audible during pregnancy may suggest anemia however, benign systolic murmurs can be heard in women after the first trimester.
During pregnancy, which hormone is produced by the placenta and supports progesterone synthesis in the corpus luteum?
a. Progesterone
b. Human chorionic gonadotropin (HCG)
c. Estrogen
d. Human placental lactogen
b. Human chorionic gonadotropin (HCG)
**APEA Pregnancy
Human chorionic gonadotropin (HCG) is produced by the placenta and supports progesterone synthesis in the corpus luteum, effectively preventing the early embryo from being lost to menstruation
During pregnancy, a patient’s fundal height measured 26 centimeters. This would suggest that the gestational age was:
a. 13 weeks
b. 26 weeks
c. 30 weeks
d. 36 weeks
b. 26 weeks
**APEA Pregnancy
During pregnancy, which hormone increases tidal volume and alveolar minute ventilation, lowers esophageal sphincter tone, and relaxes tone in the uterus and bladder?
a. Progesterone
b. Human chorionic gonadotropin (HCG)
c. Estrogen
d. Human placental lactogen
a. Progesterone
**APEA Pregnancy
Progesterone affects numerous body systems. Rising progesterone leads to increased tidal volume and alveolar minute ventilation, though respiratory rate remains constant. Respiratory alkalosis and subjective shortness of breath result from these changes. Lower esophageal sphincter tone results from rising levels of estradiol and progesterone, contributing to gastroesophageal reflux. Progesterone relaxes tone in the ureters and bladder, causing hydronephrosis and an increased risk of bacteriuria.
What is the importance of prenatal care?
a. Determines gestational age
b. Estimates expected date of delivery
c. Optimizes health and minimizes risk for mother and fetus
d. Obtain family history
c. Optimizes health and minimizes risk for mother and fetus
**APEA Pregnancy
During pregnancy, if fundal height is 4 centimeters smaller than expected, consider:
a. Large for gestational age infant
b. Extra amniotic fluid
c. Uterine leiomyoma
d. Intrauterine growth restriction
d. Intrauterine growth restriction
**APEA Pregnancy
If fundal height is >4 cm larger than expected, consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma.
If fundal height is >4 cm smaller than expected, consider low level of amniotic fluid, missed abortion, intrauterine growth restriction, or fetal anomaly.
All of these conditions should be investigated by ultrasound.
During pregnancy, the Leopold maneuvers assist in determining all of the following except:
a. Fetal position with the maternal abdomen
b. Readiness for vaginal birth
c. Adequacy of fetal growth
d. Cervical effacement
d. Cervical effacement
**APEA Pregnancy
Leopold maneuvers are used to determine the fetal position within the maternal abdomen beginning in the second trimester. Accuracy is greatest after 36 weeks gestation. These exam findings can help ascertain the adequacy of fetal growth and the readiness for vaginal birth. Since these maneuvers are performed on the maternal abdomen, cervical effacement is not included with these maneuvers. To determine cervical effacement, a vaginal exam would be performed.
Which of the following is NOT a condition associated with hyperthyroidism in pregnancy?
a. Miscarriage
b. Premature birth
c. Gestational diabetes
d. Preeclampsia
c. Gestational diabetes
**APEA Pregnancy
During pregnancy, a brownish black pigmented vertical stripe along the midline of the abdomen may appear. This finding is:
a. Hegar’s sign
b. Chadwick’s sign
c. Striae gravidarum
d. Linea nigra
d. Linea nigra
**APEA Pregnancy
As the skin over the abdomen stretches to accommodate the fetus, purplish striae gravidarum “stretch marks” may appear.
Heger’s sign is the palpable softening of the cervical isthmus, the portion of the uterus that narrows into the cervix.
Increased vascularity throughout the pelvis during pregnancy gives the vagina a bluish color, known as Chadwick’s sign.
During pregnancy, which supplement is recommended to decrease the risk of neural tube defect.
a. Vitamin B12
b. Iron
c. Folic acid
d. Calcium
c. Folic acid
**APEA Pregnancy
During pregnancy, a palpable softening of the cervical isthmus is noted. This finding is:
a. Hegar’s sign
b. Chadwick’s sign
c. Striae gravidarum
d. Linea nigra
a. Hegar’s sign
**APEA Pregnancy
Linea nigra is a brownish black pigmented vertical stripe along the midline skin of the abdomen
As the skin over the abdomen stretches to accommodate the fetus, purplish striae gravidarum “stretch marks” may appear.
Heger’s sign is the palpable softening of the cervical isthmus, the portion of the uterus that narrows into the cervix.
Increased vascularity throughout the pelvis during pregnancy gives the vagina a bluish color, known as Chadwick’s sign.
Hypertension that occurs after 20 weeks gestation in the absence of proteinuria is:
a. Gestational hypertension
b. Preeclampsia
c. Chronic hypertension
d. Primary hypertension
a. Gestational hypertension
**APEA Pregnancy
Chronic HTN occurs when systolic BP >140 or diastolic BP >90 documented prior to pregnancy, before 20 weeks gestation, or beyond 12 weeks postpartum.
Gestation HTN refers to elevated BP detected after 20 weeks gestation in the absence of proteinuria.
Pre-eclampsia occurs in a woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage.
Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause.
Which one of the following symptoms would be seen in a 39-week gestational age patient who was suspected of having HELLP syndrome?
a. Decreased liver enzymes, low platelet count, and nausea
b. Vomiting, flu-like symptoms, and platelet count <100,000
c. Flu-like symptoms, low platelet count, and decreased liver enzymes
d. Hypotensive, malaise, and elevated platelet count >100,000
b. Vomiting, flu-like symptoms, and platelet count <100,000
**APEA Pregnancy
HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of pre-eclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. Its characteristics are:
H: Hemolysis
EL: Elevated liver enzymes
LP: Low platelet count
Increased vascularity throughout the pelvis during pregnancy gives the vagina a bluish color. This sign is:
a. Hegar’s sign
b. Chadwick’s sign
c. Quickening sign
d. Leopold’s sign
b. Chadwick’s sign
**APEA Pregnancy
Linea nigra is a brownish black pigmented vertical stripe along the midline skin of the abdomen
As the skin over the abdomen stretches to accommodate the fetus, purplish striae gravidarum “stretch marks” may appear.
Heger’s sign is the palpable softening of the cervical isthmus, the portion of the uterus that narrows into the cervix.
Increased vascularity throughout the pelvis during pregnancy gives the vagina a bluish color, known as Chadwick’s sign.
During the last trimester of pregnancy, the supine position causes the uterus to overlie the vertebral column and compress the descending aorta and inferior vena cava. This position causes the patient to become faint and dizzy resulting in:
a. A hypertensive crisis
b. Supine hypotensive syndrome
c. Preeclampsia
d. Gestational hypertension
b. Supine hypotensive syndrome
**APEA Pregnancy
Irregular brownish patches around the forehead, cheeks, nose, and jaw noted during pregnancy are:
a. Pallor
b. Nevi
c. Chloasma
d. Hirsutism
c. Chloasma
**APEA Pregnancy
Chloasma, or Melasma, is also known as the “mask of pregnancy” and is considered a normal finding.
When performing the Leopold maneuver on a pregnant woman, if the buttocks are easily palpated at the fundus, the fetus is said to be in:
a. Cephalic longitudinal (vertical) lie
b. Transverse lie
c. Breech longitudinal (vertical) lie
d. Oblique presentation
a. Cephalic longitudinal (vertical) lie
**APEA Pregnancy
When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the vertex or cephalic presentation. Additionally, if the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back, then the head is extended and the fetus is in face presentation. The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie.
Symptoms on initial assessment of a pregnant woman with preeclampsia are: BP 158/100, Urinary output 50 ml/hour, Lungs clear upon auscultation, +1 urine protein on dipstick, and edema of the hands, ankles, and feet. On assessment an hour later, which one of the following symptoms would indicate worsening of preeclampsia?
a. Blood pressure 158/104
b. Urinary output of 20 ml/hour
c. Reflexes 2+
d. Platelet count of 150,000
b. Urinary output of 20 ml/hour
The decrease in urine output is an indication of a decrease in glomerular filtration rate (GFR), which indicates a loss of renal perfusion. There is not a significant rise in blood pressure, the reflexes are normal at 2+, and the platelet count is normal, though at the lower end. The assessment finding of greatest concern is the decreased urine output.
Menopause is diagnosed in a woman who has experienced amenorrhea for:
a. 6 months
b. 12 months
c. 18 months
d. 24 months
b. 12 months
**APEA Women’s Health
Menopause is diagnosed when no menstruation has occurred for 12 consecutive months, with no other identified biological of physiological cause.
When preparing to perform a pelvic exam in an older female, vaginal atrophy is noted. Due to this finding, the speculum:
a. Should not be used
b. Should be a larger size
c. Should be a smaller size
d. Should be completely dry
c. Should be a smaller size
**APEA Women’s Health
Performing a pelvic exam in an older woman, the nurse practitioner should separate the labia, press downward on the introitus to relax the levator muscles, and gently insert the speculum after moistening it with warm water or a water-soluble lubricant. If there is severe vaginal atrophy, a gaping introitus, or an introital stricture from estrogen loss, the size of the speculum may need to be adjusted to a smaller size.
If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and:
a. Milk the urethra gently from the outside inward
b. Milk the urethra gently from the inside outward
c. Massage the urethral meatus with the other hand
d. Massage the pelvic floor muscles in a clockwise fashion
b. Milk the urethra gently from the inside outward
**APEA Women’s Health
When performing this procedure, note any discharge from or about the urethral meatus. If present, it should be cultured.
Upon examination of the vagina, a tense, hot, very tender abscess with labial swelling is noted. This finding is most consistent with a:
a. Cystocele
b. Urethral caruncle
c. Rectocele
d. Bartholin gland infection
d. Bartholin gland infection
**APEA Women’s Health
A Bartholin gland infection appears as a tense, hot, very tender abscess with labial swelling over the area of the Bartholin gland.
A cystocele is a bulge of the upper 2/3 of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues.
A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus.
A rectocele is a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.
Upon examination of the vagina, a bulge is noted in the lower posterior wall of the vagina. This finding is most consistent with:
a. Cystocele
b. Cystourethrocele
c. Rectocele
d. Bartholin’s gland infection.
c. Rectocele
**APEA Women’s Health
A Bartholin gland infection appears as a tense, hot, very tender abscess with labial swelling over the area of the Bartholin gland.
A cystocele is a bulge of the upper 2/3 of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues.
When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present.
A rectocele is a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.
When discussing the female anatomy, the introitus is also known as the:
a. Uterus
b. Vaginal canal
c. Vaginal opening
d. Cervical os
c. Vaginal opening
**APEA Women’s Health
The vaginal mucosa lies in transverse folds called the:
a. Fornices
b. Rugae
c. Corpus
d. Fornix
b. Rugae
**APEA Women’s Health
The vaginal mucosa lies in transverse folds called rugae.
The fornices (pleural of fornix) are used to describe the three recesses of the vagina: anterior, posterior, and lateral fornices.
Corpus refers to the body of the uterus.
Fornix refers to the upper third of the vagina when it terminates into a cuplike shape near the cervix.
When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of a gloved hand. From a standing position, the fingers should be inserted into the vagina while exerting pressure primarily:
a. Anteriorly
b. Posteriorly
c. Toward the “4 o’clock” position
d. Toward the “8 o’clock” position
b. Posteriorly
**APEA Women’s Health
A 35-year-old female presents with complaints of swelling of her right breast. Findings reveal edema of the lower portion of her right breast. The skin appears thickened with enlarged pores. This condition is consistent with:
a. Paget’s disease
b. The peau d’orange sign
c. Nipple deviation
d. Skin dimpling
b. The peau d’orange sign
**APEA Women’s Health
Edema of the skin is caused by a lymphatic blockade. It appears as thickened skin with enlarged pores, commonly termed the peau d’orange (orange peel) sign. It is often seen first in the lower portion of the breast or areola and is considered a visible sign of breast cancer.
Upon examination of the vagina, the entire anterior wall, together with the bladder and urethra create a bulge. This condition is most consistent with a:
a. Prolapse of the urethral mucosa
b. Urethral caruncle
c. Cystocele
d. Cystourethrocele
d. Cystourethrocele
**APEA Women’s Health
When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge it is a cystourethrocele.
A cystocele is a bulge of the upper 2/3 of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues.
A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus.
A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus.
When do the ovaries become non-palpable after menopause?
a. One year
b. Two years
c. Three to five years
d. Six to ten years
c. Three to five years
**APEA Women’s Health
To palpate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen:
a. Near the symphysis pubis while pressing downward and elevating the cervix and uterus with the other hand
b. About midway between the umbilicus and symphysis pubis while elevating the cervix and uterus with the other hand
c. Just above the umbilicus while pressing downward and elevating the cervix and uterus with the other hand
d. Just below the umbilicus while pressing downward and elevating the cervix and uterus with the other hand.
b. About midway between the umbilicus and symphysis pubis while elevating the cervix and uterus with the other hand
**APEA Women’s Health
To palpate the uterus: one hand is placed on abdomen midway between umbilicus and symphysis pubis. The other hand is in vagina and elevates the cervix and uterus. Press the abdominal hand in and down, trying to grasp the uterus between the two hands.
Upon examination of the vagina, a small, red, benign tumor is noted at the posterior part of the urethral meatus. This finding is most consistent with a:
a. Prolapse of the urethral mucosa
b. Urethral caruncle
c. Cystocele
d. Cystourethrocele
b. Urethral caruncle
**APEA Women’s Health
A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus.
A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus.
A cystocele is a bulge of the upper 2/3 of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues.
When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge it is a cystourethrocele.
The findings of mucopurulent endocervical discharge and cervical motion tenderness on pelvic examination are strongly suggestive of:
a. Pelvic inflammatory disease (PID)
b. Pyelonephritis
c. Nephrolithiasis
d. Urethritis
a. Pelvic inflammatory disease (PID)
Abdominal or pelvic pain and fever are the most common clinical findings in patients with pelvic inflammatory disease (PID), although dysuria may also be present. The findings of mucopurulent endocervical discharge or cervical motion tenderness on pelvic examination are strongly suggestive of PID.
Cervical motion tenderness and endocervical discharge are not found with pyelonephritis, nephrolithiasis, or urethritis
To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and:
a. Palpate the external floor muscles in a clockwise position
b. Apply pressure against the anterior and lateral walls of the vagina
c. In the rectum
d. Palpate upward to just lateral to the pubic tubercles
d. Palpate upward to just lateral to the pubic tubercles
**APEA Women’s Health
When performing an examination of the external genitalia of a female patient, a small, firm, round cystic nodule in the labia is identified. This lesion is most consistent with:
a. A syphilitic chancre
b. An epidermoid cyst
c. Condylomata acuminata
d. Genital herpes
b. An epidermoid cyst
**APEA Women’s Health
A small, firm, round cystic nodule in the labia suggests an epidermoid cyst. They appear yellowish in color with a dark punctum marking the blocked opening of the gland.
A syphilitic chancre appears as a firm, painless ulcer and suggests the chancre of primary syphilis. Because most chancres in women develop internally, they often go undetected.
Genital warts, or condylomata acuminata, are warty lesions on the labia and within the vestibule resulting from infection with HPV.
Genital herpes appears as shallow, small, painful ulcers on red bases.
If performed correctly and in a timely fashion, which one of the following is most definitive for the diagnosis of breast cancer?
a. Breast tissue sample
b. Digital mammogram
c. Self-breast examination
d. Clinical breast exam
a. Breast tissue sample
**APEA Women’s Health
The other three options are indicative of screening tests and not always diagnostic of cancer.
An ulcerated vulvar lesion in an elderly woman may indicate:
a. Condylomata acuminata
b. A syphilitic chancre
c. Vulvar cancer
d. Ovarian cancer
c. Vulvar cancer
**APEA Women’s Health
To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for:
a. 1 second
b. 2 seconds
c. 3 seconds
d. at least 5 seconds
c. 3 seconds
**APEA Women’s Health
When performing a bimanual vaginal exam, a smooth and rather compressible non-tender lesion is palpated over the right ovary. This finding is most consistent with:
a. Ovarian cancer
b. An ovarian cyst
c. A right tubal pregnancy
d. A tubo-ovarian abscess
b. An ovarian cyst
**APEA Women’s Health
An ovarian cyst tends to be smooth and compressible and if uncomplicated, non-tender.
Ovarian tumors appear more solid and often nodular.
A right tubal pregnancy does not typically present with an ovarian lesion.
A tubo-ovarian abscess is difficult to palpate and typically presents with severe pain and purulent vaginal discharge.
A gynecological infection characterized by itching, burning, and vaginal discharge that is typically cheesy in texture and white in color is:
a. Trichomoniasis
b. Bacterial vaginosis (BV)
c. Yeast infection
d. Gonorrhea
c. Yeast infection
**APEA Women’s Health
A vaginal yeast infection is characterized by itching, burning, soreness, pain during intercourse and/or urination, and vaginal discharge that is typically cheesy in texture and white in color.
Trichomoniasis, bacterial vaginosis, and gonorrhea do not have symptoms of vaginal itching or classic presentation of a cheesy white discharge
The first sign of puberty in females is:
a. Appearance of body odor
b. Increased energy and appetite
c. Occurrence of first menses
d. Appearance of breast buds
d. Appearance of breast buds
**APEA Women’s Health
Breast buds are the first sign of puberty in girls. Body odor comes later as the apocrine glands develop. Menses first occurs about 1 year following the appearance of breast buds.
Increased energy and appetite do not relate to the signs of puberty
The cessation of menses sometime after menarche is termed:
a. Primary amenorrhea
b. Secondary amenorrhea
c. Menorrhagia
d. Hypomenorrhea
b. Secondary amenorrhea
**APEA Women’s Health
When performing a bimanual vaginal exam, a nodule on the anterior uterine surface could suggest a (an):
a. Ovarian cyst
b. Myoma
c. Pregnancy
d. Pelvic inflammatory disease
b. Myoma
**APEA Women’s Health
The shiny, pink area located around the cervical os is known as:
a. A retention cyst
b. The columnar epithelium
c. Squamous epithelium
d. The endocervix
c. Squamous epithelium
**APEA Women’s Health
There are two types of epithelia that cover the cervix: A shiny, pink squamous epithelium, which resembles the vaginal epithelium. And the Deep, red columnar epithelium, which is continuous with the endocervical lining. These two epithelia meet at the squamocolumnar junction. When this junction is at or inside the cervical os, usually only the squamous epithelium is seen. A ring of columnar epithelium is often visible to a varying extent around the os.
A retention cyst appears as a translucent nodule on the cervical surface.
The endocervix is the mucous membrane lining the canal of the cervix.
Urethritis in a female patient may arise from all of the following organisms except:
a. Neisseria gonorrhoeae
b. Herpes simplex
c. Chlamydia trachomatis
d. Campylobacter
d. Campylobacter
***APEA Women’s Health
Campylobacter is associated with bacterial infections of the GI tract and commonly produce diarrhea
Retraction of the nipple and areola suggest:
a. A cystic breast
b. An underlying breast mass
c. A fibroadenoma
d. A normal finding in most women
b. An underlying breast mass
**APEA Women’s Health
When performing a vaginal exam with a speculum, the use of the lower blade as a retractor during bearing down could expose an anterior wall defect such as a:
a. Rectocele
b. Cystocele
c. Bartholin gland infection
d. Prolapse of the urethral mucosa
b. Cystocele
**APEA Women’s Health
Use of lower blade during bearing down helps expose anterior vaginal wall defects such as cystoceles.
Use of the upper blade helps expose rectoceles.
Prolapse of the urethral mucosa and Bartholin gland infection can be visualized without the use of the speculum
Upon examination of the cervix, a yellow drainage is visible around the cervical os. This finding is most likely suggestive of:
a. Candidal vaginitis
b. Cervical polyp
c. Carcinoma of the cervix
d. Mucopurulent cervicitis
d. Mucopurulent cervicitis
**APEA Women’s Health
Mucopurulent cervicitis produces purulent, yellow drainage from the cervical os, usually from Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes infection.
Candidal vaginitis produces a white and curd-like, thin discharge from the vagina and does not originate from the cervix.
Typically a cervical polyp does not produce a cervical discharge.
Carcinoma of the cervix begins in an area of metaplasia and usually does not produce a mucopurulent cervical discharge.
When performing a rectal exam on a female, a hard nodular rectal “Shelf” is palpable at the tip of the examiner’s finger. This finding is suggestive of:
a. An ovarian cyst
b. Metastatic tissue in the rectouterine pouch
c. Rectal polyp
d. Carcinoma of the rectum
b. Metastatic tissue in the rectouterine pouch
**APEA Women’s Health
Widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum. A firm to hard nodular rectal “Shelf” may be just palpable with the tip of the examining finger. In a woman, this shelf of metastatic tissue develops in the rectouterine pouch, behind the cervix and the uterus.
Rectal polyps and carcinoma of the rectum, if palpable, are typically located in the lower section of the rectum.
To palpate the ovaries, a bimanual pelvic examination would be more appropriate
When examining the cervix, a bright, red, soft and fragile lesion is noted on the cervical surface. This finding is consistent with:
a. A retention cyst
b. An epidermoid cyst
c. A syphilitic chancre
d. A cervical polyp
d. A cervical polyp
**APEA Women’s health
A cervical polyp usually arises from the endocervical canal, becoming visible when it protrudes through the cervical os. It is bright red, soft, and fragile.
A small, firm, round cystic nodule in the labia suggests an epidermoid cyst.
A retention cyst appears as a translucent nodule on the cervical surface.
A small, firm, round cystic nodule in the labia suggests an epidermoid cyst.
A syphilitic chancre appears as a firm, painless ulcer and suggests the chancre of primary syphilis
During examination of the vagina, a bulge in the upper two-thirds of the anterior vaginal wall is noted. This symptom is most consistent with:
a. Prolapse of the urethral mucosa
b. Urethral caruncle
c. Cystocele
d. Cystourethrocele
c. Cystocele
**APEA Women’s Health
A cystocele is a bulge of the upper 2/3 of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues.
When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge it is a cystourethrocele.
A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus.
A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus.
A 45-year-old female presents to the nurse practitioner with complaints of postcoital bleeding (greater than spotting) unrelated to the menstrual cycle. What is the most likely cause?
a. Endometriosis
b. Cervical cancer
c. Early pregnancy
d. Menopause
b. Cervical cancer
**APEA Women’s Health
Postcoital bleeding suggests cervical polyps, cervical cancer, or in an older woman, atrophic vaginitis.
Postcoital bleeding is not usually noted in patients with endometriosis, early pregnancy, or menopause
Chronic pelvic pain may be secondary to all of the above except:
a. Sexually transmitted diseases
b. Sexual abuse
c. Fibroids
d. Peptic ulcer disease
d. Peptic ulcer disease
**APEA Women’s Health
Chronic pelvic pain (CPP) refers to pain of at least 6 months duration that occurs below the umbilicus. While gynecologic etiologies are common, CPP may be secondary to conditions in the urinary tract, GI tract, musculoskeletal system, and in the setting of mental health issues. Peptic ulcer disease affects the upper GI tract and produces symptoms above the umbilicus.
A female patient has a history of a retroverted uterus. This condition refers to:
a. The normal position of the uterus and cervix
b. A tilting backward of the uterus and cervix
c. A backward angulation of the uterus in relation to its cervix
d. The cervix being located at the introitus and the uterus in the vaginal canal
b. A tilting backward of the uterus and cervix
**APEA Women’s Health
Retroversion of the uterus refers to a tilting backward of the entire uterus, including both body and cervix. It is a common variant occurring in approximately 20% of women.
A backward angulation of the uterus in relation to its cervix is referred to as retroflexion of the uterus.
When the cervix is located at the introitus, and the uterus is in the vaginal canal, this is consistent with a third-degree uterine prolapse
Upon examination of the cervix, an irregular cauliflower-like growth was noted around the cervical os. This finding is most suggestive of:
a. Venereal warts
b. A cervical polyp
c. Carcinoma of the cervix
d. Genital herpes
c. Carcinoma of the cervix
**APEA Women’s Health
Carcinoma of the cervix begins with an area of metaplasia. In its earliest stages, it cannot be distinguished from a normal cervix. In later stages, an extensive, irregular, cauliflower-like growth may develop.
Warty lesions on the labia and within the vestibule suggest condyloma acuminatum, genital warts.
A cervical polyp usually arises from the endocervical canal, becoming visible when it protrudes through the cervical os. It is bright red, soft, and fragile.
Genital herpes appears as shallow, small, painful ulcers on red bases and are typically noted on the vulva
In which of the following situations would it be difficult for the examiner to palpate an ovary during the bimanual vaginal exam?
a. A slender woman
b. A woman who is anxious
c. A relaxed woman
d. A one year postmenopausal woman
b. A woman who is anxious
**APEA Women’s Health
Normal ovaries are usually tender to palpation but could pose difficulty in some women. They are usually palpable in slender, relaxed women but are difficult or impossible to feel in women who are obese or anxious. Three to five years after menopause, ovaries are atrophic and usually non-palpable
When performing a bimanual vaginal exam, a solid, nodular-like lesion is palpated over the right ovary. This finding is most consistent with:
a. Ovarian cancer
b. An ovarian tumor
c. A right tubal pregnancy
d. A tubo-ovarian abscess
b. An ovarian tumor
**APEA Women’s Health
Ovarian tumors appear more solid and often nodular upon palpation.
Ovarian cancer is relatively rare and usually presents at an advanced stage with symptoms of pelvic pain, increased abdominal size, and urinary tract symptoms.
An ovarian cyst tends to be smooth and compressible and if uncomplicated, non-tender.
A right tubal pregnancy does not typically present with an ovarian lesion.
A tubo-ovarian abscess is difficult to palpate and typically presents with severe pain and purulent vaginal discharge.
In a female diagnosed with a third-degree uterine prolapse, the cervix:
a. Is located in its normal position
b. Has slipped but is well within the vagina
c. Is located in the introitus
d. And vagina are outside the introitus
d. And vagina are outside the introitus
**APEA Women’s Health
Uterine prolapse occurs in progressive stages. The uterus becomes retroverted and descends down the vaginal canal to the exterior.
In first degree prolapse, the cervix is still well within the vagina.
In second degree prolapse, the cervix is at the introitus.
In third-degree prolapse (procidentia), the cervix and vagina are outside the introitus
When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This suggests that the mass is:
a. Cystic
b. Attached to the rib or intercostal muscle
c. Non-malignant
d. Attached to the pectoral fascia
b. Attached to the rib or intercostal muscle
**APEA Women’s Health
A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and/or intercostal muscles.
If fixed then the hand is pressed against the hip, it is attached to the pectoral fascia.
The most common cause of sexual problems in females are related to:
a. Lack of sexual desire
b. Inadequate vaginal lubrication
c. Psychosocial factors
d. Pelvic disorders
c. Psychosocial factors
**APEA Women’s Health
During a speculum exam of the cervix the speculum is maintained in an open position by:
a. Sliding the speculum along the posterior wall of the vagina
b. Rotating and adjusting the speculum until it cups the cervix
c. Gently tightening the thumb screw on the speculum
d. Rotating the speculum into a horizontal position while maintaining pressure posteriorly
c. Gently tightening the thumb screw on the speculum
**APEA Women’s Health
The other procedures are related to inserting the speculum, not to maintaining an open position.
The most important risk factor for cervical cancer is:
a. Failure to undergo screening
b. Multiple sexual partners
c. Long-term use of oral contraception
d. Persistent infection with high-risk human papillomavirus (HPV) subtypes
d. Persistent infection with high-risk human papillomavirus (HPV) subtypes
**APEA Women’s health
The most important risk factor for cervical cancer is persistent infection with HPV subtypes, especially HPV 16 or HPV 18. These two subtypes cause approximately 70% of cervical cancers, usually over the course of many years. Although the other choices pose a risk for developing cervical cancer, HPV infection is the most important risk factor.
Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a:
a. Prolapse of the urethral mucosa
b. Urethral caruncle
c. Cystocele
d. Cystourethrocele
a. Prolapse of the urethral mucosa
**APEA Women’s Health
A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus.
A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus.
A cystocele is a bulge of the upper 2/3 of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues.
When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge it is a cystourethrocele.
A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with:
a. Candidal vaginitis
b. Bacterial vaginosis
c. Trichomonal vaginitis
d. Gonorrhea
c. Trichomonal vaginitis
**APEA Women’s health
Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish/green vaginal discharge that is malodorous.
Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous.
With bacterial vaginosis, the discharge can be gray or white, thin, malodorous (fishy), and not usually profuse.
The discharge associated with gonorrhea is usually thick and bloody
The most common cause of acute pelvic pain in women is:
a. Ruptured ovarian cysts
b. Appendicitis
c. Pelvic inflammatory disease
d. Mittelschmerz
c. Pelvic inflammatory disease
**APEA Women’s health
Causes of post-menopausal bleeding typically include all of the following except:
a. Endometrial cancer
b. Hormone replacement therapy
c. Atrophic vaginitis
d. Uterine polyps
c. Atrophic vaginitis
**APEA Women’s Health
Typically, with atrophic vaginitis patients are more likely to experience postcoital bleeding as opposed to post-menopausal bleeding
A female patient presents with a white and curd-like thin vaginal discharge. This discharge is most consistent with:
a. Candidal vaginitis
b. Bacterial vaginosis
c. Trichomonal vaginitis
d. Gonorrhea
a. Candidal vaginitis
**APEA Women’s health
Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish/green vaginal discharge that is malodorous.
Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous.
With bacterial vaginosis, the discharge can be gray or white, thin, malodorous (fishy), and not usually profuse.
The discharge associated with gonorrhea is usually thick and bloody
When performing the bimanual vaginal exam, uterine enlargement is noted. This enlargement could suggest:
a. A malignancy
b. Retroversion of the uterus
c. Retroflexion of the uterus
d. Pelvic inflammatory disease
a. A malignancy
**APEA Women’s health
Uterine enlargement may suggest pregnancy, uterine myomas (fibroids), or malignancy
Retroversion or retroflexion of the uterus, and pelvic inflammatory disease do not present with enlargement of the uterus
Primary dysmenorrhea results from:
a. Endometriosis
b. Increased prostaglandin production during the luteal phase of the menstrual cycle
c. Pelvic inflammatory disease
d. Endometriosis in the muscular layers of the uterus
b. Increased prostaglandin production during the luteal phase of the menstrual cycle
**APEA Women’s health
Endometriosis, adenomyosis (endometriosis in the muscular layers of the uterus), pelvic inflammatory disease, and endometrial polyps are secondary causes
A woman complains of infrequent menses with intervals greater than 35 days. This condition is termed:
a. Oligomenorrhea
b. Polymenorrhea
c. Metrorrhagia
d. Menorrhagia
a. Oligomenorrhea
**APEA Women’s health
When performing a vaginal exam with a speculum, the use of the upper blade as a retractor could expose a:
a. Rectocele
b. Cystocele
c. Bartholin gland infection
d. Prolapse of the urethral mucosa
a. Rectocele
**APEA Women’s health
Use of the lower blade as a retractor during bearing down helps expose anterior vaginal wall defects such as cystoceles.
Use of the upper blade as a retractor helps expose rectoceles.
The other two can be visualized without the use of a speculum
Examination of a female patient’s right breast reveals a retraction of the nipple and areola. This finding is consistent with:
a. Breast cancer
b. Mastitis
c. Paget’s disease of the breast
d. Fibrocystic breast disease
a. Breast cancer
**APEA Women’s health
Retraction of the nipple and areola are suggestive of an underlying tumor.
Mastitis is an inflammation of the breast tissue.
Paget’s disease is an uncommon form of breast cancer that starts with a scaly, eczema-like lesion that may week, crust, or erode.
Fibrocystic breast disease findings include lumps, thickening and swelling in the breast tissue, and becomes prominent immediately before onset of menses.
In a female diagnosed with a first-degree uterine prolapse, the cervix is:
a. Is located in its normal position
b. Has slipped but is well within the vagina
c. Is located in the introitus
d. And vagina are outside the introitus
b. Has slipped but is well within the vagina
**APEA Women’s health
Uterine prolapse occurs in progressive stages. The uterus becomes retroverted and descends down the vaginal canal to the exterior.
In first degree prolapse, the cervix is still well within the vagina.
In second degree prolapse, the cervix is at the introitus.
In third-degree prolapse (procidentia), the cervix and vagina are outside the introitus
A twenty-year-old female complains of a milky discharge bilaterally from her breasts. This suggests:
a. A normal finding in women in their early twenties
b. Pregnancy or elevated prolactin level
c. Brease disease
d. Breast cancer
b. Pregnancy or elevated prolactin level
**APEA Women’s health
A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with:
a. Candidal vaginosis
b. Bacterial vaginosis
c. Trichomonal vaginitis
d. Gonorrhea
b. Bacterial vaginosis
**APEA Women’s health
Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish/green vaginal discharge that is malodorous.
Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous.
With bacterial vaginosis, the discharge can be gray or white, thin, malodorous (fishy), and not usually profuse.
The discharge associated with gonorrhea is usually thick and bloody
Indications for performing a rectovaginal exam include all of the following except to:
a. Palpate a retroverted uterus
b. Assess pelvic pathology
c. Assess an inguinal hernia
d. Screen for colorectal cancer in women over 50
c. Assess an inguinal hernia
**APEA Women’s health
The rectovaginal examination has three primary purposes:
1- To palpate a retroverted uterus, the uterosacral ligaments, cul-de-sac, and adnexa;
2- To screen for colorectal cancer in women 50 years or older
3- To assess for pelvic pathology
Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at a high risk for developing all of the following abnormalities except:
a. Columnar epithelium covering most or all of the cervix
b. A slit-like cervical os
c. Vaginal adenosis
d. A circular collar or ridge of tissue between the cervix and the vagina
b. A slit-like cervical os
**APEA Women’s health
A slit-like cervical os is a normal variation
In female patients with dyspareunia, superficial pain is most likely related to all of the following except:
a. Local inflammation
b. Atrophic vaginitis
c. Pressure on a normal ovary
d. Inadequate lubrication
c. Pressure on a normal ovary
**APEA Women’s health
In females, dyspareunia (painful intercourse) can occur at the vaginal opening, occurring at the start of intercourse, or when the partner is pushing deeper. It is important to differentiate the pain to determine the etiology.
Superficial pain suggests local inflammation, atrophic vaginitis, or inadequate lubrication.
Deeper pain may be from pelvic disorders or pressure on a normal ovary
A woman complains of experiencing uterine bleeding between expected menstrual cycles. This condition is termed:
a. Oligomenorrhea
b. Polymenorrhea
c. Metrorrhagia
d. Menorrhagia
c. Metrorrhagia
**APEA Women’s health
Metrorrhagia refers to intermenstrual bleeding.
Polymenorrhea occurs when there are fewer than 21-day intervals between menses
Oligomenorrhea is infrequent bleeding with menses occurring at greater than 35-day intervals, or 4-9 menstrual cycles per year.
Menorrhagia refers to excessive or prolonged menstrual flow occurring at regular intervals
When examining the cervix, a translucent nodule is noted on the cervical surface. This finding is consistent with:
a. A retention cyst
b. An epidermoid cyst
c. A syphilitic chancre
d. A cervical polyp
a. A retention cyst
**APEA Women’s health
A retention cyst appears as a translucent nodule on the cervical surface.
A small, firm, round cystic nodule in the labia suggests an epidermoid cyst.
A syphilitic chancre appears as a firm, painless ulcer and suggests the chancre of primary syphilis. Because most chancres in women develop internally, they often go undetected.
A cervical polyp usually arises from the endocervical canal, becoming visible when it protrudes through the cervical os. It is bright red, soft, and fragile.
A 29-year-old woman with systemic lupus erythematosus (ALE) complains of facial swelling. She has been on prolonged course of corticosteroids. On assessment, moon face appearance is noted. She has most likely developed:
a. Cushing syndrome
b. Addison’s disease
c. Sjogren syndrome
d. Syndrome X
a. Cushing syndrome
**APEA Endocrine
A patient has an enlarged thyroid gland with an audible bruit. The examiner should suspect:
a. Hypothyroidism
b. A thyroid malignancy
c. Hyperthyroidism
d. Thyroiditis
c. Hyperthyroidism
**APEA Endocrine
In hyperthyroidism, there is often a localized or continuous bruit audible over the lateral lobes of the thyroid gland.
Myxedema is a symptom commonly found in patients diagnosed with:
a. Addison’s disease
b. Hypothyroidism
c. Thyroid nodule
d. Adrenal insufficiency
b. Hypothyroidism
**APEA Endocrine
Myxedema is a deposition of mucopolysaccharides in the dermis that results in swelling of the affected area, giving the skin a waxy appearance. One manifestation of myxedema in the lower limb is pretibial myxedema, a hallmark of Graves’ disease, an autoimmune form of hyperthyroidism. Myxedema can also occur in Hashimoto’s thyroiditis and other longstanding forms of hypothyroidism.
Myxedema is not associated with Addison’s disease, thyroid nodule, or adrenal insufficiency
When a patient presents with myxedema coma, which one of the following groups of symptoms may be present?
a. Hypothermia, thickening of the tongue, and disorientation
b. Dehydration, tachycardia, and tachypnea
c. Diarrhea, hyperactive peristalsis, and abdominal distention
d. Seizures, hyperthermia, and conjunctivitis
a. Hypothermia, thickening of the tongue, and disorientation
**APEA Endocrine
Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood (hypothyroidism). Myxedema coma is considered a life-threatening complication of hypothyroidism and represents the far more serious side of the spectrum of thyroid disease.
Symptoms include: hypothermia, significant edema, thickening of the tongue, difficulty breathing, constipation, and severe mental changes including hallucinations, disorientation, seizures, and ultimately deep coma
A patient presents with sweating, tremors, palpitations, hunger, and confusion. This patient is most likely experiencing:
a. A syncopic event
b. Hypoglycemia
c. Postural hypotension
d. Hypocapnia
b. Hypoglycemia
**APEA Endocrine
Hypoglycemia symptoms: sweating, tremors, palpitations, hunger, headache, abnormal behavior, confusion.
Syncope could present with nausea, vomiting, dizziness, and possible fainting.
Postural hypotension usually occurs after one stands up. Usually there are no prodromal symptoms. The BP returns to normal when the patient lies down.
Hypocapnia is decreased carbon dioxide and symptoms include dyspnea, palpitations, chest discomfort, numbness and tingling in the hands and around the mouth lasting for several minutes. Consciousness is maintained.
Hyperpigmentation of the skin and mucous membranes can be seen in patients with:
a. Acquired immunodeficiency syndrome (AIDS)
b. Addison’s disease
c. Cushing’s disease
d. Diabetes
b. Addison’s disease
**APEA Endocrine
Addison’s disease: Hyperpigmentation
AIDS: Hairy leukoplakia
Cushing’s: Striae, skin atrophy, purpura, ecchymosis, telangiectasias, acne, moon facies, buffalo hump, or hypertrichosis.
Diabetes: Necrobiosis lipoidica diabeticorum, diabetic bullae, diabetic dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic ulcers, eruptive xanthomas, and PVD.
Which of the following is NOT considered a benign tumor of the pituitary gland?
a. Craniopharyngioma
b. Prolactinoma
c. Gonadotropin-secreting adenoma
d. Thyrotropin-secreting adenoma
a. Craniopharyngioma
**APEA Endocrine
Craniopharyngiomas develop in the area of the brain near the pituitary gland and are derived from pituitary gland embryonic tissue. They are most common in children and in adults in their 50s and 60s. Almost all pituitary tumors are benign glandular tumors called pituitary adenoma. Examples include prolactin-producing adenomas (prolactinomas), gonadotropin-and growth hormone-secreting adenomas, and thyrotropin-secreting adenomas
Examination of the hair reveals a sparse amount with a coarse appearance. This finding may be seen in patients who have:
a. Hypothyroidism
b. Hyperthyroidism
c. Type 2 diabetes
d. Celiac disease
a. Hypothyroidism
**APEA Endocrine
Sparse, coarse, and thin hair is more characteristic of hair seen in patients with hypothyroidism.
Fine, silky hair may be seen in patients who have hyperthyroidism
In celiac disease and type 2 diabetes, alopecia may be seen
Symptoms of underdeveloped ovaries, web-like neck, and short stature are associated with:
a. Polycystic ovarian syndrome (PCOS)
b. Prolactinemia
c. Klinefelter syndrome
d. Turner syndrome
d. Turner syndrome
Turner Syndrome: Short stature, delayed growth, low-set ears, web-like neck, and in girls, underdeveloped ovaries.
PCOS: Infertility, unwanted hair growth, weight gain, fatigue
Prolactinoma: infertility, irregular menstrual periods, acne, and unwanted hair growth.
Klinefelter: Hypogonadism, gynecomastia in late puberty, elevated urinary gonadotropin levels, and behavioral concerns in boys
A 20-year-old with acanthosis nigricans should be evaluated for:
a. Acute renal failure
b. Diabetes mellitus
c. Alcohol-induced cirrhosis
d. Hypothyroidism
b. Diabetes mellitus
**APEA Endocrine
Acanthosis nigricans is a skin condition characterized by dark velvety patches in the body folds and creases. It is typically noted in patients who are obese or who have diabetes.
A common symptom noted in patients who have a thyroid goiter is:
a. A frequent cough
b. Decreased oral secretions
c. Fatigue
d. Gastric reflux
a. A frequent cough
**APEA Endocrine
Because of the anatomic relationship of the thyroid gland to the trachea, larynx, superior and inferior laryngeal nerves, and esophagus, abnormal growth may cause a variety of compressive syndromes. These symptoms may include: wheezing, cough, globus hystericus, dysphagia, and vocal cord dysfunction and hoarseness.
Compression of the venous outflow results in facial plethora and dilated neck and upper thoracic veins. Other symptoms include waking up from sleep with a sensation of being unable to breathe or feeling that food is stuck in the throat.
Striae, skin atrophy, and purpura may be associated with:
a. Acquired immunodeficiency syndrome (AIDS)
b. Addison’s disease
c. Cushing’s disease
d. Diabetes
c. Cushing’s disease
**APEA Endocrine
Addison’s disease: Hyperpigmentation
AIDS: Hairy leukoplakia
Cushing’s: Striae, skin atrophy, purpura, ecchymosis, telangiectasias, acne, moon facies, buffalo hump, or hypertrichosis.
Diabetes: Necrobiosis lipoidica diabeticorum, diabetic bullae, diabetic dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic ulcers, eruptive xanthomas, and PVD.
A sweat test is used to help diagnose:
a. Graves’ disease
b. Hypothyroidism
c. Cystic fibrosis
d. Crohn’s disease
c. Cystic fibrosis
**APEA Endocrine
A sweat test measures the amount of sodium and chloride in sweat and is used to assist in diagnosing cystic fibrosis. Patients with cystic fibrosis have 2-5 times the normal amount of sodium and chloride in their sweat.
Hypofunctioning of the thyroid gland would lead to all the following disorders except:
a. Myxedema
b. Grave’s disease
c. Hypothyroidism
d. Hashimoto’s thyroiditis
b. Grave’s disease
**APEA Endocrine
Disorders related to hypofunctioning of the thyroid gland include primary hypothyroidism, myxedema, Hashimoto’s thyroiditis, iodine deficiency, and myxedema coma.
A common clinical term used to refer to women with an excess growth of terminal hair in a male pattern is:
a. Androgenic alopecia
b. Alopecia
c. Hirsutism
d. Vellus hair
c. Hirsutism
**APEA Endocrine
Although hirsutism is broadly defined as excess hair, the common clinical use of the term refers to women with excess growth of terminal hair in a male pattern.
Vellus hair is short, thin, slight-colored, and barely noticeable thin hair that develops on most of the body during childhood.
Androgenic alopecia is a genetically determined disorder characterized by the gradual conversion of terminal hairs into indeterminate, and finally vellus hairs.
Alopecia is a condition in which hair is lost from some or all areas of the body. It often results in bald spots.
Thyrotoxicosis is most commonly associated with:
a. Hyperthyroidism
b. Hypothyroidism
c. Thyroid nodules
d. Non-toxic goiter
a. Hyperthyroidism
**APEA Endocrine
Hyperthyroidism occurs due to excessive production of thyroid hormone by the thyroid gland. Thyrotoxicosis is a result of high levels of thyroid hormones and therefore includes hyperthyroidism.
A thyroid nodule is an abnormal growth of thyroid cells that forms a lump within the thyroid gland. The majority are benign.
A non-toxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function
Which hemoglobin A1C level is typically used to diagnose type 2 diabetes?
a. 0.05
b. 0.055
c. 0.06
d. 0.065
d. 0.065
**APEA Endocrine
Hemoglobin A1C levels between 5.7%-6.4% are reflective of impaired glucose metabolism. Type 2 diabetes is diagnosed when the A1C is 6.5% or greater
Which of the following is NOT associated with Hashimoto’s thyroiditis?
a. Weight loss
b. Cold intolerance
c. Hair loss
d. Decreased sweating
a. Weight loss
**APEA Endocrine
Cold intolerance, hair loss, and decreased perspiration are associated with Hashimoto’s hypothyroidism. Weight loss is usually noted in patients with hyperthyroidism.
Bilateral exophthalmos suggests:
a. The presence of a goiter
b. Hashimoto’s thyroiditis
c. Grave’s disease
d. Hypothyroidism
c. Grave’s disease
**APEA Endocrine
Exophthalmos is an abnormal protrusion of the eye. When it presents bilaterally, it is suggestive of Grave’s disease, a form of hyperthyroidism. Unilateral exophthalmos may be due to Grave’s disease or to a tumor or inflammation of the orbit.
A common arrhythmia associated with hyperthyroidism is:
a. First-degree heart block
b. Atrial fibrillation
c. Ventricular tachycardia
d. Sinus bradycardia
b. Atrial fibrillation
**APEA Endocrine
Hyperthyroidism is associated with atrial fibrillation, systolic murmur, and cardiac failure.
Hypothyroidism is associated with sinus bradycardia, mild hypertension (diastolic), and narrowed pulse pressure.
Supraventricular tachycardia may be associated with hyperthyroidism, however, ventricular tachycardia is not.
A six-year-old has a history of diabetes mellitus type 1 and is now experiencing cellulitis of the right lower leg. The child presents with deep, rapid, and unlabored respirations, fruity odor, and dry skin. These are symptoms of:
a. Hypoglycemia
b. Sepsis
c. Stevens Johnson Syndrome
d. Ketoacidosis
d. Ketoacidosis
**APEA Endocrine
These are signs of diabetic ketoacidosis (DKA) and can occur in diabetic patients with infections. DKA is characterized by elevated blood glucose (usually higher than 240 mg/dl) and ketonuria. The respiratory pattern is consistent with Kussmaul breathing and are signs of hyperglycemia.
Women with hyperthyroidism often experience:
a. Oligomenorrhea
b. Normal menstruation
c. Amenorrhea
d. Menorrhagia
a. Oligomenorrhea
**APEA Endocrine
When auscultating the enlarged thyroid with a stethoscope, a bruit is suggestive of:
a. A carotid aneurysm
b. A normal finding
c. Hyperthyroidism
d. A thyroid malignancy
c. Hyperthyroidism
**APEA Endoctine
A systolic or continuous bruit auscultated with a stethoscope over an enlarged thyroid may be heard in hyperthyroidism. This is not a normal finding.
A bruit is not usually associated with a thyroid malignancy
Symptoms of Graves’ disease include:
a. Weight gain
b. Bradycardia
c. Anemia
d. Proptosis
d. Proptosis
**APEA Endocrine
Proptosis is defined as a bulging of the eyes, which is a symptom of hyperthyroidism or Graves’ disease.
Weight gain, bradycardia, and anemia are associated with hypothyroidism
A 13-year-old girl presents with complaints of insomnia and hyperactivity along with gradual weight loss despite a good appetite. She has warm, flushed, and moist skin and unusually fine hair. These manifestations are indicative of which one of the following conditions?
a. Hypothyroidism
b. Hyperthyroidism
c. Cushing’s syndrome
d. Addison’s disease
b. Hyperthyroidism
**APEA Endocrine
Symptoms of hyperthyroidism in children may include: anxiousness, irritability, nervousness, poor/restless sleet, increased activity/fidgeting, hyperactivity, increased appetite with or without weight loss, increased number of bowel movements per day, decreased/poor school performance, difficulty concentrating that may be diagnosed as “late-onset” attention deficit disorder, and a feeling of a “lump” in the throat.
During assessment of the thyroid, a fixed, firm, non-tender large mass is noted. These findings describe:
a. A cyst
b. A nodule
c. A goiter
d. Hyperplasia
b. A nodule
**APEA Endocrine
Thyroid nodule: Fixed, firm, non-tender large mass
Thyroid cyst: Fluid-filled
Goiter: causes visible swelling at the base of the neck
Hyperplasia: abnormal increase in the volume of a tissue or organ caused by the formation and growth of new normal cells.
Based on a one-step 2-hour glucose tolerance test (GTT) with 75 grams of oral glucose, a positive result for gestational diabetes is a blood sugar of at least:
a. 120 mg/dL
b. 160 mg/dL
c. 180 mg/dL
d. 200 mg/dL
b. 160 mg/dL
**APEA Endocrine
Gestational diabetes mellitus (GDM) may be diagnosed between 24-28 weeks of pregnancy based on a fasting one-step or two-step glucose tolerance test (GTT).
In one-step GTT, the patient receives 75 grams of oral glucose and plasma glucose is measured at 1 and 2 hours. GDM is diagnosed if:
1- Fasting blood glucose is >92 mg/dL.
2- 1-hour blood glucose is >180 mg/dL
3- 2-hour blood glucose is >153 mg/dL
In two-step GTT, 50 gm of glucose is administered to the non-fasting patient. If the lood glucose is 130 mg/dL or higher, then a second test is performed fasting and 100 gm of glucose is administered. The patient is diagnosed with GDM if:
1- Fasting blood glucose is >95 mg/dL
2- 1-hour blood glucose is >180 mg/dL
3- 2-hour blood glucose is >155 mg/dL
4- 3-hour blood glucose is >140 mg/dL
The presence of pubic hair in girls between the age of 5 and 8 years is termed:
a. Hypertrichosis
b. Thelarche
c. Adrenarche
d. Adrenal hyperplasia
c. Adrenarche
**APEA Endocrine
Adrenarche is the early presence of pubic hair in girls aged 5-8 years.
Hypertrichosis is an abnormal amount of hair growth over the body.
Thelarche is the onset of female breast development
Adrenal hyperplasia is the excess production of male sex hormones that results in short height, early puberty, and in females, abnormal genital development
The most common cause of death in children diagnosed with cystic fibrosis is:
a. Heart failure
b. Respiratory failure
c. Liver failure
d. Renal failure
b. Respiratory failure
**APEA Endocrine
The appearance of breast development in girls before the age of 8 years is termed:
a. Amenorrhea
b. Gynecomastia
c. Adrenarche
d. Precocious puberty
d. Precocious puberty
**APEA Endocrine
Puberty that begins before age 8 in girls and before age 9 in boys is considered precocious puberty.
Amenorrhea is the absence of menstruation.
Gynecomastia is the swelling of breast tissue in boys or men
Adrenarche is the early presence of pubic hair in girls aged 5-8 years old.
Children with type 1 diabetes mellitus usually present with which one of the following symptoms?
a. Obesity
b. High cholesterol levels
c. Polyuria
d. Hypoglycemia
c. Polyuria
**APEA Endocrine
The classic symptoms of DM1 are polyuria, polydipsia, polyphagia, and unexplained weight loss.
Obesity and elevated cholesterol are more consistent with DM2
Hyperfunctioning of the thyroid gland could lead to all of the following disorders except:
a. Grave’s disease
b. Thyrotoxicosis
c. Myxedema
d. Toxic goiter
c. Myxedema
**APEA Endocrine
Hyperfunctioning of the thyroid gland leads to a hypermetabolic state causing an increase in metabolic function, increased oxygen consumption by tissues, and heat production. Disorders include: Grave’s disease, toxic goiter, thyroid storm (thyrotoxicosis).
Myxedema is seen in hypofunctioning of the thyroid gland
When assessing the thyroid gland, the nurse practitioner palpates for abnormalities while asking the patient to:
a. Cough
b. Turn the neck
c. Stick out tongue
d. Swallow water
d. Swallow water
**APEA Endocrine
Proper posterior assessment of the thyroid is performed by palpating between the cricoid cartilage and the suprasternal notch. One hand is used to slightly retract the sternocleidomastoid muscle, the other hand palpates the thyroid. The patient is asked to swallow a sip of water during palpation while the examiner feels for the upward movement of the thyroid gland. Abnormalities include asymmetry, masses, erythema, or deviation of the trachea.
A 30-year-old woman is taking phenytoin (Dilantin) for seizures. She has recent hair loss and anorexia but is craving salty foods. Her lab results show abnormally low cortisol levels. These symptoms suggest:
a. Hyperparathyroidism
b. Addison’s disease
c. Anorexia nervosa
d. Celiac disease
b. Addison’s disease
**APEA Endocrine
Addison’s disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce adequate steroid hormones. Classic symptoms include fatigue, anorexia, chronic diarrhea, salt craving, mucosal pigmentation, and hair loss. Lab tests for adrenal function shows a subnormal rise in cortisol levels.
A finding NOT identified in boys diagnosed with Klinefelter syndrome is:
a. A low testosterone level
b. Micro-orchidism
c. Gynecomastia
d. A high sperm count
d. A high sperm count
**APEA Endocrine
Klinefelter syndrome is a chromosomal condition that affects male physical and cognitive development. S/Sx vary among patients. Low testosterone levels, micro-orchidism, gynecomastia, facial hair, baldness, and low sperm count are all associated with Klinefelter syndrome.
A hormonal disorder in adults resulting from the overproduction of growth hormones is known as:
a. Gigantism
b. Prolactinoma
c. Acromegaly
d. Congenital adrenal hyperplasia
c. Acromegaly
**APEA Endocrine
Gigantism refers to abnormally high linear growth due to the excessive action of insulin-like growth factor 1 (IGF-1) while the epiphyseal growth plates are open during childhood. Acromegaly is the same disorder of excess IGF-1 but occurs after the growth plate cartilage fuses in adulthood. Excessive growth hormone is almost always caused by a non-cancerous (benign) pituitary tumor.
A prolactinoma is a benign tumor (adenoma) of the pituitary gland that produces excessive prolactin resulting in decreased levels of some sex hormones. The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both.
A general term for an enlarged thyroid is:
a. Exophthalmos
b. A goiter
c. Lymphadenopathy
d. Acromegaly
b. A goiter
**APEA Endocrine
A butterfly-shaped gland located in the middle of the neck below the larynx and above the clavicles is the:
a. Parathyroid
b. Thyroid gland
c. Hypothalamus gland
d. Thymus gland
b. Thyroid gland
**APEA Endocrine
Fruity breath odor correlates with assessment for:
a. Salicylate toxicity
b. Diabetic ketoacidosis
c. Urinary tract infection
d. Acute pancreatitis
b. Diabetic ketoacidosis
**APEA Endocrine
Hyperplasia of the thyroid gland is caused by a deficiency of:
a. Phosphorus
b. Iron
c. Magnesium
d. Iodine
d. Iodine
**APEA Endocrine
Hyperplasia of the thyroid gland (goiter) results from an iodine-deficient diet, which causes overgrowth of the thyroid gland
A life-threatening symptom of parathyroid hormone (PTH) deficiency, hypoparathyroidism, is:
a. Dystonia
b. Myoclonia
c. Tetany
d. Choria
c. Tetany
**APEA Endocrine
A lack of PTH leads to decreased blood levels of calcium (hypocalcemia) and increased levels of blood phosphorus (hyperphosphatemia). Muscle cramps involving the lower back, legs, and feet are common in patients with hypoparathyroidism and hypocalcemia.
Tetany develops if hypocalcemia is severe. In some patients, laryngospasm and bronchospasm may be life threatening
A significant increase in 24-hour urine volume that exceeds 3 liters is called:
a. Polyuria
b. Dysuria
c. Urgency
d. Frequency
a. Polyuria
**APEA Urology
Which one of the following is NOT a cause of vaginitis?
a. Yeast infection
b. Herpes simplex virus (HSV)
c. Trichomoniasis
d. Bacterial vaginosis (BV)
b. Herpes simplex virus (HSV)
**APEA Urology
Approximately 90% of all cases of vaginitis are thought to be attributed to 3 causes: Bacterial vaginosis, vaginal candidiasis (or vulvovaginal candidiasis), and trichomonas vaginalis infection (trichomoniases.
Herpes simplex virus does not cause vaginitis
When testing for pyelonephritis, the exam technique of percussing the back over the kidney that produces flank pain is called:
a. Murphy’s sign
b. Psoas sign
c. Pasternacki’s sign
d. Rovsing’s sign
c. Pasternacki’s sign
**APEA Urology
Costovertebral angle tenderness (CVA), also known as Pasternacki’s sign (Murphy’s punch or Goldflam’s sign) is a medical test in which findings of pain are elicited by percussion of the back over either kidney when infection is present.
Murphy’s sign assesses for cholecystitis. It is positive if deep palpation in the subcostal area occurs when a patient with gallbladder disease takes a deep breath and ceases inspiration.
Psoas sign indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocecal in orientation.
Rovsing’s sign indicates peritoneal irritation. If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis
What is the average urine pH level?
a. 4.5
b. 6
c. 7
d. 8
b. 6
**APEA Urology
The average urine pH is 5-6
Acidic urine pH is 4.5-5.5
Alkaline urine pH is 6.5-8
Which one of the following conditions is not related to polyuria?
a. Lithium toxicity
b. Hyperkalemic nephropathy
c. Uncontrolled diabetes
d. Hypogonadism
b. Hyperkalemic nephropathy
**APEA Urology
Kidney diseases such as hypokalemic nephropathy, lithium toxicity, uncontrolled diabetes, and disorders of the posterior pituitary and hypothalamus (ex. Hypogonadism) cause polyuria.
Which one of the following patient positions would be least beneficial to examine the genitals of a young female child?
a. Have the child sit on her parent’s lap with the parent holding the child’s knees apart
b. Have the child lie supine in the frog-leg position
c. Have the child sit crossed legged on the examination table
d. Position the child in the knee-chest position
c. Have the child sit crossed legged on the examination table
**APEA Urology
Having the child sit crossed-legged would not expose the genitals. This position is useful when examining the male child and eliciting the cremasteric reflex
A form of urinary incontinence that is characterized by the involuntary release of urine from a full-bladder in the absence of any need to urinate is called:
a. Stress incontinence
b. Urge incontinence
c. Overflow incontinence
d. Functional incontinence
c. Overflow incontinence
**APEA Urology
This condition occurs in people who have a blockage of the bladder outlet (BPH, prostate cancer, or narrowing of the urethra) or when the muscle that expels urine from the b ladder is too weak to empty the bladder normally.
A 65-year-old woman complains that when she feels the urge to urinate, she has to go immediately or else she urinates “on herself”. She has become homebound because she wants to stay close to the bathroom. This condition is termed:
a. Functional incontinence
b. Overflow incontinence
c. Urge incontinence
d. Stress incontinence
c. Urge incontinence
**APEA Urology
One cause of proctitis could be related to:
a. Gastritis
b. Frequent anal intercourse
c. Cirrhosis
d. Pancreatitis
b. Frequent anal intercourse
**APEA Urology
Proctitis is inflammation of the lining of the rectum leading to rectal pain, bleeding, and a continuous sensation to defecate. Causes may include: inflammatory bowel disease, sexually transmitted infections, radiation therapy, and frequent anal intercourse
Patients with prior hypospadias surgery who develop slow and painful urination as well as prostatitis are experiencing symptoms of:
a. Neurogenic bladder
b. Urethral stricture
c. Benign prostatic hyperplasia (BPH)
d. Prostate cancer
b. Urethral stricture
**APEA Urology
A urethral stricture may occur in patients who have undergone hypospadias surgery and experience voiding symptoms such as urinary retention and straining to void.
Neurogenic bladder symptoms include urinary retention and/or incontinence associated with other underlying chronic neurologic conditions (multiple sclerosis) or after spinal cord injury.
BPH symptoms include daytime frequency, nocturia, urinary incontinence, and terminal dribbling.
Prostate cancer is usually asymptomatic but can sometimes present with storage, voiding, or irritative symptoms
A 40-year-old male complains of right flank pain. His temperature is 102 F. These symptoms may be characteristic of:
a. Renal calculi
b. Acute pyelonephritis
c. Urethritis
d. Prostatitis
b. Acute pyelonephritis
**APEA Urology
Kidney pain in the flank area and groin that is accompanied by fever and chills is consistent with acute pyelonephritis.
Renal or ureteral colic usually presents with a sudden onset of pain in the flank area, abdomen, or groin. Chills and fever do not generally accompany urinary calculi.
In men, painful urination without frequency or urgency suggests urethritis
Acute prostatitis presents with frequency, urgency, and dysuria
Which one of the following symptoms would be least indicative of acute glomerulonephritis?
a. Hematuria
b. Polyruria
c. Proteinuria
d. Hypertension
b. Polyruria
**APEA Urology
Acute glomerulonephritis symptoms include hematuria. This is a universal finding even if it is microscopic. Gross hematuria is reported in 30% of pediatric patients, often manifesting as smoky, coffee, or cola-colored urine. Oliguria is seen. Hypertension, proteinuria, and edema (peripheral or periorbital) is reported in approximately 85% of pediatric patients. Edema may be mild (involving only the face) to severe, bordering on a nephrotic appearance. Headache may occur secondary to hypertension. Confusion may occur secondary to malignant hypertension in as many as 5% of patients. Shortness of breath, or dyspnea on exertion may occur secondary to heart failure or pulmonary edema. It is usually uncommon, particularly in children.
Possible flank pain secondary to stretching of the renal capsule may occur.
A 50-year-old male describes difficulty emptying his bladder. On exam, a distended bladder is noted following urination. This finding may be associated with:
a. Functional incontinence
b. Overflow incontinence
c. Urge incontinence
d. Stress incontinence
b. Overflow incontinence
**APEA Urology
Overflow incontinence is associated with a neurological or anatomical obstruction from pelvic organs or the prostate which limits bladder emptying and causes a distended bladder.
Stress incontinence is commonly seen in women and arises from decreased intraurethral pressure. This condition is noted when a patient coughs, sneezes, or laughs.
In urge incontinence, urgency is followed by immediate involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance. Following an urge to void, there is an involuntary loss of urine.
Functional incontinence usually arises from cognitive impairment, musculoskeletal problems, or immobility
Symptoms of proctitis may include all of the following except:
a. Left-sided abdominal pain
b. Rectal pain
c. Suprapubic pain
d. Tenesmus
c. Suprapubic pain
**APEA Urology
Proctitis is inflammation of the lining of the rectum leading to rectal pain, bleeding, and a continuous sensation to defecate (tenesmus). Additional symptoms may also include left-sided abdominal pain, diarrhea, pain with bowel movements, and a feeling of fullness in the rectum.
Suprapubic pain is not generally associated with proctitis.
Glomerulonephritis can cause:
a. Nephrotic syndrome
b. Diabetic nephropathy
c. Polycystic kidney disease
d. Pyelonephritis
a. Nephrotic syndrome
**APEA Urology
Glomerulonephritis can lead to nephrotic syndrome, which is the loss of a large amount of protein in the urine that leads to sodium and fluid retention in the body. Complications of nephrotic syndrome include hypertension, hyperlipidemia, and peripheral edema
Benign prostatic hypertrophy begins in the:
a. Second decade of life
b. Third decade of life
c. Fourth decade of life
d. Fifth decade of life
b. Third decade of life
**APEA Urology
In men, proliferation of prostate epithelial and stromal tissue, termed BPH, begins in the third decade. Symptoms occur in only about half of men with enlargement. Hyperplasia continues to increase prostate volume until the seventh decade, then appears to plateau. These changes are androgen dependent
An infection or irritation of the bladder that leads to pain on urination is called:
a. Polyuria
b. Dysuria
c. Urgency
d. Incontinence
b. Dysuria
**APEA Urology
A useful mnemonic for elucidating causes of incontinence in the older adult is:
a. STOOL.
b. DIAPERS.
c. DRIP.
d. URINE
b. DIAPERS.
**APEA Urology
DIAPERS:
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Excess urine output from conditions like hyperglycemia or heart failure
Restricted mobility
Stool impaction
OR
DDRRIIPP
Delirium
Drug side effects
Retention of feces
Restricted mobility
Infection of urine
Inflammation
Polyuria
Psychogenic
Which of the following symptoms is NOT associated with nephrotic syndrome?
a. Proteinuria
b. Hyperlipidemia
c. Lower leg edema
d. Hyperalbuminosa
d. Hyperalbuminosa
**APEA Urology
Chronic bladder pain syndrome (BPS) that causes symptoms of urinary urgency, frequency, and hesitancy is also known as:
a. Interstitial cystitis
b. Endometriosis
c. Urinary tract infection
d. Pelvic inflammatory disease
a. Interstitial cystitis
**APEA Urology
Symptoms of fever, chills, flank pain, costovertebral angle tenderness (CVA), and vomiting suggest:
a. Pelvic inflammatory disease (PID)
b. Pyelonephritis
c. Nephrolithiasis
d. Urethritis
b. Pyelonephritis
**APEA Urology
Which of the following substances is found in the urine of a child suspected of having post streptococcal glomerulonephritis?
a. Blood and protein
b. Bacteria and ketones
c. Glucose and white blood cells
d. Casts and mucous threads
a. Blood and protein
**APEA Urology
With post-streptococcal (strep) glomerulonephtiris, a child may have a recent strep infection (pharyngitis or impetigo). Proteinuria is secondary to altered glomerular structure and functioning. Gross hematuria causes the urine to be tea-colored.
Bacteria, white blood cells, and mucus can be seen with urinary tract infections.
Glucose and ketones present in the urine may be associated with diabetes
In renal adaptation of the newborn, which one of the following statements is correct?
a. The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte stress
b. In the nephrons of the kidneys, long tubules enhance the effectiveness of tubular reabsorption
c. The kidneys are fully capable of concentrating urine and maintaining fluid and electrolyte balance
d. The kidneys have the ability to increase the production of antidiuretic hormone (ADH) effectively
a. The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte stress
**APEA Urology
In the neonate the kidneys are structurally complete but physiologically immature. The glomeruli have an inability to filter and concentrate urine, therefore glucose and amino acids escape and there is decreased ability to remove uric acid crystals which give the reddish appearance to the urine. There is an inability to adapt to fluid and electrolyte stress leading to loss of bicarbonate and poor reabsorption. This puts the neonate at increased risk of metabolic acidosis. The tubules are short/narrow which causes a problem with reabsorption. The nephrons function well within a month.
ADH inhibits diuresis and the immature kidney causes an increased risk for dehydration
In men, painful urination without frequency or urgency suggests:
a. Cystitis
b. Urethritis
c. Constipation
d. Acute prostatitis
b. Urethritis
**APEA Urology
Cystitis would present with frequency and urgency.
Constipation does not usually present with urinary tract symptoms.
Acute prostatitis presents with frequency, urgency, and dysuria.
A whitish sebaceous secretion that collects between the glans penis and foreskin or in the vulva is known as:
a. Candida
b. Smegma
c. Leukorrhea
d. Leukocoria
b. Smegma
**APEA Urology
Candida appears as a white substance usually causing vaginal itching
Leukorrhea refers to thick whitish or yellowish vaginal discharge commonly seen during pregnancy
Leukocoria is an abnormal white reflection from the retina of the eye and its presence could indicate retinoblastoma or a congenital cataract
On opthalmoscopic exam of the older adult, there is an increased cup-to-disc ratio. This finding is suggestive of:
a. Cataracts
b. Macular degeneration
c. Open angle glaucoma
d. Blindness
c. Open angle glaucoma
**APEA ENT
The cup-to-disc ratio compares the diameter of the “cup” portion of the optic disc with the total diameter of the optic disc. In glaucoma, an increase in intraocular pressure will damage the delicate nerve fibers and produces additional cupping of the optic disc. As glaucoma worsens, the cup enlargens until it occupies most of the disc area.
A teenager complains of itching and burning of his eye. Examination reveals an erythematous eyelid margin with crusting and clear mucus discharge. These findings are consistent with:
a. Conjunctivitis
b. A chalazion
c. A corneal ulcer
d. Blepharitis
d. Blepharitis
**APEA ENT
Blepharitis is an inflammation of eyelid margin, glands, and lash follicles. It presents with red-rimmed eyes, burning, itching of the eyelid margins, and mucous discharge with crusting and scaling of lid margins.
Conjunctivitis is inflammation of the conjunctiva. It presents with erythematous conjunctiva and frequent discharge.
Chalazion is a granulomatous eyelid cyst or nodule.
Corneal ulcer of a local necrosis of the cornea caused
A condition that involves optic nerve damage and visual field changes is termed:
a. Retinoblastoma
b. Cataracts
c. Glaucoma
d. Pterygium
c. Glaucoma
**APEA ENT
Glaucoma is a leading cause of blindness in the United States. Glaucoma is a condition that produces optic nerve damage and visual field changes. The risk of glaucoma increases with age but can occur in anyone in any age group.
Retinoblastoma is a rapidly developing tumor and is the most common malignant tumor of the eye in children.
A cataract is an opacity of the lens and may be seen through the pupil
Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea and may interfere with vision but does not cause blindness.
The Rinne hearing test allows the examiner to screen for:
a. Sensorineural hearing loss
b. Conductive hearing loss
c. General hearing loss
d. Bilateral hearing loss
b. Conductive hearing loss
**APEA ENT
The Rinne hearing test is used primarily for evaluated hearing in one ear as compared to the other ear. It compares the perception of sound transmitted by air conduction to those sounds transmitted by bone conduction through the mastoid. Therefore, it screens for conductive hearing loss.
The patient complains of seeing floating spots. This is consistent with:
a. Macular degeneration
b. A detached retina
c. Glaucoma
d. Cataracts
b. A detached retina
**APEA ENT
A detached retina is the separation of the sensory layer of the retina from the choroid layer. Initially, the patient is aware of the presence of floaters or floating spots, and/or flashing lights.
Macular degeneration is the degeneration of the macular area of the retina with a loss of central vision and intact peripheral vision.
In patients who have glaucoma, there is damage to the optic nerve and a loss of peripheral vision, the appearance of halos around lights, and difficulty focusing on near objects.
Mydriasis is a term used to describe:
a. The shape of the pupils
b. Constriction of the pupils
c. Dilation of the pupils
d. Symmetry of the pupils
c. Dilation of the pupils
**APEA ENT
Miosis refers to constriction of the pupils.
Mydriasis refers to dilation of the pupils.
Findings following assessment of a person’s eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with:
a. A conjugate gaze
b. Left cranial nerve III (oculomotor) paralysis
c. Cranial nerve IV (trochlear) paralysis
d. Cranial nerve VI (abducens) paralysis
a. A conjugate gaze
**APEA ENT
Conjugate, or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view.
With a left cranial nerve VI paralysis, a person’s gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left.
With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired.
The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis.
An eight-year-old complains of itching in the right ear and an increase in pain when the pinna is pulled or the tragus is palpated. Examination reveals slight redness in the ear canal with a clear odorless fluid. This could be suggestive of:
a. Otitis media
b. Otitis externa
c. Mastoiditis
d. A tympanic membrane rupture
b. Otitis externa
**APEA ENT
Otitis externa (swimmer’s ear) is an infection or inflammation of the external ear or the ear canal. Symptoms include itching and tragal pain. The external canal may have a discharge.
Otitis media is a middle ear infection and usually the tympanic membrane is bulging with fluid or pus behind it.
Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear).
A ruptured tympanic membrane is usually secondary to infection that causes pus and fluid to build-up behind the eardrum and as the pressure increases, the eardrum may rupture. Ear pain decreases when the membrane ruptures and the discharge can be pus, blood, or a clear fluid
A patient presents with findings of pain, warmth, redness, and swelling below the inner canthus toward the nose. Tearing is present and when pressure is applied to the lacrimal sac, purulent discharge from the puncta is noted. This is suggestive of:
a. Blepharitis
b. Dacryocystitis
c. A hordeolum
d. A chalazion
b. Dacryocystitis
**APEA ENT
Dacryocystitis is an infection and blockage of the lacrimal sac and duct. Symptoms include pain, warmth, redness, and swelling below the inner canthus toward the nose. Tearing is usually present and when pressure is applied to the lacrimal sac, a purulent discharge from the puncta can be noted.
Blepharitis: Red, scaly, greasy flakes and thickened, crusted lid margins. Symptoms include burning, itching, tearing, foreign body sensation, and some pain.
Hordeolum is an infection usually secondary to localized staphylococcal infection of the hair follicles at the lid margin.
On examination of the tympanic membrane, a red bulging ear drum is detected. This is consistent with:
a. Acute otitis externa
b. Chronic otitis externa
c. Acute otitis media
d. A serous effusion
c. Acute otitis media
**APEA ENT
Acute Otitis Media: red, bulging tympanic membrane may be found
Acute otitis externa: Canal may be swollen, narrow, moist and pale with tenderness on touching. The ear drum is intact.
Chronic otitis externa: Skin of canal may be thickened, red, and pruritic. The ear drum is usually unaffected.
Serous effusion: the ear drum appears amber and there usually is no bulging of the eardrum.
On ophthalmoscopic examination, glaucomatous cupping appears:
a. Pink and hyperemic
b. Yellowish orange to creamy pink
c. Pale
d. White
c. Pale
**APEA ENT
Glacomatous cupping: A pale disc with a backward depression is characteristic of glaucomatous cupping.
Papilledema: Pink and hyperemic disc
Normal disk: yellowish-orange to creamy pink and the vessels are tiny with disc margins that appear sharp
Optic atrophy: death of the optic nerve fibers leads to loss of the tiny disc vessels giving a white appearance.
Ophthalmoscopic examination of a 30-year-old with a history of an eye injury 3 years ago reveals a superficial grayish-white opacity in the right cornea. This may be indicative of a:
a. Corneal arcus
b. Corneal scar
c. Pterygium
d. Cataract
b. Corneal scar
**APEA ENT
Corneal scar: Superficial grayish-white opacity in the cornea
Corneal arcus: thin grayish-white arc noted on the lower end of the cornea. This is common during normal aging but can be seen in younger people and may be suggestive of dyslipidemia.
Pterygium: triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea
Cataract: opacity of the lens visible through the pupil
Where in the mouth would reddened areas, nodules, or ulcerations that are suspicious of malignancy be present?
a. Mucous membranes
b. Tongue
c. Gums
d. Palate
b. Tongue
**APEA ENT
Reddened areas, nodules, or ulcerations noted on the sides and undersurface of the tongue and the floor of the mouth would be suggestive of cancer. Cancer of the tongue is the second most common cancer of the mouth, the lip is number one.
Performance of the Weber and Rinne tests to assess for hearing loss is best performed using tuning fork with a frequency of:
a. 256 Hz
b. 512 Hz
c. 800 Hz
d. 1000 Hz
b. 512 Hz
**APEA Ent
Tuning forks with a lower frequency may be better felt than heard, while tuning forks at higher frequency tend to lose vibratory energy quickly and are difficult to activate for them to be heard with moderate or severe sensorineural impairment. A tuning fork with a frequency of 512 Hz is the most effective in assessing for air and bone conduction of hearing
A term used to describe drainage from the nose is:
a. Rhinitis
b. Rhinorrhea
c. Cerumen
d. Otorrhea
b. Rhinorrhea
**APA ENT
Rhinitis refers to inflammation in the nose
Cerumen is the medical term for earwax
Otorrhea refers to ear discharge
Leukoplakia was noted during an exam of the mouth. This symptom may be:
a. A normal finding
b. Precancerous
c. Associated with periodontal disease
d. Consistent with gingivitis
b. Precancerous
**APEA ENT
Leukoplakia are thickened white patches located on any area of the mouth. These patches cannot be rubbed off. Most are not serious but some can be considered precancerous. Therefore, they should be evaluated. These lesions are not considered normal findings. Periodontal disease usually includes an infection of the gums and may involve the teeth. Generally, the infection causes redness and swelling but not white patches.
When administering ear drops to a 6-year-old, the pinna should be pulled:
a. Downward
b. Downward and back
c. Upward
d. Upward and back
d. Upward and back
**APEA ENT
To examine the ears of an infant it is usually necessary to pull the auricle backward and downward. In the older child, the external ear is pulled backward and upward.
A 57-year-old man with a history of diabetes complains of difficulty hearing on the telephone and muffled sounds while watching the television at a low volume. He should be further evaluated for:
a. Acoustic neuroma
b. Granulomatous disease
c. Cholesteatoma
d. Presbycusis
d. Presbycusis
**APEA ENT
Presbycusis is the most common type of sensorineural hearing loss caused by the natural aging of the auditory system. It occurs gradually and initially affects the ability to hear higher-pitched (higher frequency) sounds. It also muffles the sounds of voices.
Acoustic neuroma is a rare condition that develops from direct effects on the main nerve or from a tumor pressing on adjacent nerves or brain structures. It causes symptoms of dizziness, loss of balance, and facial numbness.
Cholesteatoma and granulomatous disease present with physical symptoms of infectious ear drainage.
Gingival hyperplasia could be seen in all the following conditions except:
a. Those patients undergoing phenytoin (Dilantin) therapy
b. Adolescents with nickel braces
c. In patients diagnosed with diabetes
d. In adults with leukemia
c. In patients diagnosed with diabetes
**APEA ENT
Gingival hyperplasia describes erythematous, swollen gums that are over grown. This condition can be seen in some patients during pregnancy or puberty, or those with leukemia. It is associated with certain medications: phenytoin, cyclosporine, and calcium antagonists. This condition is not characteristically seen in diabetes.
A softening of the skin at the angles of the mouth which may be due to nutritional deficiency is commonly referred to as:
a. Actinic cheilitis
b. Herpes simplex
c. Angular cheilitis
d. Leukoplakia
c. Angular cheilitis
**APEA ENT
Angular cheilitis begins with softening of the skin at the angle of the mouth with subsequent development of fissures. This condition may be seen in patients who have nutritional deficiencies or ill-fitting dentures.
Actinic cheilitis typically results from excessive exposure to sunlight and generally affects the lower lip. The lip becomes slightly everted, scaly, somewhat thickened, and loses its red color.
Herpes simplex presents with recurrent and painful vesicles on the lips and surrounding areas.
Leukoplakia appears as thickened white patches anywhere in the oral mucosa
A swollen deviated uvula may be associated with a:
a. Vagus nerve lesion
b. Peritonsillar abscess
c. Person who smokes cigarettes
d. A normal finding in the elderly population
b. Peritonsillar abscess
**APEA ENT
Presence of swelling of the uvula with a deviation may be a strong indication of a peritonsillar abscess or parapharyngeal abscess.
A deviated uvula with no evidence of swelling may be due to a vagus nerve (CN X) lesion. CN X innervates the uvula. Peritonsillar abscess and smoking may be associated with a swollen uvula but not associated with deviations of the uvula. A deviated uvula is not a common finding in the elderly but may be present if a person experiences a stroke.
A person who has been blind since birth presents for a physical exam. Expected findings of the pupillary reaction when light is shown would be:
a. Constriction of both pupils
b. Dilation of both pupils
c. No reaction from either pupil
d. It depends
d. It depends
**APEA ENT
It depends on the type of blindness. Pupillary reaction is controlled by the muscles which are innervated by nerves. As long as there is no damage to the nerve or the muscle, the pupil will still contract or dilate.
Miosis is a term used to describe:
a. The shape of the pupils
b. Constriction of the pupils
c. Dilation of the pupils
d. Symmetry of the pupils
b. Constriction of the pupils
**APEA ENT
When examining the pupils, the left pupil is noted to be fixed and dilated to light and near accommodation. This condition may be suggestive of:
a. A tonic pupil
b. Oculomotor nerve (CN III) paralysis
c. Horner’s syndrome
d. Argyll Robertson pupils
b. Oculomotor nerve (CN III) paralysis
**APEA ENT
Oculomotor cranial nerve (CNIII) paralysis: dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present.
Tonic Pupil (Adele’s pupil): When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent.
Horner’s syndrome: affected pupil reacts briskly to light and near effort but the pupil is small.
Argyll Robertson: pupil appears small, irregular shaped and accommodate but do not react to light.
A six-year-old child presents with sore throat, difficulty swallowing, and a temperature of 102 F. Findings reveal lymphadenopathy and pharyngeal erythema. This is probably:
a. Sinusitis
b. Exudative tonsillitis
c. Pharyngitis
d. The flu
c. Pharyngitis
**APEA ENT
Pharyngitis is caused by swelling between the tonsils and the larynx secondary to either viral or bacterial infections. The most common bacterial pharyngeal infections in children are caused by group A beta-hemolytic strep.
A patient with sinusitis is more likely to present with nasal congestion, nasal discharge, headache, and an absence of fever.
Exudative tonsillitis presents with tonsillar exudate. There is no mention of this in the question stem.
Influenza infection typically presents with cough, headache, and body aches.
A man with a history of long-term use of chewing tobacco presents with a mouth lesion that is suspicious for malignancy. Oral assessment findings describe:
a. A smooth circular pustule lesion on the base of the gum
b. A soft, solitary papule lesion located apical to the molar
c. A small, shallow, sore lesion at the base of the gums
d. An ulcerated lesion with indurated margins on the lateral tongue
d. An ulcerated lesion with indurated margins on the lateral tongue
**APEA ENT
Oral malignant lesions: usually present as ulcerated with indurated margins. They are not usually circular or smooth
Dental abscess presents as a soft, solitary papule located apical to the molar.
Canker sore is a small, shallow sore at the base of the gum
A gradual loss of vision with a change in color and size of the optic disc is referred to as:
a. Macular degeneration
b. Glaucoma
c. Cataracts
d. Retinoblastoma
b. Glaucoma
**APEA ENT
Glaucoma: change in the color and size of the optic disc resulting in a gradual loss of vision.
Macular degeneration: loss of vision in the central visual fields because of damage to the retina. Peripheral vision remains intact
Cataracts: usually appear as cloudiness or opacity in the lens.
Retinoblastoma- rapidly developing cancer of the retina and an absent red reflex is noted on opthalmoscopic exam
With transillumination of the frontal sinuses, a dim red glow is observed on the forehead. This dim red glow would be indicative of:
a. Thickened mucosa or secretions in the frontal sinuses
b. Clear frontal sinuses
c. An absent frontal sinus
d. A developmental absence of both frontal sinuses
b. Clear frontal sinuses
**APEA ENT
Dim red glow would suggest a normal finding. An absence of this red glow could be suggestive of a thickened mucosa or the presence of secretions or lesions in the frontal sinuses. Absence of the red glow could also indicate the absence of the frontal sinuses
A cyclist sustained an avulsion of the upper central incisor. If he is unable to position the tooth in the socket until he is able to be seen by a dentist, he should:
a. Transport the tooth in a cup of lukewarm tap water
b. Place the tooth between the molars and the inside of the cheek
c. Rinse the tooth and transport it in a clean, dry cloth
d. Not rinse the tooth but transport it in a clean dry cloth
b. Place the tooth between the molars and the inside of the cheek
**APEA ENT
Saliva, saline, milk, and culture medias are physiologic medias for storing the tooth until it can be reimplanted. Tap water is avoided because the hypotonic environment causes rapid cell lysis and increased inflammation on reimplantation.
All of the following diseases may be associated with the appearance of a strawberry tongue except:
a. Scarlet fever
b. Folic acid and B-12 deficiencies
c. Rubeola
d. Kawasaki syndrome
c. Rubeola
**APEA ENT
Five medical reasons for the appearance of strawberry tongue: Kawasaki disease, scarlet fever, folic acid and vitamin B12 deficiencies, bacterial toxic shock syndrome, and a geographic tongue.
Rubeola does not present with a strawberry tongue. Koplik’s spots are diagnostic of rubeola and they appear as clustered white lesions on the buccal mucosa.
In patients who have allergic rhinitis, the nasal mucosa appears:
a. Erythematous
b. Pale
c. Green
d. Yellow
b. Pale
**APEA ENT
Rhinitis is inflammation of the nasal mucosa and the mucosa appears somewhat redder than the oral mucosa.
With allergic rhinitis, it appears pale, bluish, or a darker red than normal.
In viral rhinitis, it tends to appear erythematous and swollen
A yellow or green color may be due to the appearance of exudate in the nasal cavity
When a person shifts gaze from a near object to a far object, the pupils:
a. Dilate
b. Constrict
c. Remain unchanged
d. Depends
a. Dilate
**APEA ENT
Upon examination of the right tympanic membrane, a cone of light was visible at the four o’clock mark. This would be interpreted as:
a. A perforation of the ear drum
b. An acute otitis media
c. A normal eardrum
d. Tympanosclerosis
c. A normal eardrum
**APEA ENT
The normal eardrum or tympanic membrane appears pinkish gray. The handle and short process of the malleus and the cone of light are all clear and visible. The cone of light fans anteriorly and downward from the umbo putting it in the four-o-clock position.
A perforation in the eardrum would appear as a hole in the membrane and the cone of light would be absent.
In acute otitis media, the eardrum appears red with loss of landmarks and may or may not have a bulge.
Tympanosclerosis is a deposit of hyaline material within the layers of the tympanic membrane that sometimes follow a severe episode of otitis media. It appears as a chalky white patch with irregular margins.
Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the:
a. Vein “winds” down on either side of the artery
b. Vein is twisted on the distal side of the artery
c. Vein crosses beneath the artery
d. Vein stops abruptly on either side of the artery
a. Vein “winds” down on either side of the artery
**APEA ENT
When the arterial walls lose their transparency, changes appear in the arteriovenous crossings.
Decreased transparency of the retina probably contributes to AV nicking and AV tapering.
In tapering, the vein appears to taper or “wind” down either side of the artery.
In AV nicking, the vein appears to stop abruptly on either side of the artery.
In the normal eye, the vein appears to cross beneath the artery
With banking, the vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance.
Examples of sudden, painful, unilateral visual loss include all the following except:
a. Retinal detachment
b. Corneal ulcer
c. Traumatic hyphema
d. Acute glaucoma
a. Retinal detachment
**APEA ENT
If a patient reports sudden, unilateral visual loss that is painless, vitreous hemorrhage from diabetes or trauma may be considered. It could also be caused by macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.
If the loss is painful, causes may be associated with the cornea and anterior chamber. Examples include corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma
Ectropion is defined as:
a. An inward turning of the lower eyelid
b. An outward turning of the lower eyelid
c. Drooping of the eyelid
d. A retracted eyelid with a wide-eyed stare
b. An outward turning of the lower eyelid
**APEA ENT
Ectropion exhibits an outward turning of the lower eyelid exposing the palpebral conjunctiva. This condition is more common in the elderly.
Entropion exhibits an inward turning of the lower eyelid with irritation to the conjunctiva and lower cornea. This condition is more common in the elderly.
Ptosis presents as drooping of the eyelid caused by damage to the oculomotor nerve, myasthenia gravis, or damage to the sympathetic nervous system.
Lid retraction and exophthalmos is a condition that appears as a wide-eyed stare and suggests retracted eyelids. This condition could be suggestive of hyperthyroidism
On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of:
a. A tonic pupil
b. Oculomotor nerve (CNIII) paralysis
c. Horner’s syndrome
d. Argyll Robertson pupils
a. A tonic pupil
**APEA ENT
Oculomotor cranial nerve (CNIII) paralysis: dilated pupil is fixed to light and near accommodation. Ptosis and lateral deviation of the eye are usually present.
Tonic Pupil (Adele’s pupil): When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent.
Horner’s syndrome: affected pupil reacts briskly to light and near effort but the pupil is small.
Argyll Robertson: pupil appears small, irregular shaped and accommodate but do not react to light.
When the corneal reflex is stimulated by shining the light in the right eye, the right eye blinks. The left eye:
a. Does not blink
b. Blinks
c. Turns inward
d. Turns outward
b. Blinks
**APEA ENT
The corneal reflex is the blink reflex and is an involuntary blinking of the eyelids. When the corneal reflex is stimulated, stimulation should elicit both a direct and consensual response of the opposite eye
Assessment of a patient’s visual acuity resulted in 20/200 using the Snellen eye chart. This means that:
a. At 200 feet the patient can red printed information that a person with normal vision could read at 20 feet.
b. At 20 feet the patient can read printed information that a person with normal vision could read at 200 feet.
c. The patient has normal visual acuity
d. The patient may not be able to read so he should be tested with the picture or “E” eye charts
b. At 20 feet the patient can read printed information that a person with normal vision could read at 200 feet.
**APEA ENT
A 30-year-old patient presents with a moderate “Aching” in his right eye. Findings reveal a small and irregular shaped right pupil. The cornea appears cloudy with a slight erythematous area around the corneal limbus. There is no ocular discharge noted. These findings are consistent with:
a. Acute iritis
b. Corneal injury
c. Corneal infection
d. Acute angle closure glaucoma
a. Acute iritis
**APEA ENT
Acute iritis: moderate aching deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection of tuberculosis.
Corneal injury or infection usually presents with watery or purulent ocular discharge and severe eye pain.
Acute angle closure glaucoma: pain is severe, aching, and deep but the pupils are dilated and fixed and the cornea appears steamy or cloudy. If an increase in intraocular pressure is present in conjunction with these findings, this would be an emergency situation
Findings following assessment of a person’s left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with:
a. A conjugate gaze
b. Left cranial nerve III (oculomotor) paralysis
c. Cranial nerve IV (trochlear) paralysis
d. Cranial nerve VI (abducens) paralysis
b. Left cranial nerve III (oculomotor) paralysis
**APEA ENT
Which of the paranasal sinuses are accessible to clinical examination?
a. Ethmoidal sinuses
b. Sphenoidal sinuses
c. Frontal sinuses
d. Vestibular sinuses
c. Frontal sinuses
**APEA ENT
Examination of the nose and paranasal sinuses reveal local tenderness, pain, fever, and rhinorrhea. These symptoms are suggestive of:
a. Chronic sinusitis of the frontal and maxillary sinuses
b. Allergic rhinitis
c. Upper respiratory infection
d. Acute sinusitis of the frontal and maxillary sinuses
d. Acute sinusitis of the frontal and maxillary sinuses
**APEA ENT
When a light bean shines into one pupil causing pupillary constriction in that eye, the term used is:
a. Indirect reaction to light
b. Consensual reaction to light
c. Optic radiation
d. Direct reaction to light
d. Direct reaction to light
**APEA ENT
What visual acuity constitutes legal blindness?
a. Visual acuity of 20/80 or worse bilaterally
b. Visual acuity of 20/200 or worse in the better eye with corrected lens
c. Visual acuity of 20/200 in the better eye without corrected lens
d. Visual acuity of 20/100 with corrected lens
b. Visual acuity of 20/200 or worse in the better eye with corrected lens
**APEA ENT
If a patient complains of seeing flashing lights across the field of vision, this could be:
a. A normal response if around bright lights
b. A retinal detachment
c. Detachment of the vitreous from the retina
d. Lesion in the visual pathways
c. Detachment of the vitreous from the retina
**APEA ENT
Flashing lights or new vitreous floaters suggest detachment of vitreous from the retina. A detached retina would present with a sudden loss of vision. With a lesion in the visual pathway, one may visualize fixed defects such as a scotoma. At any rate, this is not a normal finding even if the person was around bright lights.
Actinic chelitis is a condition of the lower lip most commonly seen in:
a. Dark-skinned males who work in coal mines
b. People of all races with nutritional deficiencies
c. People with a history of intestinal polyps
d. Fair-skinned men who work outdoors
d. Fair-skinned men who work outdoors
**APEA ENT
A patient complains of a sore tongue. Findings reveal a smooth and erythematous tongue. This condition is termed:
a. Gingivitis
b. Stomatitis
c. Glossitis
d. Candidiasis
c. Glossitis
**APEA ENT
A 60-year-old patient presents with severe, deep left eye pain. Findings reveal dilated and fixed left pupil and the cornea is cloudy. There is no ocular discharge noted. These findings are most likely consistent with:
a. Acute iritis
b. Corneal injury
c. Corneal infection
d. Acute angle closure glaucoma
d. Acute angle closure glaucoma
**APEA ENT
With acute angle closure glaucoma, the pain is described as severe, aching, and deep. The pupils are dilated and fixed and the cornea appears steamy or cloudy. If increase in intraocular pressure is present, this would be an emergency situation.
Acute iritis presents with a moderate aching pain deep within the eye. The pupils are small and irregular and vision is decreased and photophobia is usually present. The cornea is clear or slightly cloudy with injection confined to the corneal limbus. This is considered an emergency and is usually related to Herpes zoster infection or tuberculosis.
Corneal injury or infection usually presents with watery or purulent ocular discharge and the pain is severe
One cause of nasal septum perforation may be:
a. Nasal polyps
b. Intranasal use of cocaine
c. Cystic fibrosis
d. Chronic sinusitis
b. Intranasal use of cocaine
**APEA ENT
The ethmoidal sinuses:
a. Are located between the eyes
b. Are located above the eyes
c. Surround the nasal cavity
d. Are located behind the sphenoid sinuses
a. Are located between the eyes
**APEA ENT
Paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The ethmoidal sinuses are between the eyes, the frontal sinuses are above the eyes. The maxillary sinuses are located around the nasal cavity. The sphenoidal sinuses lie just behind the ethmoidal sinuses.
Redness, bleeding, pain, and swelling of the gums is most likely:
a. Stomatitis
b. Gingivitis
c. Leukoplakia
d. Aphthous ulcers
b. Gingivitis
**APEA ENT
All of the following are examples of causes of sensorineural hearing loss in children except:
a. The presence of cerumen impaction
b. Prolonged use of tobramycin
c. Maternal history of herpes infection
d. Congenital rubella syndrome
a. The presence of cerumen impaction
**APEA ENT
Sensorineural hearing loss involves problems with the transmission of sound from the inner ear to the 8th cranial nerve. It is a permanent condition that usually affects both ears. Sensorineural hearing loss can be present at birth or as a result of conditions acquired later in life. Examples include: Prolonged exposure to loud noise, infection, severe head injury, medication exposure, and some inherited diseases.
A condition in which the eyes are not properly aligned with each other is termed:
a. Hyperopia
b. Myopia
c. Strabismus
d. Astigmatism
c. Strabismus
**APEA ENT
Strabismus (heterotropia) is a condition in which the eyes are misaligned. “cross-eyed”, “wall eye” or “lazy eye” are all associated with strabismus.
Hyperopia (farsightedness) occurs when light rays focus posterior to the retina.
Myopia (Nearsightedness) occurs when light rays focus anterior to the retina
Astigmatism- light rays do not focus correctly on the retina. This causes blurriness.
Causes of sensorineural hearing loss include all of the following except:
a. Aging
b. Loud noises over prolonged periods of time
c. Perforated tympanic membrane
d. Acoustic neuroma.
c. Perforated tympanic membrane
**APEA ENT
A perforated tympanic membrane is an example of a cause of a conductive hearing loss.
Sensorineural hearing loss involves disorders of the cochlear nerve, cochlea, and an interruption in the neuronal impulse transmission to the brain. Causes include: exposure to loud noises, inner ear infections, acoustic neuroma, aging, and congenital and/or familial disorders.
A forty-five-year-old female complains of frequent attacks of dizziness accompanied by a sense of fullness in the right ear, headache, nausea, reduced hearing in the right ear. This patient may need further workup for:
a. Otosclerosis
b. Meniere’s disease
c. Paget’s disease
d. Mastoiditis
b. Meniere’s disease
**APEA ENT
Meniere’s Disease: disorder of the middle ear with excessive endolymphatic fluid accumulation in the membranous labyrinth. It may be due to malabsorption or a blocked endolymphatic duct. Symptoms include recurrent attacks of dizziness, a sense of fullness in the ears with roaring or ringing tinnitus. There is gradual but progressive sensorineural hearing loss. It usually occurs in adults around forty years of age.
Otosclerosis is a disorder of the labyrinthine capsule where abnormal bone growth occurs around the ossicles leading to a reduction of sound transmission to the inner ear.
Paget’s disease results in abnormal bone destruction or growth of bone. It is also a malignant disease of the breast.
Mastoiditis is an infection of the mastoid process.
Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss?
a. Weber test
b. Rinne test
c. Whispered voice test
d. Bilateral hearing loss
a. Weber test
**APEA ENT
The weber hearing screening test can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear) hearing loss.
In order to visualize the opening of Stensen’s duct, examine the:
a. Dorsal surface of the tongue
b. Area beneath the mandible at the angle of the jaw
c. Buccal mucosa opposite the second molar
d. Small openings along the sublingual fold under the tongue.
c. Buccal mucosa opposite the second molar
**APEA ENT
The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen’s duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through the Stensen’s duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged.
The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw.
Wharton’s duct runs up and forward to the floor of the mouth and opens at either side of the frenulum.
The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue.
A localized Staphylococcal infection of the hair follicles at the lid margin is suggestive of:
a. A hordeolum
b. Blepharitis
c. A chalazion
d. Dacryocystitis
a. A hordeolum
**APEA ENT
Hordeolum: Localized staphylococcal infection of the hair follicles at the lid margin. (Stye). Symptoms include a painful, red, and swollen pustule at the lid margin. Rubbing the eyes can cause cross-contamination and development of another hordeolum.
Blepharitis: Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis.
Chalazion is a chronic inflammatory lesion that develops when a meibomian gland becomes obstructed. It produces a beady nodule on the lid.
Dacryocystitis represents an infection of the lacrimal sac and duct
Examination of the nasolacrimal duct reveals a mucopurulent discharge from the puncta. This finding is suggestive of:
a. Conjunctivitis
b. An obstructed nasolacrimal duct
c. Dacryocystitis
d. Pinguecula
b. An obstructed nasolacrimal duct
**APEA ENT
Obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta of the eye.
Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes.
Dacryocystitis represents an infection of the lacrimal duct and the lacrimal sac, the area between the lower eyelid and the nose. It presents as a painful, red, and tender area around the eye, especially near the nose.
Pinguecula- harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust
A 40-year-old male was umpiring a little league baseball game when he was hit in the face with flying debris. He presents with decreased vision and severe pain in the left eye. Findings reveal watery, left ocular discharge. The pupils are normal in appearance and the cornea is slightly cloudy with areas of corneal erythema. These findings are most consistent with:
a. Acute iritis
b. Corneal injury
c. Corneal infection
d. Acute angle closure glaucoma
b. Corneal injury
**APEA ENT
When comparing veins and arteries in the eyes of older adults, the arteries appear:
a. Bright red
b. Widened
c. Less brilliant
d. Curvy
c. Less brilliant
**APEA ENT
In older adults, the fundi lose their youthful shine and light reflections. The arteries look narrowed, pale, straight, and less brilliant than in young or middle adults
Examination of the eye reveals a painful, erythematous, and tender area around the nose and lower eyelid. This condition is most likely:
a. Conjunctivitis
b. An obstructed nasolacrimal duct
c. Dacrocystitis
d. Pinguecula
c. Dacrocystitis
**APEA ENT
Dacryocystitis represents an infection of the lacrimal duct and the lacrimal sac, the area between the lower eyelid and the nose. It presents as a painful, red, and tender area around the eye, especially near the nose.
Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes.
Obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta of the eye.
Pinguecula- harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust
A reduction in vision in one or both eyes causing loss of binocular vision is termed:
a. Strabismus
b. Amblyopia
c. Cataracts
d. Macular degeneration
b. Amblyopia.
**APEA ENT
Amblyopia results from anything that causes visual deprivation to the eye, including congenital cataracts, untreated strabismus, and refractive errors. With amblyopia, there is a reduction in vision in one or both eyes causing loss of binocular vision.
Cataracts are visualized by a cloudiness or opacity in the lens.
Macular degeneration is defined as degeneration of the macular area of the retina
A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with:
a. A pinguecula
b. A chalazion
c. Episcleritis
d. Xanthelasma
d. Xanthelasma
**APEA ENT
Pinguecula- harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust
Chalazion is a chronic inflammatory lesion that develops when a meibomian gland becomes obstructed. It produces a beady nodule on the lid.
Episcleritis- an ocular inflammation of the episcleral vessels
Xanthelasma- Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal areas of one or both eyelids, consistent with lipid disorders.
A patient presents with complaints of earache, blood-tinged discharge from the ear, and hearing loss. Findings reveal painful hemorrhagic vesicles on the tympanic membrane and the ear canal. These findings and symptoms are suggestive of:
a. Tympanosclerosis
b. Serous effusion
c. Otitis media with purulent effusion
d. Bullous myringitis
d. Bullous myringitis
**APEA ENT
Bullous myringitis: viral infection characterized by painful hemorrhagic vesicles on the tympanic membrane and/or in the ear canal. Hearing loss, blond-tinged discharge from the ear, and an earache are classic symptoms.
Tympanosclerosis is a deposit of hyaline material within the layers of the tympanic membrane that sometimes follow a severe episode of otitis media. It appears as a chalky white patch with irregular margins.
Otitis media with purulent effusion is usually bacterial and the eardrum is red and the landmarks are not visible.
Otitis media with serous effusion is usually viral and amber fluid can be seen behind the eardrum
All of the following symptoms in a 10-month-old would be indicative of acute otitis media (OM) except:
a. Nausea, vomiting, and possibly diarrhea
b. Increased mobility of the tympanic membrane
c. Persistent crying and irritability
d. Reluctance to suck a bottle
b. Increased mobility of the tympanic membrane
**APEA ENT
The hallmark of acute otitis media (AOM) is the recent onset of a middle ear infection manifesting one or more of the following signs or symptoms: Otalgia (tugging or rubbing of the ear in children <2 years), fever, irritability, anorexia, nausea, vomiting, diarrhea, rhinitis or purulent discharge in the ear canal accompanied by decreased mobility of the tympanic membrane (TM)
A patient presents with complaints of burning, itching, tearing, and some pain in the eye. Findings reveal red, scaly, greasy flakes and thickened, crusted lid margins. This would be suggestive of:
a. A chalazion
b. Blepharitis
c. A hordeolum
d. Dacryocystitis
b. Blepharitis
**APEA ENT
Blepharitis: Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis.
Chalazion is a chronic inflammatory lesion that develops when a meibomian gland becomes obstructed. It produces a beady nodule on the lid.
Hordeolum: Localized staphylococcal infection of the hair follicles at the lid margin. (Stye). Symptoms include a painful, red, and swollen pustule at the lid margin. Rubbing the eyes can cause cross-contamination and development of another hordeolum.
Dacryocystitis represents an infection of the lacrimal duct and the lacrimal sac, the area between the lower eyelid and the nose. It presents as a painful, red, and tender area around the eye, especially near the nose.
On otoscopic examination, the cone of light can be visualized:
a. At the 1 o’clock to 2 o’clock position of the left tympanic membrane
b. At the 4 o’clock to 5 o’clock position of the left tympanic membrane
c. At the 7 o’clock to 8 o’clock position of the left tympanic membrane
d. At the 12 o’clock position of the left ear tympanic membrane
c. At the 7 o’clock to 8 o’clock position of the left tympanic membrane
**APEA ENT
Ptosis is defined as:
a. An inward turning of the lower eyelid
b. An outward turning of the lower eyelid
c. Drooping of the eyelid
d. A retracted eyelid with a wide-eyed stare
c. Drooping of the eyelid
**APEA ENT
A deviated uvula without swelling may be suggestive of a:
a. Vagus nerve lesion
b. Peritonsillar abscess
c. Person who smokes cigarettes
d. A normal finding in the elderly population
a. Vagus nerve lesion
**APEA ENT
A deviated ulna with no evidence of swelling may be due to a vagus nerve (CN X) lesion. CN X innervates the ulna.
A deviated ulna with swelling may be a strong indication of a peritonsillar abscess or parapharyngeal abscess.
Peritonsillar abscess and smoking may be associated with a swollen uvula but not with deviations of the uvula.
A deviated uvula is not a common finding in the elderly but may be seen after a stroke
A sixty-year-old complains of a progressive bilateral hearing loss over the past four months. He has difficulty understanding spoken words and has become sensitive to loud noises. These symptoms are consistent with:
a. Otosclerosis
b. Mastoiditis
c. Presbycusis
d. Meniere’s disease
c. Presbycusis
**APEA ENT
Presbycusis is the most common type of sensorineural hearing loss caused by the natural aging of the auditory system. Most common hearing problem in people over age 50. It occurs gradually and initially affects the ability to hear higher-pitched (higher frequency) sounds. It also muffles the sounds of voices. Patients may have a hard time hearing what others are saying or may become sensitive to loud noises. Hearing loss is usually bilateral.
Mastoiditis is an infection of the mastoid process (temporal bone adjacent to the middle ear) and generally results from inadequately treated otitis media.
Otosclerosis is a sensorineural hearing loss because of reduced sound transmission to the middle ear.
Meniere’s disease is a disorder of the middle ear due to impaired absorption of endolymph
Raised or flat, deep, purple-colored lesions noted in the mouth may be suggestive of:
a. Koplik’s spots
b. Kaposi’s sarcoma
c. Torus palatinus
d. Fordyce spots
b. Kaposi’s sarcoma
Kaposi’s sarcoma: A low-grade vascular tumor associated with human herpes virus 8. Associated with flat or raised, deep purple-colored lesions of the mouth. Approximately 1/3 of patients with Kaposi’s sarcoma have lesions in the oral cavity. Other sites that could be affected include the gastrointestinal tract and the lungs.
Koplik’s spots: Frequently seen in the early stage of measles (Roseola) and appear as small, white specks that resemble grains of salt on a red background on the buccal mucosa.
Torus palatinus: develops as a bony growth in the hard palate and is common in adults.
Fordyce spots: granules appear as yellow spots in the buccal mucosa or on the lips. They are considered normal sebaceous glands.
When a 512 Hz tuning fork is placed over the mastoid bone and then held next to the ear canal with recordings of how long sound was heard in each ear, this is known as the:
a. Absolute bone conduction test
b. Pure tone audiometry test
c. Weber test
d. Rinne test
d. Rinne test
**APEA ENT
Opthalmoscopic examination of the fundus reveals blood anterior to the retina and obscuring retinal vessels. These findings are consistent with:
a. Superficial retinal hemorrhages
b. Preretinal hemorrhages
c. Microaneurysms
d. Deep retinal hemorrhages
b. Preretinal hemorrhages
**APEA ENT
Deep retinal hemorrhages: appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause.
Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel.
Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundus and are seen in hypertension, papilledema, and occlusion of the retinal vein.
Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy.
Round or oval shaped lesions surrounded by erythematous mucosa and noted on an area of the oral mucosa may be:
a. Leukoplakia
b. Aphthous ulcers
c. Koplik’s spots
d. Ulcerative gingivitis
b. Aphthous ulcers
**APEA ENT
Leukoplakia appears as thickened white patches anywhere in the oral mucosa
Aphthous ulcers: (Canker sore) can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and are surrounded by a halo of reddened mucosa. They are usually painful.
Koplik’s spots: Frequently seen in the early stage of measles (Roseola) and appear as small, white specks that resemble grains of salt on a red background on the buccal mucosa.
Ulcerative gingivitis is a painful form of gingivitis that is characterized by the development of ulcers in the interdental papillae. If untreated they can become necrotizing along the gum margins and appear as erythematous ulcers.
A fine, rhythmic oscillation of the eyes is termed:
a. Presbyopia
b. Nystagmus
c. Strabismus
d. Proptosis
b. Nystagmus
**APEA ENT
On ophthalmoscopic examination, optic atrophy appears:
a. Pink and hyperemic
b. Yellowish orange to creamy pink
c. Pale
d. White
d. White
**APEA ENT
Papilledema: Pink and hyperemic disc
Normal disk: yellowish-orange to creamy pink and the vessels are tiny with disc margins that appear sharp
Optic atrophy: death of the optic nerve fibers leads to loss of the tiny disc vessels giving a white appearance.
Glacomatous cupping: A pale disc with a backward depression is characteristic of glaucomatous cupping.
A toddler with a suspected hearing loss would:
a. Exhibit little or no babbling or vocalization sounds
b. Likely communicate through gestures
c. Display poor school performance
d. Need to watch television with the volume on high
b. Likely communicate through gestures
An infant with hearing loss: does not startle to loud noises, arouses to touch and not noise, does not turn head in response to sounds, and has little or no babbling or vocalization.
A toddler with hearing loss: would communicate with gestures, exhibits little or no intelligible speech, and does not respond to surrounding noises.
A school-aged child with hearing loss: would sit close to the television with the volume on high, may have poor school performance, speech problems, and inability to correctly respond unless directly in front of the speaker’s face.
To palpate for sinus tenderness, press up on the frontal sinuses from under the bony brows, then:
a. Press down on the ethmoid sinus
b. Press up on the maxillary sinus
c. Palpate around the orbit
d. Observe the turbinates
b. Press up on the maxillary sinus
**APEA ENT
A patient complains of seeing specks that obscure his line of vision when he looks in certain direction. This impairment could be caused by:
a. Vitreous floaters
b. Retinal detachment
c. Macular degeneration
d. Scotomas
d. Scotomas
**APEA ENT
Scotomas, or fixed defects: lesions appear in the retina or visual pathways of a certain area of the field of vision.
Vitreous floaters: moving specks or strands. Specks can be seen throughout the visual fields.
A detached retina is the separation of the sensory layer of the retina from the choroid layer. Initially, the patient is aware of the presence of floaters or floating spots, and/or flashing lights.
Macular degeneration is the degeneration of the macular area of the retina with a loss of central vision and intact peripheral vision.
When assessing extraocular movements:
a. Use the Snellen eye chart
b. Use the ophthalmoscope to view the fundus
c. Include the cardinal directions of gaze
d. Shine a penlight into the pupils
c. Include the cardinal directions of gaze
**APEA ENT
The maxillary sinuses:
a. Are located between the eyes
b. Surround the nasal cavity
c. Are located above the eyes
d. Are located behind the ethmoidal sinuses
b. Surround the nasal cavity
**APEA ENT
Ophthalmoscopic examination of the retina reveals AV banking. This appears as if the:
a. Vein tapers down on either side of the artery
b. Vein is twisted on the distal side of the artery
c. Vein crosses beneath the artery
d. Vein stops abruptly on either side of the artery
b. Vein is twisted on the distal side of the artery
**APEA ENT
When the arterial walls lose their transparency, changes appear in the arteriovenous crossings. Decreased transparency of the retina probably contributes to AV nicking and AV tapering.
AV nicking: The vein appears to stop abruptly on either side of the artery.
AV tapering: The vein appears to taper down either side of the artery.
Normal eye: Vein appears to cross beneath the artery
AV banking: Vein appears to be twisted on the distal side of the artery and forms a dark wide knuckle appearance
A condition of the sclera that appears as localized ocular inflammation of the episcleral vessels is most likely:
a. Scleroderma
b. Episcleritis
c. Conjunctivitis
d. Pinguecula
b. Episcleritis
**APA ENT
Episcleritis: condition of the sclera when the vessels appear movable over the scleral surface. The appearance may be nodular or show only redness and dilated vessels. This condition can be seen in rheumatoid arthritis, Sjogren’s syndrome, and herpes zoster.
Scleroderma: Characterized by thickened, hardened skin. It may be accompanied by multisystem involvement.
Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes.
Pinguecula- harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust
Ophthalmoscopic examination of the fundus reveals small, rounded, slightly irregular red spots embedded in the retina. These findings are consistent with:
a. Superficial retinal hemorrhages
b. Preretinal hemorrhages
c. Microaneurysms
d. Deep retinal hemorrhages
d. Deep retinal hemorrhages
**APEA ENT
Deep retinal hemorrhages: appear as small, rounded, slightly irregular red spots and are sometimes called dot or blot hemorrhages. They occur in a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is a common cause.
Preretinal hemorrhages lie anteriorly between the retina and the vitreous and are typically larger than retinal hemorrhages. These hemorrhages obscure any underlying retinal vessel.
Superficial retinal hemorrhages appear as small, linear, flame-shaped, red streaks in the fundus and are seen in hypertension, papilledema, and occlusion of the retinal vein.
Microaneurysms present as tiny, round, red spots commonly seen in and around the macular area. These are classic in diabetic retinopathy.
A 50-year-old patient complains of being unable to read the hymnal at church. This describes:
a. Hyperopia
b. Myopia
c. Presbyopia
d. Astigmatism
c. Presbyopia
**APEA ENT
Presbyopia may begin in the 5th or 6th decade. Symptoms include diminished ability to focus on near objects.
Hyperopia (farsightedness): occurs when light rays focus posterior to the retina.
Myopia (nearsightedness): occurs when light rays focus anterior to the retina.
Strabismus (heterotropia): a condition in which the eyes are misaligned. Cross-eyed, wall-eye, or lazy eye are all associated with strabismus.
Which disorder of the eye can be detected with the cover-uncover and the Hirschberg test?
a. Amblyopia
b. Conjunctivitis
c. Strabismus
d. Cataracts
c. Strabismus
**APEA ENT
Strabismus (heterotropia): a condition in which the eyes are misaligned. Cross-eyed, wall-eye, or lazy eye are all associated with strabismus. Can be detected with the cover-uncover and the Hirschberg test. With the cover-uncover test, eye muscle weakness is seen as eye deviation when the eye is uncovered. With Hirchberg’s test, an asymmetric light reflex indicates a deviation.
Surgical perforation of the tympanic membrane to allow drainage of middle ear secretions is termed:
a. Otosclerosis
b. A myringotomy
c. A tympanocentesis
d. A tympanoplasty
b. A myringotomy
**APEA ENT
Myringotomy: Surgical perforation of the tympanic membrane to allow drainage of the middle ear secretions and to relieve pain and pressure from a bulging ear drum.
Otosclerosis: abnormal bone growth that occurs around the ossicles.
Tympanocentesis: Procedure where a fine needle is inserted into the tympanic membrane to relieve pressure, pain, and to drain secretions, or to obtain a culture of the fluid.
Tympanoplasty: Surgical reconstruction of the ossicles and tympanic membrane to help restore hearing.
The whispered voice test allows the examiner to screen for:
a. Low-frequency hearing loss
b. High frequency hearing loss
c. General hearing loss
d. Conductive hearing loss
c. General hearing loss
**APEA ENT
Sudden, bilateral and painful vision loss is rare but can be associated with:
a. Cholinergics
b. Anticholinergics
c. Steroids
d. Radiation exposure
d. Radiation exposure
**APEA ENT
Sudden, bilateral vision loss that is painful: Can result from exposure to chemicals or radiation
Sudden, bilateral vision loss that is painless: Can result from certain medications including cholinergics, anticholinergics, and steroids.
When examining the conjunctiva and sclera, have the patient look upward and then:
a. Cover one eye while visualizing the sclera and conjunctiva of the uncovered eye.
b. Depress both lower lids with your thumbs, exposing the sclera and conjunctiva
c. Look for excessive tearing or dryness in the conjunctiva sac
d. Note the position of the lids in relation to the eyeballs and color of the sclera
b. Depress both lower lids with your thumbs, exposing the sclera and conjunctiva
**APEA ENT
Sudden visual loss suggests:
a. Retinal detachment
b. Hyperopia
c. Macular degeneration
d. Hyperglycemia
a. Retinal detachment
If a patient reports a change in vision and states that the vision loss was sudden, this is suggestive of retinal detachment, vitreous hemorrhage, or occlusion of the central retinal artery. Immediate ophthalmology consultation is needed.
Macular degeneration is the degeneration of the macular area of the retina with a loss of central vision and intact peripheral vision.
Hyperopia (farsightedness): occurs when light rays focus posterior to the retina.
Hyperglycemia can cause blurring, but not a loss of vision.
All of the following are examples of causes of sensorineural hearing loss in children except:
a. The presence of cerumen impaction
b. Prolonged use of tobramycin
c. Maternal history of Herpes infection
d. Congenital rubella syndrome
a. The presence of cerumen impaction
**APEA ENT
A disease that may present as indigestion, but is precipitated by exertion and relieved by rest is most likely:
a. Gastroesophageal reflux
b. Inflammatory bowel disease
c. Angina
d. Aortic stenosis
c. Angina
**APEA Cardiovascular
Absent or diminished pulses in the wrist could be indicative of:
a. Varicosities
b. Right-sided heart failure
c. Venous insufficiency
d. Arterial occlusive disease
d. Arterial occlusive disease
**APEA Cardiovascular
Absent or diminished pulses at the wrist are found in arterial occlusive disease such as acute embolic occlusion, in Buerger’s disease, or thromboangiitis obliterans.
Varicosities, venous insufficiency, and right-sided heart failure are consistent with venous conditions.
The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of:
a. Hiccoughs
b. Chest pain
c. Wheezing
d. Hypertension
a. Hiccoughs
**APEA Cardiovascular
Pacemaker failure is uncommon. Most malfunctions are caused by electrode dislocation, poor contact, or interference by other tissues. Symptoms include dizziness, lightheadedness, hiccoughs, sudden changes in heart rate, electric shock feeling in the chest. Chest pain is usually absent. Wheezing and hypertension are not specifically characteristic of pacemaker malfunction.
A patient complains of a tight, bursting pain in the calf that increases with walking. Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with:
a. Intermittent claudication
b. Raynaud’s disease
c. Deep vein thrombosis
d. Superficial Thrombophlebitis.
c. Deep vein thrombosis
**APEA Cardiovascular
DVT: Venous disorder. Patient often describes the pain as tight and bursting around the affected area. The pain may be accompanied by swelling and tenderness.
Raynaud’s disease: Usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress.
Intermittent claudication: Episodic muscular ischemia induced by exercise. Due to atherosclerosis of large or medium-sized arteries. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot depending on the level of obstruction. Rest usually stops the pain within a few seconds.
Symptoms of orthostatic hypotension include all of the following except:
a. Syncope
b. Unsteadiness
c. Visual blurring
d. Respiratory rate greater than 30
d. Respiratory rate greater than 30
**APEA Cardiovascular
Orthostatic hypotension: Occurs in 20% of older adults and in up to 50% of frail nursing home residents. Common when first arising in the morning. Symptoms include lightheadedness, weakness, unsteadiness, visual blurring, and in 20-30% of patients syncope occurs.
A patient describes chest pain as persistent, sharp, and knife-like. these symptoms are more characteristic of:
a. Myocardial infarction
b. Costochondritis
c. Pericarditis
d. Dissecting aortic aneurysm
c. Pericarditis
**APEA Cardiovascular
Persistent, Sharp, and knife-like pain: Characteristic of pericarditis and pleuritic pain.
Pressing, squeezing, tight, heavy, and occasionally burning: Characteristic of myocardial infarction
Stabbing, sticking, dull, or aching pain: Characteristic of costochondritis
Ripping and tearing pain: Dissecting aortic aneurysm
A heart rate of 100-180 beats per minute in an adult is considered:
a. Normal sinus rhythm
b. Sinus tachycardia
c. Supraventricular tachycardia
d. Ventricular tachycardia
b. Sinus tachycardia
**APEA Cardiovascular
Rates that exceed 180 beats per minute are usually supraventricular. Normal sinus rhythm is a measurement of the heart’s electrical activity, not mechanical activity. Ventricular tachycardia is rapid and chaotic ventricular activity.
When palpating the carotid pulse, it is important to:
a. Place the fingers on the upper third of the neck
b. Palpate both carotids simultaneously
c. Position the patient in the lying or sitting positions
d. Position the patient’s chin on the chest
c. Position the patient in the lying or sitting positions
**APEA Cardiovascular
The carotid artery should be palpated gently and while the patient is sitting or lying down. The patient’s chin should be elevated to allow easy palpation and yet not enough to tighten the neck muscles. Stimulating its baroreceptors with low palpation can provoke severe bradycardia or cause cardiac arrest in some sensitive persons. Carotid arteries should never be palpated at the same time, this may limit blood flow to the head possibly leading to fainting or cerebral ischemia. Carotid pulse is palpable between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage
Characteristic symptoms of chronic arterial insufficiency may include which one of the following?
a. Persistent leg pain
b. Petechiae leading to brown pigmentation noted over the feet
c. Feet warm to touch
d. Feet appear pale on elevation and dusky red on dependency
d. Feet appear pale on elevation and dusky red on dependency
**APEA Cardiovascular
Arterial insufficiency: Skin becomes pale on elevation and a dusky red color on dependency. Skin is cool to touch. Intermittent claudication symptoms (intermittent pain).
Venous insufficiency: Persistent leg pain is noted. Skin color appears normal or may be cyanotic on dependency. Petechia occur initially, then progress to brown pigmentation. Feet are usually warm to the touch.
The four classic structural defects of Tetralogy of Fallot include:
a. Tricuspid atresia, atrial septal defect, pulmonary stenosis, and left ventricular hypertrophy
b. A ventricular septal defect, an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy
c. Dextroposition of the aorta, ventricular septal defect, aortic stenosis, and patent ductus stenosis
d. An atrial septal defect, ventricular septal defect, pulmonary atresia, and the aorta arising from the right ventricle
b. A ventricular septal defect, an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy
**APEA Cardiovascular
While auscultating the patient’s heart, a medium, soft murmur is audible. It is pansystolic and heard loudest at the apex with radiation to the left axilla. These findings are consistent with:
a. Tricuspid regurgitation
b. Mitral regurgitation
c. A ventricular septal defect
d. An innocent murmur
b. Mitral regurgitation
**APEA Cardiovascular
Tricuspid regurgitation: Audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. Produces a blowing sound and is pansystolic.
Mitral regurgitation: Pansystolic, harsh murmur. Heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill it can be loud.
Ventricular Septal Defect: High pitch and is usually heard throughout systole.
Innocent murmur: Heard loudest at mid systole near the second to fourth intercostal spaces between the left sternal border and the apex. Usually decreases or disappears when sitting.
The ankle-brachial index is a screening test used to assess a person’s risk for:
a. Deep vein thrombosis
b. Peripheral artery disease
c. Venous insufficiency
d. Thromboangiitis obliterans
b. Peripheral artery disease
**APEA Cardiovascular
A widened pulse pressure greater than or equal to 60 in an older patient is a risk factor for cardiovascular disease, stroke, and:
a. Emboli
b. Systolic hypertension
c. Renal disease
d. Orthostatic hypertension
c. Renal disease
**APEA Cardiovascular
When auscultating heart sounds arising from the aortic valve in an adult patient, place the stethoscope:
a. Near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line
b. Between the 2nd and 3rd intercostal spaces at the right upper sternal border
c. Between the 2nd and 3rd intercostal spaces at the left sternal border
d. Between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border
b. Between the 2nd and 3rd intercostal spaces at the right upper sternal border
**APEA Cardiology
To auscultate the heart sounds arising from the pulmonic valve in an adult patient, place the stethoscope:
a. Near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line
b. Between the 2nd and 3rd intercostal spaces at the right upper sternal border
c. Between the 2nd and 3rd intercostal spaces at the left sternal border.
d. Between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border
c. Between the 2nd and 3rd intercostal spaces at the left sternal border.
**APEA Cardiology
When auscultating the heart of a 55-year-old patient, a loud murmur with a thrill is audible in the right second intercostal space that radiates to the carotid arteries. Also noted is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. This finding is consistent with:
a. Pulmonic stenosis
b. Tricuspid regurgitation
c. Mitral regurgitation
d. Aortic stenosis
d. Aortic stenosis
**APEA Cardiovascular
Aortic Stenosis: Murmur is audible loudest in the right second intercostal space and radiates to the carotid arteries, down the left sternal border, or the apex. There is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward.
Pulmonic Stenosis: soft intensity murmur with a crescendo-decrescendo pitch. It is loudest at the 2nd or 3rd intercostal spaces and radiates to the left shoulder and neck.
Tricuspid regurgitation: Audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. Produces a blowing sound and is pansystolic. The intensity may increase with inspiration.
Mitral regurgitation: Pansystolic, harsh murmur. Heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill it can be loud.
A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually associated with:
a. Angina pectoris
b. A myocardial infarction
c. An aortic dissection
d. Pericarditis
c. An aortic dissection
**APEA Cardiology
Aortic Dissection: Ripping and tearing pain. Sudden, sharp pain that radiates to the back or into the neck.
Myocardial Infarction: Pressing, squeezing, tight, heavy, and occasionally burning. Retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm.
Angina: Exertional pain.
Pericarditis: Persistent, Sharp, and knife-like pain. May radiate to the tip of the shoulder and to the neck.
A condition that presents with symptomatic limb ischemia upon exertion is termed:
a. Neurogenic claudication
b. Intermittent claudication
c. Atherosclerotic peripheral vascular disease
d. Raynaud’s disease
c. Atherosclerotic peripheral vascular disease
**APEA Cardiology
Raynaud’s disease: Usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress.
Neurogenic Claudication: Pain with walking or prolonged standing, radiating from the psinal area into the buttocks, thighs, lower legs, or feet.
Intermittent claudication: Episodic muscular ischemia induced by exercise. Due to atherosclerosis of large or medium-sized arteries. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot depending on the level of obstruction. Rest usually stops the pain within a few seconds. Pain or cramping in the legs that occurs with exertion.
Atherosclerotic peripheral vascular disease: Symptomatic limb ischemia with exertion.
Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with:
a. Neurogenic claudication
b. Intermittent claudication
c. Atherosclerotic peripheral vascular disease
d. Raynaud’s disease
a. Neurogenic claudication
**APEA Cardiovascular
Raynaud’s disease: Usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress.
Neurogenic Claudication: Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet.
Intermittent claudication: Episodic muscular ischemia induced by exercise. Due to atherosclerosis of large or medium-sized arteries. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot depending on the level of obstruction. Rest usually stops the pain within a few seconds. Pain or cramping in the legs that occurs with exertion.
Atherosclerotic peripheral vascular disease: Symptomatic limb ischemia with exertion.
Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed:
a. Neurogenic claudication
b. Intermittent claudication
c. Atherosclerotic peripheral vascular disease
d. Raynaud’s disease
b. Intermittent claudication
–APEA Cardiovascular
Raynaud’s disease: Usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress.
Neurogenic Claudication: Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet.
Intermittent claudication: Episodic muscular ischemia induced by exercise. Due to atherosclerosis of large or medium-sized arteries. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot depending on the level of obstruction. Rest usually stops the pain within a few seconds. Pain or cramping in the legs that occurs with exertion.
Atherosclerotic peripheral vascular disease: Symptomatic limb ischemia with exertion.
A bruit heard in the epigastric area with both systolic and diastolic components is suggestive of:
a. Renal artery stenosis
b. Aortic regurgitation
c. Femoral artery occlusion
d. An aortic aneurysm
a. Renal artery stenosis
**APEA Cardiovascular
Pulmonic Stenosis: soft intensity murmur with a crescendo-decrescendo pitch. It is loudest at the 2nd or 3rd intercostal spaces and radiates to the left shoulder and neck.
Renal Artery Stenosis: A bruit heard in the epigastric area, upper quadrants, or in the costovertebral region that has both systolic and diastolic components.
Aortic regurgitation: Could be evidenced by the presence of S2, S2, and a diastolic murmur.
Aortic Aneurysm: A pulsation visible or palpable in the epigastrium could be consistent with aortic aneurysm
Presence of a heart murmur in a child would be considered organic if the child:
a. Is 18-months-old and was recently diagnosed with anemia
b. Was a 3-year-old, afebrile and diagnosed with an upper respiratory infection
c. Was a 10-month-old who presents with a temperature of 103 F
d. Was a 2-year-old with a congenital heart defect
d. Was a 2-year-old with a congenital heart defect
**APEA Cardiovascular
A heart murmur is classified an organic murmur if there is an anatomic cardiac defect with or without a physiologic abnormality.
If a murmur was heard and the child presents with fever or anemia, the murmur is considered a non-organic or physiologic. The 3-year-old with the upper respiratory infection without fever would be an example of an innocent murmur since there is an absence of an anatomic or physiological condition.
