Exam 2 Flashcards
1
Q
Cirrhosis+fever+abdominal pain=
A
Spontaneous bacterial peritonitis
2
Q
ECG findings most consistent with diagnosis of Hypokalemia
A
U waves, flattened or inverted t waves, st depression, qt prolongation
3
Q
34 year old presents to the ED five days after total thyroidectomy with tingling in her hands. On PE she has twitching at the corner of her mouth upon tapping the side of her face. Which of the lab abnormalities is likely?
A
Hypocalcemia (low pth, low ca, high phosphorus)
4
Q
A 67 year old man is being treated for T2DM. He has a hx of obesity with bmi 33 and chf. Which class of diabetic meds works by suppressing hepatic gluconeogenesis?
A
Biguanides such as metformin
5
Q
What is the first line treatment for type 2 diabetes in the absence of contraindications such as class3 or 4 chf, severe renal or hepatic failure, or iv contrast
A
Metformin
6
Q
First line of treatment for DM T2 is
A
Lifestyle modification
7
Q
A 42 year old man 12 hr post thyroidectomy when he begins to complain of perioral numbness. An ecg reveals a prolonged qt segment. What’s is the likely diagnosis
A
Hypocalcemia
8
Q
A 19 year old woman presents to the ED with severe flushing, tremors, and vision changes. Bp 240/110 104 20 100.4F. Recently found to have a mass on her kidney. Which of the following is the most appropriate course of treatment for this patient?
A
Phenylalanine followed by labetalol
9
Q
How to manage hypertensive emergency in pheochromocytoma?
A
Alpha blockade prior to beta blockade
Administer phenoxybenzamine or phentolamine followed by a beta blocker such as labetalol or propranolol
Otherwise malignant hypertensive crisis
10
Q
A 65 year old woman presents to ED with a cough and rapid heart rate. She reports a history of hyperthyroidism. On PE, you note tachycardia and bilateral ocular proptosis (thyroid storm). Which of the following is the most common trigger for the patients disease process
A
Infection
11
Q
Low TSH and elevated T4 and T3
A
Hyperthyroidism
12
Q
Tachycardia, hyperpyrexia, agitation, anxiety, goiter, lid lag, hand tremor, warm moist skin
A
Thyroid storm
Tx: beta blocker propanolol
Thioamide (propylthiouracil or methimazole)
Iodine solution
Glucocorticoid
13
Q
Pathologic activation of which of the following enzymes contribute to the patho genesis of pancreatitis?
A
Trypsinogen in the pancreatic acinar cells
14
Q
Epi gastric abdominal pain radiating to the back, nausea, vomiting, and anorexia. PE grey turners sign and Cullen sign
A
Pancreatitis
15
Q
What finding is commonly seen in primary adrenal insufficiency but is not seen in secondary adrenal insufficiency?
A
Skin hyperpigmentation
16
Q
What is the most common cause of adrenal insufficiency, regardless of type
A
Chronic corticosteroid therapy
17
Q
High ACTH
A
Primary AI
18
Q
Low ACTH
A
Secondary disease
19
Q
Which of the following clinical findings can best differentiate Graves’ disease from other causes of hyperthyroidism?
A
Exophthalmos
20
Q
A 32 year old woman presents with tachycardia, palpitations, nausea and vomiting and fever. She was recently diagnosed with Graves’ disease. On exam she is diaphoretic and mildly agitated with heart rate 132, bp 189/91 and temp39.4 C. What is the correct order of treatment for this patient. (Thyroid storm)
A
Propanolol, propylthiouracil, iodine, hydrocortisone
21
Q
Primary hyperparathyroidism is characterized by which of the following?
A
Decreased serum phosphate
(^pth^ca ⬇️phosphorus)
22
Q
Bones, stones, abdominal groins, and psychic moans
A
Hypercalcemia
23
Q
Which environments would be most appropriate for the initial dissemination of evidence based literature?
A
Oral presentation at your hospital’s journal club
24
Q
Sample size of the study
A
The sample size is the total number of participants in the study
25
To avoid variation in therapeutic effect which of the following meds shouldn’t be prescribed interchangeably
Generic and brand levothyroxine
26
According to ADA screening for DM in the asymptomatic adult with no risk factors should begin at what age?
35 years
27
A 76 year old man presents with SOB fever hypotension. His cxr show right lower lobe infiltrate, and he is intubated in the ED. He remains hypotensive despite resuscitation with crystalloid Ivf requiring initiation of a norepinephrine infusion. Upon reassessment 12 hrs later PE reveals normal active bowel sounds, a soft abdomen, and mean arterial pressure > 65 on norepinephrine at 4 mcg/min. Which interventions regarding nutrition is most appropriate for this patient?
Establish enteral access and begin tube feeding
28
A 50 year old obese woman with medical hx significant for anxiety and depression and smoking presents to the ED with complaints of SOB, persistent cough, night sweats, and a 15 lbs weight loss in the last 2 months. She has smoked one pack of cigarettes a day for 35 years. Bp 120/80 he 80 resp 14 o2 98% 36.6 C. PE reveals moist mucus membranes, normal skin turgor and absence of peripheral edema. Lungs clears. Cardiac exam normal.
SIADH ⬇️serum Na
⬇️serum osmolarity
⬆️urine osmolarity
⬆️urine specific gravity
29
AGACNP is transferring a patient to a new facility. Utilizing the SBAR format is an example of which of the following
Standardized handoff
30
What is an example of closed loop? Communication 
A nurse repeating a medication order that was received from the AGACNP to ensure its correct
31
The AG, aCMP is caring for a patient with type one diabetes. The patient reports recurrent episodes of hypoglycemia overnight, followed by episodes of hyperglycemia in the morning which of the following is the most likely cause.
Somogyi effect (low 3 am)
32
Which of the following would be the most effective strategy to strengthen a patient provider relationship
Shared decision making 
33
After verbally explaining insulin self in ministration to your patient, they continue to voice misunderstanding. Which of the following strategies would be best to ensure the patient is adequately, educated
Have them teach back what was demonstrated
34
In Graves’ disease, which of the following activates, the thyroid stimulating hormone receptor, leading to increase thyroid hormone production release
Thyrotropin, receptor antibodies, activate, the stimulating hormone receptor to increase thyroid, hormone production, and release
35
A patient with no reporter past medical history presented altered, mental status, hypotension, acetone, breath, ketonuria, and a blood glucose of 572. Additional findings, revealing anion gap of 22 serum potassium of 6.2. Which of the following is the most appropriate initial therapy for this patient?
Fluid resuscitation with isotonic solution
36
Which of the following electrolyte abnormalities is the hallmark and catalyst for the pathophysiology of refeeding syndrome 
Hypophosphatemia 
37
A patient with which of the following diagnosis be the most likely to require stress dosed steroids, following major surgery
Addison’s disease due to the damaging of the adrenal glands and reducing hormone production 
38
What are the common symptoms associated with acute adrenal crisis?
Severe hypotension, shock, fever, confusion, nausea, vomiting, in coma 
39
Which of the following is the best example of primary prevention?
Exercising for 30 minutes a day
40
The adult gerontology, acute care, nurse practitioners, attempting to acquire, informed consent for an invasive procedure for the patient that is intubated and sedated, which of the following parties is able to sign the informed consent
The patient’s adult child
41
Who is responsible for protecting the scope of practice for advanced practice registered nurse
American nurses association
42
The AG, aCMP has been granted permission to insert central venous catheter’s, but not arterial lines, which of the following best defines limitations
Partial privileging
43
What is the most common symptoms related to eosinophilic esophagitis
Dysphasia to solid foods
44
A 52-year-old man with medical history significant for chronic kidney disease presents to your clinic for a follow up exam for previously identified hypertension. Notably his blood pressure is 155/87. What would be the most appropriate first line drug for managing hypertension in this patient.
Lisinopril
Ace inhibitors increase blood flow to the kidneys 
45
You are caring for a patient admitted to the intensive care unit with a history of heart transplant, which combination of immunosuppressive agent is commonly used for the prevention of acute rejection, following allogenic, organ transplant
Tacrolimus and mycophenolate mofetil
46
 The food and drug administration issued which of the following black box warnings for metformin
Lactic acidosis
47
A 74-year-old critically ill woman is hospitalized in the intensive care unit she has metastatic ovarian cancer had been cared for in a long-term nursing facility and had failure to thrive in malnutrition recently. She was receiving less than 5 cal per kilogram per day prior to admission she has a history of small bowel resection completed after small bowel structure 10 years ago on admission parental nutrition is initiated by side of his catheter at a rate of 50 a day which of the following adverse effects of parental nutrition is this patient most at risk for
Refeeding syndrome
48
Which of the following antimicrobials provides anaerobic coverage for intra-abdominal infections
Metronidazole
49
What part of the colon is the most common location for the development of diverticular disease?
Sigmoid
50
A patient presents with a large pituitary tumor. The patient is at risk for which of the following.
The patient is at risk for panhypopituitarism
51
What endocrine pathology may occur following surgical removal of the pituitary?
Diabetes, insipidus
52
A 35-year-old woman presents with heat intolerance, unexplained weight loss of 30 pounds in the last six months and exophthalmos. Which of the following would be
Free thyroxine, 2.2 ng/dl thyroid, stimulating hormone, 0.2 MLU/l
⬆️free thyroxine levels,⬇️tsh
53
Which of the following is likely to result in hypothyroidism
Iodine deficiency
54
A 57-year-old man is hospitalized for congestive heart failure exacerbation. He has a past medical history of congestive heart failure, hypertension, hyperlipidemia, diabetes, and rheumatoid arthritis. His home medication‘s are lisinopril, metoprolol, atorvastatin, insulin, gargling, insulin as part as needed, and infliximab the heart failure exacerbation is treated successfully. On hospital day too, a ride plantar foot ulcer is noticed there’s no surrounding erythremia or swelling. Granulation tissue of screws and appreciation of its depth. The patient hemoglobin A1c is 10.4 he has no history of claudication . His temperature is 99 eight, blood pressure is 122/34, both 87, respiratory rate 19. White blood cell count is 8500. His ankle brachial index is 0.94 on the left and 0.92 on the right which of the following is an express step in management.
De Briding and offloading of pressure 
55
Which of the following physical examination findings is suggestive of hyperthyroidism
Presence of a bruit the increase size of the thyroid gland a man’s a greater blood supply, which may result in the presence of a bruit
56
What labs would you expect for hypothyroidism?
⬇️TSH ⬆️free T4
57
Unfunded, scopic examination, you note arterial, venous nicking. What is the most common cause of this finding? 
Chronic hypertension
58
A 45 year old woman with a history of type two diabetes mellitus presents with a complaint of occasional episodes of diaphoresis, anxiety, tremors, and weakness. Which of the following medication is most likely to be the cause of her symptoms?
Glipizide
59
You are called to the bedside of a patient who recently underwent surgery to remove a functioning, adrenal tumor. The patient is in shock with weakness, Confusion, and abdominal pain. You suspect the patient is an acute adrenal crisis. What is the recommendation treatment for this condition? 
HydroCortisone. An adrenal crisis is a medical emergency indicative of severe adrenal insufficiency caused by a deficiency of mineralocorticoid and a glucocorticoid treatment consist of injectable Hydro Cortisone and volume resuscitation. 
60
A patient presents to a specialty clinic with frequent infections over the past six months. Today the patient is febrile, endorses, an unintentional, 20 pound weight loss, and has candidiasis. Which of the following physical examination findings would be most supportive of the patient’s diagnosis?
Lymphadenopathy
61
A patient presenting in a comatose state has a blood glucose level of 957. There’s serum bicarb level is 20, serum osmolarity of 350, and a serum, beta-hydroxybutyrate level of one. Which of the following is the most appropriate initial treatment of this patient?
Fluid replacement
62
Which of the following insulin preparation has the longest duration of action?
Glargine
63
Which preparation of insulin has the peak
Rapid acting insulin like lispro, aspart, and glulisine have the fastest onset and greatest peak
64
Which of the following lab results is the most consistent with a diagnosis of type two diabetes?
Hemoglobin A1c of 6.7. 
65
A patient presents with a temperature of 101.4 Fahrenheit, white blood cell count of 14,000, and severe right upper quadrant pain. Which of the following physical examination findings for the supports the presume diagnosis?
Murphy sign cholecystitis as a result of inflammation of the gallbladder, and may precipitate after a meal that is large in high in fatty content and patient may have steady and severe, right upper quadrant or epigastric pain. 
66
Ecchymotic discoloration may be observed in the Peri umbilical area, and may indicate a retroperitoneal bleed secondary to pancreatic necrosis
Cullen sign
67
Is associated with traumatic splenic rupture. Patients may have left upper quadrant, abdominal pain that is referred to the left shoulder and worsens with inspiration. It is caused by irritation to the phrenic nerve.
Kehr sign
68
Is associated with appendicitis when the left lower quadrant is palpated, pain persist in the right lower quadrant, indicating peritoneal irritation
Rovsing sign
69
What is the gold standard for diagnosing cholecystitis?
HIDA scan
70
Which of the following lab interpretations most consistent with a patient who is experiencing an anxiety attack
PH 7.5 bicarbonate 22 CO2 30.
71
Which of the following lab values is most consistent with a diagnosis of hypothyroidism
High thyroid, stimulating, hormone, low, free T4, anti-thyroid peroxidase, and anti-thyroglobulin auto antibodies
72
A 26 year old man involved in a high-speed, motor vehicle crash, sustains multiple cranial facial fractures, a right temporal epidural hematoma in by frontal contusions. He underwent a right sided decompressive. He may craniotomy, but continues to have high intracranial pressure is requiring heavy sedation on day three he becomes polyuric and labs revealed. His sodium is up to 150 mil equivalence from 144 mil equivalence on morning labs the urine study show a low you’re in sodium and osmolarity which of the following is most likely the cause of the laboratory findings
 Diabetes, insipidus
73
What are typical labs in diabetes insipidus
Increase plasma osmolarity
Decrease in urine osmolarity
74
When administering an insulin infusion to a patient with either diabetic keto acidosis or hyperosmolar hyperglycemia non-ketotic state, which of the following clinical labs should be evaluated frequently to prevent iatrogenic complications?
Glucose and potassium
75
A 53 year old man presents to clinic for a routine follow-up for his type 2 diabetes mellitus. His health history includes CAD with 3 stents to the LCA, hypertension, heart failure, hyperlipidemia and obesity. He is currently taking glucophage for his diabetes. Todays hemoglobin is A1C is 8.3. Which of the following is the next therapy to add to his diabetic regimen
Liraglutide
76
You are a member of the rapid response team and are called to the bedside of an 81 year old patient admitted for surgical repair of a fractured hip for which he has been NPO. This morning, he has acute onset of and confusion and lethargy. Which of the following is the most appropriate initial action in the management of this patient
Point of care glucose measurement
77
You are called to the bedside of a patient who is acutely pale, diaphoretic, and confused. The nurse checked a point of care blood glucose which was 54. Which of the following interventions is the most appropriate in the management of this patient?
Administer dextrose
78
Which of the following urine specific gravity values is most concerning for SIADH?
1.040 norm is 1.01-1.03
79
You are caring for a patient following resection of a pituitary tumor. Which of the following pathologies is the patient most at risk for developing post operatively
Diabetes insipidus
80
Which of the following pathologies is associated with central diabetes insipidus?
TBI
81
You are managing a patient who present with fatigue and secondary amenorrhea. You decide to order thyroid function tests, which of the following result would support a diagnosis of hypothyroidism
Decreased t3 and increase tsh
82
An 46 year old woman present with nausea, vomiting, and malaise for more than 24 hours. She denies a significant medical history, reporting only chronic low back pain for which she takes Tylenol regularly the past 6 months. On PE you note hyperpnea and generalized abdominal discomfort to palpation. Lab work demonstrated Hypokalemia and hyponatremia. While abgs reveals ph of 7.29
Metabolic acidosis
83
A 54 year old woman presents with central obesity, a moon face, and a Buffalo hump. You suspect Cushing syndrome and complete the work up generating finding that support the diagnosis. Which of the following is a cortisol related comorbidity or complication the patient must be monitored and treated for due to Cushing syndrome
Osteoporosis
84
A patient has been declared brain dead. Which of the following actions is most appropriate
Contact the organ-procuring organization
