Exam study Flashcards
The most commo cancer found on the aurcle is Actinic keratosis Basal cell carcinoma Squamous cell carcinoma Acral-lentiginous melanoma
Basal cell carcinoma
Which of the following medication classes should be avoided in patients with acute or
chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the
patient?
Xanthines
Antihistimine
Steroids
Anticholinergics
Antihistimines
A 47 year old male patient presents to the clinic with a single episode of a moderate
amount of bright red rectal bleeding. On examination, external hemorrhoids are noted.
How should the nurse practitioner proceed?
Instruct the patient on measures to prevent hemorrhoids such as
bowel habits and diet.
Order a topical hemorrhoid cream along with a stool softener.
Refer the patient for a barium enema and sigmoidoscopy.
Refer the patient for a surgical hemorrhoidectomy.
Refer the patient for a barium enema and sigmoidoscopy.
Which of the following patient characteristics are associated with chronic bronchitis?
Overweight, cyanosis, and normal or slightly increased
respiratory rate
Underweight, pink skin, and increased respiratory rate
Overweight, pink skin, and normal or slightly increased
respiratory rate
Normal weight, cyanosis, and greatly increased
respiratory rate
Overweight, cyanosis, and normal or slightly increased
respiratory rate
A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and
polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain.
Her current medications include omeprazole 20 milligrams po daily, lisinopril 20
milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po
daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The
most appropriate diagnostic test for this patient at this time is
CBC/diff
Erythrocyte
sedimentation rate
Abdominal ultrasound
CT scan
CT Scan
A patient reports “something flew in my eye” about an hour ago while he was splitting
logs. If there were a foreign body in his eye, the nurse practitioner would expect to find
all except:
Purulent drainage
Tearing
Photophobia
A positive fluorescein
stain
Purulent drainage
A 21 year old college student presents to the student health center with copious,
markedly purulent discharge from her left eye. The nurse practitioner student should
suspect
Viral conjunctivitis
Common pink eye
Gonococcal
conjunctivitis
Allergic
conjunctivitis
Gonococcal Conjuctivitis
A 35 year old man presents with radicular pain followed by the appearance of grouped
vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He
complains of pain, burning, and itching. The nurse practitioner should suspect:
A common case of shingles and prescribe an analgesic and an antiviral
agent
A complicated case of shingles and prescribe acyclovir, an analgesic,
and a topical cortisone cream
Herpes zoster and consider that this patient may be
immunocompromised
A recurrence of chickenpox and treat the patient’s symptoms
Herpes zoster and consider that this patient may be
immunocompromised
Which type of lung cancer has the poorest prognosis?
Adenocarcinoma
Epidermoid
carcinoma
Small cell
carcinoma
Large cell
carcinoma
Small cell
carcinoma
An 83-year-old female presents to the office complaining of diarrhea for several days.
She explains she has even had fecal incontinence one time. She describes loose stools 3–
4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The
history suggests that the patient has:
Acute diarrhea
Chronic diarrhea
Irritable bowel
Functional bowel
disease
Chronic Diarrhea
Margaret, age 32, comes into the office with painful joints and a distinctive rash in a
butterfly distribution on her face. The rash has red papules and plaques with a fine scale.
What do you suspect?
An allergic reaction
Relapsing
polychondritis
Lymphocytoma cutis
Systemic lupus
erythematosus
Systemic lupus
erythematosus
Antibiotic administration has been demonstrated to be of little benefit to the treatment of
which of the following disease processes?
Chronic sinusitis Acute bronchitis Bacterial pneumonia Acute exacerbation of chronic bronchitis
Acute bronchitis
Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2
agonist daily. Her exacerbations affect her activities and they occur at least twice weekly
and may last for days. She is affected more than once weekly during the night with an
exacerbation. Which category of asthma severity is Lisa in?
Mild
intermittent
Mild persistent
Moderate persisent
Moderate persistent
Which of the following is the most appropriate therapeutic regimen for an adult patient
with no known allergies diagnosed with group A B-hemolytic strep?
Penicillin V 500 milligrams PO every 8 hours
for 10 days
Ampicillin 250 milligrams PO twice a day for
10 days
Clarithromycin 500 milligrams po daily for 7
days
None of the above
Penicillin V 500 milligrams PO every 8 hours for 10 days
A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by
leg elevation. She occasionally has edema in her lower legs at the end of the day. What is
the most likely cause of these problems?
Congestive heart
failure
Varicose veins
Deep vein
thrombosis
Arterial
insufficiency
Varicose veins
Which statement below is correct about pertussis?
It is also called whooping cough
It begins with symptoms like strep throat
It lasts about 3 weeks
It occurs most commonly in toddlers and
young children
It is called whooping cough
Which of the following is the most important diagnosis to rule out in the adult patient
with acute bronchitis?
Pneumonia
Asthma
Sinusitis
Pertussis
Pneumonia
A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly
tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which
correctly describes the suspected condition?
Diverticulitis
Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This
morning she noticed a rash with erythematous papules in that site. What do you suspect?
Varicella
Herpes
zoster
Syphilis
Rubella
Herpes zoster
A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows
that the most common cause of pancreatitis is:
Alcohol
Gallstones
Medications
Pregnancy
Gallstones
When a patient presents with symptoms of acute gallbladder disease, what is the
appropriate nurse practitioner action?
Order abdominal x-rays
Order an abdominal ultrasound
Refer the patient to a surgeon for
evaluation
Prescribe pain medication
Order an abdominal ultrasound
A false-positive result with the fecal occult blood test can result from:
ingestion of large amounts of
vitamin C
a high dietary intake of rare
cooked beef
colonic neoplasm that is not
bleeding
stool that has been stored
before testing
a high dietary intake of rare
cooked beef
A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and
pain. Physical findings include an abdominal mass and stool positive for occult blood. The
nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test
for this patient is
Colonoscopy
Small bowel follow through
Barium enema
CT abdomen
Small bowel follow through
A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity
edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner
knows that these findings are consistent with:
Mitral
regurgitation
Systolic heart
failure
Cardiac myxoma
Diastolic heart
failure
Systolic heart failure
Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is
an indication that she should be hospitalized?
Multilobar involvement on chest x-ray with the inability to take oral
medications
Alert and oriented, slightly high but stable vital signs, and no one to
take care of her at home
Sputum and gram positive organisms
A complete blood count showing leukocytosis
Multilobar involvement on chest x-ray with the inability to take oral
medications
A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner
correctly tells him:
“It is the most common cause of death in patients with skin
cancer.”
“It can be cured with surgical excision or radiation therapy.”
“It is a slow growing skin cancer that rarely undergoes
malignant changes.”
“It can be cured using 5-flurouracil cream twice daily for 2
to 4 weeks.”
“It can be cured with surgical excision or radiation therapy.”
Expected spirometry readings when the patient has chronic emphysema include:
Decreased residual volume (RV)
Increased vital capacity (VC)
Increased forced expiratory volume
(FEV-1)
Increased total lung capacity (TLC)
Increased total lung capacity (TLC)
An 80-year-old male admits to difficulty swallowing during the review of systems. The
nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:
Esophageal
cancer
Chest pain
GERD
A and C
All of the
above
A and C
A 40 year old female with history of frequent sun exposure presents with a multicolored
lesion on her back. It has irregular borders and is about 11mm in diameter. What should
the nurse practitioner suspect?
Squamous cell
carcinoma
Malignant
melanoma
A common nevus
Basal cell
carcinoma
Malignant melanoma
Which of the following is not a goal of treatment for the patient with cystic fibrosis?
Prevent intestinal obstruction Provide adequate nutrition Promote clearance of secretions Replace water-soluble vitamins
Replace water-soluble vitamins
The nurse practitioner is performing a physical exam on a middle-aged African-American
man. Which of the following areas is a common site for melanomas in African-Americans
and other dark-skinned individuals?
Scalp Nails Feet B and C All of the above
B and C
An adult presents with tinea corporis. Which item below is a risk factor for its
development?
topical steroid use
A patient has experienced nausea and vomiting, headache, malaise, low grade fever,
abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a
shift to the left. He is requesting medication for diarrhea. What is the most appropriate
response?
Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours.
Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and
symptom management.
Offer an anti-emetic medication such as ondansetron (Zofran) and
provide oral fluid and electrolyte replacement instruction.
Order stool cultures.
Prescribe a broad-spectrum antibiotic such as ciprofloxacin and symptom management
Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed
with urticaria. What do you order?
Aspirin
NSAIDs
Opioids
Antihistamines
Antihistamine
Of the following signs and symptoms of congestive heart failure (CHF), the earliest
clinical manifestation is:
Peripheral
edema
Weight gain
Shortness of
breath
Nocturnal
dyspnea
Weight gain
A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical
adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what
drug would be least appropriate to prescribe?
Ibuprofen
Erythromyci
n
Amoxicillin
Acetam
Amoxicillin
A 70 year old man who walks 2 miles every day complains of pain in his left calf when he
is walking. The problem has gotten gradually worse and now he is unable to complete his
2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans?
“Are you wearing your usual shoes?”
“Do you also have chest pain when you
have leg pain?”
“Is your leg pain relieved by rest?”
“Do you ever have the same pain in the
other leg?”
Is your leg pain relieved by rest
Which of the following statements about malignant melanomas is true?
They usually occur in older adult males
The patient has no family history of melanoma
They are common in blacks
The prognosis is directly related to the thickness of the lesion
The prognosis is directly related to the thickness of the lesion
Sheila, age 78, presents with a chief complaint of waking up during the night coughing.
You examine her and find an S3 heart sound, pulmonary crackles that do not clear with
coughing, and peripheral edema. What do you suspect?
Heart failure
Which antibiotic would be the most effective in treating community acquired pneumonia
(CAP) in a young adult without any comorbid conditions?
Erythromycin
Clarithromycin
(Biaxin)
Doxycycline
(Vibramycin)
Penicillin
Clarithromycin
Biaxin
Which of the following dermatologic vehicles are the most effective in absorbing moisture
and decreasing friction?
Powders
Gels
Creams
Lotion
Powders
A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her
forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects
actinic keratosis. This lesion is a precursor to:
Squamous cell
carcinoma
Basal cell
carcinoma
Malignant
melanoma
Acne vulgaris
Squamous cell Carcinoma
An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by
sitting or lying down. How should the nurse practitioner proceed with the physical
examination?
Assist the patient to a standing position and take her blood
pressure.
Assess the patient’s cranial nerves.
Compare the patient’s blood pressure lying first, then sitting,
and then standing.
Compare the amplitude of the patient’s radial and pedal pulses.
Compare the patient’s blood pressure lying first, then sitting,
and then standing.
`
What oral medication might be used to treat chronic cholethiasis in a patient who is a
poor candidate for surgery?
Ursodiol
Ibuprofen
Prednisone
Surgery is the only
answer
Ursodiol
A 46-year-old female with a past medical history of diabetes presents with a swollen,
erythematous right auricle and is diagnosed with malignant otitis externa. The nurse
practitioner knows that the most likely causative organism for this patient’s problem is:
Staphylococcus aureus
Group A beta hemolytic
streptococcus
Haemophilus influenza
Pseudomonas aeruginosa
Pseudomonas aeruginosa
Which of the following is not a symptom of irritable bowel syndrome?
Painful diarrhea
Painful constipation
Cramping and
abdominal pain
Weight loss
Weight loss
A patient comes in complaining of 1 week of pain in the posterior neck with difficulty
turning the head to the right. What additional history is needed?
Any recent trauma
Difficulty swallowing
Stiffness in the right
shoulder
Change in sleeping
habits
Any recent trauma
Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive.
Which of the following drugs has the potential to cause the development of bronchial
asthma and inhibit gluconeogenesis?
ACE Inhibitor
Beta Blocker
Calcium channel
blocker
Diuretic
Beta Blocker
The differential diagnosis for a patient complaining of a sore throat includes which of the
following?
Gonococcal
infection
Thrush
Leukoplakia
B only
A, B, and C
A,B and C
A patient presents to the primary care provider complaining of a rash on his right
forehead that started yesterday and is burning and painful. The physical exam reveals an
erythematous, maculopapular rash that extends over the patient’s right eye to his upper
right forehead. Based on the history and examination, the most likely cause of this
patient’s symptoms is:
Rhus
dermatitis
Ophthalmic
zoster
Chemosis
Optic neuritis
Opthalmic zoster
Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse
practitioner orders liver function studies. The patient’s aminotransferase (ALT) is
elevated. What laboratory test(s) should be ordered?
Serologic markers for hepatitis
Serum bilirubin
Serum cholesterol with HDL
and LDL
A liver biopsy
Serologic markers for hepatitis
A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he
calls to report generalized muscle aches. The nurse practitioner should suspect:
A drug interaction
Hepatic dysfunction
Hypersensitivity to
lovastatin
Rhabdomyolysis
Rhabdomyolysis
Treatment of acute vertigo includes:
Bedrest and an
antihistamine
Fluids and a
decongestant
A sedative and
decongestant
Rest and a low sodium
diet
Bedrest and an
antihistamine
Treatment of H.pylori includes which of the following?
Proton pump
inhibitor
Antibiotic
therapy
Bismuth
subsalicylate
A and B
A, B, and C
A, B, and C
Carl, age 78, is brought to the office by his son, who states that his father has been
unable to see clearly since last night. Carl reports that his vision is “like looking through a
veil.” He also sees floaters and flashing lights but is not having any pain. What do you
suspect?
Cataracts
Glaucoma
Retinal
detachment
Iritis
Retinal detachment
In order to decrease deaths from lung cancer:
All smokers should be screened annually
All patients should be screened annually
Only high risk patients should be
screened routinely
Patients should be counseled to quit
smoking
Patients should be counseled to quit smoking
John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened
for hypercholesterolemia?
Every 5 years
Every 2 years
Every year
Whenever blood work is
done
Every 5 years
Mort is hypertensive. Which of the following factors influenced your choice of using an
alpha blocker as the antihypertensive medication?
Mort is black
Mort also has congestive heart
failure
Mort has benign prostatic
hyperplasia
Mort has frequent migraine
headaches
Mort has benign prostatic
hyperplasia
John, age 59, presents with recurrent, sharply circumscribed red papules and plaques
with a powdery white scale on the extensor aspect of his elbows and knees. What do you
suspect?
Actinic keratosis
Eczema
Psoriasis
Seborrheic
dermatitis
Psoriasis
Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her
hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and
Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC
VIII guidelines, what should you do next to control Harriet’s blood pressure?
Increase her Lisinopril to 20mg daily
Add a thiazide diuretic to the Lisinopril 5mg daily
Discontinue the Lisinopril and start a combination of ACE Inhibitor and
calcium channel blocker
Discontinue the Lisinopril and start a diuretic
Add a thiazide diuretic to the Lisinopril 5mg daily
An active 65-year-old man under your care has known acquired valvular aortic stenosis
and mitral regurgitation. He also has a history of infectious endocarditis. He has recently
been told he needs elective replacement of his aortic valve. When he comes into the
office you discover that he has 10 remaining teeth in poor repair. Your recommendation
would be to:
defer any further dental work until his valve replacement is completed
instruct him to have dental extraction done cautiously, having no more
than 2 teeth per visit removed.
suggest he consult with his oral surgeon about having all the teeth
removed at once and receiving appropriate antibiotic prophylaxis
coordinate with his cardiac and oral surgeons to have the tooth
extractions and valve replacement done at the same time to reduce the
risk of anesthetic complications.
suggest he consult with his oral surgeon about having all the teeth
removed at once and receiving appropriate antibiotic prophylaxis
Appropriate therapy for peptic ulcer disease (PUD) is:
Primarily by eradication of infection
Based on etiology
Aimed at diminishing prostaglandin
synthesis
Dependent on cessation of NSAID
use
Based on etiology
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than
her diabetes medications, what would you prescribe today during her routine office visit?
A calcium channel
blocker
A beta blocker
An ACE Inhibitor
No hypertension
medication
An ACE Inhibitor
Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?
It is important to “undercode” so that one does not get charged with Medicare fraud
The practice of “overcoding” is essential in this age of decreasing reimbursements
Failing to bill for billable services will lead to unnecessarily low revenues
Time spent with the patient is a very important determinant of billing
Failing to bill for billable services will lead to unnecessarily low revenues
A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?
Viral conjunctivitis
Glaucoma
Corneal abrasion
Retinoblastoma
Retinoblastoma
Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?
Pharmacological therapy
A labyrinthectomy
A vestibular neurectomy
Wearing an earplug in the ear with the most hearing loss
A Vestibular neurectomy
Which of the following is not a risk factor for coronary arterial insufficiency?
Hyperhomocysteinemia
Smoking
Genetic factors
Alcohol ingestion
Alcohol ingestion
An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms?
Allergic conjunctivitis
Bacterial conjunctivitis
Gonococcal conjunctivitis
Viral conjunctivitis
Allergic conjunctivitis
A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?
A long-acting bronchodilator
An inhaled corticosteroid and cromolyn
Theophylline and a short acting bronchodilator
A bronchodilator PRN and an inhaled corticosteroid
A bronchodilator PRN and an inhaled corticosteroid
Acute rheumatic fever is an inflammatory disease which can follow infection with:
Group A Streptococcus
Staphlococcus areus
Β-hemolytic Streptococcus
Streptococcus
Β-hemolytic Streptococcus
A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:
Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days
Order mandibular x-rays and question the patient about physical abuse
Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic
Initiate a parenteral antibiotic and consider hospital admission
Initiate a parenteral antibiotic and consider hospital admission
If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:
Iritis
Allergic conjunctivitis
Viral conjunctivitis
Bacterial conjunctivitis
Iritis
The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:
160 mg/dL
130 mg/dL
100 mg/dL
70 mg/dL
100 mg/dL
A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:
Referral for surgical intervention such as a partial or complete fundoplication
Dependent upon how sever the practitioner believes the condition
To repeat the 8 week course of drug therapy while continuing lifestyle modifications
Investigation with endoscopy, manometry, and/or pH testing
Investigation with endoscopy, manometry, and/or pH testing
Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?
Under 3 years of age
Preschool children
6 to 12 years of age
Adolescents
6 to 12 years of age
The most appropriate treatment for a child with mild croup is:
A bronchodilator
An antibiotic
A decongestant
A cool mist vaporizer
A cool mist vaporizer
A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?
Peritonsillar abscess
Thyroiditis
Mononucleosis
Epiglottitis
Peritonsillar abscess
Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?
It is not effective during an acute asthma attack.
It may take 2 to 3 days to begin working.
This drug works within 10 minutes.
This drug may be used by patients 6 years and
It is not effective during an acute asthma attack.
Which intervention listed below is safe for long term use by an adult with constipation?
Stool softeners
Laxatives
Osmotic agents
Bulk-forming agents
Bulk-forming agents
A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
Apply a topical antibiotic and warm compresses.
Apply cool compresses and avoid touching the hordeolum.
Use an oral antibiotic and eye flushes.
Apply light palpation to facilitate drainage.
Apply a topical antibiotic and warm compresses.
Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?
An antihistamine intranasal spray
A decongestant nasal spray
Ipratropium
Omalizumab
A decongestant nasal spray
What is the Gold standard for the diagnosis of asthma?
Patient’s perception of clogged
airways
Validated quality-of-life questionnaires
Bronchoscopy
Spirometry
Spirometry
A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?
Methyldopa
Enalapril
Amlodipine
Hydrochlorothiazide
Enalapril
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:
Aphthous ulcers
Candidiasis
Oral cancer
Herpes simplex
Candidiasis
Risk factors for acute otitis media (AOM) include all of the following except:
Household cigarette smoke
Group daycare attendance
Sibling history of acute otitis media
African-American ethnicity
African-American ethnicity
Which of the following can result from chronic inflammation of a meibomian gland?
A chalazion
Uveitis
Keratitis
A pterygium
A chalazion
What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?
You must initiate the plan of care for the patient
The physician must be on-site and engaged in patient care
You must be employed as an independent contractor
You must be the main health care provider who sees the patient
The physician must be on-site and engaged in patient care
Of the following choices, the least likely cause of cough is:
Asthma
Gastroesophageal reflux
Acute pharyngitis
Allergic rhinitis
Acute pharyngitis
The most common correlate(s) with chronic bronchitis and emphysema is(are):
Familial and genetic
factors
Cigarette smoking
Air pollution
Occupational environment
Cigarette smoking
Which choice below is least effective for alleviating symptoms of the common cold?
Antihistamines
Oral decongestants
Topical decongestants
Antipyretics
Antihistamines
When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?
Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control
Sodium restriction can cause serious adverse effects
A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable
Seventy-five of sodium intake is derived from processed foods
Seventy-five of sodium intake is derived from processed foods
Which of the following heart murmurs warrants the greatest concern?
Systolic murmur
Venous hum murmur
Diastolic murmur
Flow murmur
Diastolic murmur
A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?
Hordeolum; treat with a topical antibiotic and warm compress
Conjunctivitis; treat with topical antibiotic and warm compresses
Blepharitis; treat with warm compresses and gentle debridement with a cotton swab
Chalazion; refer to an ophthalmologist for incision and drainage
Blepharitis; treat with warm compresses and gentle debridement with a cotton swab
A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?
Inferior wall
Anterior wall
Apical wall
Lateral wall
Inferior wall
The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:
Acute otitis media (AOM)
Otitis media with effusion
Mucoid otitis media
Serous otitis media
Acute otitis media (AOM)
Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:
epigastric hernia
umbilical hernia
incisional hernia
inguinal hernia
epigastric hernia
A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?
Omeprazole
Ranitidine
An antacid
None of the above
Omeprazole
Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:
Quit smoking
Maintain aggressive hypertension therapy
Stick to a low-fat, low-sodium diet
Continue with his exercise program
Quit smoking
Risk factors for acute arterial insufficiency include which of the following?
Recent myocardial infarction
Atrial fibrillation
Atherosclerosis
All of the above
All of the above
Impetigo and folliculitis are usually successfully treated with:
Systemic antibiotics
Topical antibiotics
Topical steroid creams
Cleansing and debridement
Topical antibiotics
What are signs & symptoms of SIADH (Syndrome of inappropriate antidiuretic hormone)?
Increased production of ADH (antidiuretic hormone), hyponatremia, concentrated urine (from excess water resorption), elevated urine osmolality, mental status changes from cerebral edema.
Diabetes insipidus is associated with what sodium level?
Hypernatremia
Psychogenic polydipsia results in urine that is:
diluted with low osmolality and hyponatremia
How would you determine the cause of a patient’s AKI who presents with decreased urine output, history of neurogenic bladder, chronic foley, dark urine, and Cr increase from 1.3 to 2.1 over 3 months?
Flush the foley catheter to see if urine comes out and assess the patency of the catheter. This action will unblock clogged sediment or biofilm from chronic bacteriuria.
When a female patient presents to the ER after sexual assault, what medications should be offered prior to discharge?
Ceftriaxone, azithromycin, Plan B, and Metronidazole.
Manifestations of Conn syndrome (hyperaldosteronism)?
hypernatremia, hypokalemia, and hypertension
What causes Cushing syndrome?
Increased levels of glucocorticoids, can be exogenous (from therapy) or endogenous (from adenoma or neoplasm).
Manifestations of Cushing syndrome?
hypertension, truncal obesity, osteoporosis, skin fragility, and hyperglycemia.
What differentiates primary adrenocortical insufficiency from secondary adrenocortical insufficiency?
Skin hyperpigmentation is present in primary adrenocortical insufficiency
What is Trousseau’s sign?
A carpal spasm elicited by compression of the upper arm with a BP cuff that indicates hypocalcemia.
What is Chovstek’s sign?
A hemifacial tic that is induced by tapping the facial nerve below the maxilla that indicates hypocalcemia.
What is Babinski’s sign?
An upward response (extension) of the hallux when the sole of the foot is stimulated with a blunt instrument. Can identify spinal cord disease in adults.
What is Romberg’s sign?
Loss of balance in standing when eyes are closed. Usually indicating a loss of proprioception or lesion in the cerebellum.
What is Homan’s sign?
pain on passive dorsiflexion of ankle, associated with DVT.
What is the clinical presentation of Goodpasture’s syndrome?
Urinalysis: Specific gravity: 1.020. pH 5.5, 1+ albumin and large blood present. Chest XR positive for bilateral diffuse infiltrates.
BUN 30, Cr 3.0
Symptoms: dyspnea with hemoptysis
What is Goodpasture syndrome?
Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.
Initial treatment for Goodpasture’s syndrome?
Hospitalization, pulse dose of steroids, begin plasmapheresis and cyclophosphamide therapy.
Characteristics of Grave’s disease
Ophthalmopathy (lid retraction, scleral show, proptosis) and hyperthyroidism
What organism causes the formation of a staghorn calculus?
Proteus mirabilus
What organism causes Toxic shock syndrome?
Staphylococcus aureus
What electrolyte disturbance is most likely to lead to tetany and neuromuscular irritability?
Hypocalcemia
Features of hypercalcemia include?
“Stones, groans, moans, and bones.” Delirium and renal stones
When you see hypochloremia, the patient may have?
Metabolic Alkalosis
Hyperkalemia is associated with what cardiac abnormalities?
peaked T-waves, wide QRS, and ventricular arrhythmias.
A patient presents with arcus cornea, LDL 285, TG 110, HDL 45, and father died of an MI at age 45. What is his most likely diagnosis?
Heterozygous familial hypercholesterolemia
A fasting blood glucose level of 130 mg/dL indicates:
Diabetes
What are risk factors for ectopic pregnancy?
smoking, previous tubal surgery, previous ectopic pregnancy, exposure to diethylibestrol, current IUD, PID, advanced maternal age, infertilitiy for more than 2 years.
What hormones are most critical to replace in a patient at risk for anterior pituitary insufficiency?
Glucocorticoids, and thyroid hormone
What is diabetes insipidus?
a disorder caused by inadequate amounts of ADH which causes excessive water loss
CKD Stage 1
GFR >90 with evidence of renal damage, as indicated by proteinuria.
CKD Stage 2
GFR 60-89
CKD Stage 3a
GFR 45-59
CKD Stage 3b
GFR 30-44
What is the diagnosis and initial treatment of a patient with history of nonfunctional pituitary macroadenoma with severe retro-orbital headache, nausea, vomiting, mental status change, right third nerve palsy with stiff neck, and pituitary adenoma (enlarged) hemorrhage?
Pituitary apoplexy
dexamethasone 2mg IV q 6hr then surgery if mental status change present.
What causes hypocalcemia in patients with end stage renal disease?
Decreased conversion of Vitamin D.
What condition is associated with recurrent nephrolithiasis?
Primary hyperparathyroidism
What stabilizes the cardiac membrane in treatment of hyperkalemia?
Calcium gluconate
What medication acts rapidly to antagonize the membrane effects of potassium in hyperkalemia?
Calcium is cardioprotective
What is the most common cause of euvolemic hyponatremia?
SIADH (syndrome of inappropriate antidiuretic hormone secretion)
What causes are associated with hypervolemic hyponatremia?
Cirrhosis and CHF
What is a long-term complication of radio-active iodine therapy?
Hypothyroidism
80% of acute pyelonephritis cases in women are caused by what pathogen?
E coli
Most common cause of acute scrotal pain in adults?
epididymitis
What are predisposing factors for hypocalcemia?
hypoparathyroidism, pancreatitis, vitamin D deficiency, chronic alcohol use disorder, and medications such as phenytoin, cisplatin, and estrogen.
What are prerenal causes of AKI?
decrease in extracellular fluid volume, decreased renal blood flow, or altered intrarenal hemodynamics.
Post-renal causes of AKI
benign prostatic hyperplasia, bladder cancer, nephrolithiasis, neuromuscular disorders, prostate cancer, strictures, trauma
What is are intrinsic causes of renal failure?
Acute glomerulonephritis, ischemic injury, nephrotoxins, malignant hypertension
What classification of drugs cause urinary retention?
anticholinergics (ipratropium)
Common secondary causes of nephrotic syndrome
lupus and diabetes
Presenting symptoms of nephrotic syndrome
loss of appetite, fatigue, ascites, lower extremity edema, proteinuria, low blood albumin, and hyperlipidemia.
What is the initial insulin loading dose for a patient in DKA?
0.1 to 0.15 units/kg/hr
with hourly glucose monitoring
What is Hashimoto’s thyroiditis?
autoimmune destruction of thyroid gland, Anti-thyroid stimulating hormone (TSH) receptor antibodies inhibit release of thyroid hormone.
What would you do first for an incidental finding of an adrenal mass?
Overnight dexamethasone suppression test.
Clinical signs of PCOS
oligomenorrhea, infertility, hirsutism, obesity, and 2/3 Rotterdam criteria: oligo-ovulation or anovulation
clinic of biochemical signs of hyperandrogenism polycystic ovaries on US
Treatment for simple cystitis
5 days of nitrofurantoin
Define the acronym MUDPILES
Acronym for identifying a high anion gap metabolic acidosis: Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron, isoniazid Lactate Ethanol, ethylene glycol Salicylates
First-line evaluation of vulvovaginal candidiasis
wet mount
Prolonged nausea and vomiting can result in:
Metabolic alkalosis loss of gastric acid
Clinical signs/symptoms of uremic pericarditis
worsening anemia, absence of diffuse ST-segment T-wave elevations, fever, pleuritic chest pain, pain that increases in recumbent position.
Hemodialysis treatment should be heparin free.
What is hepatorenal syndrome?
chronic or acute renal disease with advanced hepatic failure and portal hypertension.
What complaint is common with patients who have acute on chronic urinary retention?
urinary incontinence
For a patient who is lethargic and hyperkalemic, what is the first line therapy?
Calcium gluconate or calcium chloride
Priapism is a known side effect of what medication?
Trazodone
What is the maximum compensation of PaCO2 in metabolic acidosis?
26
signs of preeclampsia
BP > 140/90 proteinuria >300 mg of protein in urine in 24 hours headache visual changes 2+ pitting edema
Which of the following is a potential acquired cause of thrombophilia
Homocysteinuria
Protein C deficiency
Factor V Leiden
Antiphospholipid antibodies
Antiphospholipid antibodies
Phalen’s test, 90°wrist flexion for 60 seconds, reproduces symptoms of:
Ulnar tunnel syndrome
Carpal tunnel syndrome
Tarsal tunnel syndrome
Myofascial pain syndrome
Carpal tunnel syndrome
Which patient would benefit most from screening for type 2 diabetes?
A 30 year old female with unintended weight loss.
A 25 year old male with family history of type 1 diabetes
An obese female with recurrent vaginitis
A 50 year old hyperlipidemic male
An obese female with recurrent vaginitis
A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?
Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Lupus
Peripheral neuropathy
Osteoarthritis (OA)
A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be:
Trimethoprim-sulfamethoxazole for 3 days
Ciprofloxacin for 7-10 days
Trimethoprim-sulfamethoxazole for 14 days
Ciprofloxacin for 3 days
Trimethoprim-sulfamethoxazole for 3 days
A thymectomy is usually recommended in the early treatment of which disease?
Parkinson’s disease
Multiple sclerosis
Myasthenia gravis
Huntington’s chorea
Myasthenia gravis
The diagnosis of human papilloma virus (HPV) infection in males is usually made by
Clinical appearance
Viral culture
Tzanck smear
KOH prep
Clinical appearance
The most effective intervention(s) to prevent stroke is (are):
81 mg of aspirin daily
Carotid endarterectomy for patients with high-grade carotid lesions
Routine screening for carotid artery stenosis with auscultation for bruits
Smoking cessation and treatment of hypertension
81 mg of aspirin daily
What is the most common cause of Cushing’s syndrome?
Excessive ACTH production
Administration of a glucocorticoid or ACTH
Pituitary adenoma or a non-pituitary ACTH-producing tumor
Autonomous cortisol production from adrenal tissue
Administration of a glucocorticoid or ACTH
Diagnostic radiological studies are indicated for low back pain:
Routinely after 3 weeks of low back pain symptoms.
To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection
As a part of a pre-employment physical when heavy lifting is included in the job description.
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection
After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured?
An enzyme-linked immunosorbent assay titer
A urea breath test
A rapid urease test
A repeat endoscopy
A urea breath test
Which appropriate test for the initial assessment of Alzheimer’s disease provides the performance ratings on 10 complex, higher order activities?
MMSE
CAGE questionnaire
FAQ - Functional Activities Questionnaire
Holmes and Rahe social readjustment scale
FAQ - Functional Activities Questionnaire
Major depression occurs most often in which of the following conditions?
A. Myocardial infarction
Parkinson’s disease
Stroke
Alzheimer’s disease
Stroke
Which of the following statements about multiple sclerosis (MS) is correct?
MS is a chronic, untreatable illness that is almost always fatal.
MS is a disease of steadily progressive and unrelenting neurologic deterioration.
MS is a chronic, treatable illness with unknown cause and a variable course.
Patients with MS who take active steps to improve their health have the best cure rate.
MS is a chronic, treatable illness with unknown cause and a variable course
