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Question 1

What is the INR range for most

Answer 1

2-3

Question 2

What is the acceptable range for INR for those with mechanical heart valve

Answer 2

2.5-3.5

Question 3

What does high INR mean

What is low INR mean

Answer 3

INR measures how long it takes for your body to clot

High INR:
Prolonged bleeding risk
Frequent nose bleeds
Bloody/ tarry stools
Hematuria
Petechiae
Excessive bruising

Low:
Can reduce the anticoagulant effect of warfarin if you eat lots of food with vitamin K (green leafy, broccoli)

Question 4

Which antibiotic med has an increase risk in Achilles tendon rupture

Answer 4

Fluoroquinolones (levofloxacin)

Question 5

What does high sensitivity mean

Answer 5

It can correctly identify an individual who has the disease.

Question 6

What does it mean to have high specificity

Answer 6

High specificity is the ability of a test to correctly identify an individual who does not have the disease.

Question 7

What is positive predictive value

Answer 7

Positive predictive value is the probability that subjects with a positive screening test truly have the disease

Question 8

What is negative predictive value

Answer 8

Negative predictive value is the probability that subjects who have a negative screening test truly do not have the disease.

Question 9

Labyryntitis presents like

Answer 9

rapid onset of severe vertigo with nausea, vomiting, and gait instability.

Question 10

BPPV presents like

Answer 10

recurrent episodes of vertigo provoked by certain head movements.

Question 11

Ménière’s disease present as

Answer 11

Ménière’s disease experience vertigo as a rotatory spinning or rocking with nausea and vomiting, hearing loss, and tinnitus.

Question 12

A patient presents with reduced hearing, tinnitus, and fullness in the affected ear. The patient reports frequent spontaneous episodes of vertigo, each lasting at least 30 to 45 minutes. Audiometry confirms sensorineural hearing loss in the affected ear. Which of the following is the first-line treatment for this diagnosis based on the clinical findings?

A.Vestibular rehabilitation therapy
B.Lifestyle modification including salt restriction
C.Pharmacotherapy with diuretics
D.Glucocorticoid therapy for symptom management

Answer 12

Answer: B. Lifestyle modification including salt restriction

This patient is presenting with findings supporting the clinical diagnosis of Ménière’s disease. Patients experience progressive hearing loss with vestibular symptoms, including spontaneous episodes of vertigo that last 20 minutes to 12 hours and occur two or more times, and fluctuating aural symptoms (reduced hearing, tinnitus, or fullness). Audiometry confirms sensorineural hearing loss. Initial therapy includes lifestyle modifications such as salt restriction and limiting of caffeine and alcohol consumption. Vestibular rehabilitation and pharmacotherapy may be considered with patients with persistent disequilibrium and refractory symptoms.

Question 13

What is the first-line treatment for allergic rhinitis?

A.Saline nasal spray
B.Oral antihistamine
C.Topical nasal decongestant spray
D.Topical nasal steroid spray

Answer 13

Answer: D. Topical nasal steroid spray

The first-line treatment for allergic rhinitis is a topical nasal steroid spray, which is used once or twice per day. Allergic rhinitis can be seasonal (e.g., due to ragweed, mold, or pollens), or it can be due to an indoor allergen, such as dust mites. If it is severe or accompanied by asthma, referral to an allergist for allergy testing is helpful. Topical nasal decongestant spray (e.g., Afrin) is for short-term use only because it can result in a rebound effect with worsening of symptoms (rhinitis medicamentosa).

Question 14

A patient presents with a severe sore throat, fever, and a “hot potato,” or muffled, voice. The patient is drooling due to difficulty opening the mouth. Unilateral swelling and a bulging red mass are noted on physical examination. These findings are suggestive of which diagnosis?

A.Epiglottis
B.Acute pharyngitis
C.Infectious mononucleosis
D.Peritonsillar abscess

Answer 14

Answer: D. Peritonsillar abscess

These findings are suggestive of a peritonsillar abscess, a collection of pus between the palatine tonsil and the pharyngeal muscles. Common symptoms include a severe sore throat; a fever; a “hot potato,” or muffled, voice; drooling; and trismus. Physical assessment reveals an enlarged tonsil with deviation of the uvula. Epiglottis also presents with fever and drooling; however, airway stridor and respiratory distress are more common, along with “sniffing” posture. Acute pharyngitis causes nonspecific symptoms such as a sore throat and cervical lymphadenopathy. Infectious mononucleosis presents with fever, pharyngitis, adenopathy, fatigue, and atypical lymphocytosis.

Question 15

A patient presents with conductive hearing loss secondary to otitis media. What findings are expected with the Rinne and Weber tests?

A.Weber lateralizes to good ear
B.Bone conduction > air conduction
C.No lateralization noted on the Weber test
D.Air conduction > bone conduction

Answer 15

Answer: B. Bone conduction > air conduction

An abnormal Rinne test (bone conduction > air conduction) is seen in patients with conductive hearing loss. The Weber test suggests sensorineural hearing loss if the sound lateralizes to the good side; conductive hearing loss is suggested if the sound lateralizes to the bad side.

Question 16

A patient presents for their annual routine eye exam. Which of the following findings on fundoscopy examination warrants rapid lowering of the blood pressure?

A.Arteriovenous nicking
B.Cotton-wool spots
C.Papilledema
D.Microaneurysms

Answer 16

Answer: C. Papilledema

All patients with newly diagnosed hypertension should receive a fundoscopy because the retina is the only part of the vasculature that can be visualized noninvasively. Ocular diseases directly related to hypertension are progressive and can be classified by their degree of severity. Arteriovenous nicking alone indicates mild hypertensive retinopathy, whereas cotton-wool spots, hemorrhages, and microaneurysms are indicative of moderate hypertensive retinopathy. Severe hypertensive retinopathy is indicated by swelling of the optic disc (papilledema), alongside retinal hemorrhages, hard exudates, cotton-wool patches, microaneurysms, and arteriovenous nicking. The presence of papilledema warrants rapid lowering of the blood pressure. It occurs when increased intracranial pressure spreads to the optic nerve sheath. Urgent diagnosis, evaluation, and treatment are needed to prevent serious complications.

Question 17

When do you send to emerge for a burn?

Answer 17

> 10% TBSA (adult)
5% TBSA (children)
If face, ears, eyelids, arms, perineum is involved
If hands or feet or circumferential burns
Concomitant trauma (electrical)

Question 18

An adult patient presents after a cooking accident with hot oil. The patient presents with burns to their bilateral anterior arms and upper anterior chest. Using the rule of nines, what is the percentage of burned body surface area?

A.18%
B.9%
C.27%
D.21%

Answer 18

Answer: A. 18%

Using the rule of nines, each anterior arm is 4.5%, and the upper anterior chest is 9% (4.5 + 4.5 + 9 = 18%).

Question 19

What is a complete CI to wound closure?

Answer 19

Wounds with presence of cellulitis or abscess

An absolute contraindication to wound closure is the presence of cellulitis or abscess (erythema, warmth, swelling, and pain with or without pus drainage).

Question 20

What is closure by primary intent

Answer 20

refers to wound closure immediately following the injury and prior to the formation of granulation tissue

Most patient presents within 8 hours of injury and can have the wound closed by primary intent

Question 21

When should you not close a wound?

Answer 21

If >8hrs has lapsed since injury

Question 22

What is closure by secondary intent

Answer 22

Allowing wounds to heal on their own without surgical closure.

Question 23

Closure by tertiary intent, what is it

Answer 23

Approach of having the pt return in 3-4 days, after initial wound cleansing and dressing for wound closure. Usually used for patients with wounds who present late for care, contaminated crush wounds and mammalian bites when leaving the wound open would result in an unacceptable cosmetic result

Question 24

A patient with a history of frequent nail biting presents with a rapid onset of painful erythema and swelling of the proximal and lateral nail folds. The patient denies any past medical history. Physical examination reveals a superficial abscess. Initial treatment includes which of the following?

A.Topical antibiotics
B.Warm water or antiseptic soaks
C.Oral antibiotic therapy with Methicillin-resistant Staphylococcus aureus (MRSA) coverage
D.Incision and drainage

Answer 24

Answer: D. Incision and drainage

This patient is presenting with paronychia, an acute local bacterial skin infection of the proximal or lateral nail folds. Risk factors include manicuring, nail biting, and picking at a hangnail.

Paronychia with an abscess is treated with incision and drainage.

For paronychia without abscess, treatment includes topical antibiotics and warm water or antiseptic soaks (e.g., chlorhexidine, povidone-iodine) multiple times per day.

Empiric oral antibiotic therapy may be indicated in patients with or without an abscess with persistent inflammation after initial treatment. However, this patient does not have a risk factor that indicates the need for MRSA coverage (e.g., recent hospitalization, HIV infection, IV drug use, military service, crowded living conditions).

Question 25

A patient with diabetes and a prior history of cellulitis presents with yellow to brown discoloration of more than 50% of the nail of the great toe. The nail is opaque and thickened with separation of the nail plate from the nail bed. First-line treatment for this condition includes which of the following?

A.Topical efinaconazole
B.Oral ketoconazole
C.Topical ciclopirox
D.Oral terbinafine

Answer 25

Answer: D. Oral terbinafine

The patient is presenting with clinical features suggestive of onychomycosis. Treatment is not necessary for all patients but is recommended for patients with diabetes or a history of cellulitis, patients with pain or discomfort with infected nails, immunosuppressed patients, and patients who desire treatment for cosmetic purposes. This patient meets the criteria for moderate to severe dermatophyte onychomycosis because the dermatophyte onychomycosis involves more than 50% of the nail. First-line treatment is oral terbinafine.

Topical therapies (e.g., efinaconazole, ciclopirox) are treatment options for mild to moderate onychomycosis <20% of nail. Oral ketoconazole is not recommended due to the risk of life-threatening hepatotoxicity, adrenal insufficiency, and multiple drug interactions.

Question 26

Which of the following is a palpable lesion measuring <1 cm in diameter?

A.Macule
B.Plaque
C.Papule
D.Vesicle

Answer 26

Answer: C. Papule

Papules are palpable, discrete lesions measuring <1 cm in diameter.
Macules are nonpalpable lesions measuring <1 cm that vary in pigmentation from the surrounding skin.
Plaques are elevated lesions that are >1 cm in diameter.
Vesicles are small (<1 cm in diameter), circumscribed skin papules that are filled with clear serous or hemorrhagic fluid.

Question 27

Which of the following is a reportable disease?

A.Molluscum contagiosum
B.Rocky Mountain spotted fever
C.Scarlet fever
D.Scabies

Answer 27

Answer: B. Rocky Mountain spotted fever

Spotted fever rickettsioses, including Rocky mountain spotted fever, is a nationally notifiable condition. Molluscum contagiosum, scarlet fever, and scabies are not reportable.

Question 28

A figure skater lands incorrectly after a jump and injures the right ankle. The patient is unable to bear weight immediately after the injury but is able to limp into the clinic. The patient reports pain in the malleolar zone. On physical examination, there is significant swelling, but a palpable dorsalis pedis and posterior tibialis pulse are present. Based on the Ottawa ankle rules, is a radiograph necessary?

A.Yes, the patient reports pain in the malleolar zone.
B.No, there are palpable distal pulses with no concern for neurovascular compromise.
C.Yes, the patient is unable to bear weight immediately after the injury.
D.No, the patient is able to limp into the clinic, so they are considered able to bear weight.

Answer 28

Answer: D. No, the patient is able to limp into the clinic, so they are considered able to bear weight.

According to the Ottawa ankle rules, plain radiographs of the ankle are indicated only if there is pain in the malleolar zone and bony tenderness over the posterior edge or tip of the medial or lateral malleolus or inability to bear weight both immediately after the injury and for four steps into the ED or doctor’s office. The patient is considered able to bear weight if they can transfer weight twice to each foot (four steps), even if they limp.

Question 29

A football player presents to the clinic with knee pain. The patient reports a direct blow to the lateral aspect of the knee during a tackle. A plain radiograph is negative for an acute fracture. On exam, there is knee swelling, ecchymosis, and tenderness to palpation. The valgus stress test reveals laxity at about 30 degrees of flexion. Based on this presentation, the nurse practitioner suggests which of the following?

A.Medial meniscus tear
B.Medial collateral ligament injury
C.Lateral collateral ligament injury
D.Hamstring injury

Answer 29

Answer: B. Medial collateral ligament injury

The patient is presenting with concern for an injury to the medial collateral ligament, which is often injured through stress from a direct blow to the lateral aspect of the knee. The valgus stress test is used to identify an injury to the medial collateral ligament; pain or laxity while the knee is flexed at about 30 degrees suggests a positive finding. The varus stress test is used to identify an injury to the lateral collateral ligament. McMurray’s test is used to assess for a meniscal injury. Patients with meniscal injury often present with joint line tenderness, abnormal knee motion, inability to squat or kneel, joint effusion, and inability to fully extend the knee or loss of smooth passive motion. A hamstring injury often presents with posterior thigh pain with focal warmth and tenderness.

Question 30

Varus stress applied to the knee assesses for which type of injury?

A.Posterior cruciate ligament
B.Medial collateral ligament
C.Anterior cruciate ligament
D.Lateral collateral ligament

Answer 30

Answer: D. Lateral collateral ligament

The varus stress test identifies an injury to the lateral collateral ligament. The valgus stress test identifies an injury to the medial collateral ligament. The anterior drawer test helps to identify an injury to the anterior cruciate ligament. The posterior drawer test looks to identify an injury to the posterior cruciate ligament.

Question 31

A 37-year-old male patient complains of an acute onset of pain and redness of his left wrist. He denies trauma or injury to the wrist. He reports that the condition has occurred on the same wrist before. The symptoms started at night after drinking a few glasses of wine. During the physical exam, the left wrist is red, swollen, and tender to palpation. The skin is intact but feels warm to the touch. Which of the following is recommended for the initial treatment of this flare?

A.Interleukin-1 inhibitor
B.Oral glucocorticoids
C.Aspirin
D.Intraarticular glucocorticoids

Answer 31

Answer: B. Oral glucocorticoids

Oral glucocorticoids (e.g., prednisone), nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., naproxen, indomethacin), or colchicine can be used to treat a gout flare. Aspirin is not used because of the paradoxical effects of salicylates on serum urate. Intraarticular glucocorticoids are indicated if the patient is unable to tolerate oral medications. Interleukin-1 inhibitors (e.g., anakinra, canakinumab) are indicated for patients who are unresponsive or have contraindications to initial therapy.

Question 32

In a patient with osteoarthritis without known cardiovascular disease who is at increased risk of gastrointestinal (GI) bleeding, which of the following analgesics is preferred?

A.Naproxen
B.Celecoxib
C.Ibuprofen
D.Acetaminophen

Answer 32

Answer: B. Celecoxib

Celecoxib is preferred in patients without known cardiovascular disease who are at increased risk of GI bleeding due to its greater long-term GI safety profile compared with naproxen and ibuprofen. Acetaminophen is no longer recommended for the treatment of osteoarthritis given safety concerns and nonclinically significant effects on pain.

Question 33

An older adult patient with osteoarthritis of the knee presents with persistent joint pain, stiffness, and motor restriction. The patient has engaged in physical therapy and weight management strategies with little relief of symptoms. The patient has a history of hypertension and peptic ulcer disease. Which of the following treatment regimens should be trialed first in this patient?

A.Topical diclofenac
B.Oxycodone
C.Duloxetine
D.Acetaminophen

Answer 33

Answer: A. Topical diclofenac

Nonpharmacologic therapy is recommended first in patients with knee osteoarthritis. For those who have not responded adequately to initial interventions, pharmacologic therapies can be used when symptoms are present. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for knee osteoarthritis due to their greater safety. The risk of gastrointestinal, renal, and cardiovascular toxicity is much lower with topical NSAIDs compared with oral formulations. Opioids should be avoided due to their adverse effects for long-term use in the older adult population. Acetaminophen is no longer recommended given safety concerns and nonclinically significant effects on pain. Duloxetine may be used for patients with knee osteoarthritis who have not responded to other initial treatments.