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Adult Primary Care Review
Terms in this set (171)
Which is a modifiable risk factor for melanoma
Considerable sun exposure and sunburn
A 19 year old female comes to your clinic for a routine visit to obtain birth control pills. You notice a red sunburn over her body. She states that she stayed a little too long in the sunbed. She denies pain and appears happy. What is your most appropriate course of action for skin health promotion and disease prevention?
Ask how often she uses the sun bed and explore why it is important to her
Large, flaccid bullae with honey-colored crusts around the mouth and nose are characteristic of
You examine a patient with a well demarcated erythematous rash with silvery scale. You diagnose____?
A teenage male comes to your clinic with the chief complaint of foot odor. He notes "extra" white skin between his toes. He denies pain at this time. On history you find that he plays on the local high school football team and is sexually active. What will you include in your plan of care?
Miconazole nitrate 2% cream or Clotrimazole 1% solution twice a day x 4 weeks
A 60 year old male comes to your office with a history of urticaria. He is staying at home more due to his "rash". The lesions are papular and scabbed on extremities and trunk. What will you include in your treatment plan?
Assess medication list for ACE inhibitors and NSAIDs
A teenager comes to your clinic with the chief complaint of warts located on her hands. Which treatment is NOT an evidence-based option?
Shaving the warts
Mr. Jackson, age 64, is active and continues to farm as he has all of his adult life. He is asymptomatic for skin lesions. What should you discuss with him for skin health promotion and disease prevention course of action in this patient encounter?
Show Mr. Jackson how to inspect his skin using the ABCDE model and encourage him to do self-skin-inspections
A 40 y/o man comes to the office with a rash of 4-5 months duration. He had bumps on his shoulders, back and arms. He reports that the bumps are larger, he has nighttime pruritis and oral and topical corticosteroids have not helped. He has no pets, lives alone, and recalls no insect bites or contacts with anyone with a rash. On eaxm there is a symetric eruption with erythematous papules and excorations on his back, shoulders, axillae, wrists, scrotum, and upper legs. There are a few pustles in the axillae. Which of the following is the most appropriate next step?
Examine a skin scraping in mineral oil under a light microscope
A 75 y/o man in a nursing facility has developed a Stage 3 pressure ulcer. He weighs 160 lbs with a 10 lb weight loss in the last month. BMI=20.5, Albumin 3.2, Pre-albumin 14. Which of the following is most likely to aid healing?
Protein 100 GM qd
A 70 y/o patient has a large sacral ulcer measuring 11 by 10 cm, with a depth of 4 cm. There is surrounding erythema, exposed muscle, undermining of the edges and a tunneling tract that extends another 2 cm. Within the ulcer, there is necrotic material and a significant amount of exudate with a foul odor. Which of the following is the next step to reduce odor?
Perform surgical debridement
A 60 y/o woman is evaluated because she has erythematous lesions. Initially, the lesions were on her arms and legs. By the end of week 1, the lesions spread to her trunk and several large blisters appeared. The lesions are pruritic and cause her to scratch. On exam, there are areas of erythema with tense blisters and serous exudate. Some blisters have opened into oval erosions with serous exudate. Some blisters are covered in scabs. What is the most likely diagnosis?
A 32 y/o woman comes to the office c/o a bad taste in her mouth. She takes Metformin and Valsartan. Three weeks ago she took Nitrofuratonin for a UTI. On exam, there are white plaques on the surface of her cheeks, hard palate, and tongue. Wiping off some of the plaques reveals an erythematous mucosal surface. Which of the following is the most likely diagnosis?
Acute psuedomembranous candidiasis
All of the following are true about renal dosing EXCEPT
Reducing each dose while maintaining the dose interval presents no risks
When following up on response to treatment for a bite injury which diagnostic test can be used to evaluate the response to the treatment?
C reactive protein
Which of the following factors contributes to the potential for antibiotic resistance?
Environment, Patient, Drug
The best description of logical antibiotic prescribing involves which of the following
Answering the 10 questions of logical prescribing
An example of a disease caused by vector transmission is
An example of a disease caused by indirect transmission is
An example of a disease caused by direct transmission is
Herpes Type 1
Infections are defined as a harmful invasion and spread of a foreign species or pathogen. Which of the following are sources of infection?
All of the above: Prions, Fungus & Protists
Epidemiology is defined as
The science of discovering the causes of illnesses and injury in populations
Which of the following statements is true regarding the first pass metabolism process?
After a drug is taken by the oral route, it is absorbed in the small intestines and enters the liver through the portal circulation before being released into general circulation.
You would recommend the pneumococcal vaccine to patients with all of the following conditions EXCEPT
G6PD deficiency anemia
Erythromycin inhibits the cytochrome P450 system. The following drugs should be avoided because of drug interaction EXCEPT
All of the following are included in the criteria used to diagnose patients with AIDS EXCEPT
Which of the following is the confirmatory test for the HIV screening test?
Cat and human bites have higher rates of infection than dog bites. A patient comes to your office with a bite. It does not require sutures or appear infected. You want to prescribe antibiotic prophylaxsis. The patient has no history of allergies. You presctibe:
74 y/o with a 4 month history of severe stiffness and aching in her neck and both shoulders and hips that is worsened by movement. She reports having difficulty getting OOB and dressing. She also has a low grade fever, fatigue, loss of appetite and weight loss. Yesterday the vision in her right eye has progressively worsened. Which of the following is the most likely?
Multiple myeloma is a malignancy of the
Which of the following exam findings is most specific for lupus?
Which of the following lab tests is positive in a large number of patients with lupus?
Which of the following is recommended treatment for early Lyme disease?
Doxycycline 100 mg bid x 30 days
Which of the following viral infections is associated with occasional abnormal forms of lymphocytes during an acute infection?
Lyme disease is caused by the bite of a
Sue has sickle cell anemia. What is the optimum range for her hemoglobin and hematocrit levels?
Slightly below normal.
You have ordered a CBC for your patient you suspect has polymyalgia rheumatica (PMR). Which two clinical findings are common in patients with PMR?
normochromic, normocytic, anemia with thrombocytosis
In terms of immune response, a mantoux skin reaction is an example of:
T cell immunity
Frank, a 66-year-old white male who is on diuretic therapy, presents with an elevated hematocrit. He also has splenomegaly on examination, as well as subjective complaints of blurred vision, fatigue, headache, and tinnitus. You suspect:
You begin ferrous sulfate 325mg daily for your patient who was recently diagnosed with iron deficiency anemia with corrected source of iron loss. Based on the life span of RBCs, when would you expect to see a maximum response to your treatment plan?
3 - 4 months
The total iron for a 56 year old female patient is 40 mcg/dl, TIBC 401 mcg/dl, Transferrin Saturation 8%, Ferritin 150 ng/ml, MCV is 82, Hgb is 10.6, Hct 30.3 and WBC is 8.5. These lab results indicate:
anemia of chronic disease
Anemia of chronic disease is most commonly associated with which of the following conditions:
Inflammation, infection, neoplasms
responsible for immunity obtained from vaccinations
eliminates pathogens in the early stages of B cell mediated (humoral) immunity
Found in mucosal areas; prevents colonization of pathogens
Binds to allergens and triggers release from histamine receptors, basophils, and mast cells
Pernicious anemia is due to a(n):
Intrinsic factor deficiency.
Amy, a 34-year-old patient receives an influenza vaccination in your office today. Understanding how humoral immunity develops, you expect which of the following:
She will have immediate immunity due to an increase in IgM antibodies.
The following clinical signs are seen in Parkinson's disease EXCEPT
Increased facial movements due to tics
A 56 y/o complains of episodes of lacinating pain that shoots up to his right cheek when he eats or drinks, He has stopped drinking cold drinks because of the pain. Most likely this is
When assessing a patient suspected of having vertigo, which description provided by the patient is most consistent with the diagnosis?
A sensation of spinning or rotating
During the eye exam of a 50 y/o patient with HTN complaining of an onset of a severe headache, you find that the borders of the disc margins in both eyes are blurred. What is the name of this clinical finding?
Carol, a 73 y/o, complains of episodic vertigo, slight confusion, and weakness that last nearly an hour each time. Movement does not worsen the symptoms. She rests and her symptoms subside but is puzzled because the weakness "jumps from side to side", sometimes on the right and sometimes on the left of her body. Her symptoms suggest:
TIA (transient ischemic attack)
Jean, a 68 y/o, is suspected of having Alzheimer's disease. Which of the following is the best initial method for assessing the condition?
MMSE or MOCA
A 60 year old female patient in your clinic reports the recent onset of lancinating, cutting pain (pain scale: 8) on the right side of her face that lasts for approximately 5-10 seconds. The pain commenced after brushing her teeth and there has been no pain between the two recent episodes. You suspect trigeminal neuralgia (tic douloureux). Which of the following best describes your plan of care today?
Schedule MRI and start Carbamazepine (Tegretol) at 100 mg. BID. Plan to monitor Tegretol blood levels and liver function.
Your patient comes for an annual visit and notes his legs have started "twitching" at night. Sometimes they feel like they shake. What do you know about restless leg syndrome?
May be seen in iron deficiency anemia, peripheral neuropathy (especially diabetic); there may be a genetic component
A patient comes to your clinic with the chief complaint of hand tremor and some balance problems. You want to differentiate between a benign essential tremor and Parkinsonism since he has neither diagnosis on record. What information do you need to collect?
Family history, evidence of rigidity, bradykinesia & postural instability
A 21 year old female patient comes to your clinic with complaints of headache. The headache is described as unilateral; throbbing or pulsatile. There was no preceding aura but she states mild dizziness with the headache. She denies acute visual changes, nausea, vomiting & photophobia. She states noises bothered her most.On a scale of 1 - 10 she states the headache was 7 but it disrupted her daily activities enough to make an appointment with you. The headache lasted several hours. When asked about her current medications, she states that she recently began taking birth control pills. You forget to ask about a family history so you do not have this information at the current time. You are developing your differential diagnoses. Of the differential diagnoses below, which one do you most suspect?
Classic migraine headache
All of the following drugs commonly cause confusion in older adults except
Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the differential is:
Rapid change and fluctuating course of cognitive function
A 25 year old female comes to your clinic with the chief complaint of new onset headache. What will you include in your history of present illness?
Location of pain, duration of pain, description of pain, triggers, past treatments
Which form of headache is bilateral?
A 32-year-old patient with the right half of her face is paralyzed. She is unable to wrinkle her forehead or close the eye completely. The corner of her mouth droops. She cannot whistle or show her teeth. She has no pain. These findings are consistent with which of the following?
Choose all of the following cranial nerves that innervate the ear.
V, VII, VIII, IX & X
Dignity and respect includes all of the following EXCEPT
Justice is described as
The lack of bias, right to fair and equitable treatment and distribution of societal resources
Utilitarianism is described as
Presenting information in an honest and truthful way
Nonmalficence is described as
Obligation to avoid harm
Beneficence is described as
Obligation to help the patient, remove harm, prevent harm, promote good
Autonomy is defined as
Personal liberty of action and self determination with respect to all persons as individuals
An adult patient is being evaluated for TB and has a positive 2 step PPD. The patient denies symptoms and has a negative chest xray. The patient reports he is in the country illegally and is fearful of discovery. What is the most appropriate acition for the NP?
NPs have the ethical duty to provide quality health care to patients, so do not report and treat him accordingly
A coworker calls the NP and wants to know about a patient's progress. She tells the NP that they are neighbors and she is worried about the patient's health status. The coworker works in the same facility but is not directly involved in this patient's case. Which of the following is the most appropriate action?
Inform the coworker that you cannot release information about the patient because she is not directly involved in her neighbor's care
A patient with amenorrhea is tested for pregnancy and it is positive. She tells the NP that she is seriously considering terminating the pregnancy. She tells the NP she wants to be referred to Planned Parenthood. The NP's personal beliefs and religious beliefs are pro-life. Which of the following is the best action for the NP?
The NP should tell the patient that an NP peer who is working with her can help to answer her questions more thoroughly
The NP calls a patient to discuss the results of routine lab tests, which are all normal. She calls the patient twice and each time the answering machine is on. Which of the following is the most appropriate action for the NP?
When the NP is unable to speak to the patient directly, leave a message with her name and telephone number and instruct the patient to call back
The HIPPA Act was passed in 2003. All of the following statements are true EXCEPT
Patients have the right to review mental health and psychotherapy health information
Sources of legal risk for the nurse practitioner would include all of the following EXCEPT
inservice training of staff
Patients who are considered mentally competent have a right to consent or refuse medical treatment. What is the medical term for this right?
Laws governing NP authority are determined by
Board of Nursing
Nurse practitioners and clinical nurse specialists derive legal right to practice from
The Nurse Practice Act of the state where they practice
Personal liberty of action and self-determination, along with respect for all persons as individuals is the ethical principle of
In Healthy People 2020, one of the goals is to identify nationwide health improvement priorities. What ethical principle below will help achieve this goal?
A 56 year old patient is seen in your office for follow-up of results of routine lab work. You decide, based on his lipid profile that a statin medication is indicated and believe that atorvastatin is the best option for this patient. You note that the patient's estimated glomerular filtration rate is 56ml/min/1.732 . According to the 2012 KDOQI Clinical Practice Guideline, which of the following would be the appropriate rationale in deciding the appropriate dosage of atorvastatin based on his current kidney function?
The patient has Stage III CKD, no dosage adjustment is indicated for atorvastatin
Ms. Smith is a 30 year old nonpregnant, healthy patient with a first-time diagnosis of acute uncomplicated cystitis. Which one of the following medication regimens below is your first choice for treating Ms. Smith?
Trimethoprim-sulfamethoxazole (DS) one tablet q 12 hours for 3 days
The major factor to preventing urinary tract infections is:
Maintaining sterility of the urinary tract
Over the past decade, several studies have shown that proteinuria predicts faster progression of kidney disease to ESRD. Studies have shown that drugs that reduce proteinuria can also slow the progression of established kidney disease. These drugs include which of the following:
Angiotensin-Converting Enzyme (ACE) Inhibitors
Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) are significant public health problems in the US and a major source of suffering and poor quality of life for those affected. Which of the following ethnic group is least likely to develop CKD?
Risk factors for glomerulonephritis include all of the following except:
Which of the following statements about fluid balance in the elderly is false?
Assessment of skin turgor at the sternum is a reliable indicator of dehydration in the elderly
You are reviewing a patient's labwork from a clinic visit. You note that serum creatinine is elevated for the second lab draw in a row. What are you thinking about the patient's glomerular filtration rate (GFR)?
The patient's GFR is probably going down.
A geriatric patient comes to your clinic with a family member who notes an acute onset of confusion. You suspect delirium. Which office urinalysis result are you most interested in today?
Maria, a 45 year old patient, is seen today for routine office visit. She has no specific complaints. Her medical history is pertinent for hypercholesterolemia. Her urine dipstick shows 1+ nitrites, 10 RBCs, specific gravity 1.022, and 2+ protein. Your plan of care includes which of the following?
Repeat urinalysis in 1 week.
Nephritic syndrome is synonymous with:
A 72 y/o patient comes to the clinic for treatment for recurrent cystitis. In addition to antibiotic treatment for the current symptoms, she asks what can see use to prevent further episodes. What would you advise?
Cranberry juice > 10 oz per day
Your patient with a history of glaucoma is noted to have a new onset of bilateral wheezes and your differential diagnosis includes asthma. In reviewing the medication list what category of medications would give you concern?
A patient comes to clinic with an acute eye complaint. Your initial focus is on the history and you include all of the following in your history of present illness except
Presence of muscle paresis
A 50 year old male is seen in your clinic for a history of hoarseness lasting greater than 3 weeks. His voice has a harsh quality with a low pitch. He denies a recent history of upper respiratory infection. To assist you in defining the differential diagnoses, the pertinent review of systems would include all of the following except :
Current use of ACE inhibitor
A 35 year old female is seen in your clinic with the following findings on right ear exam: erythematous tympanic membrane with altered bony landmarks and diminished cone of light. A small amount of fluid is noted directly behind the membrane. She gives a history of feeling fatigued and she had sinusitis two weeks ago that has resolved. What is your diagnosis today?
A 66 year old White male is seen in your clinic for continued tinnitus. His past occupational exposure history is positive for excessive loud noises. His history is negative for head trauma, allergies, hypertension and thyroid disease. His cholesterol is borderline high and he has chronic knee pain from years of jogging. You review his medication list and want to discontinue any medications that may contribute to tinnitus. Which medication below are you most likely to discontinue today?
The definitive test for sleep apnea is
an overnight polysomnogram
Hordeolum and chalazia are commonly seen in the primary care setting. Knowing the etiology and common organisms associated with the disorders assists the provider in selecting appropriate therapies. What common gram-positive bacteria is oftern associated with hordeolum and chalazia?
Papilledema is caused by?
Increased intracranial pressure
Obtaining an occupational and environmental history in patients is important for the assessment of many upper and lower respiratory diseases. It is not sufficient to ask a patient, "Have you been exposed to anything?" The NP must be directed and specific in questioning a patient when an environmental exposure assessment is done. Consider the following and mark all that would be included in an occupational and environmental history.
cigarette use, type of industry and specific work, pets, military service, location of military service, loud noise exposure
A 74 y/o woman comes to the office for a routine exam, when asked about her hearing she indicates she cannot always understand what people are saying because they mumble. She appears to struggle to hear questions and seems more withdrawn and confused than in the past. Which of the following is the most appropriate next step?
screen for hearing impariment and handicap
A 58 y/o woman comes to the office c/o considerable frustration understanding clients in her law office. She has worn hearing aids since age 40 when severe to profound sensorineural hearing impairment developed in both ears. She recently had a hearing test that showed no changes and reaffirmed the diagnosis. She has read about bone-anchored heading aids and cochlear implants and wonders if these may be appropriate in her case. Which of the following is the best recommendation?
Cochlear implant in one ear and a new hearing aid in the other
A 85 y/o man comes to the office because he has severe pain and blurring in the right eye that improves with blinking or rubbing. Which of the following is most likely cause of his symptoms?
A 30 y/o comes to the office because he has a loss of taste, painful ulcerations on the lips and tongues, and soreness in his mouth that hinders chewing. He started chemo and radiation 2 weeks go for laryngeal cancer. On exam, his oral mucosa is red, raw, and tender with sloughing tissues. Which of the following is the most appropriate management?
initiate supportive treatment for oral mucositis
You are seeing a 54 year old Asian-american patient with Type II DM. In review of his lab work, his HgbA1c is 10.6. His calculated eGFR is 52ml/min/1.732 . He is 68 inches tall and weighs 210 pounds (95.45 kg) today. You determine he needs to begin insulin therapy. You calculate his total daily dosage of insulin to be (round to the nearest whole number):
The diagnosis of hypothyroidism is made by measuring
TSH and T4
Blood sugar is considered well controlled in an older adult with comorbid conditions when Hemoglobin A1C is:
Your patient has no past history of diabetes, heart disease, or endocrine disorders. Today your patient presents with a recent onset of polyuria, polydipsia, weight loss, and fatigue. What will your plan of care include today?
urinalysis and glycosylated hemoglobin (A1C)
A 86-year old woman presents to the geriatrics clinic with lower back pain. She has a history of vertebral-crush fractures secondary to osteoporosis. She took hormone replacement for five years after menopause (from age 50 to 55), but she discontinued it due to the intolerable side effects. Her only other significant medical condition is gastroesophageal reflux disease (GERD). In addition to calcium and vitamin D, which of the following is the most appropriate treatment for this patient's osteoporosis?
All of the following are considerations in treating a patient with hypothyroidism EXCEPT
Practitioners are encouraged to write prescriptions that allow substitution so the patient may obtain a less expensive generic form of the medication
Your patient had a vitamin D [25(OH)D] level below 20 ng/ml. You prescribed Cholecalciferol 50,000 iu weekly for 8 weeks. The patient assures you that she has been compliant with her regimen but her levels have not responded to treatment as expected. What laboratory test would you now consider in your plan of care to further evaluate the poor response?
Parathyroid hormone (PTH)
The diagnosis of autoimmune thyroid disease is made by adding which of the following to a standard thyroid panel?
Antimicrosomal antibody (anti-TPO antibody)
According to the American Association of Clinical Endocrinologists (AACE), in a patient with type 1 diabetes mellitus with a HgbA1c > 8, which of the following is not an appropriate treatment plan option?
Begin insulin therapy and metformin concurrently to assist with insulin resistance.
You have a 33-year-old patient with diabetes type 2. Your patient has a fasting plasma glucose of 280 mg/dl and a HbA1c of 10%. What is the first step in assessing her for diabetic nephropathy?
random urine for protein
A 75 y/o woman receives a new diagnosis of DM Type II. History includes DVT 5 years ago, HTN, depression, and generalized anxiety. Meds include HCTZ 12.5 mg qd, Lisinopril 10 ng qd, Citalopram 40 mg qd, and ASA 81 mg qd. Physical exam: Height 5 ft., Weight 86 lbs., BP 130/80, P 82. Labs: Glucose 147, Creatinine 1.0, BUN 16, HgbA1C 9. Which of the following is the best initial approach to this patient?
Glargine (Lantus) 7units qd
An 84 y/o diabetic is taking Metformin 1000 mg bid and Glipizide 10 mg q 12 hours. He performs fingersticks bid with ranges between 100 and the low 200s. His HgbA1C is 8.3. Which of the following is the most appropriate next step?
A 52 y/o woman comes to the office c/o severe burning in her feet which is worse at night. She recently tried Gabapentin but dc'ed it because it caused a gait disturbance. She takes Glargine 20 units qhs and Metformin 1000 mg q12 hours. Her fingersticks have been between 180-200 in the morning and mid 200s in the evening. Which of the following is the next step for her symptoms?
Start pregbalin (Lyrica)
Stewart, age 58, has just been diagnosed with hypertension. His medical history is pertinent for DM. His social history is pertinent for a 30 pack year history of smoking. The NP should take which of the following potential pharmacological effects into consideration when choosing a treatment plan for Stewart's choosing a treatment plan for Stewart's hypertension.
B-Blocker may cause fatality during respiratory distress d/t pharmacologic action
James, an 88 year old patient is seen in the clinic today. His exam is suggestive of atrial fibrillation. In addition, you hear a low grade II rumbling murmur over the aortic area. His EKG shows the absence of P waves and prominent R wave in V1. These findings are suggestive of
Dan, a 65 year old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. It is characterized as dull and aching, 8/10 during activity, otherwise 0/10. It began a few months ago and has been intermittant, aggravated by exercise and relieved by rest. Has occasional nausea. Pain is retrosternal radiating to the left shoulder, definitely affects quality of life by limiting activity. Pain is worse today, did not go away after he stopped walking. BP 120/80, Pulse 72 and regular. Normal heart sounds, S1, S2, no murmurs. Which of the following differential diagnoses would be the most likely?
CAD with angina
Sarah, who is postmenopausal, has well-controlled asthma and hypertension comes to the office for a routine visit. She is a current smoker with a 10 year pack history. Her LDL cholesterol is 170 mg/dl and her HDL cholesterol is 40 mg/dl. To maxmize Sarah's risk reduction for a cardiovascular event, the primary focus of her treatment plan would be
Jamie, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be?
hospitalize in monitored bed with meds
Martin, age 56, has hypertension and has been taking anti-hypertensive medication for about 10 years. He has been very stable. You have not seen him in 6 months. His exam today should specifically include
Pharmacologic therapy should be started in any patient who is diagnosed with hypertension and has end organ disease. In most cases it should begin with
The best evidence rating drugs to consider in a post MI patient include
ASA, statin, ACEI/ARB, Beta Blocker
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find a S3 heart sound, pulmonary crackles (rales) that do not clear with coughing, and peripheral edema. What do you suspect?
In the person with hypertension, which of the following yields the greatest potential reduction in blood pressure in a patient with a BMI of 35
10kg weight loss
Jose is a 68 year old man who presents to your primary care practice for a physical. He has had Type 2 diabetes for 5 years, diet controlled. His BMI is 32. Smokes a pack a day for the last 25 years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now deceased, CHF, DM, hypertension for mother. According to the AHA/ACC guidelines, which heart failure stage would you grade Jose?
Stage A: at high risk for heart failure but without structural heart disease or symptoms of heart failure
The classic change seen on a 12 lead EKG during an acute MI is
ST segment elevation
Which of the following statements is true regarding grading systolic heart murmurs
V/VI heard with stethoscope off chest
Which of the following symptoms might a client with congestive heart failure resulting from pulmonary hypertension exhibit
An 81 year old man comes to the office for a routine appointment. History includes moderate aortic stenosis for the past 8 years, managed with beta blockers, chronic CAD, prostate cancer Stage 2, and mild COPD. He received a left anterior descending artery stent in 2001. At this appointment, his daughter notes that her father is much less active than in the past. An echocardiogram last month showed a 3m/sec increase in peak aortic velocity.Which of the following is true regarding the management of this patient?
valve replacement considered
A 74 year old woman comes to the office for preoperative evaluation before cataract surgery. History included MI 10 years ago, and her record states that her ejection fraction is 30%. Medications include extended release metoprolol, lisinopril, and spironolactone. Dyspnea on exertion is consistent with NYHA functional class II. She has never been hospitalized for heart failure and has no palpitations or syncope. EKG shows a 4 beat run of sustained ventricular tachycardia. Which of the following is the most appropriate next step?
Recommend placement of an ICD
A 92 year old comes to the office for follow up. History includes osteoarthritis, well-controlled hypertension, GERD, and a recent cold. Prescribed medication include chlorthalidone and lisinopril. On exam, BP 162/70 and pulse is 76. On further questioning, the patient states her daughter has been giving her OTC Ibuprofen because she has knee pain which is now resolved. She has also been taking an OTC pseudophedrine 30 mg for several days of congestion. Which of the following is the most likely cause of her high blood pressure?
A 70 year old woman comes to the office for routine follow up. History includes diabetes, hypertension, and hypercholesterolemia. Medications include ASA, glipizide, lisinopril, simvastatin, and a multi-vitamin. Total cholesterol is 180, LDL is 120, and HDL is 40. She is interested in using therapies other than a statin to improve her cholesterol profile. Which of the following has the strongest evidence to support the effectiveness in lowering cholesterol?
viscous fibers (oats, barley, psyllium)
A 21 year old woman is seen in the clinic with a 3 month history of watery diarrhea. She had similar episodes on three prior occasions with negative stool cultures. Past medical history is notable for knee surgery 2 years ago. Her medications include oral contraceptives. She has not traveled out of the state in the recent past and is a nonsmoker. Examination reveals a slender woman in no distress. Rectal exam shows black mucosa and a negative Heme test. Which of the following statements is correct?
Suspect surrepitious laxative abuse
An 75 year old man comes to the office to discuss whether he should undergo colorectal cancer screening. He has well controlled HTN and walks 2 miles per day. Which of the following is the most accurate statement about colorectal screening for this patient?
UPSTF guidelines say no screening or benefits outweigh burdens
An 80 year old patient comes to the office because she has epigastric discomfort and heartburn. The symptoms occur daily and are not associated with SOB, diaphoresis or dizzyness. She has been taking aluminum and magnesium hydroxide tablets to relieve the symptoms but they provide only temporary relief. A month ago, the patient underwent cardiac catheterization with drug-eluting stents for coronary lesions; history also includes DM and HTN. Medications include Plavix, ASA, Metoprolol, Lisinopril, Pravastatin and Glipizide. She lives with her husband and is independent in all ADLs. Which of the following is the most appropriate pharmacologic intervention for her symptoms?
An overweight middle-aged woman has right upper quadrant pain that radiates to her right subscapular area and is severe and persistent. She is also experiencing anorexia, nausea and a fever. Her most recent meal was a double quarter-pound hamburger with cheese, french fries and a vanilla milkshake. Based on this information, the NP examines the abdomen and percusses for costovertebral angle tenderness. The abdomen is tender in the right upper quadrant. Which of the following signs, if positive, corresponds to the correct diagnosis?
Murphys sign; patient has choleycystitis
A patient with a history of arthritis and gastric ulcers comes to the clinic complaining of severe GI distress. The patient has been taking Ranitidine (Zantac) 150 mg bid. Although the NP would ask all of the following questions, which would be the most important?
"What medications are you using for arthritis?"
A patient has a history of colon polyps. The NP knows
Colon polyps sessile are more likley malignant.
Factors that promote the progression of HCV to liver fibrosis Include
Increased alcohol intake, age greater than 40 years at time of infection, male gender
The NP's patient has early alcoholic chirrhosis diagnosed by liver biopsy. In teaching the patient about her disease, it is important for the NP to inform her that the disease is most likely irreversible at this point, but that the following will generally halt the progression of the disease
Abstinence from alcohol
The NP is performing the initial physical exam on a 51 year old man. The history reveals that the client's father died of colon cancer but the client is asymptomatic. What priority diagnostic tests are used to screen this patient?
stool for O&P and colonoscopy
An elderly patient presents with fever, leukocytosis, colicky lower left quadrant pain and diarrhea alternating with constipation. The NP would make the diagnosis of
A diagnostic tool for assessing chronic constipation is
Clostridium difficile is
Gram positive, spore forming
Folate deficiencies, as seen in alchoholics, is most likely related to
poor dietary intake
A patient with peptic ulcer disease is being treated with a regimen of bismuth subsalicylate (Pepto-Bismol), tetracycline and Flagyl. The patient calls the NP to report his stools are unusually dark. He is not experiencing any gastric discomfort, orthostatic hypertension or increased lethargy. How would the NP interpret this information?
His stools are dark secondary to Pepto-Bismol use
Marcie just returned from Central America with severe nausea and diarrhea. You suspect traveler's diarrhea. Which antibiotic did you order?
John, 42, has changed his diet and lifestyle to treat GERD without success. Your next treatment should include which medication(s)?
Calcium carbonate 500 mg qd and Omeprazole 20 mg qd
L5-S1 nerve compression
Straight leg lift
De Quervain's tenosynovitis
During a pre-participation sports examination, you hear a grade II/VI early midsystolic ejection murmur heard best at the second intercostal space of the left sternal border in an asymptomatic young adult. The most likely represents:
innocent flow murmur
When evaluating a patient with low back pain, bowel incontinence and overflow urinary incontinence most likely indicate which of the following?
Cauda Equina Syndrome
Patients with a grade III ankle sprain should be advised that full recovery will likely take a:
number of months
A grade II ankle sprain is best described as:
Moderate swelling, mild to moderate ecchymosis, moderate joint instability
Risk factors for gout include
Thiazide diuretic use
A 25 year old male presents with complaints of daily back pain localized to his lower back after lifting a heavy box at work 3 days ago. The symptoms interfere with his ability to participate in his bowling league. He denies incontinence, gait instability or radicular symptoms. On examination, you note normal musculature, FROM of the spine with moderate paravertibral tenderness throughout the lubrosacaral spine without spasm. The client complains of posterior thigh pain when his right leg is elevated 75 degrees. His remaining examination is unremarkable. Your diagnosis is:
A 55 year old female presents as a new patient with complaints of a several year history of worsening joint pain that is worse in the morning. On examination, the NP notices Heberden's nodes and understands that this is a sign of:
A 28 year old female presents with complaints of chronic aching pain and stiffness, frequently involving the entire body but with prominence of pain around the neck, shoulders, low back, and hips. She reports frequent headaches and trouble sleeping at least three nights per week and reports that even minor exertion aggravates pain and increases fatigue. Physical examination is normal except for "trigger points" of pain produced by palpation of various areas such as the trapezius, the medial fat pad of the knee, and the lateral epicondyle of the elbow. Your most likely diagnosis would be:
In accurately assessing a client who reports back injury, it is critical to first question:
Mechanism of injury
You've conservatively treated a client for carpel tunnel syndrome for six weeks with cock-up splints, avoidance of repetitive activities, and NSAIDS without significant improvement. Your patient education should include which of the following:
Carpel Tunnel Syndrome patients should be referred to a specialist for injection of corticosteroid into the carpal tunnel or for operation when they do not improve.
A 45 year old female complains of a several week history of pain, burning, and tingling in palmar surfaces of the thumb, the index and long fingers, and the radial half of the ring finger. The pain radiates into the forearm and is exacerbated by her work as a transcriptionist. It is most bothersome at night. On examination she has a positive Tinel's sign and Phalen's maneuver. Your most likely diagnosis is:
Carpal Tunnel Syndrome
A 22 year old presents with significant effusion of the knee resulting from a football injury. You perform a knee aspiration and collect 50 ml of bloody synovial fluid. Choose all components applicable to your plan of care:
Plan to immobilize, MRI and refer due to chance of ACL rupture.
A 36 year old male presents with complaints of pain and swelling in his left knee with associated knee instability and occasional "locking" when walking. He reports playing tennis last week and felt a tearing, popping sensation that caused him to fall to the ground. He denies any bruising. He has self treated with Ibuprofen and wearing a knee brace with partial resolution. Based on this history your differentials should include all of the following except:
Could not be trochanteric bursitis due to locking.
A 36 year old male presents with acute onset of unilateral inflammation, pain, and erythema of the first metatarsophanlangeal (MTP) joint. Differential diagnoses that should be considered include:
cellulitis, arthritis and gout