APEA 3P EXAM 2024 AND PRACTICE EXAM TEST BANK, Exams of Nursing

Download APEA 3P EXAM 2024 AND PRACTICE EXAM TEST BANK and more Exams Nursing in PDF only on Docsity! APEA 3P EXAM 2024 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE | ACCURATE REAL EXAM QUESTIONS WITH ANSWERS | DETAILED AND VERIFIED FOR GUARANTEED PASS | LATEST UPDATE Mr. Jones is a patient with type 2 diabetes. He brings his obese 15-year old son in to see the nurse practitioner. You examined the 15-year old son and find acanthosis nigricans. This probably indicates: a. undiagnosed diabetes b. insulin resistance c. familial skin change d. poor hygiene B A 45-year old female patient has had fatigue for the past three months and a 10 pound weight gain. She previously had regular periods occurring about every 30 days but in the last three months her periods have varied between 30 and 45 days. Her TSH value is 13M LU/L. It was repeated and one week later found to be 15 M LU/L. What explains this finding? a. Subclinical hypothyroidism b. Hypothyroidism c. Transient hypothyroidism d. Perimenopause B A patient who is taking long-acting basal insulin has elevated blood sugars. Which blood sugars are important to review in order to increase the dose of insulin? a. AM fasting b. Two-hour postprandial c. Preprandial d. Bedtime A A patient has a TSH value of 13.1. Today the NP has decided to initiate replacement with levothyroxine 88mcg daily. When should the NP recheck the patient's TSH level? a. Two weeks b. 4 weeks c. Six weeks d. 8 weeks C A 30-year old female patient who complains of fatigue undergoes a screening TSH. Her TSH 8 M LU/L. What should be done next? a. Begin thyroid supplementation b. Repeat the TSH and add T4 c. Begin supplementation and repeat the TSH in 4-6 weeks d. Measure the T4 and consider repeating the test in a month B A 65-year old person with diabetes has been on oral antihyperglycemic agents and is still having poor glycemic control. His AM fasting glucose range from 140 to 160. You decide to add insulin. He weighs 127kg. What should the NP order as an initial starting dose. a. 10 units of long acting insulin at bedtime b. 30 units of long-acting insulin before breakfast c. 5 units of intermediate insulin at bedtime d. 20 units of short-acting insulin at breakfast A The most appropriate time to begin screening for renal nephropathy in a patient with type 1 diabetes is: a. At diagnosis b. Once annually after diagnosis, two to three years after diagnosis c. Two to three years after diagnosis d. Five years after diagnosis D A 52-year old person presents with thirst and frequent urination today. His glucose is 352. How should this be managed today? a. Have him return tomorrow to recheck his blood glucose b. Start metformin c. Start insulin d. Start metformin plus pioglitazone B A nurse practitioner identifies filamentous structures and many uniform oval shaped structures during a microscopic exam of vaginal discharge. These are probably: a. Bacteria b. Sperm c. Hyphae d. Candida albicans C Noninfectious epididymitis is common in: a. Soccer players c. blood pressure 160/100 d. varicose veins D A 25year old male patient is training for a marathon. He reports an acute onset of scrotal pain after a 10-mile run. He has nausea and is found to have an asymmetric high riding testis on the right side. What should be suspected? a. Sports hernia b. Epididymitis c. Testicular torsion d. Prostatitis C A 72-year old patient with a history of polymyalgia rheumatica complains of new onset unilateral headache and visual changes. Her sedimentation rate is elevated. Her neurologic exam is otherwise normal. What is the most likely reason for her symptoms? a. Transient ischemic attack b. Temporal arteritis c. Meningitis d. CVA B A patient complains of right leg numbness and tingling following a back injury. He has a diminished right patellar reflex and his symptoms are progressing to both legs. What test should be performed? a. Lumbar X-rays b. Lumbar CT scan c. Lumbar MRI d. Lumbar MRI with contrast C A 70-year old male patient is diagnosed with vertigo. Which choice below indicates that the vertigo is more likely to be of central etiology a. Brief duration b. Nystagmus present c. Nausea and vomiting d. Persistent symptoms D A patient is examined and found to have a positive Kernig's and positive Brudzinski signs. What is the most likely diagnosis? a. Parkinson's disease b. Encephalitis c. Meningitis d. Pneumonitis C A 75-year old is diagnosed with essential tremor. What is the most commonly used medication to treat this? a. Carbidopa b. Long-acting propranolol c. Phenobarbital d. Gabapentin B A patient is diagnosed with carpal tunnel syndrome. Which finger is not affected by carpal tunnel syndrome? a. thumb b. second finger c. 4th finger d. 5th finger D Which of the following would not be part of the differential diagnosis for an 84-year old patient with dementia symptoms? a. Tumor b. Cerebral hemorrhage c. Cerebral infarct d. Normal aging process D Which of the following are diagnostic criteria for migraine headaches without aura? a. Pain is episodic during the headache b. Pain lasts 4 to 72 hours c. There is underlying neurologic abnormalities d. Photophobia must be present B Mr. Williams has moderate cognitive deficits attributed to Alzheimer's disease and has been started on a cholinesterase inhibitor. The purpose of this drug is? a. Decrease agitation b. Increase anticholinergic stimulation of the brain c. Improved depression d. Slow the progression of his cognitive deficits D Asking the patient to visually follow a finger through the cardinal fields of gaze assesses which cranial nerve? a. I b. II c. III d. V C A young male patient with a herniated disk reports bilateral sciatica and leg weakness. If he calls the nurse practitioner with complaints of urinary incontinence what should be suspected? a. Opioid overuse b. Medial or lateral herniation c. Rupture of the disc d. Cauda Equina syndrome D What recommendation should be made to an older adult who is diagnosed with mild dementia? a. driving will probably not increase your risk of an accident b. the health care provider should recommend that the patient stop driving today c. the health care provider should recommend assessment of driving to determine risk of an accident d. the patient may continue to drive as long as he feels comfortable C A patient who is 82 years old is brought into the clinic. His wife states that he was working in his garden today and became disoriented and had slurred speech. She helped him back into the house, gave him cool fluids, and within 15 minutes his symptoms resolved. He appears to be in his usual state of health when he is examined by you. He states that although he was scared by the event, he feels fine now. How should the nurse practitioner proceed? a. Prescribe an aspirin daily b. Re-examine him tomorrow c. Send him to the ED d. Order an EEG C A 60-year old patient has anosmnia. Which cranial nerve must be assessed? a. I b. II c. V d. X A D When should functional rehabilitation occur once a patient has had an ankle or knee sprain? a. The day of the injury b. Five days post injury c. Two to three weeks after injury d. When the patient's pain level allows A A 45-year old male who is in good health presents with complaints of pain in his left heel. He states that the first few steps out of bed in the morning are extremely painful. He has no history of trauma. What is the likely etiology of his pain? a. Achilles tendonitis b. Plantar fasciitis c. Calcaneal spur d. Arthritis of the foot B Which diagnosis is the least likely cause of extrinsic shoulder pain? a. Angina b. Hepatobilliary disease c. Pneumonia d. Gout D An adolescent athlete has injured his ankle playing basketball. He has right ankle pain, ecchymosis, and significant edema and he is unable to bear weight at the time of the clinical exam. Which diagnosis is least likely? a. Avulsion fracture b. Grade 1 sprain c. Grade 2 sprain d. Grade 3 sprain B Which medication is recommended by the 2020 American College of Rheumatology guidelines as a first line agent for osteoarthritis pain in the knee? a. topical capsaicin b. glucosamine c. topical NSAID d. duloxetine C A 60-year old patient who is otherwise healthy presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with pre- patellar Bursitis. What is a common finding? a. Limping and erythema around the anterior knee b. Swelling and pain to touch in the anterior knee c. Posterior knee pain and anterior knee edema and redness d. Tenderness to touch the tibial tubercle B Which joints are least commonly involved in osteoarthritis? a. Fingers b. Wrists c. Hips d. Knees B An older adult with a complaint of shoulder pain has a positive drop arm test. What is his likely diagnosis? a. Peripheral neuropathy b. Shingles c. Frozen shoulder d. Torn rotator cuff D A patient presents with right shoulder pain after an acute shoulder injury yesterday. He fell against a brick wall while working at his home. He reports pain that radiates into his upper arm. How should this be managed? a. Immobilize the right shoulder for 3 days b. Rest, Ice, and Naproxen for one week c. Order an X-ray of the right shoulder d. Prescribe physical therapy for the patient C A long-distance runner is diagnosed with a tibial stress fracture. Which statement is true about this injury? a. the pain worsens with rest b. the patient should be casted for six weeks c. plain X-rays will confirm the diagnosis d. rest and an alternative activity are recommended D A 75-year old female who knits daily has a positive Finklestein test. What is her likely diagnosis? a. gamekeepers thumb b. DeQuervain's tenosynovitis c. Osteoarthritis of the thumb d. Trigger thumb B Which findings are most commonly associated with rheumatoid arthritis? a. Morning stiffness, positive rheumatoid antigen, and antinuclear antibody b. fever, symmetrical joint involvement, normal sedimentation rate c. Asymmetrical joint involvement, male gender pain, d. Nodular lesion on the elbow, negative sedimentation rate, positive antinuclear antibody A Which of the following tests if positive is part of the criteria for systemic lupus erythematosus? a. antinuclear antibody b. rheumatoid factor c. elevated liver function studies d. elevated sedimentation rate A Which statement about attention deficit disorder is correct? a. This is more common in girls younger than 9 b. Family history does not play a role in this disorder c. Hyperactivity must be present for this diagnosis d. DSM V is used to diagnose a child with ADD D A patient with an eating disorder might also exhibit evidence of: a. thyroid disease b. sleep disorders c. anxiety disorders d. sexual abuse C A patient presents to your clinic numerous times with vague complaints. She seems to respond poorly to medical treatment that is given to her. What should be considered when obtaining a history from her? a. physical abuse or depression b. depression or HIV c. hepatitis or HIV d. Anemia or depression A c. Mother has chlamydia d. Delivery was by C-section C A nurse practitioner is assessing the head of a three-day old infant. What would be a normal observation in a healthy three-day old infant who is crying? a. there are pounding pulsations over the anterior fontanelle b. there are palpable pulsations over the anterior fontanelle c. there is a palpable nodule near the posterior fontanelle d. the fontanelle is depressed B A 2-month old is diagnosed with thrush. An exam of this patinet's saliva demonstrates all except what? a. Hyphae b. Yeast c. Spores d. a positive KOH C Which choice below is a risk factor for sudden infant death syndrome? a. maternal age greater than 40 years old b. SIDS in a second degree relative c. low birth weight d. female gender C A child's resting heart rate is expected to be between 60 and 100 beats per minute once he reaches what age? a. 4 years of age b. Six years of age c. 10 years of age d. 12 years of age C Cranial nerve II could be evaluated in a young infant by assessing what? a. Squinting response to bright light b. a blink reflex c. a pupillary response d. rapid eye movement A Which infant feeding behavior is least likely related to congenital heart disease? a. limited intake of volume of milk b. feedings that take a long time to complete c. feedings that are interrupted by sleeping d. infants that burp frequently when feeding D An otherwise healthy 6-year old male has been diagnosed with otitis media. His mother reports that he has not had an ear infection since he was three years old. How long should he be treated with an antibiotic? a. 5 days b. 5-7 days c. 10 days d. until the erythema has resolved B Which reflexes might a one-month old infant be expected to exhibit? a. Morrow, stepping, rooting b. Stepping, rooting, tonic neck c. Morrow, Babinski only d. Fencing, stepping, rooting A A mother reports that her child is not allergic to chicken but is allergic to duck and duck feathers. The child is four years old today. Which immunizations should he receive? a. Avoid flu, but all others OK b. Avoid Hepatitis B c. MMR and tetanus are contraindicated d. None are contraindicated D At what age should initial blood pressure screening take place? a. 3 years b. 4-6 years c. 6 years d. 6-10 years A A 6-year old complains that his legs hurt. His mother states that he has complained for the past two weeks and she thought it was from playing outside too much. When asked to identify the painful areas, the child points to the mid-shaft of the femur. He grimaces slightly when asked to walk. What should be part of the differential diagnosis? a. Osgood-schlatter disease b. Growing pains c. Acute lymphocytic leukemia d. Psychogenic pain C A full-term newborn is diagnosed with hyperbilirubinemia. When would his bilirubin level be expected to peak? a. 1-2 days b. 3-4 days c. 5-7 days d. 7-10 days B Risk assessment for hyperlipidemia in a child should begin at? a. 2 years b. 6 years c. 18 years d. 21 years A An 8-year old has a painful limp. He reports that his knee hurts medially. On exam, he has pain with internal rotation of the hip. How should the NP manage this? a. He should immediately be referred to orthopedics b. The NP should order a hip x-ray, CBC, and ESR c. the NP should order a hip and knee x-ray d. He should be referred for synovial fluid aspiration B A child has 8-10 medium brown cafe au lait spots >1cm in diameter. The differential diagnosis should include: a. Vitligo b. Eczema c. Neurofibromatosis d. Neuroblastoma C When does a child's vision approximate 20/20? a. 2 years b. 3 years c. 4 years d. 5-6 years D Newly diagnosed pregnant teenager has suspected depression. Before a diagnosis is made, she should have a CBC, TSH, renal and liver functions and a. sedimentation rate b. quantitative beta HCG level c. Hemoglobin A1c d. Urine toxicology screen D Hand foot and mouth disease and herpangina: a. Both produce pustules on oral mucous membranes b. potentially can cause orchitis in infected males c. are viral infections caused by coxsackie virus d. will only occur in the spring and summer C The initial step in the management of encopresis is: a. Client and family teaching b. Bowel cleansing c. Dietary changes d. Psychosocial evaluation A A child who can stack a maximum of five blocks is probably: a. one year of age b. 15 months of age c. two years of age d. three years of age C Hirschsurung's disease is characterized by: a. Intermittent constipation in the first year of life b. Inability to absorb carbohydrates c. Failure to pass meconium in the first 48 hours of life d. Chronic fecal incontinence C The age at which a child can first walk backwards is: a. 12 months b. 15 months c. 18 months d. 24 months C A 3-year old female had a fever of 102 Farenheit for the last three days. Today she woke up from a nap and is febrile. She has a maculopapular rash. Which statement is true: a. This child probably has measles b. The rash will blanch c. This is a streptococcal rash d. This could be Kawasaki disease B A young female has bilateral breast buds. This represents tanner stage: a. I b. II c. III d. IV B What advice should be given to a parent who has a child with Fifth Disease? a. this commonly causes pruritus in young children b. He can return to school when the rash has disappeared c. Acetaminophen should be avoided in this child d. A patient may experience joint aches and pains D When is a child first able to stand on one foot? a. 18 months b. 2 years c. 3 years d. 4 years C When can a child with chickenpox return to daycare? a. 24 hours after he is fever free b. 48 hours after he is fever free c. after all of the lesions have crusted d. when he no longer itches C A three-day old full term infant has a bilirubin level of 16 mg/dl. How should this be managed? a. Monitor only b. Increase fluids and stop breastfeeding c. Increase breastfeeding d. Order phototherapy for the child D An adolescent male has suspected varicocele. He has dull scrotal pain that is relieved by: a. Standing b. Recumbent c. Having a bowel movement d. Elevation of the testicle B A patient has suspected scarlet fever. He likely has a sandpaper rash and: a. negative throat swab b. a positive rapid strep test c. diarrhea with abdominal cramps d. petechiae on the trunk B A healthy appearing 3-year old female presents with non-blanchable redness over both knees and elbows. During the exam she is found to have normal growth and development and she interacts appropriately with the NP. She had an upper respiratory infection about four weeks ago that cleared without incident. Her CBC demonstrated a platelet count of 50. The rest of her CC is normal. Her urinalysis demonstrated hematuria. The most likely diagnosis is: a. septic arthritis b. acute lymphocytic leukemia c. von Willebrand's disease d. Idiopathic thrombocytopenia purpura D Which of the following increases the risk of cryptorchidism? a. Family history of hearing problems b. Premature birth c. Maternal iron deficiency d. Constipation B What is the earliest age that an average child would be able to copy a triangle, know his colors, and count on his fingers? a. 3 years b. 4 years c. 5 years d. 6 years C A 9-year old boy has been diagnosed with chickenpox. A drug that should be avoided in him is: a. penicillin b. aspirin A Which form of kinetic factor is influenced by a decrease in liver mass in an older adult? a. Absorption b. Distribution c. Metabolism d. Elimination C An older adult patient has been diagnosed with shingles on the right lateral aspect of her trunk. It initially appeared yesterday. It is very painful. How should she be managed? a. Treatment with a topical lidocaine patch only b. An oral antiviral agent and ibuprofen c. An oral antiviral agent and pain medication d. An oral antiviral agent, pain medication, and oral steroids C A 91-year old female with a long standing history of chronic heart failure has renal and liver studies that have slowly worsened over the past year. This probably indicates: a. final stage of heart failure b. target organ damage secondary to heart failure c. poor nutrition intake and need for nutrition assessment d. new disease processes involving the liver and kidneys B Symptoms of uncomplicated reflux disease in older adults should be treated: a. by referring for upper GI testing b. with empiric treatment c. ambulatory pH testing d. referral to gastroenterology B Metformin is a good choice for many older adults with type 2 diabetes. Whatever, while on metformin, the NP should carefully monitor for: a. hypoglycemia b. fluid retention c. lactic alkalosis d. renal dysfunction D A 75-year old male patient has been in poor health for a decade. Which type of anemia is least likely in this patient? a. Sideroblastic anemia b. pernicious anemia c. anemia of chronic disease d. folic acid deficiency anemia A In older adults, the three most common ailments are: a. hearing loss, vision loss, hypertension b. hearing loss, hypertension, arthritis c. depression, vision loss, hypertension d. arthritis, hearing loss, depression B A patient who wrote a living will has changed his mind about the initiation of life sustaining measures. Which statement is true about this? a. He cannot change his mind regarding the content of the living will b. He can only change the content if he is of sound mind c. A health care provider is exempt from liability if they provide care outside of the living will d. An attorney must be consulted if the living will is changed at any time B What is the AM fasting glucose goal for 75-year old patient who has diabetes? a. 80 to 100 b. 100 to 120 c. 80 to 130 d. 120 to 140 C To the American Cancer Society, what recommendation should be made to a 70-year old female regarding mammograms if she is considered at low risk? a. she no longer needs mammograms b. she should have them annually until age 75 c. she should have them every three years d. she should have them every one to two years as long as she has a reasonable life expectancy D Older adults have a unique blood pressure pattern. Which blood pressure reading below reflects this pattern? a. 100/50 b. 140/100 c. 160/60 d. 160/100 C A 70-year old presents to the NP office for a well exam today. What medication probably has no effect on screening for occult blood in the stool? a. aspirin b. clopidogrel c. acetaminophen d. ibuprofen C A 66-year old African American female has multiple risk factors for osteoporosis. Which choice listed below is not a risk factor for osteoporosis? a. her age b. her race c. glucocorticoid intake d. excessive alcohol intake B A 79-year old female patient with urinary frequency is found to have a UTI. What medication could possibly produce arrhythmias in her? a. doxycycline b. amoxicillin c. ciprofloxacin d. macodantin C A 69-year old with coronary artery disease is found to have hypothyroidism. Which dose of levothyroxine is considered appropriate for initial treatment? a. 25 micrograms b. 50 micrograms c. 75 micrograms d. 100 micrograms A The Get-Up-And-Go test in an older adult is used to evaluate: a. risk for falls b. lower extremity strength c. mental acuity d. driving safety A An 80-year old has stage 3 COPD. He is most likely to have concomitant: a. anxiety or depression b. thyroid disease D A patient with hypertension describes a previous allergic reaction to a sulfa antibiotic as sloughing of the skin and hospitalization. Which medication is contraindicated in this patient? a. Lisinopril b. Metoprolol c. Hydrochlorothiazide d. Verapamil C A 75-year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies: a. Palpitations and weakness b. Ventricular arrhythmias c. Shortness of breath and syncope d. Fatigue and exercise intolerance C A 74-year old patient has peripheral artery disease. Which term listed below is an important non- modifiable risk factor for PAD? a. Cigarette smoking b. Hyperlipidemia c. Diabetes d. Alcohol consumption C Lisinopril should be discontinued immediately if: a. Dry cough develops b. Pregnancy occurs c. Potassium levels decrease d. Gout develops B The valve most commonly involved in chronic rheumatic heart disease is the: a. Aortic b. Mitral c. Pulmonic d. Tricuspid B A patient taking an ACE inhibitor should avoid what: a. strenuous exercise b. potassium supplements c. protein rich meals d. grapefruit juice B A 28-year old has a grade 3 murmur. Which characteristic indicates a need for referral? a. A fixed split b. An increase in splitting with inspiration c. A split S2 with inspiration d. Changes in intensity with position change A Mr. Smith is a 72-year old patient who takes warfarin for chronic atrial fibrillation. His INR today is 4.0. The nurse practitioner should: a. Stop the warfarin for the next four days and repeat the INR on day 5 b. admit to the hospital immediately c. Administer Vitamin K and repeat INR in two hours d. Stop the Warfarin today and repeat the INR tomorrow D According to the National Heart Lung and Blood Institute, which characteristic listed below is a coronary heart disease risk equivalent that is which risk factor places the patient at AC CHD risk similar to a history of CHD? a. Hypertension b. Cigarette smoking c. Males over the age of 45 d. Diabetes D A patient diagnosed is with mild heart failure. What drug listed below would be a good choice for reducing morbidity and mortality long-term? a. Verapamil b. Digoxin c. Furosemide d. Metoprolol D A patient has shortness of breath. If heart failure is the etiology which test demonstrates the highest sensitivity in diagnosing this? a. Echocardiogram b. B type natriuretic peptide (BNP) c. EKG d. Chest X-ray B A 50-year old patient with hypertension has taken hydrochlorothiazide 25mg daily for the past four weeks. Her blood pressure has decreased from 155/95 to 145/90. How should the nurse practitioner proceed? a. Wait four weeks before making a dosage change b. Increase the hydrochlorothiazide to 50mg a day c. Add a drug from another class to the daily 25mg hydrochlorothiazide d. Stop the HCTZ and start a drug from a different class C Where would the murmur associated with mitral regurgitation best be auscultated? a. Aortic listening point b. Microl listening point c. Pulmonic listening point d. Tricuspid listening point B What is the earliest detectable glycemic abnormality in a patient with type 2 diabetes? a. Postprandial glucose elevation b. Nighttime hyperglycemia c. Fasting glucose elevation d. Abnormal HgbA1c A You are auscultating Jon's chest. When he sits up and leans forward, you can hear a high pitched, blowing murmur at S2. What does this type of murmur most likely indicate? a. Mitral stenosis b. Aortic Stenosis c. Mitral regurgitation d. Aortic regurgitation d. Aortic regurgitation Aortic regurg is soft, high pitched, blowing diastolic decrescendo that best heard at the 3rd left interspace at base. Murmur initiated w/ S2 and heard when Pt sits up and leans forward. Mitral Stenosis= low pitched diastolic rumble & doesn't radiate. Best heard in apex when in left lateral position. Aortic stenosis= loud, harsh murmur midsystole, radiated down the side of neck and down apex. Mitral regurg= loud blowing murmur heard at apex and is pansystolic. Which of the following is the most common clinical manifestation of osteoporosis? a. Bone deformity b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30 c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20 d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 3 of the 4 measurements are above what should be; HDL <40 in men & 50 in women increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed to increase risk heart disease. This low-molecular-weight heparin is indicated for use with warfarin for the treatment of acute symptomatic deep vein thrombosis, either with or without pulmonary embolism: a. Nadroparin b. Dalteparin c. Tinzaparin d. Fondaparinux c. Tinzaparin- can be combined with warfarin for DVT, aids warfarin in inhibiting clotting of blood. Nadroparin & Dalteparin don't use w/ warfarin, use independently. Fondaparinux is a Xa inhibitor NOT LMWH. he main reason for discontinuance of implanted etonogestrel (Nexplanon) is: a. Weight gain b. Pregnancy c. Breast tenderness d. Irregular bleeding d. Irregular bleeding For the treatment of relapsing-remitting multiple sclerosis, the nurse practitioner knows that: a. First-line therapy typically involves an immunomodulator b. Natalizumab is one of the safest drugs to use as initial therapy c. A patient using interferon-beta products would have to have renal function monitored. d. Fingolimod is given intravenously for patients with resistant remitting-relapsing multiple sclerosis. a. First-line therapy typically involves an immune modulator therapy begins with interferon-beta products (fingolimod, glatiramer, natalizumab) which are immune modulator. Natalizumab limited (assoc w/ infections in brain) are used if others don't work. Meds are hepatotoxic and need liver function monitoring. Fingolimod is 1st ORAL disease modifying med approved for MS. Which of these are unique features of aripiprazole (Abilify)? a. It causes hyperprolactinemia and gynecomastia as side effects. b. It is a dopamine system stabilizer with affects against schizophrenia, mania, and agitation. c. It causes agranulocytosis, which may be fatal; patient monitoring is necessary d. It induces diabetes and myocarditis in certain patients b. It is a dopamine system stabilizer with affects against schizophrenia, mania, and agitation. All of the following facial movements are still possible after a cerebrovascular accident except: a. Raising the eyebrows b. Wrinkling the forehead c. Raising both sides of the mouth d. Closing both eyes c. Raising both sides of the mouth Which of the following is a characteristic of Somogyi effect? a. It is characterized by an early morning rise in blood glucose, with no hypoglycemia during the night. b. It is more common in type 2 diabetics c. It presents with a combination of hypoglycemia followed by rebound hyperglycemia. d. It is more common in elderly patients with poorly controlled blood sugars. c. It presents with a combination of hypoglycemia followed by rebound hyperglycemia - Nocturnal hypoglycemia stimulates hyperglycemia counter-regulation in am. No hypoglycemia in night is Dawn phenomenon, more common in T1DM, esp children w/ T1DM Which of the following is a characteristic of B cell deficiency? a. Inability to fight off cancer cells. b. Inability to make antibodies c. Increased incidence of granulomas d. Increased incidence of anemia b. Inability to make antibodies When counseling a pregnant patient on drug use during pregnancy, it is important that the nurse practitioner advises her: a. "The placenta provides a good protective barrier for your baby against almost all drugs you might ingest." b. "The placenta will screen out most harmful drugs, so they will never reach significant levels in your baby." c. "The placenta will protect your baby against narcotic exposure, but all other drugs will permeate within 15 minutes to an hour." d. "The placenta is a barrier as far as time is concerned only- ultimately, your baby will be exposed to any drug that you take." d. "The placenta is a barrier as far as time is concerned only- ultimately, your baby will be exposed to any drug that you take." Assuming these do not present with symptoms other than those stated, antibiotic use is most likely to be appropriate for which of the following patients? a. The 2-year-old with onset of mucopurulent rhinitis two days ago b. The 10-year-old with dry cough lasting 7 days c. The 60-year-old with clear rhinorrhea for 3 weeks. d. The 5-year-old with cough and mucopurulent rhinitis for 3 weeks d. The 5-year-old with cough and mucopurulent rhinitis for 3 weeks In a patient diagnosed with syndrome of inappropriate antidiuretic hormone, the nurse practitioner would expect to find which of the following? a. Solute retention and water retention b. Solute retention and water loss c. Solute dilution and water retention d. Solute dilution and water loss c. Solute dilution and water retention SIADH (syndrome of inappropriate antidiuretic hormone) defined as hyponatremia despite NL or increased plasma volume= impaired water excretion. Result of excess H2O vs deficiency of sodium. Sandra comes into the clinic complaining of the inability to discern touch as well as she used to. During the physical examination, you tell Sandra to close her eyes and trace the outline of a number into the palm of her hand. Which of the following tests have you performed? a. Graphesthesia b. Position c. Stereognosis d. Vibration a. Graphesthesia A 68-year-old male patient desires testosterone replacement to enhance his libido. His testosterone level is found to be 250 ng/dL. The nurse practitioner knows that a. AndroGel once daily would restore sex drive and fertility in this client b. Testosterone replacement is associated with cardiovascular risks, including myocardial infarction, and is not indicated for this patient. c. Testosterone cypionate injections would be a good treatment option for this patient. d. Testosterone replacement is known to suppress the development of prostate cancer, which would be a benefit. pleuritic chest pain more w/ bacterial CAP, decreased breath sounds, dyspnea also more with bacterial CAP. Inc resp rathe and resp alkalosis not usually hallmark sx of CAP. Jenny, age 32, comes into the clinic complaining of severe acid reflux. When taking her health history, you try to identify aggravating factors and things that make the pain a little more manageable. Jenny tells you that when she remains active and doesn't lie down, the pain almost completely disappears. Which part of the PQRSTU method is designed to acquire information about what makes the symptoms worse? a. T b. S c. Q d. P d. P- P is for provocative or palliative so what have tried to make better, or has made worse. T= timing of sx, S= scale of pain, Q= quantity and quality of pain. U= understanding of problem. The nurse practitioner is examining a patient with a presumed diagnosis of Osgood-Schlatter disease. Which of the following is true regarding this condition and/or patient? a. This patient is a postmenopausal female who should have calcium and vitamin d supplementation as part of her treatment plan b. This patient is an adult athlete with a repetitive use injury of the anterior tibial tubercle c. This patient has bursitis of the subscapular bursa in the glenohumeral joint. d. This patient is an adolescent without a history of knee injury or sport participation. b. This patient is an adult athlete with a repetitive use injury of the anterior tibial tubercle. Result of repetitive quadriceps contraction through patellar tendon. Repeated traction on anterior portion developing ossification center= multiple subacute fx or tendinous inflammation. Pain, swelling, tender. Seen in Adolescents, combo w/ growth spurt and sports. Any active adult or athlete at risk. Ca = Vit D= tx for osteoporosis. Postmenopausal female not traditionally at risk. Bursitis= inflammation of Bursa= soft, fluid filled sac cushions mvmt btw bones, shares similarities w/ Osgood but is different condition. . A patient with sepsis is at risk of developing shock via which mechanism? a. Loss of systemic vascular resistance b. Slowly evolving pump failure of the heart c. Loss of blood volume d. Loss of centrally-mediated neurogenic tone a. Loss of systemic vascular resistance The advances practice nurse is considering an anticonvulsant regimen in a patient who suffers from partial seizures and who takes several other medications for comorbid conditions. Which of the following antiepileptic drugs would cause the lowest drug interactions? a. Carbamazepine (Tegretol) b. Phenytoin (Dilantin) c. Levetiracetam (Keppra) d. Valproic Acid (Depakene) c. Levetiracetam (Keppra) Beta blockers are not used for which of the following conditions? a. Performance anxiety b. Migraine prophylaxis c. Reduction of perioperative mortality d. Insulin induced hypoglycemia d. Insulin induced hypoglycemia.- will not aid, more likely to retard recovery. Low dose can be used for performance enhancement, treat migraines, and decrease perioperative mortality of cardiac Pts. A patient presents with pustular lesions on her perineum and groin. She has some oral mucous membranes lesions, a warty rash on her hands and feet, lymphadenopathy, and pruritis. A presumptive diagnosis would be: a. Herpes simplex b. Syphilis c. Chlamydia d. Trichomonas b. Syphilis A patient who has suffered a cerebrovascular accident has speech dysphasia involving word finding and difficulty writing. Which area of the brain has most likely been affected? a. Parietal lobe b. Left frontal lobe c. Temporal lobe d. Limbic system. b. Left frontal lobe- Broca's area is in left frontal lobe is one of language centers= non fluency w/ sparse output, agrammatism, impaired repetition, affects writing r/t to speech. Parietal lobe= agnosia, Temporal lobe = word deafness, limbic = emotional instability Sally, age 46, comes to your practice concerned about a lump in her breast that appeared within the past few days. She is very worried that is may be cancerous and says that the lump is tender and moves around when she touches it. Based on Sally's description of the lump, what is most likely true? a. Masses that are tender and movable are typically benign b. It is most likely fibroadenoma c. Masses that are tender and moveable are typically malignant d. The lump can likely be diagnosed with a routine physical exam. a. Masses that are tender and movable are typically benign In which part of the lung fields should vesicular breath sounds be noted? a. Anterior chest b. Peripheral lung fields c. Anterior bifurcation of the mainstream bronchi d. Posterior chest. b. Peripheral lung fields - hear vesicular here, low, soft like, sound of wind in trees. Anterior- bronchial breath sounds= high & loud (harsh, hollow, tubular), anterior bifurcation = bronchovesicular sounds which also hear in posterior chest & are soft/ tubular . For managing breakthrough pain in the opioid tolerant cancer patient already receiving around the clock opioids: a. Transmucosal fentanyl (Actiq) or immediate release oral morphine would be considered first choice medications. b. Based on the equianalgesic table, the dosage of opioid to manage this pain should be half the total daily opioid dose c. Dosing of the breakthrough pain medication should be repeated every 6 hours on a fixed schedule. d. Breakthrough pain should be managed with nonpharmacologic means or acetaminophen. a. Transmucosal fentanyl (Actiq) or immediate release oral morphine would be considered first choice medications. 61. Which of the following is most likely to be effective in the treatment of acute cluster headaches? a. 6 mg subcutaneous injection of sumatriptan b. 300 mg acetaminophen a. Hypoactive- associated w/ decreased movement in intestines, after surgery, peritoneum is inflamed, or perforated acute abdomen. Harsh= bruits/ arterial sounds from atherosclerotic lesions in vessels, hyperactive= loud, high pitched tinking = increased motility w/ gastroenteritis, diarrhea, laxative use, paralytic ileus. A patient presents with chronic neuropathic pain in his feet secondary to type 2 diabetes. Of the following, the best therapeutic choice would be: a. Phenobarbital (Luminal) b. Carbidopa (Lodosyn) c. Tiaganine (Gabitril) d. Gabapentin (Neurontin) d. Gabapentin (Neurontin) A child presents with congenital phenylketonuria. Which statement is true regarding this disease? a. The nucleus if red blood cells is defective in this disorder b. This disease is due to a deficiency of phenylalanine hydroxylase c. This disease is an X-linked disorder seen in male offspring d. This disease is passed from fathers to sons on sex chromosomes b. This disease is due to a deficiency of phenylalanine hydroxylase When Bethanechol is administered, its main effect is to a. Cause relaxation of the bladder's detrusor muscle to relieve bladder cramping b. Cause contraction of the urinary sphincter to eliminate urinary incontinence c. Cause contraction of the bladder's detrusor muscle to foster voiding d. Cause urinary retention and constriction of the trigone. c. Cause contraction of the bladder's detrusor muscle to foster voiding- stimulates gastric motility. Contracts the detrusor muscle, relaxes urinary sphincter. Treats urinary retention, does NOT constrict trigone. Sara, age 24, is rushed to the hospital after having elevated blood pressure, chills, and vomiting. She also has trouble walking and her pupils are dilated. After doing a blood test, you find that Sarah has been using cocaine recently. Which of her symptoms is not common for people under the influence of cocaine? a. Dilated pupils b. Inability to walk c. Elevated blood pressure d. Vomiting b. Inability to walk Endometriosis is most likely caused by which of the following? a. Obstruction within the fallopian tubes prevents the endometrial tissue from adhering to the lining of the uterus b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and remains responsive to hormones. c. Inflammation of the endometrial tissue develops after recurrent sexually transmitted diseases. d. Endometrial tissue lies dormant in the uterus until the ovaries produce sufficient hormone to stimulate it's growth b. Endometrial tissue passes through the fallopian tubes and into the peritoneal cavity and remains responsive to hormones. A patient is diagnosed with primary Raynaud's disease. In simple terms, this disorder may be explained to the patient as: a. An inflammatory disorder of small- and medium-sized arteries in the feet and sometimes in the hands b. A neoplastic disorder of the lining of the arteries and veins of the upper extremities c. A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly the toes d. An autoimmune disorder of the large arteries and veins of the upper and lower extremities c. A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly the toes.- vasospasm of smaller arteries & limits circulation/ inhibits blood supply to skin. Not caused by tumors. Secondary Reynaud's can be concomitantly with autoimmune, no autoimmune in Primary A patient is diagnosed with general anxiety disorder. This diagnosis is based on a history which indicated a span of at least how many months spent worrying excessively? a. 3 b. 6 c. 9 d. 12 b. 6- 3 months not long enough, could still indicate panic, anxiety or depression. 9-12 months = too long and could indicate other psychiatric disorders as well, including psychosis. . Which of the following descriptors is best associated with Reynaud's Phenomenon? a. Arterial b. Venous c. Unilateral d. Painless a. Arterial A child born with Tetralogy of Fallot often squats. The practitioner knows that squatting helps to: a. Shunt more blood to the pulmonary circulation b. Reduce the heart rate c. Increase the blood pressure in the legs d. Relieve lower back pain a. Shunt more blood to the pulmonary circulation Second-generation antihistamines like loratadine (Claritin) offer what advantage over first- generation drugs? a. Less gastrointestinal upset b. Less rebound stuffiness upon discontinuance c. Less headaches d. Less daytime sedation d. Less daytime sedation When a practitioner initiates therapy with a second-generation antipsychotic, which of the following is appropriate? a. A baseline measurement of waist circumference should be recorded b. A baseline blood pressure measurement should be recorded. c. A baseline liver function test should be recorded. d. A red blood cell count should be recorded. a. A baseline measurement of waist circumference should be recorded- can cause increase in weight gain and new onset diabetes. Typically do not influence BP or liver enzymes. Do not affect RBC's directly. 40. What factor is responsible for the hypertrophy of the myocardium associated with hypertension and cardiac remodeling seen in heart failure? a. Increased epinephrine b. Natriuretic peptides c. Angiotensin II d. Insulin resistance c. Angiotensin II a. 4 th intercostal space (ICS), sternal border b. 2 nd intercostal space (ICS), midclavicular line (MCL) c. 5 th ICS, MCL d. 3 rd ICS, sternal border c. 5 th ICS, MCL Which of the following takes place during pregnancy? a. Blood volume normally decreases, and blood pressure normally increases b. Both blood volume and blood pressure increase c. Blood volume normally increases, and blood pressure normally decreases d. Both blood volume and blood pressure decrease. c. Blood volume normally increases, and blood pressure normally decreases a patient is diagnosed with acute inflammatory demyelinating polyneuropathy and resulting Gillian-Barre syndrome. The patient needs to be assessed for which of the following? a. Cerebrospinal fluid high in protein (500 mg/dl) without cellular abnormality b. Decreased levels if acetylcholine c. Asymmetric paralysis d. Demyelination of the central nervous system nerves a. Cerebrospinal fluid high in protein (500 mg/dl) without cellular abnormality- Most will have when it is viral or bacterial. Acetylcholine is not affected by GBS, effect on DTR's or numbness/ paralysis will be symmetric, demyelination of peripheral nerve system NOT CNS Jully, age 33, has a blood pressure of 134/80 mmHG. What do her vital signs suggest, according to ACC/AHA guidelines? a. Normal blood pressure b. Pre-hypertension c. Stage 1 hypertension d. Stage 2 hypertension. c. Stage 1 hypertension- Stage 1 is 130-139/ 80-89; NL is less than 120/80Stage 2 if > 140/90 Which of the following is the most common cause of Cushing syndrome? a. Failure of the zona granulosa b. Steroid use c. Adrenal hyperplasia d. Adrenal destruction b. Steroid use If a patient's abdomen is protuberant but soft and non-distended, what is the most likely diagnosis? a. A hernia b. Enlarged liver c. Enlarged spleen d. Obesity d. Obesity Of the following, the most common cause associated with disseminated intravascular coagulation (DIC) is: a. Sepsis, with secretion of endotoxins from gram-negative or gram-positive bacteria b. Cancer or acute leukemia c. The placement of foreign bodies, such as balloon catheter or other medical device in the patient d. Metabolic disturbances such as diabetes or hyperglycemic shock. a. Sepsis, with secretion of endotoxins from gram-negative or gram-positive bacteria The most common site for hemorrhagic stroke to occur is in the: a. Cerebrovascular arteries b. Basal ganglia c. Cerebellar hemispheres d. Pons b. Basal ganglia- occur most often here. Thrombotic strokes most common in cerebrovascular arteries, not common for hemorrhagic to occur in Pons or cerebellar hemispheres. The nurse practitioner is considering the use of levofloxacin in a patient with a respiratory tract infection. Which of the following in the patient's medical history would contraindicate the use of levofloxacin? a. Patient has a frequent history of urinary tract infections b. Patient has a history positive for myasthenia gravis c. Patient is 48 years old d. Patient has a history of vaginal yeast infections b. Patient has a history positive for myasthenia gravis You are talking to Jimmy about how he has been feeling lately. He starts to say that he has been feeing tired and before he can finish his sentence, he falls asleep. You say his name and he opens his eyes, but is inattentive and slow. How would you chart Jimmy's level of consciousness? a. Semi-coma b. Obtunded c. Delirious d. Lethargic d. Lethargic Of the psychiatric syndromes below, which is correctly matched to its first-line drug of choice as dictated by the Food and Drug Administration? a. Obsessive Compulsive Disorder: Fluvoxamine b. Social anxiety disorder: phenelzine c. Panic disorder: Alprazolam d. Post-traumatic stress disorder: trazodone a. Obsessive Compulsive Disorder: Fluvoxamine 19. Which of the following is a true statement regarding migraines? a. These headaches typically present with an aura in most patients b. Migraines are typically bilateral, and if caught early, respond well to ice and mild analgesics. c. Premenopausal females are the largest group of migraine sufferers d. Migraines occur when macrophages attack myelin sheaths in the CNS c. Premenopausal females are the largest group of migraine sufferers.- menstruation is one of leading causes migraine triggers. Estrogen withdrawal with menses can be a trigger. Aura in only 20-25%, Unilateral, not bilateral, macrophages do not cause, are from triggers of stress, diet, sleeping patterns. Ken comes into the clinic stating that he has lost the ability to drive because every time he gets in the car, everything around him starts spinning. When asked in the symptom occur during any other time, he states it does on occasion. What is Ken most likely experiencing? a. Dizziness b. Syncope c. Tinnitus d. Vertigo d. Vertigo The treatment of choice for pharyngeal gonococcal infections is: a. Metronidazole, 500 mg taken orally twice per day for seven days b. Benzathine penicillin G, 2.4 million units administered intramuscularly once c. Moxifloxacin, 400 mg taken orally once daily for seven days d. Ceftriaxone, 250 mg administered intramuscularly once; 1 gm of azithromycin taken orally once A neonate is born with fetal alcohol syndrome. Which of the following abnormalities may be observed? a. Alveolar collapse and flail chest b. Cognitive impairment and facial anomalies c. Incompetent semilunar valves (ex aortic and pulmonic). d. Esophageal stricture and short gut syndrome b. Cognitive impairment and facial anomalies The smoky, brown-colored urine in acute poststreptococcal glomerulonephritis is due to: a. The presence of red blood cells b. The presence of urobilinogen c. The slough from the collecting tubules d. The protein that is in the urine a. The presence of red blood cells- inflammation causes RBC to leak into glomeruli and low pH turns it brown. Urobilinogen from breakdown of bilirubin in intestines and indicates liver dz, the RBC will pass the the collecting tubules not slough. Protein is lost as well, but doesn't cause to be brown color. You are advising a patient who has been diagnosed with autosomal dominant polycystic kidney disease. Which of the following accurately describes the condition? a. "this disease may cause you to lose function of one of your kidneys, but we will monitor it as it progresses" b. "this disease is a cause of kidney cancer and is treatable with chemotherapy." c. "you got this disease from having chronic problems with kidney stones. Now you will need dialysis." d. "You will need a kidney transplant to treat this disease. You will be placed on the transplant list." d. "You will need a kidney transplant to treat this disease. You will be placed on the transplant list."- effective way to treat PCKD, also need to treat symptoms- BP meds & diuretics, loss of function of both kidneys, not just 1, Not associated with kidney CA, PCKD may cause development of kidney stones, dialysis may help if end stage disease, but is inherited and not from having kidney stones. In infectious mononucleosis (IM), the Monospot test detects which of the following antibodies within the first few weeks after infection? a. Immunoglobulin E (IgE) b. Immunoglobulin M (IgM) c. Immunoglobulin G (IgG) d. Immunoglobulin A (IgA) b. Immunoglobulin M (IgM)- IgM detected 2 weeks - 6 months after exposure. IgG in recovers, IgE is an allergic rxn, IgA is protective barrier from outside substances. A patient is taking furosemide (Lasix) for stage three heart failure. Along with Lisinopril, an aspirin a day, warfarin, atorvastatin, and metoprolol, which other medication should this patient be prescribed? a. Tenecteplase b. Amitriptyline c. Phytonadione d. Potassium Chloride d. Potassium Chloride Adenosine triphosphate levels decrease in ischemia. What effect does this have on cells? a. Cells shrink because of an influx of calcium b. Cells shrink because of the influx of potassium c. Cells swell because of the influx of sodium d. Cells swell because of the influx of nitric oxide. c. Cells swell because of the influx of sodium The SSRI class of antidepressants have many "black box" warnings on their label. Among these warnings is which of the following: a. Likely to affect renal function b. May cause harmful side effects such as suicidal thoughts c. Age-specific prescription requirements excluding adolescents or children d. Toxic when taken with certain foods b. May cause harmful side effects such as suicidal thoughts Most common type of skin cancer in USA - CORRECT ANSWER Skin cancer Most common type of skin cancer - CORRECT ANSWER basal cell carcinoma basal cell carcinoma symptoms - CORRECT ANSWER Appearance varies; smooth, shiny bump, pink to pearly white Basal cell carcinoma common locations - CORRECT ANSWER cheeks, nose, face, neck, arms, back basal cell carcinoma diagnosis gold standard - CORRECT ANSWER biopsy. if not an option, refer to derm Actinic keratosis - CORRECT ANSWER Precursor to squamous cell carcinoma numerous dry, round and pink to red lesions w/ rough and scaly texture --> does not heal, slow growing in sun exposed areas Actinic keratosis diagnosis gold standard - CORRECT ANSWER Biopsy. if not an option, refer to derm Actinic keratosis treatment gold standard - CORRECT ANSWER small- cryotherapy large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, crust, scab and be red **5-flouracil/ efudex-wear sunscreen!!** squamous cell cancer - CORRECT ANSWER chronic red scaly rough textured lesion w/ irregular borders crusting or bleeding may be present Squamous cell carcinoma common locations - CORRECT ANSWER rims of ears, lips, nose, face and top of hands precursor lesion to squamous cell cancer - CORRECT ANSWER actinic keratosis squamous cell carcinoma diagnosis by? - CORRECT ANSWER biopsy gold standard. if biopsy is not an option, refer to dermatology . Risk factors for skin cancer(melanoma and both non-melanoma) - CORRECT ANSWER Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer Rocky mountain spotted fever (RMSF) symptoms - CORRECT ANSWER Fever chills N/V myalgia arthralgia 2-5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk and becomes generalised. sometimes rash develops on palms and soles **RASH DEVELOPS INWARDS** RMSF pneumonic (RMSF) - CORRECT ANSWER R-Rash M-Muscle aches (myalgia) S-Stomach aches (nausea and vomiting) F-Fever (>102 F) Rocky Mountain Spotted Fever (RMSF): Located: - CORRECT ANSWER •Think "Rocky"- North Carolina, Oklahoma, Arkansas, Tennessee, Missouri Spring to Fall (April to September) Rocky Mountain Spotted Fever (RMSF): DX - CORRECT ANSWER PCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii Rocky Mountain Spotted Fever (RMSF): tx - CORRECT ANSWER Doxycycline is always first line for all ages 100 mg every 12 hours x 7-10 days Can be fatal if not treated within the first 5 days Erythema Migrans (early Lyme disease): Symptoms - CORRECT ANSWER Usually appears in 7-14 days after being bitten by a deer tick; range 3-30 days Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central clearing • Common locations are belt line, axillary area, behind the knees, and groin area • Positive for flu like symptoms. Lesions and rash resolve within a few weeks with or without treatment Erythema Migrans (early Lyme disease): DX - CORRECT ANSWER Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no further testing needed. If positive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi 1. Enzyme immunoassay 2. western blot test (immunoflurorescence assay/ IFA) Exam Tip: E before I Will have increased ESR Erythema Migrans (early Lyme disease): TX - CORRECT ANSWER Doxycycline is always first line for all ages 100 mg BID x 10-21 days Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap and water. Dispose of the tick by flushing it into the toilet Tick repellant skin use - CORRECT ANSWER DEET Tick repellant clothing use - CORRECT ANSWER Permethrin Brown Recluse Spider Bite: SX - CORRECT ANSWER • Fever, chills • Nausea and Vomiting • Located in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender, or can be painless • Blisters appear within 24-48 hours • Necrotic in center, which kills the tissue **can be painless Brown Recluse Spider Bite treatment - CORRECT ANSWER Treatment: • Ice packs to wound as the cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and watch Skin lesions - CORRECT ANSWER primary skin lesions Macule Vesicle Papule MVP Size: <1 CM Macule - CORRECT ANSWER Flat, nonpalpable, but visually distinct areas on the skin surface with color different from the person's normal skin; less than 1 cm FRECKLE Vesicle - CORRECT ANSWER elevated, raised lesion filled with serous fluid (herpetic lesions) Papule - CORRECT ANSWER palpable solid lesion (acne, moles) primary skin lesions >1cm in size - CORRECT ANSWER Nodule Plaque Bullae (Blister) Pustule Wheal Nodule - CORRECT ANSWER raised solid lesion (BCC) Plaque - CORRECT ANSWER solid raised lesion with flat top (psoriasis) Bulla/Bullae - CORRECT ANSWER elevated superficial blister filled with serous fluid (2nd degree burn, impetigo) Pustule - CORRECT ANSWER circumscribed elevated lesion containing pus (acne pustules) Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If you suspect osteomyelitis order an MRI If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) Erysipelas: - CORRECT ANSWER Bacteria: Group A Streptococcus Located: • Involves upper dermis and superficial lymphatics • Found on the cheeks and shins Erysipelas: Symptoms - CORRECT ANSWER Symptoms: • Bright red plaque or induration with sharp or elevated margins on the face or lower legs • If fever and chills present pt. is septic (hospitalization is recommended) Erysipelas: Treatment - CORRECT ANSWER If treating facial erysipelas assume MRSA is present. Use appropriate antibiotics or refer to ER if septic Dicloxacillin QID, Cephalexin or Clindamycin x 10 days If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) MRSA: Treatment - CORRECT ANSWER Bactrim Doxycycline Minocycline Clindamycin --> If patient is allergic to Sulfa do not use Bactrim Human bites - CORRECT ANSWER "Dirtiest" bite of all. Watch for closed-fist injuries of the hands (may involve joint capsule and tendon damage). Eikenella corrodens & numerous bacteria may be involved Animal bites: - CORRECT ANSWER Cat bites have a higher risk of infection that dog bites Redness, swelling, pain Systemic symptoms may develop within 12-24 hours Treatment for human bites and animal bites - CORRECT ANSWER •Augmentin 875/125 mg BID x 10 days or IV antibiotics in ER Penicillin Allergy § Doxycycline BID or Bactrim DS BID PLUS Flagyl BID or Clindamycin TID Also give Tetanus booster if needed Evaluate for rabies prophylaxis Tetanus Vaccination - CORRECT ANSWER Initial series (3 doses) DTaP (infants to age 6): 5 doses Ages 7 and older Td or Tdap Need every 10 years for lifetime Common reaction: pain at injection site in 24-48 hours Contaminated wounds: give one dose if last dose was more than 5 years ago or is due Impetigo - CORRECT ANSWER Bacteria (Gram Positive): Beta Streptococcus or Streptococcus aureus Most common bacterial skin infection in young children ages 2-5 Impetigo symptoms - CORRECT ANSWER Itchy pink-red lesions, evolve into vesiculopustules that rupture easily, honeycolored crusts (from dried serous exudate) Very pruritic and contagious Impetigo Treatment - CORRECT ANSWER Order C&S of fluid Severe Case= Keflex or Dicloxacillin QID x 10 days Penicillin Allergy o Give Azithromycin 250 mg x 5 days or o Clindamycin x 10 days **If no blisters- topical mupirocin ointment (bactroban) 2% x 10 days Acne Vulgaris (common acne): treatment - CORRECT ANSWER First line is always topical retinoid such as tretinoin cream (Retin-A) Acne: Mild treatmetn - CORRECT ANSWER open comedones blackheads/closed comedones (whiteheads) w/ or w/o papules topical retinoid (Retin-A) **Acne will worsen during first 4-6 weeks** IF no improvement in 8-12 weeks, increase dose or ADD benzoyl peroxide and/or erythromycin Acne: Moderate (topicals plus antibiotics) - CORRECT ANSWER papules and pustules with comedones (3 part treatment) Topical retinoid (Retin-A) AND topical benzoyl peroxide AND oral antibiotic (Tetracycline or Minocycline) x 3-4 weeks --> Exam usually asks about moderate Acne: Severe - CORRECT ANSWER painful indurated nodule, cysts, abscesses, pustules Accutane- check Liver function tests (LFTS) must use 2 forms of contraceptives, monthly pregnancy testing only prescribe 1 month supply of medication Usually, will refer to Dermatology Topical retinoid side effects - CORRECT ANSWER Irritation, dry skin, flaking, redness during first 4 weeks due to increase in skin turnover After washing face wait 30 minutes before applying medication to help minimize irritation Christmas tree pattern Rash on the hands or soles of the feet Pityriasis Rosea: Treatment - CORRECT ANSWER Resolves on its own in about 4-6 weeks Test for secondary syphilis with RPR then VDRL as screening • If positive then do FTA-ABS if this is positive patient has syphilis; treat appropriately Tinea Corporis (body-think of core): symptoms - CORRECT ANSWER Ring like itchy rash, slowly enlarges with central clearing Tinea Corporis (body-think of core): Treatment - CORRECT ANSWER Most respond to topical antifungals, if severe do oral Lamisil Med ends with azole on exam Tinea Capitis (scalp-think of baseball cap): symptoms &Treatment - CORRECT ANSWER Scaly round itchy patches on the scalp. Hair becomes fragile at the roots and breaks (black dot sign) Treatment: Oral meds only (Griseofulvin, terbinafine, fluconazole, or itraconazole) Obtain baseline LFT and repeat in 2 weeks o Gold standard: § Griseofulvin QD-BID x 6-12 weeks Avoid hepatotoxic substances (alcohol, statins, acetaminophen) Avoid sharing combs, headgear, towels, pillows, and clothes with others Tinea Cruris (groin):symptoms and treatment - CORRECT ANSWER Erythematous annular (ring-shaped) rash located in the groin area which can sometimes extend to buttocks Usually associated with tinea pedis Treatment: • Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days Tinea Pedis (Hands/Feet- think pedicure):symptoms and treatment - CORRECT ANSWER Symptoms: • Scaling of the soles • Skin feels wet, strong odor, vesicles and bullae that rupture • "Two feet and one hand" disease (dominant hand used for itching the feet becomes infected) Treatment: Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days Onychomycosis aka tinea unguium (fingernail or toenail fungus): Symptoms and treatment - CORRECT ANSWER Symptoms: Elderly with yellow-colored nails Thickened nails with debris Treatment: Mild cases fingernails: o Topical Penlac Toenails: Systemic antifungals either 6 weeks or pulse therapy (once per week for 3- 4 cycles) Tinea Versicolor: Cause/symptom/treatmetn - CORRECT ANSWER Cause: • Yeast Pityrosporum orbiculare or P. ovale Symptoms: • Multiple hypopigmented round macules on chest, shoulders, and/or back that appear after skin becomes tan from sun exposure Condition is asymptomatic • KOH slide will show hyphae and spores ("spaghetti and meatballs") Treatment: • Topical selenium sulfide and topical azole antifungals (Nizoral) or terbinafine (Lamisil) cream BID x 2 weeks • Hypopigmented spots may take several months to fill in Herpetic Whitlow (caused by herpes simplex): symptoms and treatment - CORRECT ANSWER Symptoms: HSV 1 or HSV 2 infection Abrupt onset of small red papules/bumps which become vesicular Extremely painful, tingling, and burning sensation. Usually on index finger or thumb Treatment: Rest, elevation, and NSAIDs -As this is a self-limiting infection If recurrent or severe infection can prescribe oral acyclovir DO NOT chose topical acyclovir as an option because it's expensive and does not work well Varicella Zoster Virus (VZV): symptoms/lab/treatment - CORRECT ANSWER Symptoms: Contagious for 48 hours before and until all lesions are crusted over Low grade fever Generalized lymphadenopathy Intense itching • Erythematous macules • Papules develop over macules, then vesicles erupt • "Initially on trunk, then scalp and face" Labs: • Gold Standard: PCR Treatment: • Supportive, antihistamines • Oral Acyclovir if given within the first 24 hours; will work best Subungual Hematoma:Treatment - CORRECT ANSWER Treat subungual hematoma by trephination If blood is not drained and the hematoma involves ≥25%, there is a high risk of ischemic damage to nail matrix Use either a large paperclip or 18-gauge needle and heat up the tip Position at 90 and apply steady pressure until you have blood draining Remove either the paperclip or needle and gently evacuate the blood Systemic Lupus Erythematosus: symptoms/treatment - CORRECT ANSWER Symptoms: •Maculopapular butterfly-shaped rash on the middle of the face (malar rash) •May have nonpruritic thick scaly red rashes on sun-exposed areas Treatment: • Refer to rheumatology • Avoid sunlight and other UV light exposure can worsen the disease • Wear broad-spectrum sunblock that's effective against UVA and UVB Molluscum Contagiosum: cause/symptoms/tx - CORRECT ANSWER Cause: • Poxvirus Symptoms: • White plug, dome shaped with central umbilication • Highly contagious (spreads via skin-to-skin contact) Treatment: Scrub eyelids in warm water and baby shampoo Pterygium (Surfer's eye): Symptoms/Treatment - CORRECT ANSWER Symptoms: Triangular-shaped white to yellow superficial growth On nasal side Caused by long term UV damage Treatment: Surgical remove if it grows into the pupil Prevention: wear sunglasses Pinguecula (think of Ping-Pong): Symptoms/Treatment - CORRECT ANSWER Symptoms: White to yellowish small round superficial lesion on each side of the cornea Caused by long- term UV damage Treatment: • Prevention: wear sunglasses Chalazion: Symptoms & Treatment - CORRECT ANSWER Symptoms: Small painless nodule Chronic inflammation of the meibomian gland (specialized sweat gland) Grows gradually Treatment: • Hot compress QID if large otherwise no treatment Hordeolum (Stye): Symptoms and Treatment - CORRECT ANSWER Symptoms: Painful • Swollen • Red, warm, abscess, and it's acute Think Hordeolum "Hurts" Treatment: • Hot compress until it drains QID • Avoid wearing eye make-up • Erythromycin or dicloxacillin QID if preseptal cellulitis develops 17 o Refer to ophthalmology for I&D Senile arcus: Symptoms and Treatment - CORRECT ANSWER Symptoms: White-gray ring on edge of cornea in elderly and is bilateral Normal finding in elderly Result of lipid deposit Treatment: None Age less than 50 check lipid profile Xanthelasma: Symptoms and treatment/ DX - CORRECT ANSWER Symptoms: • Soft yellow flat plaques on the upper and lower lids by the inner canthus or palpebrum • Cholesterol plaques Dx: • Order fasting lipid profile to rule out hypercholesteremia Treatment: • Trichloroacetic acid, surgery, laser Allergic Conjunctivitis (Keratoconjunctivitis): Symptoms & Treatment - CORRECT ANSWER Symptoms: Typically, bilateral itchy eyes with "stringy discharge and increased tearing" Type I sensitivity (IgE) Rhinitis and allergic shiner Treatment: PO (oral) antihistamines Eye drops olopatadine (Patanol), Visine (short term or episodic use only) Cool compresses and avoid allergens *May be called keratoconjunctivitis on ANCC Bacterial Conjunctivitis: Symptoms and treatment - CORRECT ANSWER Symptoms: • Acute onset of red eye • Dried yellow-green crusting on eyelids on awakening Treatment: Topical ophthalmic fluroquinolones (Ofloxacin) Q 2-4 hours x 2 days, then QID x 5 days Viral Conjunctivitis (Pink Eye): Symptoms and treatment - CORRECT ANSWER Symptoms: • Acute onset of red eye • Complaint of itchy eyes; one or both eyes • Periauricular lymphadenopathy 18 • Very contagious Treatment: No treatment; frequent hand washing Keep away from school for 1 week Herpes Keratitis: Cause, symptoms, DX, TX - CORRECT ANSWER Cause: Herpes Simples Virus or Shingles (Herpes Zoster) Symptoms: Abrupt onset of eye PAIN, blurred vision, and tearing, Vesicles and/or small rash on the temple on affected side Follows the V1 branch (ophthalmic branch) of the trigeminal nerve (CN V) Dx: Fluorescein dye o Shows "fern-like" lesion Treatment: Ophthalmologist or ER STAT Corneal Abrasion: Symptoms & DX & treatment & alternative meds - CORRECT ANSWER Symptoms: Acute onset of severe eye PAIN Abrasion is round/irregular Foreign body sensation Dx: Fluorescein dye. Will help rule out herpes keratitis Treatment: • Erythromycin ointment QID x 3-5 days DO NOT PATCH THE EYE Common in infants, adults over 40 also have higher risk of developing Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery eye/excess tearing Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic antibiotics 7-10 days Allergic Rhinitis: Background & symptoms & treatment - CORRECT ANSWER Background: Inflammatory changes of nasal mucosa due to allergies Atopic family history (asthma, eczema) May have seasonal or daily symptoms Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip, Blue- tinged or pale boggy (spongy) nasal turbinate's Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamcinolone (Nasacort Allergy) 1-2 sprays QD • Antihistamine Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN. Avoid in infants and children • Avoid triggers Epistaxis (Nosebleed): Background & Treatment - CORRECT ANSWER Background: Anterior nosebleed more common. Caused by bleeding at Kisselbach's plexus Treatment: Have the pt. blow their nose first Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal septum and hold for 10 minutes Meniere's Disease: Symptoms - CORRECT ANSWER Vertigo Hearing loss Tinnitus Meniere's Disease Mnemonic: VAST - CORRECT ANSWER Vertigo (Episodic) Aural (auditory) fullness Sensorineural Hearing Loss (Fluctuating) Tinnitus (Subjective) Meniere's Disease Treatment - CORRECT ANSWER Usually, self-limiting. Treat acute attacks Antihistamines for vertigo Meclizine, dimenhydrinate Antiemetics for nausea/vomiting o Promethazine, prochlorperazine Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX - CORRECT ANSWER Symptoms: Ages 30-60 Gradual onset, one-sided Sensorineural hearing loss, tinnitus that is insidious; CN 8 Facial numbness and pain if it compresses CN 5 Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing loss and tinnitus. If it compresses on CN 5 will have facial numbness and pain Treatment: Surgery Cholesteatoma symptoms and treatment - CORRECT ANSWER Symptoms: Cauliflower Foul-smell Hearing loss (typically conductive unless it's way inner than can have sensorineural) If erodes bones in face affects CN VII Treatment: SURGERY Battle Sign (Basilar Skull Fracture): - CORRECT ANSWER Bruising behind the ear (mastoid area) appear within 1-3 days after trauma Parietal bone is most fractured. Linear fracture most common leaking of clear fluid from nose and eyes, raccoon eyes Look for clear, golden serous discharge from the ear or nose treat immediately-Refer to ER Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX & Treatment - CORRECT ANSWER Symptoms: Vertigo lasting <1 minute caused by sudden head movements and position changes May lose balance and fall Due to calcium carbonate crystals (otoconia) being trapped in the semicircular canals Dx: Gold Standard: Dix-Hallpike Epley Maneuver in clinic or at home by pt Test won't ask how to conduct treatment just be able to associated Epley with BPPV Vestibular Neuritis and Labyrinthitis: Cause/ Symptoms/ TX - CORRECT ANSWER Viral infection/Inflammation High frequency Acute Bacterial Rhinosinusitis (ABRS): bacteria & symptoms - CORRECT ANSWER Bacteria: Streptococcus pneumoniae, H. influenzae, Viral Symptoms: Persistent URI symptoms for 10 days or more or a cold that resolved but symptoms returned • Unilateral facial pain/pressure or a toothache (upper molar pain) with nasal congestion • Purulent nasal and/or postnasal drip (may have a cough when supine) Frontal sinusitis: § Frontal headache or headache behind one eye Maxillary sinusitis: § Facial pain and upper molar tooth pain Transillumination: Compare each side. Affected side may be duller or smaller Treatment: Either immediate antibiotic treatment or observation First Line: Augmentin 2000 mg/125 mg BID x 5-7 days Symptom relief: Saline irrigations, nasal steroids, NSAIDs for pain Do not use antihistamines or decongestants Penicillin Allergy: Levofloxacin 750 mg QD x 5-7 days or Doxycycline BID x 5-7 days Infectious Mononucleosis: cause/sx/dx/tx - CORRECT ANSWER Epstein Bar Virus (Herpes Virus Family) Symptoms: Sore throat with tonsillitis. May have whitish tonsillar exudates • Posterior lymphadenopathy • Severe fatigue present for many weeks • Maculopapular rash • Hepatomegaly and or splenomegaly Classic Triad: Fever, Pharyngitis, Lymphadenopathy Dx: • Monospot (heterophile antibody) Treatment: Symptomatic • Rest • Avoid contact sports and heavy lifting for at least 4-6 weeks. A Ruptured spleen is a rare but serious sequela of mono May do an abdominal US to clear patient for sports Test Tip: If the patient has strep throat and mono, avoid using Amoxicillin as the antibiotic of choice. The patient may develop a rash with this drug. Macrolides are a good option (Clarithromycin). Levofloxacin works as well but it is overkill Strep Throat:Cause, symptoms, TX - CORRECT ANSWER Cause: • Group A streptococcal bacteria (Streptococcus pyogenes)• Most common cause of sore throat is viral (rhinovirus, adenovirus, RSV) • Strep is most common in school-aged children SX: • Abrupt onset of fever, sore throat, and pain on swallowing • Absence of viral symptoms (coryza, cough, hoarseness, runny nose, watery eyes) • Tender anterior cervical lymphadenopathy • Scarlatiniform rash (sandpaper rash) • Children: May have abdominal pain and diarrhea TX: First line-Pencillin V or amoxicillin suspension immediate or XR QD x10 days ANAPHYLAXIS HX: z pack or clindamycin Strep Throat, Nonpuruluent SSTI Risks - CORRECT ANSWER o Rheumatic fever, scarlet fever, acute poststreptococcal glomerulonephritis, poststreptococcal reactive arthritis (develops within 1 month after strep) Strep throat, purulent risks - CORRECT ANSWER • Suppurative (Pus): Tonsillopharyngeal abscess, cellulitis, OM, sinusitis Strep throat • Centor Criteria: - CORRECT ANSWER • Be able to connect Centor Criteria with Strep Throat Fever (1 point) Anterior cervical lymphadenopathy (1 point) Tonsillar exudate (1 point) Absence of cough (1 point) Age 3-14 (1 point) Age 15-44 (0 points) Age >44 (-1 point) Score of 0-1 unlikely need to test for strep; score of 3-4 confirm with rapid strep test Hypertension Retinopathy - CORRECT ANSWER Cotton wool, Retinal arterioles constriction • Copper/silver wire arterioles • AV nicking (mild retinopathy) • Retinal Hemorrhages Diabetic Retinopathy: - CORRECT ANSWER damage to the retina as a complication of uncontrolled diabetes Symptoms: • Cotton wool spots (moderate retinopathy) • Micro-aneurysms • Neovascularization Koplik's Spots - CORRECT ANSWER Symptoms: • "Clusters of small size red papules with white centers in the buccal mucosa by lower molars" • Caused by Rubeola (Measles) o Rubeola and Koplik's have an "O" • Fever, conjunctivitis, coryza, cough • Morbilliform rash HTN meds that cause heartburn - CORRECT ANSWER CCB, BB, alpha agonists Atrial Fibrillation (AF) (Most common arrhythmia in the US) - CORRECT ANSWER • Can be paroxysmal or persistent • Pt. will complain of the sudden onset of heart palpitations accompanied by weakness, dizziness, fatigue, and dyspnea • May have chest pain and feel like passing out Rapid and irregular pulse which may be greater than 110 per minute with hypotension --> Consider antithrombic therapy Afib diagnosis - CORRECT ANSWER A diagnostic test is 12 lead ECG which won't show discrete P waves and will be irregularly irregular CHA2DS2-VASc score - CORRECT ANSWER C- congestive heart failure -1 H- hypertension - 1 A2- Age > 75 -2 D- Diabetes mellitus - 1 S2- Stroke - Tia - throboembo-2 V- vascular disease -1 A-Age -65-74-1 Sc- Sex women - 1 Max score 9 Score of 0= low risk Score of 2 or more= requires anticoagulation A2 & S2= gives PT 2 points right away Drugs that increase INR include: - CORRECT ANSWER Sulfa drugs (Bactrim) macrolides (erythromycin) NSAIDS/Ibuprofen Anticoagulation Therapy Goal - CORRECT ANSWER INR 2-3 Orthostatic Hypotension - CORRECT ANSWER A decrease in the systolic BP of at least 20 mmHg or the diastolic BP of at least 10 mmHg within 3 minutes upon standing Coarctation of the Aorta: Background/ SX/ DX - CORRECT ANSWER Background: • Normally SBP is higher in the legs than the arms. • If patient has coarctation of aorta the SBP is higher in the arms than legs. Symptoms: • Pulses in legs won't be palpable • The radial pulse will be bounding • The BP will be high • A heart murmur may be present Dx: • Echo, ECG, cardiac MRI or cardiac CT hypertension - CORRECT ANSWER Stage 1 (140-159/90-99) Hypertension: If Goal BP is not reached at __ month, increase the dose on the initial drug and/or add a second drug - CORRECT ANSWER • If Goal BP is not reached at 1 month, increase the dose on the initial drug and/or add a second drug Thiazide diuretics; do not give to a patient with a _____ allergy - CORRECT ANSWER Do not give thiazide diuretics to a patient who has a sulfa allergy Ace inhibitors - CORRECT ANSWER -pril: HTN, HF. AD: angioedema, cough, hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use contraception (teratogenic), avoid sports drinks/salt substitutes (extra K) ARB drugs - CORRECT ANSWER -sartan Losartan Valsartan HTN drug of choice for diabetics - CORRECT ANSWER Ace inhibitors or ARBS these protect kidneys Do not use Ace drugs and _____ together - CORRECT ANSWER Do not use Ace drugs (lisinopril) and Arb drugs (losartan) together Beta bocker - CORRECT ANSWER -olol Avoid abrupt discontinuation: wean slowly to avoid rebound HTN Calcium channel blocker - CORRECT ANSWER "CA" Calan, Procardia, Cardizem Slow the HR and decrease BP (check HR and BP before). Inhibits mvmt of Calcium ions across membrane or cardiac and arterial muscle cells. Results in slowed impulse conduction, depression of myocardial constractility, dilation of coroanry arteries. SE: Constipation Procardia sometimes causes peripheral edema First line treatment of HTN for african americans - CORRECT ANSWER CCB or Thiazide