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CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) What is the biggest side effect of colchicine? - correct answer diarrhea How would you describe the appearance of molluscum contagiosum? - correct answer papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant? - correct answer no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? - correct answer week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - correct answer week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus? - correct answer week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - correct answer week 28 At what week of pregnancy is the fundus just below the xiphoid process? - correct answer week 34 Increased sweat production is a sign of what endocrine disorder? - correct answer hyperthyroidism What is Paget's disease? - correct answer there is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures How do we treat Paget's diseease? - correct answer bisphosphonates How should pregnant women wear their seatbelt? - correct answer with the shoulder strap like a normal person and then the groin strap below the belly and across the hips What is another name for fifth disease? - correct answer parvovirus aka slapped cheek disease aka erythema infectiosum Which type of prevention are vaccinations? - correct answer primary When should patients begin antiretroviral therapy for HIV infection? - correct answer as soon as it is detected, even if in the acute phase What are the first generation antihistamines? - correct answer diphenhydramine (benadryl) and chlorpeniramine (actifed) What are s/s of the secondary stage of syphilis? - correct answer rash on hands and feet, lymphadenopathy, fever
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) What is the recommended treatment for chronic bacterial prostatitis? - correct answer a fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for acute prostatitis? - correct answer cipro (if not STI related) or ceftriaxone What are s/s of an intraductal breast papilloma? - correct answer clear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area If a patient has GABHS but has an allergy to penicillins, what is the second line option? - correct answer first generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a - mycin PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - correct answer in those who are on any type of nitrate or triptan because it could result in hypotension What class of drug is sildenafil (viagra)? - correct answer a PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What are the symptoms of peripheral artery disease? - correct answer think P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What is first line treatment for PAD? - correct answer walking and physical activity to improve circulation. second line is an aspirin or anti-platelet What should we tell our patients with PAD NOT to do? - correct answer do not elevate the feet; keep them down How do we diagnose PAD? - correct answer an ABI < 7; doppler can also be used to diagnose as well but is the second choice What are s/s of peripheral vascular disease? - correct answer think V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - correct answer Bactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - correct answer Rifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - correct answer decrease the weekly dose by 5-10%
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) What can be a sequelae of an ectopic pregnancy? - correct answer pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What is the Coomb's test and when is this completed? - correct answer test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? - correct answer nothing, she is RH positive so we do not need to treat If a patient's Coomb's test is negative, what do we do? - correct answer give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? - correct answer IUD The vaginal ring for contraception must be taken out how often? - correct answer every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - correct answer increase the progesterone How do we treat temporal arteritis? - correct answer steroids If a patient is on birth control and they miss one pill, what should they do? - correct answer double up If a patient is on birth control and they miss two pills, what should they do? - correct answer double up for 2 days If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - correct answer do a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - correct answer mammogram; ultrasound When do we screen for group B strep in pregnancy? - correct answer weeks 35- 37 When do we perform alpha fetoprotein screening in pregnancy? - correct answer 15 - 20 weeks Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - correct answer spina bifida and anencephaly What is placenta previa? - correct answer when the placenta blocks the cervical opening of the uterus What is placenta abruptio? - correct answer when the placenta either fully or partially detaches from the uterine wall
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) When does placental abruption most commonly occur? - correct answer in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa?
- correct answer a placental abruption is painful whereas placenta previa is painless If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - correct answer placenta previa What is the recommended treatment for polymyalgia rheumatica? - correct answer steroids Patients with SLE are going to have what abnormal labwork? - correct answer elevated ESR and CRP How do we treat lupus flares? - correct answer steroids What are common sequelae of fibromyalgia? - correct answer insomnia and depression What is a great treatment option for fibromyalgia? - correct answer amitriptyline (a TCA) because it helps with chronic pain, sleep, and depression How is fibromyalgia diagnosed? - correct answer when at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months What is slipped capital femoral epiphysis? - correct answer when the femoral head of the hip is out of place What is the trendelenburg sign and when is it positive? - correct answer when the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What is the main characteristic of a slipped capital femoral epiphysis? - correct answer walking with a limp SCFE is most common in which patient population? - correct answer adolescents What is legg-calve-perthe disease? - correct answer avascular necrosis of the femoral head due to a lack of blood supply Legg-calve-perthes disease is most common in which patient population? - correct answer young children What is the radiographic study of choice for the knee? - correct answer MRI What is the radiographic study of choice for the back? - correct answer x ray What is bursitis? - correct answer a fluid collection in the bursa of a joint How is bursitis treated? - correct answer a needle to instill intraarticular steroids and then pull off fluid
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) How can we abort cluster headaches? - correct answer calcium or 100% oxygen application Which type of headaches come with lacrimation and sinus symptoms? - correct answer cluster headaches What does the apprehension test assess for? - correct answer used to assess for stability of the shoulder or knee; assesses for stability How does the parathyroid gland regulate calcium? - correct answer when parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine What is the first line treatment for trigeminal neuralgia? - correct answer carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? - correct answer steroids and anti-virals How is the pain of trigeminal neuralgia vs temporal arteritis different? - correct answer in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? - correct answer beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? - correct answer adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? - correct answer bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - correct answer molar pregnancy What bacteria is the leading cause of urethritis? - correct answer neisseria gonorrhea What is the most common cause of hypercortisolism? - correct answer excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? - correct answer Pavlik harness; if older than 6 months may need surgery It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - correct answer 5 years old; penicillin When can cervical cancer screening stop if no abnormal screening history is present? - correct answer age 65 When should breast cancer screening begin and end with a biannual mammogram? - correct answer age 50- 74
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) When should colorectal cancer screening stop? - correct answer age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? - correct answer age 50 - 80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - correct answer Do HPV testing with this. If positive, repeat in one year if age 21- 24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? - correct answer LSIL If a patient has LSIL with a negative HPV test, what would you do? - correct answer repeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - correct answer refer for colposcopy If a patient's pap results show NILM, what should you do? - correct answer repeat in 3 years If a patient's pap results show ASC-H or HSIL what should you do? - correct answer refer for colposcopy The valgus stress test assesses what? - correct answer the medial collateral ligament The varus stress test assesses what? - correct answer the lateral collateral ligament The Lachman's test assesses what? - correct answer the ACL The McMurray's test assesses for what? - correct answer a torn meniscus The anterior drawer test assesses what? - correct answer the acl The posterior drawer test assesses what? - correct answer the posterior cruciate ligament (pcl) a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - correct answer dawn phenomenon How can you tell between the dawn and somogyi effect? - correct answer If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. A 14yo male with bronchitis is being treated with fluids and expectorants. He returns to the clinic with a fever of 103F, right pleuritic chest pain, and green sputum. Which of the following examination results would be expected? A. Right lower lobe crackles B. Decreased Fremitus C. Bilateral Wheezing
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) A. Amoxicillin-Clavulanate (Augmentin) B. Ceftriaxone (Rocephin) C. Levofloxacin (Levaquin) D. Erythromycin - correct answer A. Amoxicillin-Clavulanate (Augmentin) Which of the following is the leading cause of cancer-related deaths in the majority of women? A. cervical Cancer B. Ovarian Cancer C. Breat Cancer D. Lung Cancer - correct answer D. Lung Cancer A 29-year old male with noncomplicated Chlamidia infection may exhibit: A. Urticaria B. No remarkable clinical symptoms C. A green mucoid penile discharge D. A penile ulcer - correct answer B. No remarkable clinical symptoms To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: A. The meaning of a common proverb B. What action the patient would take if their was a fire in the house C. To count backwards from 100 by 7s D. To spell a word backward. - correct answer A. The meaning of a common proverb A common rule to follow when prescribing many medications for the elderly is to: A. Give most medications in the morning to allow slowed body functions to have time to adjust to the drug. B. Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. C. Perform a creatinine clearance test for baseline data on all person over age 70 before starting on new medications. D. Give medication with a full glass of water to promote absorption and limit harm to the kidneys. - correct answer B. Start at a low dose than what is commonly prescribed for adults, and increase the dose slowly.
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) A 72 year old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3am, is reluctant to go out although she has family member living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: A. Stroke, depression, and hyperthyroidism B. Depression, Unresolved grief, and hypothyroidism C. Migraine, anxiety disorder, and hypertension D. Dementia, delirium, and pna - correct answer B. Depression, Unresolved grief, and hypothyroidism The parent of a 13-year old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that development of fever may: A. make the seizure medication less effective B. Lower the seizure threshold C. Increase the seizure threshold D. Have no effect on the seizure threshold - correct answer B. Lower the seizure threshold After a 3-week camping trip, an 11-year old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: A. trimethoprim-sulamethoxazole (Bactrim) B. Azithromycin (Zithromax) C. Metronidazole (Flagyl) D. Doxycycline (Doryx) - correct answer D. Doxycycline An 88 year old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Folstein Mini-Mental State examination B. Geriatric Depression Scale
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) A 3 year old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? A. throat culture B. sputum culture C. Mantoux (PPD) skin test D. Cold agglutinin test - correct answer B. Sputum culture A 25-year old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated with movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? A. Palpate structures around the shoulder B. Obtain an MRI to evaluate the shoulder C. Order an Xray of the shoulder D. Request an EMG - correct answer A. Palpate the structures around the shoulder A 17 year old femlae has never had her menses. She is at Tanner stage III of sexual development. Her physical exam in completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? A. Ovarian dysgenesis B. Dysmenorrhea C. Primary amenorrhea D. Secondary amenorrhea - correct answer C. Primary amenorrhea An 18-month old child presents with a bulging, immobile tympanic membrane; T-103F(39.4C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: A. Obtain an EKG B. Obtain an Echocardiogram C. Reevaluate the patient in 10 days D. Refer the patient to a cardiologist - correct answer C. Reevaluate the patient in 10 days
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) Which of the following is NOT an indication of preeclampsia? A. visual disturbances B. Glucosuria C. Edema of the face and hands D. Headaches - correct answer B. Glucosuria Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? A. Olopatadine (Patanol) B. Cromolyn opthalmic (Crolom) C. Timolol (Timoptic) D. Gentamycin Opthalmic (Genoptic) - correct answer D. Gentamycin Opthalmic (Genoptic) An 88 year old patient presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? A. Seizure B. Right-sided Stroke C. Left-sided stroke D. Trans ischemic attack - correct answer C. Left-sided Stroke A nurse pracitioner is evaluating a 40 year old patient suspected of having a pulmonary embolus. The patient complains of anxiety and cough. A stat chest x-ray is normal. Which of the following tests should the nurse practitioner perform next? A. Spirometry B. MRI C. Contrast venography D. Helical CT pulmonary angiography - correct answer D. Helical CT pulmonary angiography A routine laboratory assessment of a 12 year old patient with a family history of thalassemia and anemia reveals Tanner II presentation and Hct=355. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? A. serum folic acid
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) C. Fasting blood sugar (FBS), complete blood count (CBC), BUN, and sex hormone binding globulin D. Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, and thyroid- stimulating hormone (TSH) - correct answer D. FSH, LH, TSH Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? A. Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells B. Squamous epithelial cells with clear cytoplasm and distinct borders, many lactobacillus rods, and occasional WBC C. Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus rods, and many WBC D. Hyphae and spores, few lactobacillus rods, and occasional WBC - correct answer Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells. A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? A. edema B. Tachycardia C. Palpitations D. Sweating - correct answer D. Sweating A 67-year old with type 2 diabetes mellitus, congestive heart failure, and mild coronary artery disease is currently taking Digoxin, 0.25mg daily; HCTZ, 25mg daily; Metformin 500mg daily; glipizide 10mg daily; and Atorvastatin (Lipitor) 20mg HS. Which of the following is an accurate statement regarding the regimen? A. The glipizide will increase the risk of potassium depletion. B. The digoxin will increase the risk of hypoglycemia C. The HCTZ will predispose the patient to Digoxin toxicity D. The atorvastatin will worsen the diabetes. - correct answer C. The HCTZ will predispose the patient to Digoxin toxicity
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) The initial therapy for a 3 week old infant with uncomplicated symptoms of gastroesophageal reflux disease includes of the following positions and change in diet? A. Prone position and rotate formulas in order to find one that causes less reflux B. Smaller, more frequent feedings while holding infant C. Semisupine position and offer more ounces of formula less frequently D. Lateral position and start small amounts of solid food with formula - correct answer Smaller, more frequent feedings while holding infant. Which of the following best describes psoriatic lesions in an elderly patient? A. Shiny, purple, smooth lesions B. Localized erythematous vesicles C. Erythematous plagues with central clearing D. Red, sharply defined plaques with silvery scales - correct answer D. Red, sharply defined plaques with silvery scales A 68-yo female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other lab values are WNL. The headache is most likely due to: A. TIA B. NSAID induced headache C. Temporal arteritis D. Glaucoma - correct answer C. Temporal arteritis A patient with Type 1 diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of an at-home glucose test reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: A. Insulin resistance B. Cortisol deficiency C. the Somogyi effect D. pawn phenomenon - correct answer C. the Somogyi effect
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) B. Loud, high-pitched pansystolic murmur C. Diastolic murmur with split S D. Early diastolic murmur with an S3 wave. - correct answer B. Loud, high-pitched pansystolic murmur During an employment physical exam of a 21-year old female, bruising around the areola on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: A. Current social relatonships B. History of present or past traumas C. Mental health status D. Socioeconomic status. - correct answer D. Socioeconomic status. According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a vlaue equal to or greater than: A. 100 mg/dl B. 126 mg/dl C. 140 mg/dl D. 180 mg/dl - correct answer B. 126 mg/dl A nurse practitioner orders pulmonary rehabilitation for a 75 yo patient with COPD. Expected outcomes of this program include all the following EXCEPT: A. enhanced quality of life B. Increased lung capacity C. Decreased in-patient hospitalizations D. Improved exercise capacity - correct answer B. Increased lung capacity A 2month old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (not beet red) macular rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted. The infant's rash is most likely caused by. A. Candida albicans infections.
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) B. Eczema C. Seborrheic dermatitis D. Contact dermatitis - correct answer D. Contact dermatitis A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T=100F (37.8C). The patient does not apear toxic and can tolerate fluids. An appropriate plan should include: A. barium enema and nothing by mouth B. Clear liquids and antibiotics C. low-fiber diet and referral to gastroenterologist D. hospital admission for IV antibiotics - correct answer B. Clear liquids and antibiotics. Which of the following criteria differentiates a TIA from a stroke? A. focal symptoms B. Amnesia of incident C. Slowness of onset D. Absence of residual symptoms - correct answer D. absence of residual symptoms A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields - correct answer B. In the center of the visual fields. Trigeminal neuralgia manifests itself primarily with: A. electric-shock-like unilateral facial pain B. Unilateral facial asymmetry C. Burning bilateral facial pain D. jaw pain extending to the neck - correct answer A. Electric-shock-like unilateral facial pain A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with
