Medical Terminology and Concepts, Exams of Nursing

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A patient comes to your office concerned about a gray arc visible above and below the outer part of his cornea. Upon exam, you diagnose the patient for which of the following underlying medical conditions? A. Hyperlipidiemia B. Ketonemia C. Hypoglycemia D. Presbyopia - ✔✔A. Hyperlipidemia HLD is usually associated with arcus senilis in adults. Tx is generally aimed at controlling cholesterol and trigylyceride levels. Aware of the high rate of prostate cancer in middle-aged men, you routinely consider administering cancer screens to your patients within this demographic. The earliest time a NP could begin performing DRE of prostate on males is which of the following? A. 45 B. 50 C. 40 D. 55 - ✔✔A. 45 Although there is some conflicting views on when digital rectal exams should be initiated, it is generally accepted that some male patients such as African-Americans and men with a positive family history of prostate cancer are at high risk and should be screened as early as 40 years of age. Age 45 and 50 are also possible recomendations for screening by some organizations; however, these are not the earliest possible ages. Lastly, 55 is not recommended for when digital rectal exams for prostate cancer should begin A caretaker is taking an Alzheimer's patient for a walk and hands him his jacket. However, the patient merely looks back at the caretaker and stares, as though he is confused. What should the caretaker do? A. Assume that the patient does not need that coat and continue the walk, carrying the coat B. Put the jacket on the patient C. Cancel the walk and reschedule for another time D. Remind the patient by telling him to put his jacket on again - ✔✔D.

The nurse practitioner should put the jack on the patient. This patient is exhibiting apraxia, an inability to perform previously learned tasks, which is a common finding in Alzheimer's patients. The other choices are inappropriate in the handling of the situation. The patient should have a jacket on to prevent susceptibility to ailments. With the patient's current apraxic state, a reminder would not lead the patient to put on the jacket as he has forgotten how to complete the task at hand. If the patient continues to be apraxic before scheduled walks, constant rescheduling would not help to address the situation James, 28, presents with what he thinks is an asthma attack and tightness in his chest. While taking his medical history, you learn he has a history of severe asthma attacks. Which arterial blood gas abnormality would you initially expect to see in James during this asthma attack? A. Metabolic alkalosis B Metabolic acidosis C Respiratory alkalosis D Respiratory acidosis - ✔✔C. Respiratory alkalosis often occurs during an asthma attack. Respiratory alkalosis occurs as a result of hyperventilation which elevates the blood pH. The other choices feature conditions that do not typically occur during an asthma attack. You have finished assessing a 37-year-old female who has been diagnosed with hyperthyroidism, and you begin a discourse concerning her treatment options. Which of the following is not typically used in the management of hyperthyroidism? A. Methimazole B. Propranolol C. Levothyroxine D. Thiourea drugs - ✔✔C. Levothyroxine is used only in the treatment of hypothyroidism. Propranolol can be used for treatment of symptoms due to hyperthyroidism. Thiourea drugs are used for mild cases, small goiters, or fear of isotopes. Radioactive iodine, thyroid surgery, and Lugol's solution are used to reduce vascularity of the gland. A feverish young woman comes to your clinic complaining of a runny nose and a spotty rash. She also complains of occasional abdominal and joint pain. During the interview process, she explains she recently returned from a trip visiting family in South Carolina. What is the most likely diagnosis? A. Viral pneumonia

B. Bacterial pneumonia C. Lyme disease D. Rocky Mountain spotted fever - ✔✔D. While both Rocky Mountain spotted fever (RMSF) and Lyme disease are spread via bites from infected ticks, RMSF is the only aforementioned disorder that presents with abdominal and joint pain. Lyme disease presents with a distinctive "bulls-eye," macular or papular rash in 50% of cases. RMSF is less well known than Lyme disease but, if left untreated, can be fatal. While viral and bacterial pneumonia both present with fever and nasal congestion, the rash distinguishes RMSF from these conditions. A patient comes to your office complaining of gnawing epigastric pain. After further inquiry, you discover that the pain only subsides when the patient is eating. Which of the following is the most likely diagnosis? A. Duodenal peptic ulcer disease B. Gastroesophageal reflux disease C. Gastric peptic ulcer disease D. Gastroenteritis - ✔✔A. If a patient is experiencing epigastric pain that is relieved with eating, the most likely diagnosis is duodenal peptic ulcer disease. Gastric peptic ulcer disease, on the other hand, is classified as gnawing epigastric pain that is worsened by eating. Gastroesophageal reflux disease (GERD) is characterized by back flow, otherwise known as reflux, of acidic gastric contents into the esophagus, but gnawing epigastric pain is not a finding of GERD. Lastly, gastroenteritis is a characterized by acute inflammation of the gastric mucosa that results in vomiting, diarrhea and cramping, none of which appear in duodenal peptic ulcer disease. Brenda, 57, is a mother of three and was diagnosed with Prinzmetal's angina. Which medication classification is most indicated for this patient's treatment and control? A. Beta blockers B. Glycoprotein IIb/IIIa inhibitors C. Calcium channel blockers D. Angiotensin II converting enzyme inhibitors - ✔✔C. Prinzmetal's angina is the result of coronary vasospasm rather than atherosclerosis; thus, calcium channel blockers are effective in treating Prinzmetal's angina. Beta blockers can occasionally cause more spasms in patients diagnosed with Prinzmetal's angina. Glycoprotein IIb/IIIa inhibitors are used to prevent blood clots to decrease the risk of a heart attack or a stroke and are not used in the treatment of

Prinzmetal's angina. It is not recommended that a patient with uncomplicated angina take angiotensin II converting enzyme inhibitors. In assessing the neurological function of patients, the nurse practitioner is cognizant to always check for deficiencies in cranial nerve function. Which cranial nerves (CN) are entirely sensory in function? A. CN X, CN XI, and CN XII B. CN I, CN II, and CN VIII C. CN III, CN IV, and CN VI D. CN I, CN II, and CN IV - ✔✔B. The cranial nerves (CN) CN I, CN II, and CN VIII are entirely sensory, whereas CN IV through XII control motor functions. Your patient takes levothyroxine 75 micrograms every day. His lab valves indicate an increased TSH, decreased T33, and decreased T44. Based on these findings, what is your most appropriate order? A. Decrease the dose of levothyroxine to 50 mcg every day B. Increase the levothyroxine to 100 mcg every day C. Make no changes and repeat lab values in 3 months or as needed D. Consider adding methimazole 30 mcg every day - ✔✔B. An increase, not a decrease, in levothyroxine is recommended for the management of not fully- controlled hypothyroidism, which this patient's labs indicate. Usual management of hypothyroidism is to increase dosage until patient responds. Methimazole is used to treat hyperthyroidism. The patient's labs indicate the need for increased medication, so making no changes is inappropriate. Anna, 21, comes in for a checkup. Her father has emphysema from smoking and she wants to make sure she does not also have it. She is concerned because she is an occasional smoker. Anna adds that she was previously sent to the emergency room for tightness in her chest, and her doctor said it may have been asthma. Which of the following is a finding of asthma that is not found in emphysema? A. Dyspnea B. Percussion hyperresonance C. Slight white blood cell elevation with eosinophilia D. Cough - ✔✔C.

Slight white blood cell elevation with eosinophilia is a finding that could be found in asthma but is not found in patients with emphysema. The other choices, cough, percussion hyperresonance, and dyspnea, can be found in both asthma and emphysema. Which of the following is true regarding cardiac assessment? A. During S2, the mitral and tricuspid valves are closed. B. During S2, the aortic and pulmonic valves are open. C. During S1, the mitral and tricuspid valves are open. D. During S2, the aortic and pulmonic valves are closed. - ✔✔D. During S2, the aortic and pulmonic valves are closed, not open. It is during S1, not S2, where the mitral and tricuspid valves are closed, not open. You are caring for a 67-year-old patient with Alzheimer's disease. Which of the following medications is most helpful for treating memory impairment while improving cognitive clarity? A. Pramipexole (Mirapex) B. Trihexiphenidyl (Artane) C. Donepezil (Aricept) D. Valproic acid (Depakene) - ✔✔C. Donepezil is one of the drugs (acetylcholinesterase inhibitors) that increase the availability of acetylcholine, which treats memory impairment while improving cognitive clarity in Alzheimer's patients. An acetylcholinesterase inhibitor is a chemical agent that inhibits the cholinesterase enzyme from breaking down acetylcholine, increasing both the level and duration of action of the neurotransmitter acetylcholine. Pramipexole, trihexiphenidyl, and valproic acid are medications for the treatment of Parkinson's disease and other tremor conditions, not Alzheimer's disease. Your newest patient has recently moved to your town in California. Being new to the state, she wants to know whether the reimbursement for services here differs from that in Ohio, which was the state she just moved from. Which of the following forms of reimbursement for services would you advise her is different in the state of California from that in Ohio? A. Medicaid B. Blue Cross C. Medicare B D. Medicare A - ✔✔A.

Medicaid is a federally-supported, state-administered program for low-income families and individuals. After all other insurance or third-party payments have been made, Medicaid payments are made. The benefits vary from state to state. Medicare benefits do not differ state to state, and Blue Cross is a private insurance company that has its own set of reimbursement guidelines. Your 57-year-old patient has been awakened nightly for the last three weeks by severe throbbing pain around his left eye. The pain usually subsides within three hours, but he is experiencing fatigue and lack of concentration due to sleep deprivation. Which of the following is likely causing his complaints, and how should he be treated? A. Tension headaches; analgesics B. Transient ischemic attack; ticlopidine (Ticlid) C. Migraine headaches; sumatriptan D. Cluster headaches; sumatriptan (Imitrex) - ✔✔D. The patient's pain and the time the headaches occur are characteristic of cluster headaches, which should be treated with sumatriptan. Tension headaches present with a vise-like feeling of tension and are treated with analgesics and/or relaxation. Transient ischemic attacks present with altered vision and speech and require a specific course of treatment that may include clopidogrel (Plavix) and/or ticlopidine. Migraine headaches present with varying symptoms that include unilateral dull or throbbing pain, visual disturbances, and nausea and vomiting. You are counseling a couple who is employing a surrogate to carry and deliver their baby. They are concerned because the surrogate has developed strange food cravings, including a craving to eat clay. Which of the following laboratory results drawn from the surrogate would be most expected if her condition was the result of a hemoglobinopathy? A. Low hemoglobin and normal total iron binding capacity B. Low hemoglobin and normal ferritin C. Low hemoglobin and serum ferritin is high D. Low hemoglobin and high total iron binding capacity - ✔✔D. A low hemoglobin (Hgb) paired with high total iron binding capacity (TIBC) would indicate potential iron deficiency anemia, which is most indicated by the patient's strange food cravings. All types of anemias show low Hgb; the distinguishing factor is the second term of the pairs. A low Hgb paired with normal ferritin is consistent with thalassemia, as is low Hgb paired with normal TIBC. Low Hgb paired with serum ferritin high (greater than 100 mg/ml) is consistent with anemia of chronic disease.

You saw Alexander and Maya through the birth of their son, David. Now, two months after the birth of their child, they say they are ready to resume sexual intercourse. They do not want to conceive, but they are against using birth control as it conflicts with their religious views. Which natural family planning method might be the best to recommend? A. Cervical mucus test B. Lactational amenorrhea method C. Calendar method D. Basal body temperature graph - ✔✔B. You should advise the mother that, if she is breastfeeding her 3-month-old, she is likely already delaying the onset of ovulation. Naturally, this can last up to six months. If the mother is not currently breastfeeding, you can recommend that she resume breastfeeding to help delay ovulation. The calendar method involves calculating menstrual periods, which are delayed in Maya's case. Similarly, ovulation being delayed renders basal body temperature graphs ineffective. Recording changes in the mucus with the cervical mucus test could be effective but it is not as convenient for Maya and Alexander as the lactational amenorrhea method, since Maya is already breastfeeding. Which of the following Weber test results is indicative of conductive hearing loss? A. Sound lateralizes to both ears equally. B. Sound lateralizes to the affected ear. C. Sound lateralizes to the unaffected ear. D. Bone conduction is greather than air conduction. - ✔✔B. Sound lateralizing to the affected ear is a Weber test result indicative of conductive hearing loss. Sound lateralizing to the unaffected ear is indicative of sensorineural hearing loss. Sound heard bilaterally or not lateralized is a normal Weber test result. Lastly, measurements of air and bone duction is done by conducting the Rinne test, not the Weber test. Your 35-year-old patient has abscesses in his axilla, redness extending down to the middle nipple line, and fever. He also complains of tenderness at the site of the abscess. The patient claims it is a result of the deodorant he was using. A physical exam indicates multiple open comedones at affected site. You highly suspect that he is infected with Staphylococcus aureus. Which of the following is your best diagnosis? A. Erysipelas B. Bullae C. Furuncle

D. Hidradenitis suppurativa - ✔✔D. Hidradenitis suppurativa is an infection caused by Staphylococcus aureus, which commonly occurs on the groin or axilla. Abscess formation and open comedones are also common. Erysipelas presents with a reddened, warm, indurated area, which is caused by Streptococcus. Although furuncles are also caused by S. aureus and can cause many similar signs and symptoms as hidradenitis suppurativa, furuncles would not account for the open comedones the patient exhibits. Lastly, bullae are blister formations filled with clear fluid and would not cause the patient to exhibit the symptoms he currently has. After insistence from his girlfriend, 18-year-old Tim is seeing you regarding persistent headaches that have occurred since high school. While interviewing Tim, who is overweight, you learn that his symptoms have a slow onset and sometimes he sees stars when the symptoms are at their worst. He also reports that his headaches, which usually occur during the afternoon, can last for up to several hours. Which of the following is the most likely diagnosis? A. Tension headaches B. Cluster headaches C. Headaches due to severe hypertension D. Migraine headaches - ✔✔D. The patient's description of symptoms, visual disturbances, duration, and insidious onset, indicate that he is most likely experiencing a migraine headache. The other headaches may share some similar symptoms; however, none would account for the focal neurological symptoms of the patient. Additionally, cluster headaches usually last less than 2 hours, unlike the patient's presentation. Tension headaches can last for several hours, but would not account for the patient seeing stars. Lastly, headaches due to severe hypertension often occur during the morning time and resolve throughout the day. A 19-year-old college student complains of a fluid-filled vesicle on her thigh that appeared shortly after returning from vacation. She also complains of a fever. She believes that it is a spider bite. Upon assessment, you strongly suspect community associated methicillin-resistant Staphylococcus aureus (MRSA). Which of the following would be the best drug to order after incision and drainage? A. Amoxicillin (Amoxil) B. Metronidazole (Flagyl) C. Azithromycin (Zithromax) D. Clindamycin (Cleocin) - ✔✔C. The major drugs used to treat outpatient methicillin-resistant Staphylococcus aureus, a beta-lactamase producing bacteria, include clindamycin, co-trimoxazole, and doxycycline or minocycline. Metronidazole is used to treat the bacterium Clostridium difficile. While amoxicillin is used to treat many infections, it is

beta-lactamase susceptible and should not be prescribed to treat lower extremity staphylococcus infections. Although azithromycin is used to treat or prevent certain bacterial infections, some staphylococcus infections have developed resistance against azithromycin. A 45-year-old computer technician has olecranon bursitis from repeated pressure on his elbow during the course of his work. He is experiencing severe pain with movement, as well as severe swelling and tenderness. The patient indicates that he has been taking acetaminophen for the last three weeks to ease the pain, but the swelling has not gone down. Which of the following best indicates how you will treat the patient's condition? A. X-rays to rule out other bone or joint conditions B. Cast his elbow C. Aspiration and steroid injections D. Advise patient to continue taking acetaminophen - ✔✔C. The most appropriate treatment for a patient with persistent olecranon bursitis is to drain the fluid and inject steroids into the bursa. The draining and injection would help to reduce the swelling, inflammation, and tenderness. An x-ray is unnecessary since the diagnosis is already confirmed. While acetaminophen may ease the patient's symptoms, this would not treat the patient's underlying condition. A cast is indicated to protect the casted limb and ensure proper healing; the bursa is not a limb that requires casting. You are performing diagnostic tests on a 48-year-old woman. Her signs and symptoms include polyuria, polydipsia, and a general feeling of fatigue. You suspect she has type 1 diabetes mellitus and perform a fasting plasma glucose test to confirm. Which of the following blood sugar levels (on two separate occasions) would support your diagnosis? A. 99 mg/dL or below B. 126 mg/dL or more C. 80 mg/dL or less D. 110 mg/dL or more - ✔✔B. A blood sugar level of 126 mg/dL on two separate occasions is the threshold to diagnose types 1 diabetes mellitus. A fasting plasma glucose test, or serum fasting blood sugar test, measures the blood glucose of a person who has not eaten for eight hours. A level of 100 mg/dL to 125 mg/dL indicates a form of prediabetes while 99 mg/dL and below is considered normal. Mr. Whitmore, a 74-year-old former professional athlete, is being screened for hypertension, a condition which runs in his family. He wants to know what symptoms he may experience. You tell that although

hypertension is frequently asymptomatic, symptoms that are present typically include all of the following except: A. Morning subparietal headaches B. S4 heart sound C. Epistaxis D. Blurred vision - ✔✔A. A suboccipital, not a subparietal headache, is a common hypertensive presentation in the morning. The other answer choices indicate signs or symptoms that may accompany significant hypertension. A fatigued 40-year-old female comes to your office with malaise, as well as pain and stiffness in her joints. While taking her medical history, you learn she has a decreased appetite and has lost weight in recent months. You suspect rheumatoid arthritis. What x-ray findings are not indicative of this condition? A. Osteopenia B. A thickening of the subchondral bone C. Joint swelling D. Progressive cortical thinning - ✔✔B. A thickening of the subchondral bone is a finding usually seen in patients with osteoarthritis. Joint swelling, progressive cortical thinning, osteopenia, and joint space narrowing are all indicative of rheumatoid arthritis. A patient states that she is having a recurring bout of allergic conjunctivitis. She says that she has experienced the condition many times, which her chart confirms, and she insists on a prescription for ofloxin (Ofloxacin). Upon examination, you notice that the patient has red, scaly, greasy flakes and thickened, crusted lid margins. Which of the following is the most likely cause of the patient's signs and symptoms? A. Blepharitis B. Chalazion C. Hordeolum D. Conjunctivitis - ✔✔A. The patient's presentation of red, scaly, greasy flakes and thickened, crusted lid margins are consistent with blepharitis. Although she has a history of allergic conjunctivitis, she does not present with the clear purulent discharge that is hallmark of allergic conjunctivitis. A hordeolum presents with abrupt onset inflammation and a localized, tender mass, not the flakes and crust seen in this patient. A chalazion

presents with a beady, nodular cyst accompanied by swelling and tenderness, neither of which the patient is exhibiting You are treating a 22-year-old male for exhaustion and dehydration after he attended a weekend music festival. He boasts of all the parties that he attended, admits to heavy drinking, and hints at illegal drug use. You caution him about the long-term health effects of drug and alcohol use, but he responds that he is not worried. You then caution him about long-term mental effects he could incur when he is older. When he inquires about dementia, what do you tell him is the leading cause? A. Ventricular dilation B. Alzheimer's disease C. Arteriosclerosis D. Cortical atrophy - ✔✔B. The most common cause of dementia is Alzheimer's disease. Cortical atrophy, on the other hand, is a rarer condition. Ventricular dilation and arteriosclerosis are significant risk factors but neither is the leading cause. A 59-year-old male is having a follow-up evaluation two years after the successful conclusion of radiation therapy for leukemia. He tells you that he has been feeling run-down and reports unexplained weight loss and night sweats. Upon examination, you determine that he also has a fever and pain below his ribs on the left side. You know that he is at risk for chronic lymphocytic leukemia. Which of the following results is considered the hallmark of this disease? A. Lymphocytosis B. Lymphadenopathy C. Pancytopenia with circulating blasts D. Philadelphia chromosome in leukemic cells - ✔✔A. Lymphocytosis is the hallmark of chronic lymphocytic leukemia, the most common chronic leukemia in adults. Men are more likely to develop the condition than women and exposure to chemicals, including Agent Orange, has been linked to an increased risk. The other answer choices are consistent with the patient's presentation. A young married couple comes to your office inquiring about birth control methods. They have both had bad experiences with past methods and ask you about natural family planning. Which of the following statements should you include in the management guidelines for this contraceptive treatment? A. For cervical mucus testing, one should abstain from intercourse for approximately 24 hours after the expected mucus change.

B. The symptothermal method uses the basal body temperature and lactation amenorrhea techniques. C. For the calendar method of planning, 18 days is subtracted from the shortest cycle and 11 days from the longest cycle to determine the abstinence period. D. When graphing basal body temperature, a woman's temperature drops approximately 48 hours prior to ovulation. - ✔✔C. The calendar method is a way of determining a woman's fertility by subtracting 18 days from the shortest cycle and 11 days from the longest cycle. According to the Basal Body Temperature (BBT) method, a woman's fertility can be gauged according to her body temperature, which drops 12 to 24 hours prior to ovulation rather than 48 hours. According to the cervical mucus test, the couple should abstain from intercourse when the mucus changes until approximately four days after the change rather than one day. Finally, the symptothermal method is a combination of the BBT and the cervical mucus test, not lactation amenorrhea. Harold Smith, a 56-year-old marketing executive, has a blood pressure (BP) reading of 142/90 mmHg on his current visit. His medical chart indicates previous BP readings of 145/92 mmHg and 141/93 mmHg during his last visit. Based on the ACC/AHA guidelines, how should the nurse practitioner categorize the patient's hypertensive condition, if present? A. Stage II B. Elevated C. Stage I D. Normal - ✔✔A. Stage II hypertension under the ACC/AHA guidelines is noted when the patient has at least two separate readings of systolic blood pressure (SBP)? 140 mmHg or a diastolic blood pressure (DBP)? 90 mmHg obtained on at least two occasions. Stage I refers to situations in which SBP is between 130 and 139 mmHg, or DBP is between 80 and 89 mmHg. A normal BP reading is SBP < 120 mmHg, and DBP < 80 mmHg. Any readings that fall between normal and Stage 1 are categorized as elevated. You are treating a patient who is showing signs of chancroid. Which of the following terms refers to the degree to which those who have a disease screen or test positive? A. Sensitivity B. Specialty C. Relativity D. Specificity - ✔✔A. Sensitivity refers to the degree to which those who have a disease screen or test positive. The definitive diagnosis of chancroid is made morphologically, with sensitivity no greater than 80%. Specificity refers to

the degree to which those who do not have a disease screen or test negative. The other terms are terms utilized to describe the integrity of diagnostic tests. A 24-year-old patient presents to your office with complaints of fatigue, headaches, and a recent onset of a very pale complexion. Upon examination, you note her tongue appears very smooth and lacks papillae. When you question the patient about her diet, she tells you that she frequently skips meals. What is the most likely diagnosis? A. Folic acid deficiency B. Pernicious anemia C. Anemia of chronic disease D. Sickle cell anemia - ✔✔A. Folic acid deficiency is caused by an inadequate intake and/or malabsorption of folic acid, which is needed for red blood cell production. The patient's symptoms, along with her inadequate diet, most indicate this condition. Although anemia of chronic disease presents with findings similar to this patient, this condition does not explain the patient's pallor. Sickle cell anemia would not explain the current onset of findings, as this is a genetic disorder that presents with signs during infancy or childhood. Pernicious anemia usually exhibits positive neurological findings, as well. Which of the following is not a risk factor for abnormal Pap smear results? A. Having a male partner who has a history of multiple partners B. Smoking C. Early multiple sex partners D. Excessive alcohol intake - ✔✔D. Excessive alcohol intake is not known to cause abnormal Pap smear results. Risks factors for abnormal Pap smears include having a male partner who has multiple partners, smoking, and having intercourse with multiple partners. A patient's vision is recorded as 20/40 when using the Snellen eye chart. What does this assessment indicate? A. The patient can see at 20 feet what a normal person can see at 20 feet. B. The patient can read the chart from 20 feet in the left eye and 40 feet in the right eye. C. The patient can read at 20 feet what a person with normal vision can read at 40 feet.

D. The patient can read the entire chart at 40 feet, indicating what a person with normal vision can do. - ✔✔C. A patient with 20/20 vision can see at 20 feet what a normal person can see at 20 feet; therefore, 20/ means the patient can read at 20 feet what a person with normal vision can read at 40 feet. The question does not mention anything about a different reading for each eye. Also, the standard length to read the Snellen eye chart is 20 feet away, not 40 feet away Which of the following characteristics is specific to non-Hodgkin's lymphoma? A. Often presents with lymphadenopathy B. More common in males C. Usually presents with cervical adenopathy D. Spreads in a predictable pattern along lymph node groups - ✔✔A. Cases of non-Hodgkin's lymphoma often present with lymphadenopathy, which spreads in an unpredictable pattern. This unpredictable spread pattern is different from that found in cases of Hodgkin's disease, which usually presents with cervical adenopathy that spreads in a predictable pattern along lymph node groups. Lastly, Hodgkin's disease is more common in males, whereas non-Hodgkin's lymphoma affects males and females between 20 and 40 years of age. A 52-year-old woman comes to your office horrified by the lesions on her face. The lesions are smooth, rounded, firm, and flesh-colored, pearly-white papules that are from 1 to 5 millimeters in size. She is not experiencing pain and tells you that she has recently been diagnosed with gonorrhea; however, you believe this to be a case of another kind of sexually transmitted disease. Which of the following is most likely? A. Condyloma acuminata B. Secondary syphilis C. Molluscum contagiosum D. Lymphogranuloma venereum - ✔✔C. The patient's presentation is most indicative of molluscum contagiosum. The other choices are inconsistent with the patient's presentation. Lymphogranuloma venereum involves vesicles and, often, a bubo. Secondary syphilis involves a rash, usually on the palms and soles. Condyloma acuminata presents with warts, not papules, on the genitals. One of your patients has been ill from flu-like symptoms. Over the course of five months, it has become apparent that he has contracted HIV. While treating him, he asks at what point the diagnosis changes

from HIV positive to acquired AIDS. Regardless of symptoms, which of the following is the correct answer to this question? A. When the CD4 is less than 200 cells/uL B. When the CD4 is less than 100 cells/uL C. When the CD4 is less than 300 cells/uL D. When the CD4 is less than 400 cells/uL - ✔✔A. When the patient's CD4 is less than or equal to 200 cell/uL, the diagnosis of AIDS can be considered, with or without the appearance of an opportunistic infection. Which of the following CN is most implicated in the diagnosis of Bell's palsy? A. CN X B. CN IX C. CN V D. CN VII - ✔✔D. Bell's palsy is a dysfunction of cranial nerve (CN) VII, the facial nerve, which controls the facial muscles, mouth and eyes, taste (anterior 2/3) saliva, and tear secretion. CN V is the trigeminal nerve, which controls the muscles of mastication, sensation of the face, scalp, cornea, mucus membranes, and nose. CN IX is the glossopharyngeal nerve, which controls phonation, swallowing, taste (posterior 1/3), gag reflex, and carotid reflex. CN X is the vagus nerve, which controls talking, swallowing, general sensation from the carotid body, and carotid reflex. What type of heart failure is defined as the inability of the heart to contract, resulting in decreased cardiac output? A. Chronic B. Acute C. Diastolic D. Systolic - ✔✔D. Systolic heart failure is defined as the inability of the heart to contract, resulting in decreased cardiac output. The other choices are types of heart failure with different presentations. Acute heart failure is defined by abrupt onset and usually follows acute myocardial infarction or valve rupture. Diastolic heart failure is defined as the inability to relax and fill resulting in decreased cardiac output. Finally, chronic heart failure develops as a result of inadequate compensatory mechanisms that have been employed over time to improve cardiac output.

A nurse practitioner in a family practice clinic is examining a 40-year-old patient who has recently gained 15 pounds. The patient is concerned that her diaphragm, otherwise known as a cervical cap will not be as effective because of her weight gain. Which of the following indicates the minimum weight gain thresh hold for when women would most likely need to see their healthcare provider about refitting their diaphragm? A. Twenty to 30 pounds B. Ten to 20 pounds C. Five to 10 pounds D. One to 5 pounds - ✔✔B. Diaphragms and cervical caps are common contraceptive options, but patients must be mindful that the diaphragm is a delicate device and should see their healthcare provider when they have gained atleast 10 to 20 pounds. Diaphragm users should also regularly check their device for holes and refrain from using oil-based lubricants. Which of the following types of pathogens would you least likely expect to be the cause of a urinary tract infection in an older adult? A. Virus B. Fungus C. Gram-positive bacteria D. Gram-negative bacteria - ✔✔A. Viruses are an atypical cause of urinary tract infections (UTIs). Escherichia coli, a gram-negative bacteria species, is responsible for the majority of UTIs; Gram-positive species (e.g., Enterococci) may also cause UTI. Fungal infection is less common, accounting for approximately 7% of complicated UTIs, but is a frequent cause of UTI in patients with indwelling catheters. You have been assisting a patient who has AIDS over the past year. What medication does an AIDS patient usually take daily for Pneumocystis jiroveci pneumonia prophylaxis? A. Azithromycin B. Trimethoprim-sulfamethoxazole C. Valacyclovir D. Penicillin G - ✔✔B.

Pneumocystis jiroveci is a common opportunistic infection in patients with HIV and/or AIDS, and trimethoprim-sulfamethoxazole is mainly used to treat the condition. Trimethoprim-sulfamethoxazole medication can also be used prophylactically. Azithromycin and penicillin G are used to treat some bacterial infections, but not Pneumocystis jiroveci. Valacyclovir is used only in the treatment of herpes. Although a chest x-ray is not necessary during an asthma attack, the nurse practitioner would expect to see which of the following on the film? A. Minor infiltrates B. Blunting of the costophrenic angle C. Darkening of the parenchyma D. Moderate hyperinflation - ✔✔D. Though a chest x-ray is unnecessary during an asthma attack unless used to rule out other conditions, it may show a sign of asthma in the form of hyperinflation. Darkening of the parenchyma indicates active tuberculosis rather than asthma. Pneumonia can cause pleural effusion, which can push the lung upwards, resulting in "blunting" of the sharply pointed costophrenic angle. Minor lung infiltrates can represent pneumonia and other infections including tuberculosis, pulmonary edema and hemorrhage.