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SHERPATH 2026: ECG INTERPRETATION
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During a post-hospital discharge visit, you notice your 71 year old female patient has been diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle would you anticipate auscultation of a S3 or S
heart sound? - ANSWERS -Diastole
The point of maximum impulse (PMI) is most often palpable in healthy adults when positioned in the supine or left lateral decubitus position. Which one of the following locations is most
commonly described as the PMI in a healthy adult? - ANSWERS -
left 5th ICS, MCL The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would the S1 heart sound correlate with the electrocardiographic waves? -
ANSWERS -Peak of the R wave
Michael, a 72 year old male patient who previously presented with stable cardiac-type chest pain has underwent a stress test. He presents today to review the stress test results, which show EKG findings of ST segment depression during the exam in leads V and V4 as well as some concurrent chest discomfort. Based on
these findings, which of the following are NOT priority medical decisions? *Prescribe metoprolol (Lopressor) 12.5mg PO BID *Prescribe aspirin 81mg PO daily *Refer to cardiology for angiography
- Check for thyroid dysfunction - ANSWERS -Check for thyroid dysfunction Your newly established patient states in the past year, they have progressively developed a noticeable bump on their neck and when asked about symptoms, they report feeling very anxious, have developed a tremor, and are commonly feeling palpitations in their chest.On examination, you identify an enlarged thyroid gland suspicious for a goiter. Of the following diagnoses, which is most likely for the patient to develop based on these findings
above? - ANSWERS -thyrotoxicosis
Your patient has a diagnosis of Addison's disease. Which of the following might you expect to find during examination? -
ANSWERS -low body temperature
Your patient with a diagnosis of autoimmune hepatitis is beingseen in your clinic for routine liver serology and follow-up examination. Which of the following correctly identifies the normal liver span when percussing the liver of a HEALTHY adult? -
ANSWERS -6-12 cm in the right midclavicular line.
The 19 year old male patient presents with acute symptomsof abdominal pain and a history of intermittent heartburn and spicy
While examining a 53 year old female patient, you auscultate abnormal breath sounds over all fields, and now assess transmission of voice sounds by having the patient say "ee" while auscultating the chest with the diaphragm of your stethoscope. Normally, you should auscultate a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the following will you document is present?Positive stereognosis.Positive for egophony.Negative for bronchophony.Negative for egophony -
ANSWERS -Positive for egophony
While assessing the 19 year old patient for a new onset cough, the nurse practitioner may inspect, auscultate, palpate, and/or percuss.How does performing percussion of the thorax assist the provider during the physical examination?To assist with the confirmation of cardiac origin of angina.To assess for deep- seated lesion and tumors.To assess for any pain or discomfort prior to palpitation of the chest wall.To identify if underlying
tissue are air-filled, fluid-filled or consolidated - ANSWERS -To
identify if underlying tissue are air-filled, fluid-filled or consolidated Your 42 year old male patient has been referred to your clinic for establishing care and on his intake survey, you note he has documented diagnosis of interstitial lung disease. You have decided to perform a diaphragmatic excursion test on the patient. Which one of the following results would you expect to see in this
patient? - ANSWERS -Approximately equal level of change in the
descent of the diaphragm bilaterally during maximal inspiration and expiration. with a decreased overall inspiratory capacity
Your 50 year old Caucasian male patient has not seen a primary care giver in 20+ years and is here for a history and physical examination. While examining the head and face, you see your patient has nonpitting periorbital edema, particularly underneath their eyes and very dry, thinned hair, including the lateral third of eyebrows (as pictured below: Sparse hairline, thin lateral eyebrows, Periobital edema). Which one of the folowing would you
expect to cause this finding? - ANSWERS -Severe
hypothyroidism A40 year old, female, African American patient presents for history and physical. Upon your initial assessment, you notice she has severe exophthalmos as pictured below. Which one of the following diagnoses below would be the highest on your differential diagnose of this physical examination finding? (eyes
bulging out of her head) - ANSWERS -Hyperthyroidism.
Your patient with a suspected diagnosis of COPD has been seen by pulmonology and has underwent a pulmonary function test (PFT) with spirometry. As the patient's primary healthcare provider, you have been asked to explain the findings of the PFT to the patient in afollow-up visit at which time the patient asks what the study was evaluating. To describe the PFT to the patient in more useful terms, you state that the large inspiration of air to the furthest extent they could reasonably accomplish followed by a full exhalation is referred to as which of the following
measurements during the PFT? - ANSWERS -Forced Vital
Capacity. Your 32 year old female patient presented for a routine health exam states they have a diagnoses of hyperthyroidism by
Your 49 year old male patient presents with weight loss, night sweats, anhedonia, and a CXR showing profoundly enlarged hilar adenopathy. Based on these findings, a diagnosis of lymphoma would be in your working differential. Which one of the following assessment findings when palpating lymph nodes would be
INCONSISTENT with this diagnosis? - ANSWERS -Non-tender,
minimally palpable anterior cervical chain node palpation. Your late adolescent female patient presents with a history of heavy menses and pale conjunctiva. Your review of systems is fairly unremarkable other than she lives in a house built in 1965, has an unrestricted diet, and her family heredity si Italian. She denies any history of chronic health conditions. Initial CBC with differential shows a microcytic hypochromic anemia which has not yet been diagnosed or treated and the red cell distribution width (RDW) is elevated at 15%. Based on the most common cause of microcytic hypochromic anemia, which of the following labs will
you order first? - ANSWERS -TIBC and Ferritin
While assessing the complete metabolic profile of the 66 year old female patient with end stage renal disease (ESRD) on dialysis, youfind acreatinine of 4.3, BUN of 62, phos of 5.2. On review of the CBC with differential, you would anticipate which of the
following levels? - ANSWERS -Normal MCH, Hemoglobin 9.
During your visit with a 19 year old patient for a college health physical, your health history includes a diagnosis of angioedema. What of the following parts of the body are were likely involved? -
ANSWERS -Face and Lips
Your patient has just been diagnosed with Hepatitis A. Which of the following immunoglobulin are first to be elevated in the
serum? - ANSWERS -IgM.
Your patient had a history of Hepatitis Aapproximately one year ago. Which of the following immunoglobulin is most likely to be
elevated at this time? - ANSWERS -IgG
Your 32 year old female patient presents with a suspected diagnosis of systemic lupus erythematosus (SLE). Which of the
useful labs in making the diagnosis of SLE? - ANSWERS -
Antinuclear antibody. Which one of the following sweat glands concentrated in the palms of the hands and soles of the feet and is involved in
temperature regulation? - ANSWERS -Eccrine.
Your 53 year old female patient with pale skin and easy freckling presents for a skin survey due to their family history of skin cancer. When screening for melanoma, which one of the following findings would be considered a suspicious feature of a mole
characteristic of a possible melanoma? - ANSWERS -Dual color,
particularly white-reddish or blue-black. Which of the following dermatologic lesions si precancerous and
likely due to prolonged exposure to UV-B? - ANSWERS -Actinic
Keratosis.
back of his neck, but the patient reports tremendous pain when attempting to do this. Which one of the following would you
suspect? - ANSWERS -Rotator cuff injury.
The 19 year old female patient complains of jaw pain anterior and inferior to the ear bilaterally. Al of the following are common symptoms of a temporomandibular joint (TMJ) disorder EXCEPT
which one? - ANSWERS -Relief from pain with joint displacement
Unequal shoulder height with a lateral and rotary curvature of the spine would be associated with which one of the following spinal
deformity diagnosis? - ANSWERS -Scoliosis
You perform a sensory assessment on the face and notice abnormal sensation to sharp/dull testing on the left cheek. Which one of the following cranial nerves would you expect to cause this
abnormality? - ANSWERS -Cranial nerve V
During you neurologic examination portion of your comprehensive physical of the new patient to your panel, you perform cranial nerve assessments. Which of the following represents the most effective protocol for assessment of cranial nerve I? -
ANSWERS -Have the patient close their eyes and accurately
identify two different scents with one nostril closed at a time. While performing sensory cortex testing on your patient, you gave them close their eyes and place a familiar object such as a paper clip, key or pencil in their hand, having them manipulate it
skillfully and identify it within 5 seconds. This is known as which of
the following tests? - ANSWERS -Stereognosis
During your physical examination of a 49 year old brain cancer patient, you notice their gag reflex is impaired during the exam. This suggests damage to which one of the following cranial
nerves? - ANSWERS -Glossopharyngeal
Your 18 year old patient has recently been diagnosed with streptococcal infection and has been successfully treated with an appropriateantimicrobial agent. They have no other noteworthy health history, chronic illness, or medications on record. They are complaining to day of hematuria. RBC casts on urinalysis with microscopy have been identified during this visit. Based on this finding, you can make the diagnosis of which of the following? -
ANSWERS -Glomerulonephritis
In addition to patient symptoms of painful urination and frequency, which of the following findings confirms a diagnosis of
pyelonephritis? - ANSWERS -WBC casts on urinalysis with
microscopy. In assessing your patient with suspected pyelonephritis, the following test may be sensitive to elicit a confirmatory response. -
ANSWERS -Renal punch test
As a prudent nurse practitioner, the diabetic, hypertensive patient you are seeing should be evaluated for early evidence of renal damage from both diabetes and hypertension. Which of the
symptoms at rest. This is suggestive of New York Heart
Association heartfailure classification? - ANSWERS -Class III
Your patient has presented with a new onset rapid heart rate thatis irregularly irregular, heart rate 100, BP 120/74, R 16 non labored, and SP02 is 99%. They state this has been going on for a week or so intermittently, but for the last 4 days straight it hasn't stopped. Your first priority intervention for this patient is to do
which of the following: - ANSWERS -Maintain rate control and
anticoagulate prior to rhythm conversion You are evaluating a 63 year old male patient with symptoms of chest pressure, arm numbness and tingling, as well as shortness of breath with excursion. Their health history includes diabetes mellitus, hypertension, hyperlipidemia, and rheumatoid arthritis. Thisrelieves with rest and is not becoming more frequent in the episodes. Based on these findings, you diagnose and plan for the
patient includes which of the following? - ANSWERS -Unstable
angina, and treat with sublingual nitroglycerin and order a cardiac stress test. Your 72 year old female patient with a pertinent medical history of coronary artery bypass grafting (CABG) and aortic valve replacement 7 years ago with a porcine bioprosthetic valve has been previously stable on their medical regimen. Today she complains of near syncope when standing, which she states has been getting worse over the past 6 months but failed to tell anyone as she felt it was just part of natural aging and taking medications. Your workup should include evaluation of which of
the following potential cardiac complications? - ANSWERS -
Bioprosthetic aortic valve stenosis
While evaluating a patient in your clinic for a routine health visit, you auscultate crackles in the poster left lower lobe, have the patient cough, with follow-up auscultation revealing clear breath sounds. Which one of the following would you suspect? -
ANSWERS -Atelectasis
You are working in an urgent care setting as a NP when a patient presents with shortness of breath after a fall from a ladder earlier this morning. You obtain a chest xray and radiologist on call notifies you that it appears to be a tension pneumothorax. Which one of the following findings would you expect to see on the xray
if this was the correct diagnosis? - ANSWERS -The trachea
shifted toward the unaffected side. Your 39 year old patient who has recently been hospitalized for an appendectomy and is being seen in your clinic for post-operative follow-up with primary care. On assessment, the patient complains of some incisional pain and otherwise examination is normal, with the exception of dull percussion sounds noted on the thorax over lung tissue. Which of the following diagnoses would be explained by this finding in post-operative patient? -
ANSWERS -Atelectasis
Which one of the following patients would you most anticipate to
complain of hemoptysis? - ANSWERS -Lung cancer
Gladys, a 72 year old patient with a history of anemia of chronic disease from kidney failure, diabetes mellitus, and hypothyroidism presents today with concerns her thyroid medication is not
breathing. The patient exhibits a positive Murphy sign. These findings are most consistent which one of the following? -
ANSWERS -Cholecystitis
educating your patient about the non-pharmacologic management of gastroesophageal reflux disease, you include teaching to the patient that their heartburn is aggravated by al of
the following except which one? - ANSWERS -Gastric dumping,
or increased emptying into the small intestines Mike, your 48 year old construction worker patient presents to your clinic with a chief complaint of floaters, some flashes of light, and a curtain coming down over the visual field. As a prudent nurse practitioner, you notify Mike that he needs to be seen by ophthalmology immediately as these are al signs and symptoms
of what condition? - ANSWERS -Retinal detachment.
The patient is experiencing acute closed angle glaucoma. Which of the following examination findings by the nurse practitioner is
most consistent with their diagnosis? - ANSWERS -Increase in
intraocular pressure When performing a health history, your 52 year old male patient complains of difficulty hearing people when spoken in the right ear. During physical examination, you perform a Weber test with your patient reporting increased hearing of vibrations in the right ear. Which one of the following would you suspect based on these
findings? - ANSWERS -Left side sensorineural hearing loss.
Your patient has provided you with a research paper about a new treatment plan that is being used, somewhat controversially, in otherareas of the world to treat sinus infections. She asks for your opinion. In reviewing the article, you educate the patient that they should look for which of the following, which are considered the
highest level of research quality? - ANSWERS -Systematic
review A 16-year-old female patient with heavy menses has been diagnosed with iron deficiency anemia. She is also having longer and more irregular periods than is typical as well as extremely painful cramping. You would likely need to consider which of the
following diagnoses in your workup: - ANSWERS -Endometriosis
While managing the care of the patient with chronic alcoholism, the nurse practitioner would likely anticipate which findings on
the CBC with differential? - ANSWERS -Elevated MCV and MCH.
Your 43 year old female patient with no otherwise remarkable health history has a routine health visit and when evaluating the labwork, you notice a platelet count of 80,000. Which of the
following is a correct diagnosis for this patient? - ANSWERS -
Thrombocytopenia The nurse practitioner is caring for a patient with an elevated WBC, fever, chills, and malaise. When developing a differential diagnosis for this finding, which of the following is not a potential
cause of the elevated WBC? - ANSWERS -Diabetes Mellitus Type
your evaluation, you identify darkened or velvety skin in the neck, groin, and/or axilla with associated acrochordons. This is most
likely a diagnosis of which of the following? - ANSWERS -
Acanthuses nigricans Your 21 year old sexually active female patient states during a routine health exam that they have some "weird bumps" on their vulva.She is concerned she has a sexually transmitted infection. You notify her that condyloma are caused by exposure to which of
the following? - ANSWERS -Human papilomavirus type 6 and 1
Your patient has expressed concern about a skin lesion which you identify as darkened, round, and raised. This benign lesion that appears like "stuck on" to the skin. Which of the following lesions
best fits this description? - ANSWERS -Seborrheic Keratosis.
A62 year old female patient with erythema on the face surrounding the nasolabial folds as well as very fine dandruff in the hair and skin is most likely describing with which of the
following diseases? - ANSWERS -Seborrheic Dermatitis
Your 32 year old patient exhibits mood changes with a cyclical nature of euphoria and bliss then troughs of depression and anhedonia. In addition to working them up for metabolic causes, you refer them to psychiatry and suggest a likely diagnosis of
which of the following? - ANSWERS -Bipolar disorder
Yourpatient who has underwent a recent major medical medical procedure is at a rehabilitation center and is having a hard time
being motivated to do therapy. When you interview them as the nurse practitioner on staff for the subacute rehab center, they appeardespondent, and are having a hard time being wakeful during therapy sessions. They have stable vital signs, temperature, urine output, and are not ill-appearing. As a prudent nurse practitioner, you understand this may represent which of
the following; - ANSWERS -Situation depression
Your 29 year old male patient was a military soldier who states he "saw some pretty awful things" during his time in service. When you knock to enter the room, you notice he jumps up from the exam table and stands facing the door and states he always has to have his face toward the entrance to the room. This is most
suggestive of which of the following diagnoses; - ANSWERS -
Post traumatic stress disorder The 18 year old female patient who inappropriately exhibits fear of abandonment, intense interpersonal relationships, affective instability, and recurrent self-harm describes which of the
following diagnoses: - ANSWERS -Borderline personality disorder
Your 55 year old male patient with a history of diabetes, systolic heart failure, and hyperlipidemia presents to your clinic for a new complaint of progressive onset over the past 6 months of left lower posterior leg pain with prolonged ambulation, at which time he also becomes short of breath, but this does resolve with rest. He also describes that at rest, he experiences numbnessdown the left lower leg and is having some noticeable hair loss over the anterior tibial surfaces. Based on these limited exam findings, which of the following would be the best leading diagnosis and
