Questions and Answers Graded A
Phalen’s test
Positive result?
tingling, numbness, burning, or pain over first three digitis
Which of the following is used to confirm the hashimotos thryoid?
Anti T-P-O
You are performing a school physical examination on a 5 year old boy. You are unable to pull the skin
back on the penis. what is this called?
Phimosis
Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your
next step is to
A. refer her to a hand surgeon.
B. take a more complete history.
C. try neutral position wrist splinting and order an oral NSAID.
D. order a nerve conduction study such as an electromyography (EMG).
C. try neutral position wrist splinting and order anoral NSAID.
A woman presents to your primary care office for an annual physical. She denies any complaints other
than having heavy menstrual bleeding which is something she has experienced her whole life. On
routing CBC evaluation, her hemoglobin is 11. Other values; dec ferritin, elevated total iron binding
compacity. mcv is 75. Which is the most likely cause of her anemia.
1.Iron deficiency anemia.
2.Thalassemia.
3.Sideroblastic anemia.
4.Anemia of chronic disease (ACD).
1. iron deficiency anemia
102.How soon after a facial laceration should sutures be removed?
a. 4 to 6 days.
b. 3 to 4 days.
c. 7 to 10 days.
d. 10 to 14 days.
4 to 6 days
a 51 year old diabetic male presents to the clinic after sustaining a deep scalp laceration at a
construction site 1 hour ago. The dr cleans and irrigates and sutures. Prophylactic antibiotics are
ordered… which antibiotics in addition to Cephtriaxone
Azithryo
Cephlex
Cipro
Cephlexin?
a 4 year old boy is brought to the office by his mother. His symptoms include pallor, fatigue, fever, bone
pain, adenopathy, arthralgia and hepatosplenomegaly. A cbc with differential diagnosis him with
leukemia. Which of the following is the next best step to take?
elsa test
monospot test
ultra sound
refer to peds oncologist
order pt/ptt and bleeding time
Bone Marrow Smear; elsa test
Which of the following are expected findings with a A lumbar disc herniation compressing the L5 ribs.
Weakness in great toe extension
weakness in the great toe flexion
Weakness in the ankle dorseflexion
Weakness in the ankle flexion
Which of the following is true regarding polycythemia?
increases in high altitude
men vs women
decreases with age
increases with age
…
a 26 year old male complains of painful contraction in his calf muscles after running a marathon, what is
the problem?
hyponatremia
a 79 year old male reports neck stiffness and aching discomfort on his right. The pain is aggravated with
activity and has been progressing over the last year. full strength of the others and the DTRs are 2+,
slightly limited of neck towards the right. Plain radiograph shows degeneration.
Cervical spondylosis
70 year old man diagnosed with hypothyroidism. The dr prescribes levo. It is started with a lower dose
why?
R/O cardiovascular disease
in which of the following situations would wound closure be appropriate?
over a joint
superficial lateral
6cm superficial laceration
a boy is receiving radiation for ALL. What cancer is he more at risk for when hes an adult?
Brain tumor
A 60 year old male presents to the clinic after stepping on a nail. What is the next step after assessing his
vaccination status?
Booster should be given if more that 5 years
Booster should be given if less than 5 years
If it’s been more than 5 years
A 36 year old male presents to the office with complaints of right arm and elbow pain for two weeks.
Works at amazon handling packageges. Has pain at elbow; what do you think it could be.
Lateral epicondylitis
a 63 year old male has been on bph medications, and a decrease in his PSA has not decreased by 50%.
What is the expected outcome?
Elevation
PSA to remain stable
A significant to PSA should occur by 50%
…
Your client Shirley has an elevated mean corpuscular volume (MCV). What should you be considering in
terms of diagnosis?
Iron deficiency anemias
Hemolytic anemias
Lead poisoning
Liver disease
Liver disease
An 18 year old male fell while running and has a 5 cm simple linear cut on the face and uses a 3.0 nylon.
When should the patient return to get them removed?
a. 4 to 6 days.
b. 3 to 4 days.
c. 7 to 10 days.
d. 10 to 14 days.
4-6 days
Which of the following medications is appropriate during an exacerbation of gout?
tylenol
norco
allopurinol
indomethacin
colchicine
indomethacin
What is the first line treatment for a patient with cervical spondylosis without myelopathy symptoms?
Physical therapy
Which of the following medication classes can be associated with erectile dysfunction?
beta blockers
anibolic steroids
nsaids
antibiotics
Beta blockers
Carpal tunnel syndrome is due to inflammation of which nerve?
The median nerve
A 59 year old presents to the er with a diagnosis of priaprism. Despite application of pain meds, what
medication should be given as well?
Phenylephrine
a 74 year old male presents with bilateral back and leg pain for 6 months. The leg pain is greater than
the back pain and describes it as a shooting down her legs? What in the history makes you think it is
lumbar spinal stenosis?
Leaning on grocery cart
Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after
you ask him about his diet?
1. Repeat the laboratory tests.
2. Perform a fecal occult blood test.
3. Start him on an iron preparation.
4. Start him on folic acid.
Perform a fecal occult blood test
a 35 YEAR OLD sexually active man has pain over left scrotum, with urinary frequency and dysuria. The
scrotum is edematous and tender to touch.
Acute epidymitis
A 49 year old female presents with pain on soul of her foot between 3-4 toe, feels like a pebble in her
shoe. what is this?
morton’s neuroma
Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a
microcytic hypochromic anemia. What should you do now at this visit?
1. Obtain a lead level.
2. Instruct Tina’s parents to increase the amount of milk in her diet.
3. Start Tina on ferrous sulfate (Feosol) and check the CBC in 6 weeks.
4. Recheck the CBC.
Obtain a lead level
A 20 year old male presents to the clinic complaining of right knee pain from a soccer injury today. He
felt his right ankle twist. He cannot bear weight. He now reports the knee locks up when he tries to
straighten it. What could this be?
Meniscus, tested by mcmurray
What is the expected objective finding in BPH?
Boggy and warm
rubbery and uniformly enlarged
hard indurated
tender nodules on lateral side of gland
Enlarged rubbery gland
Which of the following is not a recommended treatment option for myofacial pain?
Corticosteroids
dry needle
trigger point injection
massage therapy
Diathermy? heat?
A 52 year old OBESE male presents to the clinic with complaints of numbness and tingling in the right leg
for a month. He denies pains but feels pins and needles in the anterior right thigh. He cannot recall a
trigger. Nothing relieves or aggravates. Physical exam shows negative straight leg raise. Dull sensation
on needle prick to left thigh. DTR are 3+. The clinician looks back and sees theres been no changes,
except that the patient has gained 25 lbs. Based on these findings, which should be included in the
differential diagnosis?
cauda equina
Proximal hip fx
vascular necrosis
neuralgia parethetica
Neuralgia Paresthesia
Which of the following is contraindicated with acute prostitis?
Prostate message
x-linked recessive disorder commonly seen in AA males?
g6p deficiency
a 16 year old male presents to the clinic following a domestic cat bite on his hands. On exam two small
puncture wounds are noted without discharge, no evidence of foreign body, and does not require
treatment. What to do?
Give antibiotics
Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment
should the nurse practitioner use to check for effusion of the patient’s knee?
a. Thomas test
b. Tinel Test
c. Bulge test
d. Phalen test
Bulge test
54. Sherri’s blood work returns with a decreased mean corpuscular volume (MCV) and a decreased
mean corpuscular hemoglobin concentration (MCHC). What should you do next?
1. Order a serum iron level and a total iron-binding capacity (TIBC) level.
2. Order a serum ferritin level.
3. Order a serum folate level.
4. Order a serum iron level, a total iron-binding capacity (TIBC) level, and a serum ferritin level.
Order a serum iron level, a total iron-binding capacity level, and a serum ferritin level.
A 15-year-old boy presents to the clinic after sustaining an ankle injury. He jumped for a rebound and
landed and felt immediate pain and heard a pop. EXAM: Mod swelling and ecchymosis over right lateral
ankle extending to the fifth metatarsal. Bearing minimal weight. Based on H&P, what injury is most
likely?
Grade 3
To reduce the incidence of flares, foods High in what amino acid needs to be limited in the diets of
patients with gout?
a. Purine.
b. Glutamine.
c. Phenylalanine.
d. Alanine.
Purine
The lachman manuever is used to detect which of the following?
ACL
Jeff, age 20, presents to the college health clinic with complaints of difficulty passing his urine and a
discharge from his penis. Upon further investigation, you note that the discharge is urethral in origin.
The most common cause of these symptoms in the young adult male population is:
1. Chronic prostatitis.
2. Prostatic abscess.
3. Acute prostatitis.
4. Prostatic hyperplasia.
Acute prostatitis
Mr. Reynolds is on the antithyroid drug (ATD) methimazole (Tapazole), so you make it a point to check
his:
a. Glycated hemoglobin (HbA1c).
b. Complete blood count (CBC) and liver transaminases.
c. Uric acid level.
d. Total thyroxine (T4).
CBC and liver transaminases
Hashimotos occurs most commonly in what population?
Middle aged women
Macrocytic normochromic anemia are caused by
1. Acute blood loss.
2. An infection or tumor.
3. A nutritional deficiency of iron.
4. A deficiency of folic acid.
Deficiency of folic acid
a 32 Year old male is brought to the clinic with a gout attack. He had 1 other within last 6 months. Upon
examination they note the joint on the right great toe is swollen. Indomethacin and colchicine. What to
teach the patient about colchicine?
1 tablet every 1-2 hours until relief is obtained, or until abdominal pain.
a 40 year old female has been just diagnosed with graves. She lost 25 lbs, has palpitations and is
irritable. What is this most likely?
Tumor
auto immune
thyroid carcinoma
hyperplasia
auto immune
what lab would you expect in a pt with hyperthryoidism?
Elevated TSH and elevated t4
a 51 year old female patient was just diagnosed with acute gout. Which of the following foods would be
allowed?
mushrooms
beans
asparagus
broccoli
broccoli
A patient presents feeling more tired, and a harder time losing weight. Thyroid results reveal an
elevated thryoid and a normal t4, what is it?
Subclinical hypothryoidism
What type of anemia is beta thalacemia minor
Micro
A 45 year old male presents with gouty arthritis in the right toe. He has no pain, swelling or redness
upon exam. The patient is in which stage of gout?
Stage 3 interval between acute attacks
Which of the following is true regarding bph?
The size of prostate correlates with symptoms
it occurs to 50% of men older than 30
Saw palmetto is first line treatment
the prostate is smooth and enlarged.
the prostate is smooth and enlarged.
Which of the following medications does not have a part in the acute treatment of gout?
allopurinol
cochicine
prednisone
allopurinol
67 yr old female presents with low back pain, pain above lower back pain and spine without sciatica.
What can this be?
Musculosketal sprain
a 19 year old female was diagnosed with iron deficiency d/t menorrhia. What education should you
give?
Take it on an empty stomach
take with food
take with OJ
Take before bed
Take on an empty stomach
10 year old boy presents to the clinic following a soccer injury. The clinician says this is a positive
mcmurray sign. What does this finding mean?
Tear of meniscus
Lorie, age 29, appears with the following signs: pale conjunctivae and nail beds, tachycardia, heart
murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect?
1. Vitamin B12 deficiency.
2. Folate deficiency.
3. Iron deficiency anemia.
4. Chronic fatigue syndrome.
iron deficiency anemia
. In which of the following circumstances is the reticulocyte count elevated?
1. Aplastic anemia.
2. Iron deficiency anemia.
3. Poisoning.
4. Acute blood loss.
Acute blood loss
A new mother wants her son to be circumcised, but has hypospadius.
We have to check and see where the opening is
Your son should not be circumsized
Surgeon might need to use that tissue
Surgeon might need to use that tissue
The foreskin is needed for repair.A child’s foreskin is not removed since it is needed to help repair a
hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time.
Disc herniation occurs most commonly at which level of the spine?
L4-L5
Most common cancer in young kids?
ALL
Caroline, 65, is homeless and has iron deficiency anemia. She smokes and drinks when she can and has a
stomach ulcer. Which of the following is not one of her risk factors for iron deficiency anemia?
1. Smoking.
2. Poverty.
3. Ulcer.
4. Age greater than 60.
Smoking
Dietary modifications for the treatment of gout includes which of the following restrictions?
eggs
nuts
cheese
alcohol
alcohol
Jill, age 49, has recently begun a rigorous weightlifting regimen. She presents to the primary care office
with a shoulder dislocation. Which of the following clinical manifestations leads the nurse practitioner to
suspect an anterior shoulder dislocation over a posterior dislocation?
Inability to shrug the shoulder.
Absence of pain.
Inability to rotate the shoulder externally.
Adequate to perform only a few or none of the duties of usual occupation or self-care.
Herniated nucleus pulposus.
Shortening of the arm.
inability to shrug the shoulder
Which of the following can cause ED in patients?
lasix
prilosec
isosorbide
imdur
reserpine
Reserpine
Which of the following groups has been recommended for thyroid testing?
women 50+
35-year-old female presents to your primary care office for review of her laboratory results. Her physical
exam shows a blood pressure (BP) have 140/90, pulse (P) of 105, oxygen saturation of 97%, and
temperature of 98.6o F. She has complaints of palpitations, weight loss, hair loss, and anxiety. Her labs
are all normal except for a low thyroid stimulating hormone (TSH) and an elevated thyroxine (T4). what
would be your next course of treatment be?
a. Start metoprolol and propylthiouracil (PTU).
b. Refer the patient to psychiatry for treatment of anorexia.
c. Refer the patient for radioactive iodine treatment.
d. Refer the patient for thyroidectomy.
a. Start metoprolol and propylthiouracil (PTU).
A 55-year-old Asian male presents with a history of severe left great toe pain. He states he cannot even
touch the toe with a sheet without it causing pain. He denies trauma but states he cannot ambulate
without paying. He admits to drinking alcohol but not to excess. On physical exam, he has normal vital
signs, and you know that your erythema on the great toe at the interphalangeal (IP) joint. Which of the
following is the gold standard for diagnosis of this problem?
a. Joint aspiration with crystal analysis
b. Serum uric acid level
c. X-ray.
d. Diagnosis is made with physical exam only
joint aspiration
Prostate cancer is associated with what virus?
EBarr? Human Papilloma? TD put CMV
You are referring a 73-year-old client for management of his prostate cancer with hormonal therapy. It
is understood that goserelin acetate (Zoladex) acts as a method of androgen ablation by:
1. Blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
2. Blocking 5-alpha-reductase, which converts testosterone into dihydrotestosterone.
3. Inhibiting the binding of testosterone to cancer cells.
4. Inhibiting the progression of cancer cells through the cell cycle.
blocking the release of lH and FSH
What does not lower uric acid levels in management of gout?
Allopurinol
colchicine
euloric
colchicine
Which treatment should the clinician recommend to the patient with patella-femoral dysfunction due to
over use?
immobilization
corticosteroid
quadricept strengthening excercises
quadricept strengthening excercises
Which of the following is the most common kind of cancer in kids and adults?
ALL in kids and AML in adults
a 67 year old female presents to the office with weight gain, dry hair, fatigue, weight gain. TSH is 10 and
a FT4 at .2. Which of the following should you prescribe of levothyroxine?
…
The nurse practitioner (NP) suspects a herniated disk in a 72-year-old patient. The NP elevates the
patient’s affected leg when she is in the supine position, and it elicits back and sciatic nerve pain, which
indicates a positive test. This is known as which test or sign?
a. Femoral stretch test.
b. Crossed straight leg raise test.
c. Doorbell sign.
d. Straight leg raise test.
Straight leg raise
which of the following is the most commonly associated with vertebral fractures?
osteoporosis
What slows levothyroxine absorption?
ferrous sulfate
26 yr old female has secondary obesity. Which of the following could be a cause?
PCOS
A boy comes in and complains that his testicles feels like a bag of worms, what can this be?
Varicecole
A 12 YEAR old presents with another sprain. The NP thinks she may have never been taught on injury
management. What could she teach him?
Stretching is important
15 year old bitten by neighbors dog. The mother asks the clinician whether or not her son will need the
rabies vaccine. The clinician knows that when a domestic dog is suspected of being infected,…what is
the minimum number of days a dog suspected should be under quarantine?
10 days
Which of the following drugs used in the treatment of BPH is considered a 5-alpha-reductase inhibitor?
flomax
viagra
proscar
proscar
Gold standard for definitive diagnosis of sickle cell?
Hemoglobin electophoresis
what will a cbc with differential reveal with pernicious anemia?
macrocytic and normochromic
Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall,
osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which
of the following serious underlying conditions as the cause of her low back pain?
a. Cancer.
b. Cauda equina syndrome.
c. Neurologic compromise.
d. Spinal fracture.
spinal fracture
Which of the following diagnostic tests confirms sideroblastic anemia?
perusian blue stain
Which finding is associated with thyroid hypo function?
exopthalmus
tremor
macroglossia
pretibial edema
macroglossia
The clinician suspects testicular torsion. What finding confirms this?
absence of cremasture reflex
A nurse practitioner is trying to distinguish between an articular and a nonarticular musculoskeletal
complaint in a 26-year-old patient complaining of pain in the elbow area. Which of the following would
characterize nonarticular bursitis?
a. Deep or diffuse pain.
b. Limited range of motion (ROM) on active and passive movement. c. Point or focal tenderness.
d. Swelling and instability.
Point or focal tenderness
Anne, age 67, sustained a fall on an outstretched hand. She presents holding her arm against her chest
with her elbow flexed. Based on the specific location of her pain, you suspect a radial head fracture. The
best initial strategy to assess for a radial head fracture would be: a. To palpate for tenderness, swelling,
and crepitus just distal to the lateral epicondyle.
b. To palpate for tenderness, swelling, and crepitus along the radial wrist.
c. To palpate for tenderness in the “anatomical snuffbox.”
d. To order an x-ray of the wrist.
a. To palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle.
Which of the following reflects the sickle cell anemia heritary?
Sickle cell is autosomal recessive
a 22 year old man is diagnosed with acute low back strains and is given nsaids. what educated is
needed?
Where brace at night
call office
lower back strengthening exercises
lower back strengthening exercises
6. Sigrid, age 48, appears with a 3-month history of heat intolerance, increased sweating, palpitations,
tachycardia, nervousness, irritability, fatigue, and muscle weakness. Which test would you order first?
a. A blood chemistry panel.
b. Thyroid-stimulating hormone (TSH) level.
c. Liver function studies.
d. Electrocardiogram.
TSH level
Which of the following is not a Prostate cancer risk factor?
Smoking
Circ
high fat diet
obesity
circumscision
acute knee pain after a football game, clinician elicits a positive mcmurrays sign, meaning:
torn meniscus
A patient has just been diagnosed with chronic CLL. According to the REI classification system, which of
the following is stage 3?
Lymphocte count >2000
Thromboctopenia
liver and spleen
Thrombocytopenia
Adhesive capsulitis risk factors:
hyperthyroid
hypothyroid
diabetes
diabetes
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