1. A 59-year-old 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 and the left side. You know that he is at risk for chronic lymphotic leukemia. Which of the following results is considered the hallmark of this disease?
A. Philadelphia chromosome in leukemic cells
B. Lymphocytosis
C. Non-circulating blast cells in bone marrow
D. Pancytopenia with circulating blasts.
2. A 28-year-old single mother arrives at your office inquiring about alternative options for contraception. The woman mentions that she has been having an oral contraception for the last 10 years but is curious about the hormonal intrauterine device (IUD) option she read about in an article. Which of the following is one of the advantages of using a hormonal IUD?
A. Prevention of depression
B. Prevention of Asherman’s syndrome
C. Increased menstrual loss
D. Spotting
3. You are monitoring a toddler who has serous otitis media. The patients want to understand the treatment their child will receive. Which of the following would be the appropriate way to manage this condition?\
A. Oral antibiotics
B. Antihistamines
C. Decongestants
D. Monitor and re-evaluate in 3 months
4. Which of the following seizure patients would most likely benefit from lumbar puncture?
A. Any child with a tonic-clonic seizure
B. An 11 year old with a fever of 101.5 F
C. A four-month-old without fever
D. A two-year-old with a known seizure disorder
5. You take a serological test on a patient with hepatitis. Checking over the results, you discover the patient’s serology is positive for the following: surface antigen of the Hepatitis-B (HbsAg), antibody to the antigen of the hepatitis B virus (Anti-Hbe), immunoglobulin M (IgM0, immunoglobulin G (IgG0. What is the proper diagnosis?
A. Chronic hepatitis B
B. Recovered hepatitis B
C. Acute hepatitis A
D. Acute hepatitis B
6. Robert, a good friend of your, has called you to advice on obtaining a medical certification. He wants to know his various options. Which statement is true regarding the difference between licensure and certification?
A. Certification signifies that a person is qualified to perform a particular role and is granted by a government agency.
B. Licensure signifies mastery of specialized knowledge and is granted by a government agency.
C. Certification signifies mastery of specialized knowledge and is granted by a non-governmental agency.
D. Licensure signifies that a person is qualified to perform a particular role and is granted by a non-governmental agency.
7. A mother brings her 3-month-old baby to your clinic to screen for failure to thrive (FTT). Which of the following is not a sign or symptom that would cause you to associate the infant with FTT?
A. Absolute length/width are below the 5th percentile
B. Weight falling greater than 2nd percentiles below the standard
C. Avoids eye contact
D. Commonly cries for more food or milk
8. Which of the following is not true of progestin-only birth control?
A. It has excellent reversibility
B. It most likely changes tubal transport of female and male gametes
C. Its mechanism of action affects the cervical mucus and the endometrium
D. It is typically more effective than combination pulls but has more side effects
9. The parents of a 1-year-old patient presents to you with concerns regarding their daughter’s health. At birth, they were told that their daughter had abnormal features and decreased muscle tone. They hope that their daughter would “grow out” of some these defects but, to their disappointment, she has not.
They report that their daughter is having trouble walking and sitting up by herself. Furthermore, they state that no matter how much they feed their baby, she is always crying out for more food and, as a result, has been rapidly gaining weight. You suspect a chromosomal condition. Which of the following would be most likely?
A. Prader-Willi Syndrome
B. Hurler syndrome
C. Down syndrome
D. DiGeorge syndrome
10. The mother of a toddler complains that her 2-year-old child is picky eater, and despite evidence of a healthy growth pattern, she is concerned about her child’s appropriate food intake. Which of the following is the most accurate regarding toddler nutrition?
A. Your toddler’s diet is appropriate if he consumes 70 to 100 kcal/kg/day
B. Toddlers should consume more protein and a total of 120 kcal/kg/day
C. Toddlers must consume a least 45 kcal/kg/day
D. Parent of toddlers should insist that their children clean their plate and consume 100 to 110 kcal/kg/day
11. During a check-up with a 6-year-old, you wish to conduct an interview the child and his parents. He is a new patient, and you want to establish the proper doctor-patient relationship. Which of the following is a necessary component of your interview?
A. Assess child’s cholesterol
B. Informing the parents ahead of time if you are recording data
C. Assess liver function
D. Measure the child’s hematocrit
12. According to Jean Piaget, between the age of seven and 11, a child’s psychological development will be marked by:
A. Development of intuitive thought
B. Capability of logical thought
C. Trial and error learning
D. Capable of complex problem solving
13. After years of not conceiving, Kelly and Ed finally have a child, a girl named Beverly. They often check with you about what to expect as Beverly ages. In a month she will be 2 ½ years old. Which of the following is typically present in a 2 ½ -year-old child?
47. When performing a physical exam on an adolescent patient, you should keep in mind that hormone surging can affect which of the following part of the body?
A. Tooth eruption
B. Motor skills
C. Visual acuity
D. Liver function
60. An 18-month-old boy is diagnosed with Coxsackie virus, also known as hand, foot and mouth disease. Which of the following is the most appropriate management for this condition?
A. Steroids
B. Acetaminophen
C. Doxycycline
D. Acyclovir
61. In July, Marian brings in her 5-year-old son, Jensen, who has just started presenting with Varicella zoster virus. His contraction of the virus was intentional as Marian brought, Jensen to a “chicken pox party” where a child with the virus can spread it to other kids, so all the children can get the virus now and not when school is in session. Marian asks you for a treatment that specifically reduces the duration of his signs and symptoms. Which of the following is the best recommendation for treatment?
A. Antihistamine
B. Acetaminophen
C. Acyclovir
D. Calamine
62. After 3-month-old Jeremy was exposed to pollen found in the backyard, the parents bring him in because of red scabbing on his skin. Which of the following should Jeremy’s parents avoid using for his treatment?
A. Topical steroids
B. Ultraviolet bright light
C. Oil-based products
D. Soap and water
63. Which of the following categories of burns present as moist?
A. First and second
B. First
C. Second and third
D. Second
64. The father of a 7-year-old bring his child in with complaints of purulent discharge and pain to left ear. Upon examination you notice that the child is to be in pain upon manipulation of the auricle, but the tympanic membrane appears normal and shows evidence of mobility. Which of the following is the most likely diagnosis?
A. Acute otitis media
B. Serous otitis media
C. Otitis externa
D. Mastoiditis
65. Jimmy comes to your office for a checkup. During the physical exam, his nose begins to bleed. You begin to apply pressure to which part of the nasal septum?
A. Anterosuperior
B. Anteroinferior
C. Posterosuperior
D. Posteroinferior
66. Melissa brings her 10-year-old son Alex for a checkup. His medical history includes corticosteroid treatment for juvenile rheumatoid arthritis (JRA) with which he was diagnosed last month. Melissa was told by the immunologist that Alex would need periodic checkups with an ophthalmologist, however, she notes her son has yet to mention any problems with his eyes. Which of the following should you tell her?
A. The inflammation due to JRA often inflames the conjunctiva, causing gradual strabismus.
B. The resulting weakened immune system usually leads to recurrent conjunctivitis
C. Juvenile rheumatoid arthritis leads to glaucoma
D. Prolonged use of corticosteroids may lead to cataracts
67. What are the 2 most common presentations of mononucleosis on the 16 to 20-yeail-old group?
A. Fatigue, sore throat
B. Swollen lymph nodes, nausea
C. Swollen lymph nodes, joint aches
D. Fatigue, nausea.
68. An adolescent presents with copious mucopurulent discharge from his right eye. Given the most likely diagnosis, which of the following is the most appropriate first-line treatment?
A. Penicillin
B. Zithromax
C. Ceftriaxone
D. Erythromycin
69. You are treating a 9-year-old patient with asthma. Her symptoms, which include coughing and chest tightness, occur three times a week during the day and three times a month during the night. Additionally, she also has a forced expiratory volume in the one second of 80%. Which of the following is the most likely severity level of the asthma condition?
A. Mild persistent
B. Moderate persistent
C. Severe persistent
D. Mild intermittent
70. A 1-month-old patient presents with symptoms of chronic cough, nasal passages filled with mucus, and a respiratory infection. You find an obstructive pattern in the pulmonary function test and try to look for more signs to confirm your suspected diagnosis. Which of the following findings, if encountered at sometime, would not help you confirm the most likely diagnosis?
A. Fever
B. Delayed puberty
C. Large, liquid, bulky, foul stool
D. Salt-tasting skin
71. You are seeing a 2-year-old who has an upper respiratory infection. Findings include a fever of 102 F, grunting, and prolonged expiration. Based on these signs, which of the following would be the most likely laboratory finding for this patient?
A. Slight WBC elevation with eosinophilia
B. Abnormalities typical of obstructive dysfunction
C. Productive cough
D. Chest x-ray with hyperinflated lungs
72. The nurse practitioner conducts a physical exam on a 15-year-old patient presenting with symptoms of respiratory infection. During ausculatation, she hears decreased breath sounds in the right lower lobe. To confirm this finding, she asks the patient to say “EEE” and you hear “AAA”. What respiratory assessment is the nurse practitioner conducting on the patient?
A. Type and location of breath sounds
B. Egophony
C. Testing for heart murmur
D. Pulmonary function test
73. Which of the following is not a bacterial pneumonia?
A. Klebsiella
B. Haemophilus influenza
C. Pseudomonas
D. Rickettsia
74. Seven-year-old Will is brought to your office after developing a limp. His parents state Will has begun to experience pain in his groin, hip, and left knee since the limp began. Moreover, they express concern about their son’s growth as Will is shorter in stature than most of his peers. Physical examination finding include abduction of the hip joint and passive internal rotation of the hip. Given the patient’s age and presentation, which of the following is the most appropriate form of treatment?
A. Limitation of physical activity
B. Referral to orthopedics
C. Observation
D. Analgesics
75. The parents on a 13 year old girl come to your office concerned about the risk of scoliosis in their daughter given a family history of the condition. The daughter is developing asymmetry in her posture and is slightly shorter in stature than most her peers. Which of the following aspects of the patient’s presentation is not a risk factor for scoliosis?
A. Age
B. Gender
C. Stature
D. Family history
76. Twelve year old Adam comes to your office after having experienced a recent, sudden growth spurt. He complains of pain in the area just below his right knee and reports tenderness when you apply pressure to the area. These findings indicate which of the following as the most likely diagnosis?
A. Osgood-Schlatter disease
B. Slipped capital femoral epiphysis
C. Toxic synovitis
D. Legg-Calve-Perthes disease
77. Which of the following is not a component of the physical examination for developmental dysplasia of the hip?
A. Galeazzi’s sign
B. Barlow’s maneuver
C. Ortalani test
D. Adam’s forward bend test
78. A concerned mother brings her four-year-old son, Kevin, to the office. The mother is worried about Kevin’s weakness and clumsiness compared to other children his age as well as his abnormal posture. Further, she notes unusual movements from her son such as moving his hands up his legs when rising to stand. As you begin laboratory testing to confirm your suspected diagnosis, which of the following would you not expect to see?
A. Decreased creatine kinase
B. Necrotic degenerating fibers
C. Abnormal electrocardiogram
D. Myopathy
79. Bell’s palsy is associated with the malfunction of which cranial nerve?
A. VII
B. IV
C. VIII
D. XII
80. A mother brings her 6-year-old son, Glenn, to the clinic for a check-up. She is concerned that her son constantly says that he smells “peppermint.” Upon physical examination, you notice the child’s mouth starts twitching to the right. After a minute, the twitching stops and Glenn asks why everybody is looking at him. The child is exhibiting signs of which of the following conditions?
A. Complex partial seizures
B. Clonic seizures
C. Simple partial seizures
D. Tic disorders
93. Which of the following is not a finding of type 1 diabetes mellitus?
A. Dysfunction of peripheral sensory nerves
B. Generalized pruritus
C. Paraesthesia
D. Nocturnal enuresis
94. The parents of 5 year old Brian are worried that he has begun wetting the bed. As you educate them on enuresis, they ask how many children Brian’s age are affected by this condition. What should you tell them?
A. 10%
B. 20%
C. 3%
D. 40%
95. Which of the following typically causes urinary tract infections in childhood?
A. Urinary stasis
B. Escherichia coli
C. Obstructive lesions
D. Staphylococcus aureus
96. You have assisted Thomas and Myra through Myra’s first pregnancy. The birth of their son, Chad, was uncomplicated, but during the examination of the infant, it was discovered that the boy’s urethra was ventral side of the penis. Which of the following is the least effective cause of treatment?
A. Refer to an urologist
B. Refer for surgery in six-twelve months
C. Do not perform circumcision
D. Refer to emergent surgical intervention
108. An 8-week pregnant patient comes into your office with complaints of brown blood she say in her underwear, pelvic pain, and lower back pain. You conduct a physical examination and elicited complaints of tenderness of the cervix. Additionally, you also note uterine enlargement. Of the following, which tests should you conduct to diagnose the most likely condition?
109. Charlie, 26, complains of fever, headache, and malaise. Since it is cold and flu season, you suspect that he may have the flu. You administer a throat, swab, which is negative for bacteria. Among the following choices, which would you not recommend for his treatment?
110. Your patient, Carl, is in your office for an examination. When undergoing the physical exam, his nose starts to bleed. Carl says he thinks the weather is causing him to have more and more frequent nose bleeds. If Carl’s nosebleed is not an atypical incidence, from which of the following sites would you most expect the nose bleed to originate?
111. After performing an eye exam on 38-year-old Megan, who was recently diagnosed with type 2 diabetes, you conclude that she is at risk for retinal vein occlusion. While performing a fundoscopic exam on Megan, how should normal retinal veins compare to arteries?
112. Which of the following is not a treatment for otitis externa?
113. An 18-year-old girl presents with fever, drastic weight loss, and a general feeling of malaise. During an otoscopic exam, you find white tonsillar exudates. Upon physical examination, you notice a mass in the girl’s upper left quadrant. What tests should you order to confirm the most likely diagnosis?
114. Jo arrives with itchy patches of sharply defined red spots on her hands. Her husband works at a chemical plant, and she handles his laundry. You have diagnosed her with allergic contact dermatitis. Which of the following would not be prescribed to the patient?
115. Charles has a condition developing on his arms. You see areas of elevation of the skin that are larger than 1 cm in diameter, flat, and resemble psoriasis. Which of the following terms best fits this description?
116. Parker, a 35-year-old male. Comes to your clinic demanding an antidote for a spider bite. He states that he has already become feverish. You check his arm and see a red swollen boil, and you ask him when he was bitten. He responds, “I don’t know, it must have been while I was asleep.” After reviewing his history, you learn that he was recently hospitalized. This leads you to suspect that his condition is not a spider bite but rather a type of skin infection. Which of the following treatment would be best to prescribe first?
117. Going into summer, 54-year-old Elaine is excited to show off her new, skinnier shape. She is more distressed than usual when she comes to your office complaining of “red circles” on her skin. Upon assessment, you notice that these circles are only on her arms and legs, and are dry and scaly. Given this classic presentation, which of the following antifungals should you prescribe her?
118. You have been treating 18-year-old Timothy with an oral antibiotic for his moderate acne. He was excited that his long battle with acne might be over, but now he returns to your office for a checkup and is depressed. His condition did not improve, rather it seems to have worsened somewhat. You decide to prescribe a topical antibiotic as well. Which of the following topical antibiotic is the most frequently used for the treatment of acne?
119. Which of the following medication for type 2 diabetes mellitus is an alpha-glucosidase inhibitor to specifically reduce glucose levels?
120. Thirty-seven-year-old Fred presents with complaints of acne, sudden weight gain, and excessive hair growth. Upon examination, you note purple striae and a blood pressure reading reveals that Fred is hypertensive. Based on the patient’s findings, you order laboratory tests to confirm your suspected diagnosis. Which of the following laboratory findings you would not expect to see?
121. You are examining a patient whose blood pressure is 140/85 and triglycerides read 140 ng/dL. Moreover, upon physical examination, you find that his waist is 44 inches. Based on these findings you suspect metabolic syndrome and educate the patients on his condition. Which of the following statements is not correct information to give to him?
122. You are seeing a patient who has recently been diagnosed with hyperthyroidism and are educating him on the causes of this condition. You should tell the patient all of the following except?
123. Harold, a 63-year-old diabetic, is reporting problems with elevated blood sugar during the morning, typically when he wakes up. He is unsure as to what the problem is because he tests his blood sugar every night before going to bed and his results are supposedly within normal ranges. Problems with early morning hyperglycemia are not uncommon to diabetics, and you suspect Harold’s case is no different. If Harold’s hyperglycemia is not the result of any external circumstances, such as having a sugary snack upon waking, Harold would have a hypoglycemic blood sugar at which of the following times?
A. 5:00 am
B. 7:00 am
C. 1:00 am
D. 3:00 am
124. A 24-year-old female comes to your office complaining of pain along the buttocks, the side of her leg, and the side of her ankles. You ask her to flex her foot and you find a weakness of plantar flexion in her foot and great toes. You tap her Achilles tendon while her foot is dorsiflexed, to which you elicited a weakened response. Which of the following should you ask the patient to do to screen for the most likely disk pathology?
125. Wilma, a 63-year-old with osteoarthritis is complaining of pain and stiffness in her joints. Which of the following statements is most likely true regarding Wilma’s current state?
126. You just referred 19-year-old Emily for a cast on her sprained ankle. Which grade of ankle sprain would she have to necessitate a referral?
127. Which of the following, if found, would help differentiate rheumatoid arthritis from osteoarthritis?
128. A 32-year-old man comes to your office limping and complaining of pain in his knee. He had been playing basketball and he believes that he hurt it after a particularly unruly game. You flex his knee 90 degrees, put pressure on his heel with one hand, while rotating the lower leg internally and externally. Which of the following tests have you performed?
129. You are treating Bruce, 38 years old, who was confirmed positive for HIV. Bruce now returns to your office with fever and a non-productive cough. Moreover, he complains of shortness of breath and states that he has begun to experience unintentional weight loss and night sweats. Based on Brice’s signs and symptoms, you suspect a diagnosis of AIDS. Which of the following laboratory tests would confirm this diagnosis?
130. John, a 21-year-old male, is a college student who comes to your office complaining of painful urination. He reports that this morning he was “grossed out” when he saw yellow and green penile discharge. A gram stain of the discharge shows gram-negative diplococcic and white blood cells. Which of the following is the best treatment for John’s condition?
131. A high school girl comes to your office for a checkup. You begin a standard exam, but she immediately asks you about HIV transmission. She mentions that, though she has never had intercourse, she is worried because she has recently engaged in what she considers risky behavior. Given the most current literature, what should you tell the girls is the least likely mode of transmission for HIV?
132. After experiencing joint pain and loss of hair both on his head and in random parts of his body, 43-year-old Gregg comes to your office. During questioning, he also reveals a lack of appetite, and a general feeling of discomfort and unease. The patient reports having unprotected sex with a stranger sometime before his symptoms occurred and is worried that he may have a sexually transmitted infection. You conduct a microhemagglutination assay, which returns positive for the antibody to Treponema palladium. Which of the following drugs should be used in the plan of care?
133. You know Debbie because you treated her mother for breast cancer last year. Now she comes in complaining of discomfort and pain in her pelvic area. She has reentered dating life after withdrawing from it for a year because of her mother’s situation. She has no desire to eat, and she looks as if she has lost weight since her last visit. Which of the following test is least likely to reveal the source of Debbie’s pelvic pain?
134. You are performing a dual-energy x-ray absorptiometry (DEXA) on Katherine, a 42-year-old Asian female who is experiencing early menopause. She has requested a DEXA to screen for osteoporosis. In the process of conducting a DEXA, the measurement that compare the patient’s bone density to the average bone density of control subjects who have peak bone density is:
A. T-score
B. C-score
C. D-score
D. Z-score
135. You are treating 22-year-old Shoshanna, who admits to your that she has never had sex. You know that the administration of a Papanicolau test (Pap smear) should start three year after a patient has become sexually active, however, if a female has not yet had sex, like Shoshanna, the administration of Pap smears should begin or should have begun?
136. David, a 42-year-old, lives alone. He comes in complaining of lower back pain, fever, and testicular pain. He shows signs of scrotum edema. Although this condition is usually caused by Chlamydia, you know that is not the cause here. Which of the following is the most likely cause in this case?
137. A new patient of yours is extremely concerned about developing osteoporosis. She has come to you to learn of there are any effective ways to increase calcium in her diet. Which of the following options would be the least helpful addition to her diet?
138. You are counseling a couple who is employing a surrogate to carry and deliver their baby. They are concerned because their surrogate has developed strange food cravings, including a craving to eat clay. Which of the following results drawn from the surrogate would be most expected if her condition was the results of hemoglobinopathy?
139. 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 lost 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?
140. A 24-year-old patient presents to your office with complaints of fatigue, headache, and a recent onset of a very pale complexion. Upon examination, you note her tongue appears very smooth and has an absence of papillae. When you question the patient about her diet, she tells you that she frequently skips meals and tends to eat fast food on the times when she does eat. What is the most likely diagnosis?
141. Upon the conclusion of a 30-year old woman’s examination, you have chosen to prescribe oral ferrous sulfate. This type of therapy is the mainstay of treatment for which of the following?
142. An African American man enters your clinic complaining of weakness, dyspnea, and a sudden onset of severe pain in his back, chest, and extremities. Lab test show decreased hemoglobin, and his history reveals sickle cell anemia. Which of the following would you not order as a course of treatment?
143. You specialize in caring for the elderly and are concerned about a recent spike of suicides in the elderly community. What are the two major reasons that the elderly commit suicide?
144. 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?
145. Your patient has a history of alcoholism in his family. He is concerned by this history and asks for your advice. Which of the following is a false statement regarding alcoholism and family issues?
146. You are caring for a patient with Alzheimer’s disease. Which of the following is most helpful in assisting with memory impairment while improving cognitive clarity?
147. Scientist do not yet fully understand what causes Alzheimer’s disease, but it is clear that this disease develops because of a complex series of events in the brain over a long period of time. The likely causes of Alzheimer’s includes genetic, environmental, and lifestyle factors. One theoretical cause is an improper balance and function of neurotransmitters in the brain. Which of the following conditions is considered a casual factor of this aspect?
A. Dopamine deficiency
B. Acetylcholine deficiency
C. Serotonin excess
D. Excessive norepinephrine
148. Daniel, a 57-year-old male, presents to your office with a slow but noticeable tremor. He complains that the tremor gets worse whenever he is particularly stressed. He also states that his body has become increasingly rigid and that he is having difficulty swallowing. You notice that Daniel’s blinking very slowly and inconsistently, but, when you tap the bridge of his nose repetitively, he responds with sustained blinking. Of the following disorders, which would best account for Daniel’s condition?
149. You are about to perform diagnostic tests on Shannon, a 34-year-old with multiple sclerosis. Before you initiate your assessment, you engage in a brief conversation concerning her disorder and the laboratory examinations that surround it. Of the following statements, which is incorrect regarding laboratory diagnostics of multiple sclerosis?
150. A patient with a history of headaches is taking propranolol. However, it is noted that she does not have hypertension or anxiety, which propranolol is often used to treat. Given this information, which of the following is the most likely reason that she is on propranolol?
A. To improve alertness during headache attacks
B. To lessen the severity of migraine headaches
C. To prevent macular degeneration as a result of chronic headaches
D. To diminish the recurrence of migraine headaches
151. Mark is admitted after experiencing a short, 30-second seizure. Five minutes later, his girlfriend, who admitted Mark, said that he went in and out of consciousness. During this time, Mark did a lot of “lip smacking,” which is not normal for him. Which of the following classifications best fits the description of Mark’s seizure?
152. Which of the following is a steroid option for patients with Bell’s palsy?
153. Ruth, 39 years old, comes to your office complaining of a bitter taste in her mouth, a “burning” feeling in her chest, and excessive salivation. She states that these symptoms occur mostly at night. Based on these symptoms, you suspect a diagnosis of gastroesophageal reflux disease. Which of the following would not be given as initial treatment?
A. Cimetidine
B. Sodium bicarbonate antacid
C. Dexlansoprazole
154. Fifty-year-old Patrick presents with complaints of intense pain in his right upper abdomen that radiates to his shoulder. He also states that he has recently begun vomiting which gives him some relief from his pain. Upon physical examination, you find that Patrick has and elevated temperature and a positive Murphy’s sign. Which of the following would be the most effective test to confirm your suspected diagnosis?
D. Computerized tomography
155. Twenty-year-old Clayton comes to your office complaining of attacks of acute pain in his stomach. Clayton states that his pain has concentrated in the lower right corner of his abdomen since onset. Based on the patient’s presentation, you suspect a diagnosis of appendicitis. Which of the following signs would not confirm the diagnosis?
156. Your patient complains of experiencing continuous bouts of bloody diarrhea for the past three months. A sigmoidoscopy confirms ulcerative colitis. Which of the following is not utilized in the management of this condition?
A. Mesalamine suppositories
B. Colectomy
C. Hydrocortisone suppositories
D. Broad spectrum antibiotics
157. Horace, a 60-year-old male, states that he has been experiencing frequent gnawing stomach pain that worsens with eating. Furthermore, while at a dinner party the night before, Horace has to excuse himself from the table because of severe stomach pain. This history is specifically associated with which of the following conditions?
A. Gastric ulcer
B. Duodenal ulcer
C. Gastroesphageal reflux disease
D. Gastroenteritis
158. You have diagnosed your 70-year-old patient with pneumonia. You note from her history that she is also diabetic. Which of the following medication regimens would be most appropriate?
159. You have a patient who presents with a number of respiratory symptoms. He has a temperature, and, upon auscultation, you hear crackles. You believe your patient has either pneumonia or acute bacterial bronchitis. Which of the following signs and symptoms would confirm a diagnosis of pneumonia?
160. An 18-year-old female comes to your office two weeks before she is going to begin her first semester at college. She is anxious but also excited, especially to be living in the dormitories. To be able to live there, though, she needs to provide proof of a negative tuberculosis (TB) test. According to her results, however, she has an active TB infection and needs to begin treatment immediately. You tell her that if the condition proves susceptible to her medication regimen, the initial course of the medication could last for:
161. A patient of yours has poorly controlled chronic asthma. His history indicates that he is taking inhaled corticosteroids for treatment. Which of the following additional medications would be most effective for the maintenance of chronic asthma?
162. A 37-yesr-old patient presents with dyspnea and sputum production. His history indicates that he has been smoking for the past 15 years. Which of the following additional finding would help the nurse practitioner diagnose the patient’s condition as chronic bronchitis?
A. Productive cough for three consecutive months in the past two years
B. Mild, clear sputum
C. Blunting of shadowing of the costophrenic angle
D. Increased of chest anteroposterior diameter
163. You are visited by 29-year-olod Henry who has previously had tachycardia. Upon physical exam, you hear a low-pitched rumble that occurs during the first heart sound. Of the following conditions, which is the most likely diagnosis?
164. Brian, 42 years old, presents complaints that his extremities get cold, furthermore, he states that he is experiencing calf pains and that his pain progresses when he is at rest. Upon examination, you find ulcers, dependent rubor, and shiny, hairless skin on his legs. Additionally, you find that the patient has dependent rubor in his physical exam. Which of the following is the most likely diagnosis?
165. Andrew presents with complaints of chest pain. He states that this pain lasts several minutes at a time and is accompanied by breathing difficulty. Physical examination findings include a positive Levine’s sign as well as a transient fourth heart sound. Based on your suspected diagnosis, you know that all of the following electrocardiogram reading would confirm this diagnosis except?
166. Sixty-nine-year-old Monica presents with aching and night cramps in her legs. However, Monica states that her pain goes away when she raises her legs. Upon physical examination, you note the presence of edema stasis leg ulcers in Monica’s legs and that her leg is cool to the touch. Which of the following is the most likely diagnosis?
A. Peripheral vascular disease
B. Superficial thrombosis
C. Deep thrombosis
D. Chronic venous insufficiency
167. Your patient’s history indicates that his heart has deficient cardiac output after a myocardial infarction. The patient complains of a wheezing, frothy cough, and appears generally healthy now after the infarction. The patient, however, also has difficulty breathing while at rest. Upon auscultation, you hear a S3 gallop. The patient also tells you that he is unable to carry out any physical activity without incurring symptoms. How should you classify the patient’s condition?
168. You are treating a patient who is receiving hospice care following inpatient treatment for cancer. Which of the following types of Medicare does not include home coverage?
169. You are treating a Guatemalan patient who speaks only Spanish. According to the standards of Culturally and Linguistically Appropriate Services, it is necessary to provide all of the following for the patient except:
170. You are treating a schizophrenic patient whom you suspect is a danger of hurting himself and/or others as a result of his condition. Under which of the following procedures are you required to administer proper treatment to the patient?
171. You are treating a patient who requires surgery and are ensuring that measures are taken to prevent harm being done to the patient. Which of the following key ethical principles is associated with this duty?
172. You are treating a patient who dies unexpectedly following a surgical following a surgical procedure. As a nurse practitioner, in which of the following components of the investigation are you most likely to take part to assess the incidence?
