Chronic/Acute Exam 1 part 2
What is considered first line therapy for the treatment of pertussis? (a.) macrolides (erythromycin, azithromycin) (b.) penicillin (amoxicillin, ampicillin) (c.) tetracycline (doxycycline) (d.) glycopeptides (vancomycin)
(a.) macrolides (erythromycin, azithromycin)
What is the most common symptom of a corneal abrasion or foreign body? (a.) sudden onset of severe eye pain (b.) tearing (c.) redness (d.) swelling
(a.) sudden onset of severe eye pain
What is the most common pathogen that causes acute bacterial rhinosinusitis in all age groups? (a.) haemophilus influenzae (b.) chlamydia pneumoniae (c.) streptococcus pneumoniae (d.) moraxella catarrhalis
(c.) streptococcus pneumoniae
A 46-year-old male patient presents to the office after diagnosis of COPD with acute exacerbations. The patient continues to smoke even though smoking cessation education is given at each visit. The patient is exhibiting increased shortness of breath, repeated exacerbations with one episode per month, FEV1 <50% predicted, and has applied for disability as he is no longer able to work. What stage would you consider this patient? (a.) Stage IV - very severe COPD (b.) Stage I - mild COPD (c.) Stage II - moderate COPD (d.) Stage III - severe COPD
(d.) Stage III - severe COPD
What is the primary pathogen that causes Acute Sinusitis?a. Streptococcus pneumoniaeb. Streptococcus pyogenesc. Staphylococcus aureusd. Streptococcus species
1. A. Streptococcus pneumoniae
A homeless man is seeking a living situation in a homeless shelter. He is an active IV drug user. He has come to your hospital to have his PPD skin test read. What is deemed a positive PPD test? 2 mm induration 15 mm induration 8 mm induration 10 mm induration
10 mm induration
With treatment, acute sinusitis resolves in how many weeks?1 week12 weeks4 - 12 weeks2 - 3 weeks
2 - 3 weeks
When diagnosing Pertussis (whooping cough), what is a primary thing you should consider?a. Sputum sampleb. 1V Chest Xrayc. Nasopharyngeal swabd. CBC lab work
2. C. Nasopharyngeal swab
To test a patient's visual acuity, a Snellen Eye Chart is used. Which statement most accurate and relevant in a clinical setting?20/40 - A person could see at 20 ft. what a person with normal vision can see at 40 ft.20/40 - A person could see at 40 ft. what a person with normal vision can see at 20 ft.40/20 - A person could see at 40 ft. what a person with normal vision can see at 20 ft.40/20 - A person could see at 20 ft. what a person with normal vision can see at 40 ft.
20/40 - A person could see at 20 ft. what a person with normal vision can see at 40 ft.
For a patient that has been diagnosed with pertussis, at what period is the patient considered contagious?It's not a contagious disease3 weeks after the onset of symptoms6 weeks after the onset of symptoms12 weeks after the onset of symptoms
3 weeks after the onset of symptoms
Allergic Rhinitis predisposes patients to what two things?a. Sinusitis & otitis mediab. Asthma & Chronic rhinitisc. Asthma & Sinusitisd. Chronic rhinitis & otitis media
3. A. Sinusitis & otitis media
The inactivated influenza vaccine is NOT recommended in which of the following patients?54-year-old male with a 3-month-old grandson at home30-year-old pregnant female4-month-old infant63-year-old female with asthma
4-month-old infant
A 42-year-old female arrives at your clinic with broken and missing eyelashes, eyelid inflammation, and yellow plaques at the inner eye. She has been experiencing this for over a week now. What do you treat her with?a. topical corticosteroid eye dropsb. Neutral facial cleanser and ABX ointmentc. Artificial tears and face wipesd. Corticosteroid eye drops and systemic ABX
5. B. Neutral facial cleanser and ABX ointment
Approximately what percentage of patients with acute bronchitis report a cough productive of purulent sputum?25%50%75%90%
50%
Normal FEV1/ FVC ratio in a healthy adult is: >0.75-0.80 <0.70 >0.65-0.70
>0.75-0.80
Which patient is at greatest risk of developing parotitis? A 42-year-old female with Sjogren's syndrome currently managed on pilocarpine and NSAIDs A 30-year-old male who has been previously treated for tuberculosis successfully A 17-year-old female with cerebral palsy and ptyalism A 75-year-old male on levodopa and clozapine
A 75-year-old male on levodopa and clozapine
Which patients TB test results are considered positive? A PPD result of 6mm in a patient with a history of HIV A PPD result of 9.5 mm in a patient from Africa A PPD result of 8mm in a health care worker A PPD result of 15 mm in a patient who has no risk factors for TB
A PPD result of 6mm in a patient with a history of HIV
Which of the following would be indicative of a positive PPD test?A 2 mm wheal in a patient with a kidney transplant.A person with a 5 mm wheal with no TB risk factorsA person with 10 mm wheal who has a history of Diabetes mellitusA 3 mm wheal in an IV drug user.
A person with 10 mm wheal who has a history of Diabetes mellitus
47-year-old female comes into the clinic with symptoms that started "a couple weeks ago" and describes just feeling "crummy and tired". Her symptoms including night sweats, weight loss, fatigue, and a productive cough. You ask about being surrounded by anyone sick, travel within the last 3-6 months and any screening for TB. Patient denies being around anyone sick, she went on a mission trip to the Philippines 3 months ago and has never been screened. Select differentials you need to rule out: Pneumonia Tuberculosis Empyema Asthma
A, B & C
50yr old woman comes to office with CC of persistent cough and nasal drainage. Onset of 1 month ago and reports rhinorrhea, sore throat in morning and fullness in ears. Cough is frequent, feels like a tickle in her throat and is often induced with speaking. Symptoms have not been progressive just persistent in nature. Physical exam reveals, Heart and lungs: normal breath sounds and heart tones, Nose: turbinate's pink with small amount of clear drainage bilaterally, Throat: no redness and minimal drainage, Eyes: clear of drainage conjunctiva pink and moist bilaterally, Ears: some clear fluid on right but normal in color and no erythema, left ear WNL Neck: no lymphadenopathy. What is the most likely diagnosis for this patient. A. Allergic Rhinitis B. Sinusitis C. Bronchitis D. Intranasal Tumor
A. Allergic Rhinitis
The following are treatments for Hordeolum except?A. Intralesional corticosteroid injectionB. Apply hot compresses 2-4 times dailyC. Erythromycin, bacitracin or sulfacetamide 10% QhsD. I & D by ophthalmologist if unresolved.
A. Intralesional corticosteroid injection
Patient presents to office with complaints of acute onset of painless blurry vision. Upon exam Snellen chart vision is 20/80 with metamorphopsia. What eye disorder is most likely the cause of patients' central vision loss. A. Macular Degeneration B. Open Angle Glaucoma C. Optic neuritis D. Retinal detachment
A. Macular Degeneration
The hallmark symptoms: rhinorrhea, itchy throat, sneezing, nasal itching, with the exception of infection are all symptoms found as a result of what diagnosis? A.) Allergic Rhinitis B.) Sinusitis C.) Nasal Trauma D.) Substance use
A.) Allergic Rhinitis
65-year-old male who smokes a pack a day for over 45 years was recently diagnosed with lung cancer. The patient presents to your office with complaints of sweating on one side of his face. On examination, you note unilateral ptosis and dilated pupils. Which of the following is the most likely diagnosis? A: Horner syndrome B: Syndrome of inappropriate antidiuretic hormone C: Superior vena cava syndrome D: Carcinoid syndrome
A: Horner syndrome
A 36yo female with no prior medical history presents to the clinic for evaluation of a productive cough that started 5 days ago. Her sputum is clear to yellow and her lungs are clear to auscultation with occasional wheezes. Vital signs are T 98.9, P 76, R 18, BP 122/76, O2 sat 98% on room air. What is the most likely diagnosis? A) Pneumonia B) Asthma C) Acute Bronchitis D) Influenza
Acute Bronchitis- A cough with normal vital signs are strongly associated with acute bronchitis.
Streptococcus pneumoniae is the leading cause of all of the following EXCEPT: Community acquired pneumonia Acute bacterial sinusitis Acute bronchitis Acute otitis media
Acute bronchitis
13 year old girl is complaining of a 2 week history of facial pressure that worsens when she bends over. She complains of tooth pain in her upper molars on the right side of her face. On physical exam, her lungs and heart sounds are normal. Which diagnosis is most likely? Severe allergic rhinitis An acute dental abscess Chronic sinusitis Acute sinusitis
Acute sinusitis
A nurse practitioner is providing teaching to a newly diagnosed asthmatic patient on home treatment for management of asthma attack, the practitioner explained to the patient that after the initial treatment for asthma, and the patient is still experiencing persistent wheezing, dyspnea, tachypnea and PEF is between 50% - 79% predicted or personal best, patient should do the following next?A. Proceed to the ED.B. Add oral systemic corticosteroid, continue inhaled SABA and consult clinician urgently.C. May continue inhaled SABA every 3-4 hr for 24 - 48 hrs onlyD. Repeat SABA immediately, call the MD and refer the patient to the ED
Add oral systemic corticosteroid, continue inhaled SABA and consult clinician urgently.
According to the USPSTF recommendation for lung cancer screening, lung cancer screening with low-dose computed tomography (CT) is recommended for which of the following individuals?A. Adults aged 45-80 who have a 20 pack-year smoking history and are currently smoking or have quit within the past 15 yearsB. Adults aged 55- 80 years with a 30 year-pack smoking history, and are currently smoking or have quit within the past 15 years.C. Adults aged 50- 85 years with a 30 year-pack smoking history, and are currently smoking or have quit within the past 12 years.D. Adults aged 60- 80 years with 25 year- pack smoking history, and are currently smoking or have quit within the past 10 years.
Adults aged 55- 80 years with a 30 year-pack smoking history, and are currently smoking or have quit within the past 15 years.
24-year-old male comes in with itchy eyes, rhinorrhea, and clear discharge from eyes. He recently had a friend over who brought their new German Shephard puppy. He denies being around anyone recently who was sick and states his family has always had non-shedding dogs. Patients past medical history is negative and denies taking any medication. Patient is currently undergoing training for his pilot's license. What do you think is going on with the patient and how would you treat? Influenza- Rest, fluids and "wait it out" Allergic Rhinitis- 1st generation antihistamine (Benadryl) Conjunctivitis- Mast cell stabilizer
Allergic Rhinitis- 2nd generation antihistamine (Loratadine)
A 55 year old female presents to your office complaining of a sharp chest pain, a cough producing rust colored sputum, and a temperature of 101.2 F. The patient denies any comorbities, recent hospitalizations, or recent antibiotic use. What is the first line treatment for this patient? Amoxicillin 1g PO TID X 5 to 7 days Cefpodoxime 200 mg PO BID Cefuroxime500 mg PO BID + Doxycycline 100mg PO BID Amoxicillin-clavulanate 500/125 mg PO TID
Amoxicillin 1g PO TID X 5 to 7 days
A 26 year old female presents with Left eyelid pain for the past 48 hours. No visual changes or trauma reported. Physical exam reveals a swollen, red abscess on the left upper eyelid margin, eyes are free of discharge. What is the appropriate treatment? Initiate IV antibiotics Apply Ophthalmic ointment BID Start on Oral antibiotics BID Apply a hot compress TID
Apply a hot compress TID
What complication accounts for the majority of deaths from hemoptysis?Hemodynamic instabilityAbnormal gas exchangeAsphyxiationMassive hemoptysis
Asphyxiation
Which of the following should be used in caution (especially those with cardiovascular disease and the elderly) and can cause an irregular heart rhythm such as a prolonged QT interval when considering choice of treatment for pertussis?BactrimErythromycinAzithromycinClarithromycin
Azithromycin
The nurse practitioner would consider prescribing trimethoprim-polymycin B for a patient with diabetes who presents with which of the following signs and symptoms? Red, itchy, watery eyes with stringy white discharge present in the morning Mucopurulent discharge where eyelids stick together after sleeping Pale, swollen nasal mucosa Aching, itching, and redness noted only in one eye A, B, and D B and C B and D All of the above
B and D
A 47yo female is establishing care with you. She has a 20 pack-year smoking history and quit when she was 35. When should screening for lung cancer occur? A) When she reaches age 50 and annually thereafter B) She does not require lung cancer screening C) Every 5 years between age 50 and 80 D) Now and every 3 years thereafter
B) She does not require lung cancer screening-When she reaches age 50, she will have been tobacco free for 15 years and no longer qualify for screening.
Which of the following are considered atypical complaints associated with older adults with pneumonia? Cough and fever Fatigue Confusion Increased falls Both A and B A, B, and C B, C, and D
B, C, and D
Which of the following would be your treatment of choice for a patient diagnosed with pertussis?AmoxicillinAzithromycinTrimethoprim-sulfamethoxazoleClarithromycinB, C, and D are all correct.
B, C, and D are all correct.
Patient present to office with CC of difficulty breathing. ROS uncovers that patient is having frequent coughing at night and in the morning most days as well as night awakenings from the coughing a few days per week. You diagnose the patient with asthma. What treatment will you start them on? A. Step 2: As needed low dose ICS-fomoterol B. Step 3: Daily low dose ICS-fomoterol + as needed low dose ICS-fomoterol C. Step 3: Daily low dose ICD-fomoterol + as needed SABA D. Step 4: Daily medium dose ICS- fomoterol + as needed low dose ICS fomoterol
B. Step 3: Daily low dose ICS-fomoterol + as needed low dose ICS-fomoterol
A patient presents to the clinic with new onset over the last couple weeks of intermittent ringing in the ears, high pitched screeching, and occasional perception of sound that isn't there. What would the appropriate diagnosis for this condition? A.) Benign Tinnitus B.) Tinnitus C.) Inner Ear Infection D.) Otitis Externa
B.) Tinnitus
A 68 year old male reports to the urgent care clinic stating " something is wrong with me, everytime I move my head I feel like the room is spinning. I almost fell out of bed." Upon evaluation you notice his gait is unsteady and has a positive Romberg test. He reports that the spinning occurs after he moves his head quickly. The patient denies any medical history, hearing abnormalities, or trauma. Which of the following conditions do you most likely suspect? Meniere's disease Cerebellar infarction BPPV Labyrinthitis
BPPV
Which of the following is true regarding bacterial conjunctivitis? Topical antibiotic treatment is always necessary for everyone Discharge is clear, watery, stringy, or white S. aureus is more commonly seen in children Bacterial c
Bacterial conjunctivitis caused by H. influenzae requires systemic antibiotic treatment
Trisha is a 10-year-old female who is in your clinic complaining of her eyes feeling "glued shut," especially in the morning. She states this has been getting worse over the past week. You suspect:Bacterial conjunctivitis caused by Neisseria gonnorrhoeaeBacterial conjunctivitis caused by aureusGlaucomaEye trauma
Bacterial conjunctivitis caused by aureus
A 12-year-old patient presents with a fever of 102F, swollen and tender anterior cervical lymph nodes, exudate on tonsils, and denies cough. What diagnosis do you suspect?Bacterial pharyngitisViral pharyngitisInfectious mononucleosisURI
Bacterial pharyngitis
A 22-year-old female presents with muscle weakness of the face that has worsened over the course of a several hours. The patient reports sensitivity to sound and some loss in taste. The muscle weakness involves both the upper and lower face. What is the most likely diagnosis? Bell's palsy Guillain-Barré syndrome Otitis media HIV infection
Bell's palsy
When prescribing treatments for allergic rhinitis to a 74 year old patient, the nurse practitioner should be careful when prescribing which treatment to the patient?A. LoratadineB. BenadrylC. SingulairD. Nasal irrigation
Benadryl
For a patient who has hypertension and needs medication but also has asthma, which medication class should you avoid?Calcium channel blockersBeta blockersAce inhibitorsThiazide diuretics
Beta blockers
In the clinical diagnosis of Acute otitis media the most important characteristic for diagnosis isPositionColorBulgingTranslucency
Bulging
Based on the USPSTF guidelines for lung cancer screening, which of the following patients would you screen with a low dose computed tomography scan for lung cancer? A 22-year-old female who smoke 2.5 packs per day A 65-year-old male with a 20 pack per year smoking history who quit smoking 16 years ago. A 60-year-old male with a 35-pack year smoking history who quit smoking 5 years ago. A current 55-year-old female with a 35 pack per year smoking history who currently smokes. C and D
C and D
A patient presents to the clinic with shortness of breath while sitting up and leaning forward, dysphagia, fever, and an acute occurrence of odynophagia. What is the most likely diagnosis? A.) Anaphylaxis B.) Angioedema C.) Epiglottitis D.) Tonsillar Infection
C.) Epiglottitis
A 55 year old patient comes into the clinic for their initial visit to establish care, while reviewing with the patient their medical history they report history of recurrent respiratory tract infections requiring antibiotic therapy, smoking history, childhood history of asthma, frequent respiratory tract infections, bronchitis, nasal polyps, and recurrent sinus infections. What diagnosis should be considered most appropriate? A.) Chronic Bronchitis B.) COPD C.) Pulmonary Fibrosis D.) Lung Cancer
COPD
The inflammatory changes of ___________ causes small airway disease while the inflammatory changes of __________ are most pronounced in the medium sized bronchi. COPD, Asthma COPD, Lung Cancer Acute bronchitis, lung cancer Asthma, Pneumonia.
COPD, Asthma
What is the gold standard for Pulmonary Embolism diagnosis?Chest XrayECGV/Q ScanCT Angiography
CT Angiography
What is considered the "gold standard" for the diagnosis of a pneumothorax?A. Chest x rayB. CT scanC. Contralateral shift of the mediastinum and tracheaD. Ultrasound
CT scan
A 73-year-old female comes to your office with a chief complaint of blurred vision and difficulty seeing at night due to glares. She has been to the eye doctor and gotten new glasses 3 months ago but her vision again is blurry. What do you suspect?CataractsWide angle glaucomaDiabetic retinopathyNormal age-related vision changes
Cataracts
CK is an 82 year old male reporting nasal congestion, sneezing, and watery eyes for the lasttwo to three weeks. He has tried fluticasone intranasally without much resolution of symptoms.Which medication would be most appropriate to prescribe for this patient with a diagnosis ofrhinitis?A. ChlorpheniramineB. CetirizineC. Fexofenadine/pseudoephedrineD. Diphenhydramine
Ceitrizine
An abnormal collection of epithelial cells in the middle ear or mastoid process that cause the formation of a benign tumor is called? Auricular disorders Cholesteatoma Impaired hearing Tympanic membrane perforation.
Cholesteatoma
Steve, 34M, is a demolition worker. Three weeks ago he "got too close to a blast site and hurt his left ear." Upon exam, you appreciate a badly perforated tympanic membrane and an area of thickened white/yellow tissue against it. You know this is a:CerumenCholesteatomaCarcinomaCarbuncle
Cholesteatoma
What is a factor to predispose children to otitis media?Cigarette smoke:Increases the incidence of URI. Decreases function of mucociliary function in eustachian tubes increasing opportunities for pathogen growthChildren ages Ages 8-14Peak age is 6-15 months, eustachian tubes are narrow in this age groupChronic Cerumen buildupCerumen can be removed to better visualize the ™ by use of current or irrigation.
Cigarette smoke:
When performing the Rinne test, the patient states "I hear it now" when the tuning fork isplaced on the mastoid bone. This would be an example of:
Conductive hearing loss
A patient presents with the following symptoms: dry cough, dyspnea, chest pain, fever, fatigue, anorexia, weight loss, and occasional chills and night sweats. Which of the following are appropriate differential diagnoses? (Select all that apply) Tuberculosis Malignancy Pulmonary embolism Sarcoidosis Fungal infection
Correct answer: A, B, D, and E (tuberculosis, malignancy, sarcoidosis, fungal infection). The presenting symptoms correspond with each of the correct choices; however, c (pulmonary embolism) is not associated with dry cough, fever, fatigue, anorexia, weight loss, chills, or night sweats (Polgar-Bailey, 2021, p. 514; Rico, 2021, p. 523).
Which of the following is not part of the Centor criteria to diagnose GABHS?Harsh coughTonsillar exudateCurrent or recent fever 100.4 or greaterTender lymphadenopathy
Correct answer: Harsh cough
In adults, the three most common causes (known as the pathogenic triad) of chronic cough with normal chest radiography include:Chronic bronchitis, smoking, upper airway cough syndromeGERD, Asthma, CHFCorticosteroid-responsive eosinophilic airway diseases, upper airway cough syndrome, GERDACE inhibitor induced cough, Smoking, Corticosteroid-responsive eosinophilic airway diseases
Corticosteroid-responsive eosinophilic airway diseases, upper airway cough syndrome, GERD
In the presence of acute bronchitis, when is a chest x-ray indicated? Patient reports increased cough at nightCough present for 3 weeks or longerTemperature 99.4 FFrequent, productive cough with purulent sputum
Cough present for 3 weeks or longer
According to GINA 2022 recommendations, what is the preferred INITIAL treatment for adolescents and adults with infrequent asthma symptoms? A) No daily medication. SABA as needed. B) Low-dose ICS-formoterol daily. SABA as needed. C) Daily montelukast D) Low-dose ICS-formoterol as needed.
D) Low-dose ICS-formoterol as needed. - Current guideline for initial treatment for adolescents and adults with infrequent asthma symptoms.
Patient with history of smoking presents for AWV. When deciding if appropriate for patient to be screen for lung cancer via LDCT what patient would you recommend for this testing A. 45 yr old with 25 pack-year smoking history B. 85 yr old with 50 pack-year smoking history C. 60 yr old with 31 pack-year smoking hx who quite 16 years ago D. 56 yr old with a 31 pack-year smoking history who quite 2 years ago
D. 56 yr old with a 31 pack-year smoking history who quite 2 years ago
A patient comes into the clinic presenting with labored respirations, diaphoresis, anxiety, and breathlessness (inability to finish a sentence). From these objective findings what would be the most appropriate answer? A.) Bronchospasm B.) Acute Bronchitis C.) COPD exacerbation D.) Severe Asthma exacerbation
D.) Severe Asthma exacerbation
A patient presents to the clinic with a chief complaint of cough that started 7 days ago with little or no phylum. Patient reports presence of dyspnea and wheezing along with cough, and states that he smokes 3 packs of cigarettes daily for 15 years. Patient denies any fever, tachycardia and tachypnea, but has a past medical history of Asthma, HTN and Influenza A. Which of the following will the practitioner prescribe for the patient as treatment? Select all that apply.A. Antibiotic therapyB. DextromethorphanC. Albuterol 1-2 puff Q 6hrD. Humidification of airE. Encourage fluid
DextromethorphanC. Albuterol 1-2 puff Q 6hrD. Humidification of airE. Encourage fluid
Which of the following is the most appropriate diagnostic tool for a 41-year-old patient who presents with throat pain, inability to swallow, hoarseness, and tripod positioning? Direct laryngoscopy CT/MRI Sonography Lateral neck x-ray
Direct laryngoscopy
AM is a 12 year old female reporting a severe sore throat and malaise for the last two or threedays. She denies cough, headache or N/V. On exam, she is febrile up to 38.2 C and her tonsils areswollen with whitish/yellow exudate present. Based on her symptoms, how would you treat thispatient according to the Centor criteria?A. Swab using a rapid antigen test and treat her with antibiotics regardlessB. Do not bother getting a rapid antigen test, treat with antibioticsC. Do not treat; it is probably viral and will run its courseD. Swab using a rapid antigen test and treat only if it is positive
Do not bother getting a rapid antigen test, treat with antibiotics
In cranial never III palsy, clinical presentation of the affected eye will be Down and adducted Up and adducted Down and abducted Up and abducted
Down and abducted
Emergency intervention is necessary for a patient who presents to the office with an exacerbation of asthma with which of the following signs and symptoms? Persistent wheezing, HR 105 bpm, resp rate 22, PEF 79%, SpO2 90% Persistent wheezing, HR 107 bpm, resp rate 24, PEF 70%, SpO2 92% Drowsiness, HR 122 bpm, resp rate 34, PEF 49%, SpO2 89% Persistent wheezing, dyspnea, HR 112 bpm, resp rate 22, PEF 75%, SpO2 92%
Drowsiness, HR 122 bpm, resp rate 34, PEF 49%, SpO2 89%
Which is a classical presentation of a pulmonary embolism?Low oxygen saturation, bradycardia, and hemoptysisJugular venous distention, clear breath sounds, and orthopneaDyspnea, tachypnea, and pleuritic chest painBradycardia, bradypnea, and febrile
Dyspnea, tachypnea, and pleuritic chest pain
Which is NOT a common cause of emphysema exacerbationViral upper respiratory infectionsExcessive exposure to smokeEating peanuts to which you are allergicInadequate use of medications that control
Eating peanuts to which you are allergic
What skin disorder does this patient present with? Skin is pruritic, erythematous, dry patches sometimes with scale. Patients may present as early as 3-6 mo old but disorder can continue into adulthood.PsoriasisWell-demarcated, intensely erythematous plaques, silvery scale on elbows and knees.TineaLesions with sharply demarcated borders, scale at the edge and central clearingEczemaCrusting is possible and lichenification (thickened skin).CellulitisLocalized swelling erythema, pain and warmth to the area.
Eczema
A 45-year-old man comes to the physician because of 5-month history of progressively worsening SOB. He also notes a chronic cough productive of white sputum. He has a 20-year pack history but quit smoking 5 years ago. He breathes with pursed lips and has a barrel chest. On auscultation, breath sounds are distant, and crackles are present in lung fields bilaterally. Pulmonary function tests show a decreased FEV1:FVC ratio, increased residual volume, and decreased diffusion capacity. Which of the following is the most likely diagnosis? Asthma Chronic pulmonary fibrosis Cystic fibrosis Emphysema
Emphysema
Diagnosis of Asthma is based on all of the following, except:Episodes of wheeze, cough, or shortness of breathPartial or full reversal of airflow obstruction with bronchodilatorA positive chest x-rayExclusion of other conditions from differential diagnosis
Exclusion of other conditions from differential diagnosis
When diagnosing a patient with GABHS, Centor criteria includes: Positive cough Tonsillar exudates Swollen and tender lymph nodes (anterior) History of fever B, C, D
Exudate Lymph nodes Fever
Which of the following after post bronchodilator spirometry findings would be indicative of a diagnosis of COPD?FEV1/FVC= 0.85FEV1/FVC= 0.75FEV1/FVC= 0.68FEV1/FVC= 0.80
FEV1/FVC= 0.68
Which of the following make up the Centor Criteria. Select all that apply. Fever of at least 100.5 Productive cough Tonsillar exudates Anterior cervical adenopathy Absenc
Fever of at least 100.5 Tonsillar exudates Anterior cervical adenopathy Absence of cough
A 65-year-old patient with type II diabetes mellitus and congestive heart failure presents with a diagnosis of community acquired pneumonia (CAP) that is found to be bacterial. Based on her diagnosis and comorbid conditions which of the following would be the best treatment:AzithromycinClarithromycinDoxycyclineFluroquinolones
Fluroquinolones
In testing for loss of taste in patients, which cranial nerve(s) accounts for taste sensation on the tongue?Glossopharyngeal nerve (CN IX) and Facial nerve (CN VII)Olfactory nerve (CN I) and Optic nerve (CN II)Trigeminal nerve (CN V) and Vestibulocochlear nerve (CN VIII)Oculomotor (CN 3) and Trochlear (CN IV)
Glossopharyngeal nerve (CN IX) and Facial nerve (CN VII)
Most common pathogen of cellulitis in normal adultsStaphylococcus aureusMore likely in sites of trauma, injection drug use, surgery, indwelling catheters, or other open woundsNon-group A streptococciLikely in patients with lymphatic system abnormalities i.e. lymphadenopathyGroup A B-hemolytic streptococciMost casesMethicillin-sensitive staph aureusDependent on local resistance patterns
Group A B-hemolytic streptococci
A 45-year-old male presents to your office with symptoms of acute bacterial rhinosinusitis. He has a history of hypertension, is a prediabetic, and a current smoker. Which bacteria would you assume is the causative pathogen for your patient?Chylmydia pneumoniaeHaemophilus influenzaeMoraxelaa catarrhalisStreptoccocus pneumonia
Haemophilus influenzae
A 54-year-old female presents to the office with complaints of chest pain, you suspect that it is not cardiac related. What subjective information would give you this?Feels like heavy pressure center of my chestPain gets worse when I do physical activityHave had recent panic attacks
Have had recent panic attacks
A patient with a nasal fracture without deformity or septal hematoma may be treated with:HeatHead elevationAnticoagulation medicationFollow-up with primary care physician in 3 to 5 days for reevaluation
Head elevation
Which medication is the preferred "rescue" medication for asthma? LABA Mast cell stabilizer ISC-formoterol SABA
ISC-formoterol
A 22 year old female presents to their primary care office for blood work. Given their history as a severe asthmatic, with 3+ asthma exacerbations requiring hospitalizations per year, which lab finding is to be expected? (Buttaro et al., 2020, p.451) (Oyeyinka et al., 1984) IgE level of 1500 IU/mLIgE level of 200 IU/mLIgM level of 1000 IU/ mLIgM level of 80 IU/mL
IgE level of 1500 IU/mL
5yo unvaccinated male is brought to the clinic for evaluation of a sore throat and difficulty swallowing. Pertinent medical history includes a recent upper respiratory infection. Entering the room, you notice the child appears anxious and is drooling. What is your first intervention? A) Use a tongue depressor to help visualize a foreign body B) Immediate referral to the emergency room C) Obtain a pharyngeal swab for strep D) Refer to psychiatry for his anxiety
Immediate referral to the emergency room-Symptoms are consistent with epiglottitis which is an emergency.
During the past six months, a 52-year-old man with a BMI of 35 has complained of fatigue and decreased concentration. His wife reports the patient is snoring and has moments of apnea in his sleep. Which of the following would most likely be found on a physical exam?GynecomastiaIncrease neck circumferenceMoon-shaped faceEnlargement of hands and feet
Increase neck circumference
A 7-year-old child presents to the office for shortness of breath, accompanied by their mother. You walk into the exam room and notice the patient in tripod position. Mother states the child has been complaining of neck tenderness, a cough, and seems to be drooling more frequently. What should you not do as the provider when suspecting Epiglottitis? Ensure proper airway management Transport to nearest hospital Inspect oral cavity Initiate broad spectrum antibiotics
Inspect oral cavity
According to the U.S. Preventive Services Task Force (USPSTF), which of the following tests should be used to screen for lung cancer? Chest radiograph Sputum for cytology Low dose computed tomography Bronchoscopy with biopsy
Low dose computed tomography
In an outpatient setting, an otherwise healthy adult with no comorbidities is diagnosed with pneumonia, select the correct course of treatment for this patient in an outpatient setting.B-lactam plus macrolideDoxycyclineB-lactam plus azithromycinMacrolide
Macrolide
Your patient is a 64-year-old complaining of a loss in the center of the field of vision. Which of the following is the most likely diagnosis?CataractsMacular degenerationGlaucomaCorneal abrasion
Macular degeneration
A 40-year-old man with asthma is diagnosed with hypertension. Which of the following would you not prescribe him?AmlodipineLisinoprilMetoprololHydrochlorothiazide
Metoprolol
Which of the following is more consistent with findings of bacterial conjunctivitis that helps differentiate from allergic/viral conjunctivitis?Mucopurulent dischargeStringy/white dischargeBoggy, pale or gray mucosaUsually bilateral
Mucopurulent discharge
When trying to distinguish between pneumonia and acute bronchitis, which symptom is suggestive of acute bronchitis?FeverTachycardiaNormal vital signsTachypnea
Normal vital signs
Which of the following conditions is considered an ophthalmologic emergency and warrants immediate referral to the emergency room?Subconjunctival hemorrhageHordeolumOrbital cellulitisAllergic conjunctivitis
Orbital cellulitis
What is the most frequent childhood infectious illness, with the peak incidence at 6 to 15 months of age?ConjunctivitisOtitis MediaRhinitisTonsillitis
Otitis Media
Which of the following signs or symptoms would prompt the nurse practitioner to order a Stat CT? Productive cough for 2 weeks Yellow nasal drainage Pink conjunctiva, itchy eyes, and tearing Periorbital edema
Periorbital edema
Differential diagnoses for stomatitis include all of the following except:Oral carcinomaHand-foot-and-mouth diseaseBehcet syndromePeritonsillar abscess
Peritonsillar abscess
A 55 year old female patient comes into their primary care office complaining of dry eye. After thorough examination of the patient and review of the patient's history, which medication is most likely to account for the patient's symptoms? (Buttaro et al., 2020, pp. 365-366)Ibuprofen 600mg PRN Prednisone 60mg qd Singulair 10mg qdSertraline 50mg qd
Prednisone 60mg qd
Which of the following conditions classified as sensorineural hearing loss Otitis media Presbycusis Ceruminosis Otitis externa
Presbycusis
A 44 year old female presents to your clinic with bilateral red eye started a few weeks ago. The patient complains of white stringy discharge that is worse in the spring and fall. The patient works at a daycare. What is your best initial course of treatment? Prescribe erythromycin eye drops Advise patient to not return to work for 24 hours post treatment Prescribe Patanol eye drops Prescribe oral corticosteroid 5 day taper
Prescribe Patanol eye drops
In a patient presenting for ear pain, what information is considered critical in differentiating between acute otitis media (AOM) and otitis media with effusion (OME)? Unilateral vs bilateral pain Serous vs purulent drainage Presence vs absence of bulging tympanic membrane Vertigo vs tinnitus
Presence vs absence of bulging tympanic membrane
69-year-old male presents to your clinic with signs of a COPD exacerbation and you want to prescribe systemic corticosteroids. Which of the following medical conditions is oral corticosteroids contraindicated? Primary open angle glaucoma Mild intermittent asthma Acute bacterial rhinosinusitis Macular degeneration
Primary open angle glaucoma
A 10-year-old female presents ear pain in her left ear. The patient complains of decreased hearing, the sensation of fullness in the ear canal, and pruritus. During the physical exam, the patient has tenderness on palpation, pain with movement of the pinna, and erythema noted with visualization of the ear canal. What are the pathogens most likely to culture positive?Strep pneumoniaPseudomonasCandida albicansColi
Pseudomonas
A 34 year old male, in good health comes to his primary care office for shortness of breath. He states "I am never sick, minus my broken tibia from playing soccer, so this is strange, I can't breathe all of a sudden." Which of the following should most likely be anticipated as a diagnosis? (Buttaro et al., 2020, p.514)COPDAsthma exacerbationPulmonary embolismPneumothorax
Pulmonary embolism
What sign/symptom would help to differentiate between allergic and viral conjunctivitis?A. Watery/stringy discharge B. Itching/tearing of the eyesC. Usually no photophobiaD. Simultaneous presence of redness in both eyesReferencesButtaro, T., Trybulski, J., Bailey, P.P., & Sandberg-Cook, J. (2020). Primary care: A
Redness in both eyes
A 33-year-old female returns to your office for the third week in a row complaining of nasal congestion, headache, and fatigue. She has already received two courses of antibiotics. What is your next action?Send her immediately to the emergency roomPrescribe a third course of antibioticsRefer her to an otolaryngologistSend her for bloodwork
Refer her to an otolaryngologist
A 23 year old male presents to his primary care office for a follow up appointment after a tympanic membrane rupture 6 weeks ago. The patient reports he has been taking adequate care of his ear and preventing water from entering the canal. Upon examination of the tympanic membrane, there are signs of delayed healing, with signs of existing injury. The provider should: (Buttaro et al., 2020, p.397)Tell the patient to continue what he is doing and see the patient again in 2 weeks.Prescribe a course of antibioticsRefer to an otolaryngologist Obtain imaging
Refer to an otolaryngologist
A 38 year old immigrant from the Ukraine enters your clinic for a tuberculosis skin test and denies signs or symptoms. After 48 hours she returns with a 12mm induration on her arm. Which of the following is the best next step? Start patient on isoniazid and rifampin Consider the patient an active case and inform them to go into quarantine Do nothing. 12mm is a negative skin test. Report the positive skin test to infectious disease or the health department for treatment.
Report the positive skin test to infectious disease or the health department for treatment.
A patient comes to the office complaining about congestion, sneezing, nasal-ocular itching, but doesn't have any fever, headaches, and/or purulent discharge. What will be the likely diagnosis? Chronic Rhinosinusitis Sinusitis Epistaxis Rhinitis
Rhinitis
Which organism is the leading cause of pneumonia in adults?S. aureusS. pneumoniaeH. influenzaeM. catarrhalis
S. pneumoniae
Bob, 38M, is complaining of a dry cough which has gradually worsened over the course of 8 months. He has also recently started experiencing night sweats and endorses fatigue. You order a chest x-ray which shows bilateral hilar lymphadenopathy (BHL). You suspect Bob has which disease:Pulmonary hypertensionCovid-19Congestive heart failureSarcoidosis
Sarcoidosis
A 69-year-old man is referred to an ophthalmologist for a slow progression of bilateral vision loss. He reports difficulty driving at night due to glare from headlights. The patient undergoes pupil dilation and a slit-lamp exam. He is found to have opacification of the lens in bilateral eyes. What is the next step for this patient? Prescribe him on Xalantan (Latanoprost) eye drops for glaucoma Schedule him for cataract surgery Diagnose patient with macular degeneration Schedule appointment for glasses or contact lenses for correction of refractive error
Schedule him for cataract surgery
A patient with the history of COPD comes to the clinic with a complaint of dyspnea, unilateral chest pain, and cough. On auscultation, you heard a diminished breath sound on only one side and on inspection you noticed asymmetrical lung expansion. What is the likely diagnosis? Primary Pneumothorax Secondary Pneumothorax Tension Pneumothorax Pneumonia
Secondary Pneumothorax
A nurse practitioner is volunteering at a clinic in a low SES area. A 67 year old male comes in complaining of severe facial pain. The provider notes the patient's poor dental health. Without access to imaging, which is the best course of action? (Buttaro et al., 2020, p.412)Send patient to the ER for CT of headPrescribe a course of antibioticsTell the patient to take OTC Tylenol and Motrin for the painRefer the patient to the dentist.
Send patient to the ER for CT of head
A 15-year-old female comes in to your clinic 3 weeks post an infection you previously concluded was caused by Epstein barr virus. She states she is feeling better and wants to know when she can play softball again?She can go to practice now that she is feeling better.She must wait 4 weeks because of possible liver enlargementShe cannot play softball for the remainder of the 3 month seasonShe can return after 6 weeks because of possible splenomegaly.
She can return after 6 weeks because of possible splenomegaly.
A female patient is receiving treatment for tuberculosis. She asks when she is no longer contagious and can return to work and her typical daily life. As her practitioner, you educate her that she is not contagious when (select all that apply): She has had 3 negative sputum cultures Signs and symptoms improve Completed the full medication regime Normal chest x-ray Been on TB medications for about 3 weeks
She has had 3 negative sputum cultures Signs and symptoms improve Been on TB medications for about 3 weeks
A 63-year-old male presents to your office with dyspnea, chronic cough, sputum production, and a 30 pack year history of smoking. You suspect COPD. All of the tests listed below can be appropriate for COPD. Which is the gold standard?SpirometryChest x-rayCBC with diffPulse oximetry
Spirometry
Chad, a 22-year-old graduate student presents in your office complaining of shortness of breath and wheezing. He is A/Ox4, denies recent illness and is afebrile. He states he recently moved into a home with 4 other people and comments about being disgusted by the cockroaches and the dirty TV room. What in-office diagnostic test are you going to first order for Chad?SpirometryChest X-rayCovid-19 swabUrine Culture
Spirometry
How should COPD be diagnosed?CXRSpirometryABGsSputum culture
Spirometry
What is the gold standard for diagnosing COPD?a. Physical Lung Assessmentb. Sputum Culturec. 1V Chest Xrayd. Spirometry
Spirometry
Which of the following tests is considered the gold standard for diagnosing Chronic Obstructive Pulmonary Disease (COPD)? Forced expiratory time Chest x-ray Spirometry for FEV1/FVC Computed tomography of the chest without contras
Spirometry for FEV1/FVC
Consult to asthma specialist should occur when patient reaches the following step in the Stepwise approach for treating asthma:Immediately upon diagnosisStep 3 or 4Step 2Referral to specialist not indicated for this condition
Step 3 or 4
When treating hordeolums and chalazions, the treatment is the same, except:AntibioticsLid scrubsSteroid useWarm compress
Steroid
Typical 60-70% of typical bacterial pneumonia are caused by what organism?Staphylococcus AureusCommon after a recent influenza infectionLegionella A cause of pneumonia if patient has had recent exposure to aerosolized droplets of contaminated soil or water (A/C) unitsStreptococcus PneumoniaeMost common cause of typical pneumoniaMycoplasma pneumoniaeMost common cause of Atypical pneumonia
Streptococcus Pneumoniae
Patient is diagnosed with bronchitis at day 3 of symptoms, what is the best initial course of treatment?Antibiotic Therapy- MacrolideIf cough persists after 2 weeks, pertussis is possible treat with ABX. Only 5-10% of bronchitis have a bacterial cause.Supportive measures: antipyretics, bed-rest, and increased fluids.85% of patients with bronchitis will improve without specific treatment. AntitussivesWeak evidence to suggest their effectiveness. Occasionally useful for coughing.HospitalizationCough for >2 weeks, progressive dyspnea, O2 <90%, signs of sepsis
Supportive measures: antipyretics, bed-rest, and increased fluids.
What is the most sensitive clinical sign of a Pulmonary Embolism? Tachypnea Bradycardia Bradypnea Tachycardia
Tachypnea
A patient has been taking albuterol via a metered-dose inhaler for a month and remains in the yellow zone. Which of the following statements is true? Medication should be lowered to produce desired effects The patient is at 80% to 100% of their personal best The Patient is at 50% to 80% of their personal best Current medication dosage places the patient at risk of hypoxia
The Patient is at 50% to 80% of their personal best
Which of the following is incorrect in regards to anatomical landmarks of the eyes?Optic disc is more towards the nasal side versus the temporal side of faceThe physiological cup is 40% in size compared to discNormal disc color is yellow-orange-pink in color and round/oval in shapeThe macula is toward the temple side of the eye
The physiological cup is 40% in size compared to disc
What is the first line treatment for allergic rhinitis? Saline nasal spray Oral antihistamine Topical nasal decongestant spray Topical nasal steroid spray
Topical nasal steroid spray
Chalazion management includes all the following except:Lid scrubs with gentle massage to help express impacted secretionsTopical ophthalmic erythromycin or bacitracin ointmentFrequent warm compresses to liquefy glandular secretionsIntralesional corticosteroid injection
Topical ophthalmic erythromycin or bacitracin ointment
A 34 year old, male comes to the office complaining about cough, dyspnea, chest pain, fever, fatigue, anorexia, night sweats, weight loss and chills. Crackling sounds heard on auscultation. What will be the correct disease process? Asthma COPD Tuberculosis Hemoptysis
Tuberculosis
The main difference in differentiating between otitis externa and otitis media is:There is pain with touch and tenderness to the tragus with otitis mediaAuditory canal is grey and edematous in otitis externaUpon physical exam, bulging of the tympanic membrane and mastoid tenderness is seen in otitis mediaQ-tips are recommended(C)- With the presence of fluid in the middle ear, TM bulges and landmarks are lost
Upon physical exam, bulging of the tympanic membrane and mastoid tenderness is seen in otitis media
Select the true statement:Vasomotor rhinitis is a nonallergic, noninfectious cause of perennial nasal congestion.Vasomotor rhinitis is caused by facial trauma and can be life threatening.Vasomotor rhinitis presents with copious amounts of purulent nasal drainage.Vasomotor rhinitis is an allergic cause of perennial nasal infection.
Vasomotor rhinitis is a nonallergic, noninfectious cause of perennial nasal congestion.
Which treatment should be avoided in a patient with pterygium? Use of a wide-brimmed hat while outdoors Visine to keep eyes hydrated Sunglasses with UV filter lenses A one-week course of topical steroid drops
Visine to keep eyes hydrated
What is considered the gold standard for diagnosis of COPD? (a.) chest x-ray (b.) spirometry (c.) auscultation of the diaphragm (d.) CT scan of the chest
spirometry
