Final Exam
Alexander, age 18, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What do you tell him? A. " Use continuous heat for the first 12 hours, then use heat or cold to your own preference. " B. " Use continuous cold for the first 12 hours, then use heat or cold to your own preference. " C. " Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. " D. " Alternate between cold and heat for 20 minutes each for the first 24 - 48 hours. "
" Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. "
Bouchard's nodule is found in which of the following? A) Rheumatoid arthritis B) Degenerative joint disease C) Psoriatic arthritis D) Septic arthritis
Degenerative joint disease
The Phalen test is used to evaluate for: A) Inflammation of the median nerve B) Rheumatoid arthritis C) Degenerative joint changes D) Chronic tenosynovitis
Inflammation of the median nerve
Mr. S comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain?
Inguinal hernia and peritonitis
Mr. S. comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain? A. Inguinal herniation and peritonitis B. Renal colic and cardiac ischemia C. Pancreatitis and Crohn ' s disease D. Polyarteritis nodosa and ulcerative colitis
Inguinal herniation and peritonitis
Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct? A. Integumentary effects include swelling, erythema, and warmth at the involved site. B. There is a low-grade fever with intermittent chills C. Musculoskeletal effects include tenderness of the entire leg. D. Cardiovascular effects include bradycardia.
Integumentary effects include swelling, erythema, and warmth at the involved site.
Which of the following statements is most consistent with fibromyalgia? A. It is predominantly diagnosed in African Americans. B. It affects less than 1% of the general population. C. It is four to seven times more common in women than in men. D. It is most often initially diagnosed in adults younger than 20 years old and older than 55 years old.
It affects less than 1% of the general population.
Common symptoms of MS include all of the following except: a. Numbness or weakness in one or more limbs b. Double vision or blurring vision c. Facial weakness or numbness d. Cold sensitivity
Cold sensitivity
The most common cause of acute bursitis is: A. Inactivity B. Joint overuse C. Fibromyalgia D. Bacterial infection
Joint overuse
The most common sites for lumbar disk herniation are: A. L1 to L2 and L2 to L3. B. L2 to L3 and L4 to L5. C. L4 to L5 and L5 to S1. D. L5 to S1 and S1 to S2
L4 to L5 and L5 to S1
With the straight-leg-raising test, the NP is evaluating tension on which of the following nerve roots? A. L1 and L2 B. L3 and L4 C. L5 and S1 D. S2 and S3
L5 and S1
Which of the following is used to evaluate patients with medial collateral ligament injury? a. Varus test b. McMurray test c. Lachman test d. Valgus test
Lachman test
Which of the following is usually not a part of treatment of a sprain? A. Immobilization B. Applying ice to the area C. Joint rest D. Local corticosteroid injection
Local corticosteroid injection
According to the AUA guideline on the management of BPH, when is referral for invasive surgery automatically warranted?
With the presence of refractory retention and bladder stones.
First-line treatment options for bursitis usually include: A. corticosteroid bursal injection. B. heat to area. C. weight-bearing exercises. D. nonsteroidal anti-inflammatory drugs (NSAIDs).
nonsteroidal anti-inflammatory drugs (NSAIDs).
John, age 17, works as a stock boy at the local supermarket. He is in the office for a routine visit. You notice that he had an episode of low back pain 6 months ago from improperly lifting heavy boxes. In discussing proper body mechanics with him to prevent future injuries, you tell him, A. " Bend your knees and face the object straight on. " B. " Hold boxes away from your body at arm 's length. " C. " Bend and twist simultaneously as you lift. " D. " Keep your feet firmly together. "
" Bend your knees and face the object straight on. "
Heidi, age 29, is a nurse who has an acute episode of back pain. You have determined that it is a simple "mechanical" backache and order A) Bedrest for 2 days B) Muscle relaxants C) "Let pain be your guide" and continue activities D) Back-strengthening exercises
"Let pain be your guide" and continue activities
Screening for females are recommended at what age? A. 5 and 12 B. 7 and 11 3. 14 and 15 d. 10 and 12.
10 and 12.
According to recent epidemiologic studies, prostate cancer is the number ____ cause of cancer death in men residing within the US. (B) A. 1 B. 2 C. 3 D. 4
2
A TIA is characterized as an episode of reversible neurological symptoms that can last: A.1 hour. B.6 hours. C.12 hours. D.24 hours
24 hours
The average American man has an approximately ____% lifetime risk of prostate cancer and an approximately ____% likelihood of clinical disease. A. 15, 5 B. 25, 8 C. 40, 10 D. 60, 15
40, 10
What percent of patients with genital warts have spontaneous regression of the lesions? a. 10% B. 50% C. 25% D. 75%
50%
Anticipated organ survival exceeds 85% with testicular decompression within how many hours of torsion? A. 1 B. 6 C. 16 D. 24
6
Which HPV types are the most likely to cause genital warts or condyloma acuminatum? A. 1,2, & 3 B. 16 & 18 C. 6 & 11 D. 22 & 24
6 & 11
Up to what percentage of patients with medial epicondylitis recover without surgery? A. 35% B. 50% C. 70% D. 95%
95%
Sylvia has glaucoma and has started taking a medication that acts as a diuretic to reduce the intraocular pressure. Which medication is she taking? A. A carbonicanhydrase inhibitor B. A beta-adrenergic receptor blocker C. A miotic D. A mydriatic
A carbonicanhydrase inhibitor
The cause of multiple sclerosis is best described as: a. A destructive process of the never fiber protecting myelin b. An intracranial viral infection c. Inflammation of the brain and/or spinal cord d. An autoimmune disorder that destroys muscle fibers
A destructive process of the never fiber protecting myelin
You see a 38-year-old African American male with hypertension who is currently being treated with thiazide-type diuretic. His current blood pressure reading is 156/94 mm Hg and he has no history of diabetes mellitus or chronic kidney disease. Following current best evidence, you consider adding which of the following medications?
ACEI, angiotensin receptor blocker (ARBs), beta-adrenergic receptor antagonist, calcium channel blocker
A 35 year old sexually active man presents with a 1 week history of fever and pain over the left scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to touch. He denies flank pain, nausea, and vomiting. He reports that eh pain is lessend when he uses scrotal-support briefs. The urinalysis shows 2 + blood and a large number of leukocytes. What is the most likely diagnosis? A. Acute urinary tract infection B. Acute pyelonephritis C. Acute orthitis D. Acute epididymitis
Acute epididymitis
Risk factors for POAG include all of the following except:
African ancestry, type 2 diabetes mellitus. advanced age, blue eye color.
Common risk factors for Osgood Schlatter Disease include: a. Highly active with open growth plates b. Significant Growth Spurt c. Typically asymmetrical but can occur bilaterally d. Boys> Girls e. All of the above
All of the above
Parkinson disease is primarily caused by: a. Degradation of myeline surrounding nerve fibers b. Alterion in dopamine-containing neurons within the midbrain c. Deterioration of neurons in the brainstem d. Excessive production of acetylcholinesterase in the CS
Alterion in dopamine-containing neurons within the midbrain
The most common etiology of dementia is: A. vascular disease. B. Alzheimer's disease. C. traumatic head injury. D. drug-drug interaction induced.
Alzheimer's disease.
When performing a prostate examination, you note a tender, warm prostate. What do you suspect? A. Benign prostatic hypertrophy B. Prostatic abscess C. Prostate cancer D. Bacterial prostatitis
Bacterial prostatitis
What antibiotic would you expect NOT to give to a pregnant woman with a UTI?
Bactrim - TMP avoid use during pregnancy secondary to possible risk of teratogenicity
Risk factors for MS include all of the following except: a. Being older than 50 years of age b. Female gender c. Northern European ancestry d. Autoimmune disease
Being older than 50 years of age
A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: A) Prerenal inflammation B) Bladder outlet obstruction C) Tubular necrosis D) Intrarenal nephrotoxicity
Bladder outlet obstruction
Gerard is complaining of a scrotal mass; however, the scrotum is so edematous that it is difficult to assess. How do you determine if it is a hernia or a hydrocele?
Bowel sounds may be heard over a hernia.
The diagnosis of Parkinson disease relies on findings of: a. Clinical evaluation of six cardinal features b. Head MRI or CT scan c. Pleocytosis in the CSF d. A visual evoked potential test
Clinical evaluation of six cardinal features
Which of the following cranial nerves is evaluated when a wisp of cotton is lightly brushed against the corner of the eye? A. CN II B. CN III C. CN IV D. CN V
CN V
Acute cerebral hemorrhage is best identified with which of the following imaging techniques? a. transesophageal echocardiogram b. CT Scan c. Cerebral angiogram d. MR angiography
CT Scan
Balanitis is caused by: A. Staphylococcus aureus B. Streptococcus pyogenes C. Candida albicans D. Trichomonads
Candida albicans
The nurse practitioner recognizes that the most common cause of epididymitis in a young man is: A chlamydia B E. coli C mycoplasma D Proteus species
Chlamydia
Dopamine or dopamine agonists used to treat Parkinson disease include all of the following except: a. Levodopa b. Chlorpromazine c. Ropinirole d. Pramipexole
Chlorpromazine
A 46-year-old woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds (13.6 kg) in the past 2 months. She has a history of asthma with repeated flares during the past 6 months requiring multiple courses of prednisone therapy. A likely diagnosis for this patient is: A. type 2 diabetes. B. Cushing's syndrome. C. Cushing's disease. D. central obesity.
Cushing's syndrome.
A patient taking phenytoin can exhibit a drug interaction when concurrently taking: a. Cyclosporine b. Famotidine c. Acetaminophen d. Aspirin
Cyclosporine
Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: A. Stimulates the production of acetylcholine at the neuromuscular junction. B. Promotes the removal of antibodies that impair the transmission of impulses C. Inhibits the breakdown of acetylcholine at the neuromuscular junction. D. Decreases the production of autoantibodies that attack the acetylcholine receptors.
Decreases the production of autoantibodies that attack the acetylcholine receptors.
Dave, age 76, is brought in by his wife, who states that within the past 2 days Dave has become agitated and restless, has had few lucid moments, slept very poorly last night, and can remember only recent events. Of the following differential diagnoses, which seems the most logical from this brief history? a. Depression b. Dementia c. Delirium d. Schizophrenia
Delirium
Which of the following conditions places a patient at an increased risk of plantar fasciitis? A. Diabetes B. Pregnancy C. Alcoholism D. Thyroid disease
Diabetes
There is a higher risk of balanitis in which of the following conditions? A. Renal Insufficiency B. Diabetes Mellitus C. Graves' disease D. Asthma
Diabetes Mellitus
What medication would you expect not to use in acute pyelonephritis?
Do not use nitrofurantoin because poor tissue concentrations are achieved in the renal parenchyma
The most common gram-negative bacteria that causes both acute and chronic bacterial prostatitis is A. Staphylococcus aureus B. Klebsiella C. Escherichia coli D. Enterobacteriaceae
Escherichia coli
What is the most common symptom of upper UTI in young children?
Fever
Which of the following conditions is most likely? A. cluster headache B. migraine headache with aura C. migraine headache without aura D. Giant cell arteritis
Giant cell arteritis
Podagra is associated with which of the following? A) Rheumatoid arthritis B) Gout C) Osteoarthritis D) Septic arthritis
Gout
Beth, age 49, comes in with low back pain. An x-ray of the lumbar/sacral spine is within normal limits. Which of the following diagnoses do you explore further? A. Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus
Herniated nucleus pulposus
A middle-aged woman is complaining of feeling anxious and irritable for several months. She reports weight loss and a fine tremor in her hands that bothers her even when she is at rest. She has lost weight without changing her usual diet or activity. The patient reports that her appetite has increased. Her menstrual cycles have become irregular. Which of the following conditions is best described?
Hyperthyroidism.
Which of the following electrolyte disorders is commonly associated with delirium? a. Hyponatremia b. hypernatremia c. Hyperkalemia d. hypophosphatemia
Hyponatremia
Treatment for Myasthenia Gravis Includes: A. IVIG or Plasmapheresis B. Antibiotics C. Analgesic's D. Sedation
IVIG or Plasmapheresis
Several conditions can cause Cushing syndrome. What is the most common cause?
Iatrogenic administration of exogenous corticosteroids (predisone)
When would you consider a CT scan or renal ultrasound for patients with acute pyelonephritis?
If the patient has not improved after 48-72 hours on an appropriate antibiotic.
What four reasons would you consider the infection complicated until proven otherwise?
If the patient is a man, an older adult, or child, or has symptoms lasting more than 7 days
Which represents the most appropriate diagnostic test for the patient in the previous question? A. CBC with WBC Differential? B. Lyme disease antibody titer? C. CT scan of the head with contrast? D. BUN and Creatine levels?
Lyme disease antibody titer?
Mrs. Matthews has rheumatoid arthritis. On reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. What mechanism is responsible for this? A. Antigen-antibody formation B. Lymphocyte response C. Immune complex formation D. Lysosomal degradation
Lysosomal degradation
A 51-year-old factory worker has noticed progressive weakness over the past year. Examination and testing reveal a painless largely motor peripheral neuropathy. Of the following agents, the one most likely to be etiologic in this case is a. Lead b. Manganese c. Thallium d. Cyanide e. Mercury
Manganese
Carpal tunnel syndrome is inflammation of the: A) Ulnar nerve B) Radial nerve C) Brachial nerve D) Median nerve
Median nerve
What specific treatment is given patients diagnosed with Myasthenia Gravis that will focus on improving conduction? A. Surgery B. Physical Therapy C. Mestinon (pyridostigmine) Neostigmine D. Fluroquinolones
Mestinon (pyridostigmine) Neostigmine
An adult woman comes to the clinic presenting with gradual onset of throbbing headaches behind one eye worsening over several eyes is diagnosed as a. Cluster headache b. Migraine headache c. Trigeminal neuralgia d. Temporal arteritis
Migraine headache
All of the following are possible etiologies for papilledema a. Intracranial abscess b. Ruptured aneurysm c. Migraine headaches d. Cerebral edema
Migraine headaches
Orchitis is caused by which of the following? A. Mumps virus B. Measles virus C. Chlamydia trachomatis D. Chronic urinary tract infections that are not treated adequately
Mumps virus
What are the 2 major groups of medications used for Peripheral Neuropathy?
Neuroleptics & Antidepressants
Mary, age 72, has severe osteoarthritis of her right knee. She obtains much relief from corticosteroid injections. When she asks you how often she can have them, how do you respond? A. Only once a year in the same joint B. No more than twice a year in the same joint C. No more than three to four times a year in the same joint D. No more than five to six times a year in the same joint
No more than three to four times a year in the same joint
What risk factors contribute to varicocele? A. Younger age B. Current cigarette smoker C. Multiple sex partners D. None of the above
None of the above
A first-line prophylactic treatment option for the prevention of tension-type headache is a. Nortriptyline b. Verapamil c. Carbamazepine d. valproate
Nortriptyline
What must you you do to diagnose a distal femur, patellar, and proximal tibia fracture?
Obtain imaging according to Ottawa knee rules
A 15-year-old high school athlete complains of a painful area below both knees. He tells you they feel bone-like and are tender to palpation. He denies any hot joints, fever, rash, or difficulties with weight-bearing. Which of the following conditions is most likely? a) osteomyelitis b) internal tibial torsion c) Osgood-Schlatter Disease d) Calve-Perthe's Disease
Osgood-Schlatter Disease
A 65-year-old carpenter complains of stiffness and pain in both hands and right knee shortly after waking and worsens in the afternoon. He feels some relief with rest. On, exam the nurse practitioner notices the presence of Heberden's nodes. Which of the following is most likely? a. Osteoporosis b. Rheumatoid Arthritis c. Osteoarthritis d. Reiter's syndrome
Osteoarthritis
Which of the following mediations is associated with the highest incidence of erectile dysfunction? a. Lamotrigine (Lamictal) b. Clonazepam (Klonopin) c. Paroxetine (Paxil) d. Doxepin (Sinequan)
Paroxetine (Paxil)
Which of the following is not characteristic of rheumatoid arthritis (RA)? A. It is more common in women than in men at a 3:1 ratio. B. Family history of autoimmune conditions often is reported. C. Peak age for disease onset in individuals is age 50 to 70 years. D. Wrists, ankles, and toes often are involved.
Peak age for disease onset in individuals is age 50 to 70 years.
______ Disorder in Cushing's is due to excessive ACTH production and ACTH dependent
Pituitary
A 48-year old obese female presents to the clinic with complain of pain on the bottom of her feet with the first few steps in the morning that gets worse with prolonged walking. You would suspect: A. Gout B. Morton's Neuroma C. Rheumatoid Arthritis D. Plantar fasciitis
Plantar fasciitis
Which of the following complications is the leading cause of death shortly after a stroke? A. Septicemia B. Pneumonia C. Pulmonary embolus D. Ischemic heart disease
Pneumonia
Which of the following diseases is associated with a high risk of giant cell arteritis? A. history of transiet ischemia attacks (TIA) B. Frequent migraine headaches with focal neurological findings C. Polymalgia rheumatica (PMP) D. Systemic lupus erythematous (SLE)
Polymalgia rheumatica (PMP)
Harry has BPH and complains of some incontinence. Your first step in diagnosing overflow incontinence would be to order a:
Post void residual urine measurement
A 63-year-old man presents to you with hematuria, hesitancy, and dribbling. DRE reveals a moderately enlarged prostate that is smooth. The client's PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?
Prescribe an alpha adrenergic blocker, which will relax bladder and prostate smooth muscle to improve flow and relieve symptoms.
Which of the following is indicated in the prophylactic treatment of migraine headache a. ibuprofen (Motrin) b. Naproxen sodium (Anaprox) c. Propanolol (Inderal) d. Sumatriptan (Imitrex)
Propanolol (Inderal)
All of the following can cause an elevated PSA level except: A. Current prostate infection B. Recent cystoscopy C. BPH D. Prostatectomy
Prostatectomy
Balanitis is a symptom of which one of the following diseases A. Psoriatic arthritis B. Reactive arthritis C. Alkylosing Spondylitis D. Rheumatoid arthritis
Reactive arthritis
What type of follow up should this patient receive? A. Refer to a urologist within 48 hours B. Refer him to the emergency department as soon as possible C. Prescribe ibuprofen (advil) 600 mg QID for pain D. Order a testicular ultrasound for further evaluation
Refer him to the emergency department as soon as possible
Your 35-year-old patient is being worked up for microscopic hematuria. All of the following are differential diagnoses of microscopic hematuria except: A) Kidney stones B) Bladder cancer 527 C) Acute pyelonephritis D) Renal artery stenosis
Renal artery stenosis
A 54 year old white man with no obvious risk for prostate cancer opted to undergo PSA screening and DRE testing. The DRE findings are normal and his PSA is 3..7ng/ml. You recommend: A. Repeating the PSA test immediately. B. Repeat screening in 1 yr. C. Repeat screening in 2 yrs. D. Repeat screening in 5 yrs.
Repeat screening in 1 yr.
Your 75-year-old client with osteoarthritis of the knee will be starting on a course of NSAIDs for pain management. The most important teaching point for your patient currently is: A. You should start with a high dose first and taper down the dose as needed. B. You should continue to take your Coumadin as you have been. C. Report any excessive stomach upset or if you notice that your stools become dark or bloody. D. At this point, it will not be helpful to lose weight.
Report any excessive stomach upset or if you notice that your stools become dark or bloody.
A 45-year-old woman in complaining of generalized stiffness, especially in both her wrist and hands. It is much worse in the morning and last a few hours. She also complains of fatigue and generalized body aches that have been present for the past few months. Which of the following is most likely? a. Osteoporosis b. Rheumatoid arthritis c. Osteoarthritis d. Gout
Rheumatoid arthritis
Which of the following best describes patient presentation during tonic-clonic (grand mal) seizure? a. Blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness b. Awake state with abnormal motor behavior lasting seconds c. Rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness d. Abrupt muscle contraction with autonomic signs
Rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness
Which of the following diagnostic tests would be most helpful in the diagnosis of this illness? A. CT scan of the brain B. Cranial nerve exam C. Sedimentation rate D. CBC with differential
Sedimentation rate
What are common complications of neurofibromatosis type 1 (NF1)?
Short stature
In prescribing prednisone for the patient with Bells palsy, the NP considers that its use: A. Has not been shown to be helpful in improving outcomes in the condition. B. Should be initiated asap after the onset of facial paralysis. C. Is likely to help minimize ocular symptoms. D. May prolong the course of the disease.
Should be initiated asap after the onset of facial paralysis.
Which of the following risk factors for a stroke can be eliminated? A. Hypertension B. Carotid artery stenosis C. Smoking D. Hyperlipidemia
Smoking
The following measures are used for treating various types of headache. Which is not considered to be effective therapy for migraine? a. Propanolol prophylaxis b. Resting in a quiet and darkened room c. Trimethobenzamide suppositories for nausea d. Sodium restriction to decrease water retention
Sodium restriction to decrease water retention
What differentiates prostate cancer symptoms from BPH?
Symptoms of prostate cancer in general tend to progress more rapidly than those of BPH.
Jonas, age 62, experienced a temporary loss of consciousness that was associated with an increased rate of respiration, tachycardia, pallor, perspiration, and coolness of the skin. How would you describe this? A. Lethargy B. Delirium C. Syncope D. A fugue state
Syncope
The best screening test for detecting hyperthyroidism and hypothyroidism is:
TSH
Migraine associated with muscle or neck pain, which is NOT an International Headache Society migraine diagnostic criterion, is often diagnosed as a. Sinus headache b. Cluster headache c. Increased intracranial pressure d. Tension-type headache
Tension-type headache
A 10 year old boy complains of sudden onset of scrotal pain upon awakening that morning. He is also complaining of severe nausea and vomiting. During the physical examination, the nurse practitioner finds a tender, warm, and swollen left scrotum. The cremastic reflex is negative and the urine dipstick is negative for leukocytes, nitrites, and blood. The most likely diagnosis is: A. Acute epididymitis B. Severe salmonella infection C. Testicular torsion D. Acute orchitis
Testicular torsion
Which of the following is a false statement with regard to driving and Alzheimer's-type dementia (AD)? A. Patients with AD typically continue to drive for at least 3 years following the diagnosis. B. Those with mild-to-moderate AD have an eightfold increase in the number of accidents. C. Those at early stages of AD can continue to drive safely, though driving should be monitored regularly. D. The National Transportation Safety Board recommends surrendering the driver's license for all individuals with an AD diagnosis.
The National Transportation Safety Board recommends surrendering the driver's license for all individuals with an AD diagnosis
When caring for the child with Osgood-Schlatter Disease, the nurse practitioner would know her treatment has been effective when: a. The child no longer complains of pain at lower knee at rest b. The child no longer complains of pain at the ankle at rest. c. The child no longer complains of pain at the hip during exercise. d. The child no longer complains of pain at lower knee during exercise.
The child no longer complains of pain at lower knee during exercise.
In tension-type headache, which of the following statements is true? a. Photophobia is seldom reported. b. The pain is typically described as "pressing" in quality c. The headache is usually unilateral d. Physical activity usually makes the discomfort worse
The pain is typically described as "pressing" in quality
Of the four types of strokes, which one is the most common and has a gradual onset? A. Thrombotic B. Embolic C. Lacunar D. Hemorrhagic
Thrombotic
Treatment for patients with condyloma acuminatum include all of the following except: A. Topical acyclovir B. Podofilox C. cryotherapy D. trichloroacetic acid
Topical acyclovir
What are the 4 major ways that peripheral neuropathy can present itself?
Traumatic, Systemic, Infectious/Autoimmune, Hereditary
Treatment options for varicocele repair include all of the following except: A. Open surgery B. Laparoscopic surgery C. Treatment with a thrombolytic agent D. Percutaneous embolization
Treatment with a thrombolytic agent
A 56-year-old man complains of several episodes of severe lacerating pain that shoots up to his right cheek and is precipitated by drinking cold drinks or chewing. These episodes start suddenly and end spontaneously after a few seconds with several episodes per day. He denies any trauma, facial weakness, or difficulty swallowing. He has stopped drinking cold drinks because of the pain. Which of the following is most likely? A. Trigeminal neuralgia B. Cluster headache C. Acute sinusitis D. Sinus headache
Trigeminal neuralgia
You examine a 29-year-old woman who has a sudden onset of right sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her exam is otherwise unremarkable. This presentation likely represents paralysis of CN: A: lll B. lV C. Vll D. Vlll
Vll
Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. You are trying to differentiate between epididymitis and testicular torsion. Which test to determine whether swelling is in the testis or the epididymis should be your first choice? A. X-ray B. Ultrasound C. Technetium scan D. Physical examination
Ultrasound
Milton, a 72 year old unmarried, sexually active white man presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although you suspect benign prostatic hypertrophy, what else should your differential diagnosis include?
Urethral stricture (may develop as a result of sexually transmitted diseases and should be considered in a sexually active individual no matter what the age)
What is the role of urine analysis in the workup of neurofibromatosis type 1 (NF1)?
Urinary free catecholamines (norepinephrine and epinephrine) as well as their metabolites (normetanephrine, metanephrine and vanillyl-mandelic acid) measured on a 24-hour urine collection are good biochemical screening tests for a suspected pheochromocytoma.
What lab result will be altered if a patient has taken an antibiotic?
Urine Culture
A 17 year old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like a "bag of worms" are noted underneath the scrotal skin. It is not swollen or reddened. The most likely diagnosis is A. Chronic orchitis B. Chronic epididymitis C. Testicular torsion D. Varicocele
Varicocele
Cushing's disease is the specific type of Cushing's syndrome that is caused by: A. long-term exposure to corticosteroids. B. a benign tumor of the adrenal gland. C. a benign pituitary tumor. D.an ectopic tumor that produces ACTH.
a benign pituitary tumor.
If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured by using A. Phalen ' s test. B. skeletometry. C. the Thomas test. D. a goniometer.
a goniometer.
A patient who has had a swollen, nontender scrotum for one week is found to have a mass within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects: a.) a hydrocele. b.) a varicocele. c.) an indirect inguinal hernia. d.) carcinoma of the testis.
a hydrocele.
Clinical conditions with a presentation similar to acute bursitis include which of the following? (More than one can apply.) A. rheumatoid arthritis B. septic arthritis C. joint trauma D. pseudogout
all of the above
To decrease the production of uric acid stones, the family nurse practitioner orders which medication? A. allopurinol (zyloprim) B. indomethacin (indocin) C. bethanechol (urecholine) D. phenazopyridine (pyridium)
allopurinol (zyloprim)
You perform a DRE on a 72-year old man and find a lesion suspicious for prostate cancer. The findings are described as: A. a rubbery, enlarged prostatic lobe. B. an area of prostatic induration C. a boggy gland. D. prostatic tenderness
an area of prostatic induration
A 64-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She claims her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has A. open-angle glaucoma. B. angle-closure glaucoma. C. herpetic conjunctivitis. D. diabetic retinopathy.
angle-closure glaucoma.
An 18-year-old college freshman is brought to the student health center with a chief complaint of a 3-day history of progressive headache and intermittent fever. On physical examination he has a positive Kernig and Brudzinski sign. The most likely diagnosis is: a. viral encephalitis b. bacterial meningitis c. acute subarachnoid hemorrhage d. epidural hematoma
bacterial meningitis
Which of the following dietary supplements is associated with increased risk for gout? A. vitamin A B. gingko biloba C. brewer's yeast D. glucosamine
brewer's yeast
First-line therapy for prepatellar bursitis should include: A. bursal aspiration. B. intrabursal corticosteroid injection. C. acetaminophen. D. knee splinting.
bursal aspiration.
Medications that commonly contribute to delirium include all of the following except: a. first generation antihistamines b. cardioselective beta-adrenergic antagonists c. opioids d. benzodiazepines
cardioselective beta-adrenergic antagonists
What is the preferred method to collect a urine specimen in children who are not toilet-trained?
catheterization
Initial treatment of lateral epicondylitis includes all of the following EXCEPT: A. rest and activity modifications B. corticosteroid injections C. topical or oral NSAIDS D. counterforce bracing brace centered over the back of the forearm can help relieve symptoms
corticosteroid injections
Cushing's syndrome results from an excess of: A. luteinizing hormone. B. follicle-stimulating hormone. C. cortisol. D. aldosterone.
cortisol.
A positive drawer sign supports a diagnosis of: a. sciatica b. cruciate ligament injury c. hip dislocation d. patellar ligament injury
cruciate ligament injury
The most common trigger for delirium is: a. alcohol withdrawal b. fecal impaction c. head trauma d. acute infection
d. acute infection
Patients with lateral epicondylitis typically present with: a. electric-like pain elicited by tapping over the median nerve b. reduced joint pain c. pain that is worst with elbow flexion (elbow ROM is usually normal) d. decreased hand grip strength the pain is worse with resisted wrist extension
decreased hand grip strength the pain is worse with resisted wrist extension
Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states that it is not painful, but it is annoying. You note that the origin of swelling is above the inguinal ligament directly behind and through the external ring. You diagnose this as a(n): A. indirect inguinal hernia. B. direct inguinal hernia. C. femoral hernia. D. strangulated hernia.
direct inguinal hernia.
What is the protein lacking or absent in muscular dystrophy a. coronin b. tubulin c. dystrophin d. keratin
dystrophin
Janice is recovering from osteomyelitis of her leg. She asks you for advice as to what she can do to promote healing. You tell her to: A. put weight on the affected leg more frequently to promote increased circulation, oxygenation, and nutrition to the tissues of the wound area. B. eat foods high in vitamins and calcium and increase her calorie and protein intake. C. spend time in the fresh air and expose the wound to fresh air and sunlight. D. be sure to use strict aseptic technique when changing the dressing, which should be kept wet at all times to improve wound healing.
eat foods high in vitamins and calcium and increase her calorie and protein intake.
The nurse practitioner who suspects that one of her hypertensive patient's has Cushing's syndrome would expect to find which of the following laboratory results? a. hyponatremia b. hypoglycemia c. elevated serum cortisol levels d. decreased urine 17-ketosteroids
elevated serum cortisol levels
Your 25-year-old male patient has had a fever, dysuria, low back pain, and scrotal edema. Which of the following is likely the diagnosis? A acute bacteria prostatitis B acute pyelonephritis C epididymitis D urinary tract infection
epididymitis
Which of the following is inconsistent with the clinical presentation of fibromyalgia? A. widespread body aches B. joint swelling C. fatigue D. cognitive changes
fatigue
Ginny, age 48, has rheumatoid arthritis and gets achy and stiff after sitting through a long movie. This is referred to as A. longevity stiffness B. gelling C. intermittent arthritis D. molding
gelling
When evaluating the person who has bacterial meningitis, the NP expects to find CSF results of: a. low protein b. predominance of lymphocytes c. glucose at about 30% of serum levels d. low opening pressure
glucose at about 30% of serum levels
Risk factors for lateral epicondylitis include all of the following EXCEPT: A. repetitive lifting B. playing tennis C. hammering D. gout
gout
A first-line approach to treating Cushing's syndrome in a 56-year-old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referral for surgery. C. consideration of radiation therapy. D. prescribing mifepristone.
gradually tapering corticosteroid use.
Signs and symptoms of acute angle-closure glaucoma include A. painless redness of the eyes. B. loss of peripheral vision. C. translucent corneas. D. halos around lights.
halos around lights.
The following are causes of scoliosis except: a. unknown b. spinal congenital deformity c. arthritis d. herniated disc.
herniated disc.
First-line treatment of SLE in a patient with mild symptoms is: A. systemic corticosteroids. B. hydroxychloroquine plus NSAIDs. C. anakinra. D. methotrexate.
hydroxychloroquine plus NSAIDs.
When managing dementia, cholinesterase inhibitors offer the greatest benefit: A. for prevention of Alzheimer's-type dementia. B. in patients with mild cognitive impairment. C. in patients with mild-to-moderate AD. D. in patients with severe AD.
in patients with mild-to-moderate AD.
The most common type of hernia is a(n): A. indirect inguinal hernia. B. direct inguinal hernia. C. femoral hernia. D. umbilical hernia.
indirect inguinal hernia.
A history of urinary tract infections in males is often seen in men with chronic bacterial prostatitis. Other signs and symptoms of chronic bacterial prostatitis includes A. irritative voiding symptoms, low back pain, and perineal pain. B. nausea and vomiting, as well as fever. C. loss of appetite and weight loss. D. irritative voiding symptoms, inability to ambulate, and fever.
irritative voiding symptoms, low back pain, and perineal pain.
When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. You are trying to differentiate between a sprain and a strain. You know that a sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears of the muscles. D. does not result in joint instability.
is an injury to the ligaments that attach to bones in a joint.
In assessing a man with testicular torsion, the NP is most likely to note: A. elevated PSA level. B. white blood cells reported in urinalysis. C. left testicle most often affected. D. increased testicular blood flow by color-flow Doppler ultrasound.
left testicle most often affected.
Which of the following is usually NOT part of treatment of a sprain? A. immobilization B. applying ice to the area C. joint rest D. local corticosteroid injection
local corticosteroid injection
Patients with subscapular bursitis typically present with: A. limited shoulder ROM. B. heat over affected area. C. localized tenderness under the superomedial angle of the scapula. D. cervical nerve root irritation
localized tenderness under the superomedial angle of the scapula.
When caring for a patient with a recent TIA, you consider that: A. long-term antiplatelet therapy is likely indicated. B. this person has a relatively low risk of future stroke. C. women present with this disorder more often than men. D. rehabilitation will be needed to minimize the effects of the resulting neurological insult.
long-term antiplatelet therapy is likely indicated.
Type of muscular dystrophy that is most common in adulthood a. Becker md b. Duchenne md c. facioscapulohumeral md d. myotonic md.
myotonic md.
When taking a phosphodiesterase-5 (PDE-5) inhibitor, concomitant use of which medication must be avoided? A. statins B. sulfonylurea C. angiotensin-converting enzyme (ACE) inhibitors D. nitrates
nitrates
What type of muscular dystrophy do females get? A. becker md b. Duchenne md c. myotonic md d. none
none
Mrs. Allen is a 67-year-old woman with type 2 diabetes who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphopsia in her left eye. The most likely diagnosis is:
open-angle glaucoma, central retinal artery occlusion anterior uveitis, retinal detachment.
To prevent a recurrence of testicular torsion, which of the following is recommended? A. use of a scrotal support B. avoidance of testicular trauma C. orchiopexy D. limiting the number of sexual partners
orchiopexy
What are the key physical findings of patellar fractures?
palpable DEFECT on patella, HEMARTHROSIS, Failure to do STRAIGHT LEG RAISE = failure of EXTENSOR MECHANISM (retinaculum displaced)
Risk factors for transient ischemic attack (TIA) include all of the following except: A. atrial fibrillation. B. carotid artery disease. C. combined oral contraceptive use. D. pernicious anemia.
pernicious anemia.
You see a 58-year-old man diagnosed with a kidney stone who reports pain primarily during urination. You consider all of the following except: A. improved hydration. B. alpha blocker use. C. prescribing a diuretic. D. analgesia use
prescribing a diuretic.
A first-line approach to treating Cushing's syndrome in a 56-year-old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referral for surgery. C. consideration of radiation therapy. D. prescribing mifepristone.
prescribing mifepristone.
Immediate diagnostic imaging for low back pain should be reserved for all of the following EXCEPT: A. presence of signs of the cauda equina syndrome. B. presence of severe neurological deficits. C. presence of risk factors for cancer. D. presence of moderate pain lasting at least 2 weeks.
presence of moderate pain lasting at least 2 weeks.
All of the following can cause a elevated PSA level except: A. current prostate infection B. recent cystoscopy C. BPH D. prostatectomy
prostatectomy
The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:
reduce action of androgens in the prostate.
A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having intermittent unilateral testicular pain in the past but not as severe as this current episode. Confirmation of testicular torsion would include all of the following findings except: A. unilateral loss of the cremasteric reflex. B. the affected testicle held higher in the scrotum. C. testicular swelling. D. relief of pain with scrotal elevation.
relief of pain with scrotal elevation
Fibromyalgia is more common in patients with: A. type 2 diabetes. B. rheumatoid arthritis and systemic lupus erythematosus. C. migraine headaches. D. chronic obstructive pulmonary disorder (COPD).
rheumatoid arthritis and systemic lupus erythematosus.
Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis. B. hypertension. C. type 2 diabetes. D. osteoporosis.
rheumatoid arthritis.
Likely sequelae of intrabursal corticosteroid injection include: A. irreversible skin atrophy. B. infection. C. inflammatory reaction. D. soreness at the site of injection.
soreness at the site of injection.
The use of all of the following medications can trigger gout except: A. aspirin. B. statins. C. diuretics. D. niacin.
statins.
It is defined as a true deformity of the spine a. functional scoliosis b. structural scoliosis c. arthritic scoliosis d. neurofibroma scoliosis
structural scoliosis
In assessing the skeletal muscles, you turn the forearm so that the palm is up. This is called A. supination. B. pronation. C. abduction. D. eversion.
supination.
Common signs of high-grade aortic stenosis in an individual during exercise include all of the following except: A. dyspnea. B. angina. C. seizure. D. syncope.
syncope.
The Hallpike maneuver is performed to elicit A. a seizure. B. vertigo. C. syncope. D. a headache.
syncope.
Treatment options for an adult with seizures include all of the following agents EXCEPT: a. Carbamazepine b. Phenytoin c. Gabapentin d. tamsulosin
tamsulosin
The Lachman maneuver is used to detect which of the following? A. instability of the knee B. nerve damage of the knee due to past knee injuries C. integrity of the patellar tendon D. tears on the meniscus of the knee
tears on the meniscus of the knee
Which of the following is not a common risk factor for erectile dysfunction (ED)? A. diabetes mellitus B. hypertension C. cigarette smoking D. testosterone deficiency
testosterone deficiency
When discussing the use of a cholinesterase inhibitor with a 72-year-old woman with a recent diagnosis of Alzheimer's-type dementia and her family, you report that: A. this medication will help return memory to her pre-illness baseline. B. the risk associated with the use of this medication outweighs its benefits. C. this medication will likely afford clear, although minor and time-limited, benefits. D. the medication should have been started earlier to help prevent any change in cognition.
this medication will likely afford clear, although minor and time-limited, benefits.
An 81-year-old man who was recently diagnosed with Alzheimer's-type dementia is accompanied by his granddaughter for an office visit. The granddaughter reports that her grandfather often acts erratically with angry outbursts that can soon be followed by a more "normal" demeanor. She reports that the grandfather recently moved in with her, and she would like for this arrangement to continue as long as possible. In counseling the granddaughter, you consider all of the following except that: A.behavioral difficulties often arise in patients with AD if their usual routine is disrupted. B.treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline. C.a home safety evaluation should be conducted, and appropriate modification performed. D.any sudden change in mental status should be reported to the healthcare provider as soon as possible.
treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline.
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)
try neutral position wrist splinting and order an oral NSAID.
Lower urinary tract symptoms in males can present as a constellation of storage or voiding symptoms. Storage symptoms include:
urgency and nocturia
Neurofibromatosis NF1 is also known as ________. It is caused by a gene mutation on chromosome 17 which encodes neurofibromin and affects around 1 in 4,000
von Recklinghausen's syndrome
Common physical findings of SLE include all the following except: A. weight gain. B. joint pain and swelling. C. fatigue. D. facial rash.
weight gain.