PC2 Midterm

Acanthosis nigricans is commonly noted in all of the following except: (A) Groin fold (B) Axilla (C) Nape of the neck (D) Face

(D) Face

Consideration should be given to setting a1c goal in 22M w/ 8y h/o DM1 with no comorbidities equal to or less than: 5.5% 6 6.5 7

6

The meglitinide analogues are particularly helpful adjuncts in DM2 to minimize risk of: Fasting hypoglycemia Nocturnal hyperglycemia Postprandial hyperglycemia Postprandial hypoglycemia

Postprandial hyperglycemia

A 64-year-old man is reviewing enrollment information because he will soon qualify for Medicare. He feels well. History includes hypertension, diabetes, and heart failure. He has reviewed the premiums and deductibles and intends to get a supplemental insurance coverage plan. For which of the following services would the Medigap supplemental plan typically cover co-payments? (A) Durable medical equipment (B) Long-term care (C) Dental care (D) Private-duty nursing

(A) Durable medical equipment

5. A 75-year-old man comes to the office for his annual wellness visit. He is physically active and lives independently in an apartment. He has no significant medical history and has never fallen. His vitamin D level 6 months ago was normal. His only medication is aspirin once daily. Which of the following is the most appropriate vitamin D supplementation for this patient to prevent future falls? (A)No vitamin D supplement needed. (B)Prescribe vitamin D3 800 IU/d. (C) Prescribe vitamin D2 50,000 IU/week. D) Prescribe vitamin D3 400 IU/d with calcium 1,000 mg.

(A)No vitamin D supplement needed.

Eunice, age 32, has type 2 diabetes. She said she heard she should take an aspirin a day after she reaches menopause for its cardioprotective action. She does not have coronary artery disease, but her father does. How do you respond? (A) "You're right. Your hormones protect you against coronary artery disease until menopause; then you should start on aspirin therapy." (B) "The American Diabetes Association recommends that you start on low-dose aspirin therapy now." (C) "Aspirin therapy is recommended for all patients over age 55 as a precautionary measure." (D) "If you maintain good glycemic control, you don't need aspirin therapy."

(B) "The American Diabetes Association recommends that you start on low-dose aspirin therapy now." **ADA does NOT recommend this any longer for patients under 50, yes if over 50 w risk factors**

9. An 80-year-old man comes to the office because he has urinary frequency, low pelvic pain, dysuria, and occasional small-volume urine leakage. Cystoscopy reveals recurrence of transitional-cell bladder cancer first diagnosed 1 year ago. At that time, he was treated with intravesicular bacillus Calmette-Guérin (BCG) chemotherapy. His urologist now recommends cystectomy with consideration of systemic therapy. Urinalysis is positive for 3-5 WBCs per high-power field, 100 RBCs per high-power field, and trace glucose. Reflex to culture is negative. Which of the following is the most important next step before cystectomy? (A) Treat symptomatically with phenazopyridine and oxybutynin. (B) Perform comprehensive geriatric assessment. (C) Obtain transrectal ultrasonography of the prostate. (D) Initiate pembrolizumab immunotherapy.

(B) Perform comprehensive geriatric assessment.

Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of: (A) Hypoglycemia (B) Hepatic impairment (C) Lactic acidosis (D) Interaction with most anesthetic agents

(C) Lactic acidosis

An 84-year-old woman with end-stage dementia has lost 10% of her usual body weight. She has poor oral intake, pockets food in her mouth, and often refuses feeding attempts or spits out the food; she has pulled out a nasogastric tube three times in the past. Reversible causes of poor oral intake have been excluded. She came to the US from Korea 4 years ago and lives with her youngest daughter, who is her caregiver. She lacks the capacity to make her own decisions, and there are no advance directives. Her sons requested placement of a percutaneous endoscopic gastrostomy (PEG) tube; her daughters disagreed with the request. The eldest child claims the right to make the decision, by virtue of his being the first-born son. What is the most appropriate next step in caring for this patient? (A) Defer to the decision of the eldest son. (B) Defer to the decision of the youngest daughter, the caregiver. (C) Organize a family meeting. (D) Tell the family that the PEG tube will not be placed because the patient has advanced dementia

(C) Organize a family meeting.

7. A 66-year-old man comes to the clinic for follow-up. History includes type 2 diabetes mellitus and stage 3 chronic kidney disease; 7 years ago he had an episode of shingles. Current medications include metformin, lisinopril, and aspirin. He received the live attenuated zoster vaccine 5 years ago. What is the most appropriate recommendation regarding the zoster vaccine for this patient? (A) Live attenuated zoster vaccine (Zostavax) now (B) No vaccine (C) Recombinant adjuvanted zoster vaccine (Shingrix) now (D) He is immune to zoster.

(C) Recombinant adjuvanted zoster vaccine (Shingrix) now

All of the following medications are recommended as possible first-line medications for treatment of concomitant hypertension when seen with type 2 diabetes in a 48-year-old male of European ancestry except: (A) Beta blocker (B) Calcium channel blocker (C) a-adrenergic receptor antagonist (D)ARB

(C) a-adrenergic receptor antagonist

6. A 92-year-old man contacts the office because he has a painful, itchy rash on one side of his chest. His description of the rash suggests possible herpes zoster infection. He lives independently in senior housing that is on lockdown because of the COVID-19 pandemic. There is no nursing care in the building, and residents may not leave unless there is a medical emergency. Which one of the following is the most important consideration in advising this patient? (A) Hearing loss (B) Dual-eligibility (C) Access to a social worker at the building (D) All of the above

(D) All of the above

An 86-year-old man comes to the office for follow-up after recent hospitalization for myocardial infarction. Echocardiography done during hospitalization showed an ejection fraction of 45%, and a cardiac stent was placed. History includes diabetes mellitus, hypertension, coronary artery disease, COPD, renal insufficiency, and anemia. Current medications are insulin 70/30, lisinopril, metoprolol, aspirin, clopidogrel, simvastatin, mometasone, formoterol, and albuterol; the lisinopril and clopidogrel were added during the hospitalization. He lives alone and is independent in all instrumental activities of daily living. On examination, weight is 54.4 kg (120 lb) and BMI is 20 kg/m2. Sitting blood pressure is 98/60 mmHg, and heart rate is 70 beats per minute. Cardiovascular and pulmonary findings are normal. Laboratory findings include hemoglobin A1c of 8.0% and hemoglobin of 10.5 g/dL. Which of the following is the most appropriate adjustment to his medication regimen? (A) Add iron supplementation. (B) Discontinue simvastatin. (C) Intensify insulin therapy. (D) Discontinue lisinopril.

(D) Discontinue lisinopril.

A 72-year-old man is hospitalized for 7 days for treatment of a large left-hemisphere stroke. He is then admitted to a rehabilitation unit in a skilled nursing facility for 30 days. His neurologic improvement is minimal, and he is transitioned to long-term care within the facility. His health insurance coverage is limited to Medicare Parts A, B, and D. He has $50,000 in savings and owns a modest home. Which of the following will be the chief source of funding for his first year in the nursing home beyond the initial 30 days in the skilled nursing facility? (A) Medicare Part A (B) Medicare Part B (C) Medicaid (D) Out-of-pocket payment

(D) Out-of-pocket payment

8. A 75-year-old woman routinely comes to the office every 6 months for follow-up and renewal of prescriptions; she is due for her next visit. History includes hypertension and hyperlipidemia. She lives independently and has no significant mobility or cognitive issues. She is running low on her medications, but she hesitates to visit the office during the COVID-19 pandemic because she is concerned about exposure to the virus. Which of the following is the best alternative to an office visit for this patient? (A) Asynchronous secure messaging and refill of her prescriptions (B) Home health visit by a visiting nurse (C) Remote monitoring to collect data on her blood pressure (D) Synchronous televideo or telephone visit

(D) Synchronous televideo or telephone visit

Lung cancer ranks number ____ as a cause of cancer-related death in men and women 1 2 3 4

1

What is the greatest risk factor for the development of chronic obstructive pulmonary disease (COPD)? 1 .Cigarette smoking. 2 . Air pollution. 3 . Work exposure. 4 . Asthma.

1 .Cigarette smoking.

An 85-year-old male presents to the urgent care clinic with a history of syncopal episode without a history of head injury. On cardiac auscultation, the patient has a harsh systolic murmur at the second intercostal space, with radiation of the murmur to the carotids. What type of murmur does the patient have? 1 ] Aortic stenosis. 2 ] Aortic regurgitation. 3 ] Mitral stenosis. 4 ] Mitral valve prolapse (MVP).

1 ] Aortic stenosis.

A 75-year-old male with a history of myocardial infarction presents to your primary care office with complaints of progressive dyspnea, crackles on physical exam, and cough. The patient is a current smoker with a 60-pack-year history. He has a history of echocardiogram showing an ejection fraction of 50. His electrocardiogram (EKG) is normal and his chest x-ray shows an increased cardiac silhouette, small bilateral pleural effusions, and increased pulmonary vasculature. Which disease process is the patient experiencing? 1 ] Heart failure—left ventricular failure (LVF) subset. 2 ] Heart failure—right ventricular failure (RVF) subset. 3 ] Chronic obstructive pulmonary disease (COPD). 4 ] Pulmonary embolism.

1 ] Heart failure—left ventricular failure (LVF) subset.

Greg, age 68, has just been given a diagnosis of congestive heart failure (CHF). Which of his medications should be discontinued? 1 ] Nifedipine (Procardia XL) for long-term management of his chronic stable angina. 2 ] Hydrochlorothiazide (HydroDIURIL) for his hypertension. 3 ] Enalapril (Vasotec) for his hypertension. 4 ] Butalbital for his headaches.

1 ] Nifedipine (Procardia XL) for long-term management of his chronic stable angina.

With the use of weight loss meds, if the pt has not achieved 5% weight loss by week ____ of tx, d/c tx. 6 12 18 24

12

A TIA is characterized as an episode of reversible neurological symptoms that can last: 1 hour 6 hours 12 hours 24 hours

24 hrs

Which of the following patients would you recommend get a low-dose computed tomography (CT) scan for lung cancer screening? 1 . A 25-year-old with a 10-pack-year history and asthma. 2 . A 75-year-old with a history of pneumonia. 3 . A 65-year-old smoker who started smoking at age 12. 4 . A 65-year-old smoker who quit 20 years ago but has a previous 50-pack-year history

3 . A 65-year-old smoker who started smoking at age 12.

You have completed a physical exam on Sandra, age 32, who presented to the clinic for a cough that is particularly worse at night. She has been experiencing episodes of recurrent tightness in the chest with wheezing. She tells you that exercise and changes in the weather make her symptoms occur or worsen. Which test is performed to diagnose asthma? 1 . Bronchoprovocation with methacholine, histamine, cold air, or exercise challenge. 2 . Peak expiratory flow meter monitoring. 3 . Spirometry testing. 4 . Chest x-ray.

3 . Spirometry testing.

What do you include in your teaching about tiotropium (Spiriva) when you initially prescribe it for your client with chronic obstructive pulmonary disease (COPD)? 1 .Use it every time you use your beta-2 agonist. 2 . Stop taking all your other COPD medications. 3 . Use it once per day. 4 . Stop taking Spiriva if you develop the adverse effect of dry mouth.

3 . Use it once per day.

An active 68-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes in, you discover that he has 10 remaining teeth that are in poor repair. Your recommendation would be to: 1 ] Defer any further dental work until his valve replacement is completed. 2 ] Instruct the client to have dental extraction done cautiously, having no more than 2 teeth removed per visit. 3 ] Suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis. 4 ] Coordinate with his cardiac and oral surgeons to have the tooth extraction and valve replacement done at the same time to reduce the risk of anesthetic complications.

3 ] Suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis

Generally, testing for type 2 DM in asymptomatic undiagnosed people older than 45 years should be conducted every ___. Year 3 years 5 years 10 years

3 years

The family of a 74-year-old woman comes to the office to discuss goals of care. The patient resides in a SNF and has Alzheimer's disease. She is oriented only to herself, but she does recognize her family and close friends. She participates in activities with assistance. In the past 2 years she has had lower-extremity edema, managed with furosemide 20mg/d, and compression stockings. With the past year she has had increasing dyspnea with activities and dyspnea as rest. She has been hospitalized 2x because of dyspnea accompanied by orthopnea, labored breathing, low O2 saturation on room air, and her edema is not improving with diuretics, stocking or elevation. At the last hospitalization, N-terminal prohormone of brain natriuretic peptide (NT-ProBNP) was 2,000 pg/mL, BUN was 22, creatine level was 1.5. BMI was 22, Transthoracic echo showed an EF of 55%, without significant valvular abnormalities or pulmonary pressure elevation. At discharge, carvedilol, furosemide, and lisinopril were added to her meds. Which of the following factors is most predictive of poor long-term survival? 1- EF of 55% 2- eGFR of 34 3- NT-ProBNP of 2000 4- NYHA Class III

3- NT-ProBNP of 2000

An 82-year-old woman with a bioprosthetic mitral value has new fevers of uncertain etiology. After obtaining blood cultures, which of the following is the next best step in the management for possible bacterial endocarditis? 1- observes and monitor 2- order a transesophageal echo 3- start empiric antibiotic therapy 4- Confirm the presence of Janeway lesions or Osler nodes

3- start empiric antibiotic therapy

You see a 67 yo with very severe (GOLD 4) COPD who asks "when should I use my home o2?" you say: As needed when SOB Primarily during sleep hours Primarily during waking hours For at least 15 hours/day

For at least 15 hours/day

1.You are rotating in the outpatient clinic with Dr. Pritti, who asks you to see Lynda Jacobsen, a 65-year old female here for her "Welcome to Medicare" wellness visit. She reports no acute concerns but wants to get "every test Medicare will cover" as she plans to live to be 100. You recall there is more to prevention than just ordering tests. Which of the following are major categories of preventive care? Select all that apply. A. Behavioral counseling B. Diagnostic testing C. Immunizations D. Integrative care plans E. Prescription medications F. Screening examinations G. Stages of change

A. Behavioral counseling C. Immunizations F. Screening examinations

Annual screening with low-dose CT for lung ca should occur in 55-74 yo smokers w/a h/o at least ___ pack/yrs. 15 30 50 70

30

The use of a thiazolidinedione is not recommended in all of the following except: 57M taking a nitrate 62F with heart failure 45M on insulin 35 yo pt with newly dx'ed DM2

35 yo pt with newly dx'ed DM2

What is the first line treatment for asthma? a) Inhaled corticosteriods (ICS) b) long acting beta2 agonists (LABAs) c) Leukotriene Inhibitors d) short acting beta2 agonists (SABAs)

a) Inhaled corticosteriods (ICS)

NCCN recommends screening high-risk smokers beginning at age: 40 45 50 55

50

In a healthy person, what percentage of the body's total daily physiological insulin secretion is released as basally? 10-20% 25-35 50-60 75-85

50-60

Of the following, who is in greatest need of endocarditis prophylaxis when planning dental work? 22 yo with MVP and trace mitral regurgitation on echo 54 yo with a prosthetic aortic valve 66 yo with cardiomyopathy 58 yo who had a 3-vessel coronary artery bypass graft with drug-eluting stents 1 yr ago

54 yo with a prosthetic aortic valve

Which of the following pts has prediabetes? 70M with fasting glucose of 99 84F with a 1hr postprandial glucose of 98 33M with a hgbA1c of 5.4% 58F with a 2hr postprandial glucose of 152

58F with a 2hr postprandial glucose of 152

What is the preferred reliever medication for asthmatics according to the Gold Initiative for Asthma (GINA, 2020) treatment guideline? a) low-dose ICS with formoterol b) SABA c) LABA d) Leukotriene receptor antagonist

a) Low-dose ICS with formoterol

Recommendation a1c goal in 79F with 20y h/o DM2 who has difficulty walking, uses a walker, and has an EF of 35% and h/o of HF should be equal to or less than: 7% 7.5 8 8.5

7.5

Clinical findings characteristic of poorly controlled asthma include all but: A recurrent spasmodic cough that is worse at night Recurrent SOB and chest tightness w/exercise A congested cough that is worse during the day Wheezing with and without associated respiratory infections

A recurrent spasmodic cough that is worse at night

Concerning disabled people, Medicaid funding can assist in all but: Fund education opportunities (i.e. tuition) Provide a fuller range of healthcare services Maximize independent living opportunities Support participation in the workforce if possible

Fund education opportunities (i.e. tuition)

Clinical presentation of acute lower-extremity atherosclerotic arterial disease most likely includes: Pain and paresthesia Pallor and pulselessness Poikilothermy Paralysis or loss of limb strength

Pain and paresthesia

Which type of Emphysema is seen in patients with alpha 1 antitrypsin deficiency

Panlobular (Panacinar)

A 55-year-old man with a history of diabetes mellitus type 2 comes to your clinic for a 1-month follow-up visit. His blood pressures in the last 2 visits have been 145/90, 140/85, 140/90, and 135/90 mm Hg. Today his blood pressure shows similar numbers. What do you explain to the patient? A) That he likely has hypertension and appropriate management is important to prevent complications. B) Since he has diabetes, these numbers are not concerning, but he should continue healthy lifestyle management C) As long as there are no signs of target organ damage, there is no need to be concerned D) As long as his ASCVD score is <10%, there is no need to be concerned

A) That he likely has hypertension and appropriate management is important to prevent complications.

hgbA1c best provides info no glucose control over the past: (it didn't say over what time period? Days?) 21 to 47 48 to 68 69 to 89 90 to 120

90 to 120

After use, the onset of action of lispro 9humalog) occurs in: <30 mins About 1 hour 1-2 hours 3-4 hours

<30 mins

A patient w/ history of asthma that performs a bronchodilator challenge would be expected to have an increase in FEV1 of what percentage or higher?

>/= to 12% increase in FEV1

A patient with history of asthma that performs a bronchodilator challenge would be expected to have an increase of FEV1 of what percent or higher?

>/= to 12% increase in FEV1

Which morphological type of emphysema is seen in patients w/ alpha 1 antitrypsin deficiency?

Panlobular (Panicinar) vs. centrilobular

Which of the following antihypertensive drug classes can cause prolonged hypotension when used with PDE5 inhibitors (sildenafil, tadalafil)? A Peripheral alpha-blockers B Calcium channel blockers (CCBs) C ACE inhibitors D Thiazide diuretics E Beta-blockers

A Peripheral alpha-blockers (doxazosin, prazosin, tamsulosin)

The mechanism of action of the DPP-4 inhibitors is as: A drug that increases levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells A product virtually identical in action to sulfonylureas A drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production A facilitator of renal glucose excretion

A drug that increases levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells

The mechanism of action of the GLP-1 agonist is as: A drug that stimulates insulin production in response to an increase in plasma glucose A product virtually identical in action to sulfonylureas A drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production A facilitator of renal glucose excretion

A drug that stimulates insulin production in response to an increase in plasma glucose

Potential consequences of failing an audit due to upcoding (applying an artificially high level code to a visit) include all but: Repaying the money to the payer A malpractice lawsuit A dismissal as a reimbursable provider A mandated education

A malpractice lawsuit

In performing a cardiac exam in a person with MVP, you expect to find: An early- to mid-systolic, crescendo-decrescendo murmur A pansystolic murmur A low-pitched, diastolic rumble A mid- to late-systolic murmur

A mid- to late-systolic murmur

Additional findings in MVP include: An opening snap A mid-systolic click A paradoxical splitting of S2 S4

A mid-systolic click

The S3 heart sound has all of the following except: It's heard in early diastole A presystolic sound It is noted in the presence of ventricular overload It is heard best with the bell

A presystolic sound

The mechanism of action of sulfonylureas is as: An antagonist of insulin receptor site activity A product that enhances insulin release A facilitator of renal glucose excretion An agent that can reduce hepatic glucose production

A product that enhances insulin release

All of the following are components of medical decision making according to CPT except: Patient history taking Diagnosing Deciding a course of treatment Performing treatments

Patient history taking

Which of the following is a common vision problem in the person with untreated primary open angle glaucoma? Peripheral vision loss Blurring of near vision Difficulty with distant vision Need for increased illumination

Peripheral vision loss

When should the patient be concerned that her injury is not "just" a biceps tendonitis? Select all that apply. A. Fasting blood glucose levels rise to 200 mg/dLB. B Numbness, tingling, or weakness in the distal arm/wrist/hand C. She is able to do 20 push-ups without pain D. Symptoms last longer than four weeks

A. Fasting blood glucose levels rise to 200 mg/dLB. B Numbness, tingling, or weakness in the distal arm/wrist/hand D. Symptoms last longer than four weeks

Which of the following is an example of an appropriate question to pose to a person with obesity who is in the precontemplation change stage? A. How do you feel about your weight? B. What are barriers you see to losing weight? C. What is your personal goal for weight loss? D. How do you envision my helping you to meet your weight loss goal?

A. How do you feel about your weight?

Risk factors for TIA include all but: Afib Carotid artery dz Combined oral contraceptive use Pernicious anemia

Pernicious anemia

You see a 59-year-old man with poorly controlled hypertension. On physical examination, you note grade 1 hypertensive retinopathy. You anticipate all of the following will be present except: A. Patient report of acute visual change B. Narrowing of the terminal arterioles C. Sharp optic disc borders D. Absence of retinal hemorrhage

A. Patient report of acute visual change

What is the impact of the Affordable Care Act on Medicaid coverage? ACA increases Medicaid coverage for elderly (>65) ACA increases coverage for uninsured adults <65 yo There is no impact on Medicaid More individuals will switch from Medicaid to medicare coverage

ACA increases coverage for uninsured adults <65 yo

2. She asks you to give the flier to Dr. Pritti and let her know she wants every test that Medicare will cover. You would like to see if the tests she is interested in are recommended for someone of her age and with her medical conditions. Which of the following are reliable sources for high quality, evidence-based preventive care recommendations? Select all that apply. A. Agency for Healthcare Research and Quality (AHRQ) B. Centers for Disease Control and Prevention (CDC) C. Choosing Wisely Campaign D. Prevention website E. U.S. Preventive Services Task Force (USPSTF)

AHRQ, CDC, Choosing Wisely, USPSTF

A 19 yo p/w B/L itchy, red eyes w/tearing that occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge and clear nasal drainage. This is most c/w conjunctival inflammation caused by: A bacterium A virus An allergen An injury

An allergen

Marci, age 25, has been given a diagnosis of step 1 (intermittent) asthma. What long-term control therapy is indicated? A] None. B ] A single agent with anti-inflammatory activity. C] An inhaled corticosteroid with the addition of a long-acting bronchodilator if needed. D ] Multiple long-term control medications with oral corticosteroids if needed.

A] None.

Grade III systolic heart murmur is usually: Softer than S2 About as loud as S1 Accompanied by thrill Heard across the precordium without radiation

About as loud as S1

You see a 62 yo man w/o CKD or DM who is currently on low-dose HCTZ and losartan. His BP is 162/88. All are appropriate next steps but: Increasing losartan dose Adding a beta-adrenergic receptor antagonist Adding a CCB Increasing HCTZ dose

Adding a beta-adrenergic receptor antagonist

Which of the following best describes ethnicity and insulin sensitivity? Little variation exists in insulin sensitivity among different ethnic groups African americans are typically less sensitive to the effects of insulin compared to europeans Mexican americans are likely the most insulin-sensitive ethnic group in north america The degree of insulin sensitivity has little influence on insulin production

African americans are typically less sensitive to the effects of insulin compared to europeans

What information would be helpful for your medical assistant to have discussed with Ms. Davis before you join the virtual visit? Select all that apply. A. Accurate medication list B. Recent home blood pressure reading C. Recent home glucose monitoring results D. Whether the patient is wearing comfortable clothing for movement during the exam.

All the above

Which of the following household items could be used for a musculoskeletal exam? Select all that apply. A. 5 lb. bag of flour B. C cell batteries C. Gallon of milk D. Rolls of coins

All the above : 9 lb. weight options: gallon of milk, large bag of potatoes 5 lb. weight options: 2 L bottle of soda, bag of sugar, bag of flour 2 lb. weight options: quart of milk, 1 L bottle of soda 1 lb. weight options: can of soup, block of butter, 16 oz bottle of water 0.5 lb. weight options: Rolls of coins, cup of sugar, three C cell batteries

All of the following meds are recommended as possible 1st-line meds for HTN with DM2 for a European man except: Thiazide diuretic Calcium channel blocker Alpha-adrenergic receptor antagonist Angiotensin receptor blocker

Alpha-adrenergic receptor antagonist

Mrs Murphy is a 58 yo p/w sudden L-sided headache that is most painful in her L eye. Her vision is blurred, and the L pupil is slightly dilated and poorly reactive. The L conjunctiva is markedly injected and the eyeball is firm. Visio is 20/30 OD and 20/90 OS. The most likely dx is: Unilateral herpetic conjunctivitis Open-angle glaucoma Angle-closure glaucoma Anterior uveitis

Angle-closure glaucoma *need prompt referral to optho

A 48 yo p/w new onset R eye vision change a/w dull pain, tearing, and photophobia. The R pupil is small, irregular, and poorly reactive. Vision is 20/30 OS and 20/8 OD. The most likely dx is: Unilateral herpetic conjunctivitis Open-angle glaucoma Angle-closure glaucoma Anterior uveitis

Anterior uveitis

Which is the most appropriate choice of therapy in the tx of a mild acute COPD exacerbation in a 42 yo? Levofloxacin x5 days Amoxicillin x7 days Doxycycline x10 days Antimicrobial tx usually not indicated

Antimicrobial tx usually not indicated

You are examining an 85 yo and find a grade 3/6 crescendo-decrescendo systolic murmur with radiation to the neck. this is most likely caused by: Aortic stenosis Aortic regurgitation Anemia Mitral stenosis

Aortic stenosis

Comprehensive treatment for a person with peripheral occlusive arterial disease and DM includes all but: Daily aspirin use Lipid lowering with an HMG-CoA educates inhibitor (statin) Application of a topical antimicrobial to the affected area Maintenance of glycemic control

Application of a topical antimicrobial to the affected area

Treatment options for venous stasis ulcers in the lower extremities include: Cleansing with hydrogen peroxide Applying Burow solution Prescribing a systemic corticosteroid Applying a moisture-retaining dressing

Applying a moisture-retaining dressing

More common etiologies of acute lower-extremity atherosclerotic arterial disease include: Arterial embolism with underlying afib Chronic venous insufficiency Extension of venous thrombosis Vessel trauma

Arterial embolism with underlying afib

hgbA1c should be tested: At least annually for all patients At least 2x/year in pts who are meeting tx goals and who have stable glycemic control Monthly in pts whose tx has changes or who are not meeting glycemic goals Only via standardized lab testing because of inaccuracies a/w point-of-service testing

At least 2x/year in pts who are meeting tx goals and who have stable glycemic control

All of the following criteria can be used to distinguish a level 4 office visit for an established pt except: At least 4 elements of physical exam At least 4 elements of HPI Medical decision making of moderate complexity Positive or negative responses to at least 2 ROS questions and at least 1 notation about past hx

At least 4 elements of HPI

All of the following criteria can be used to distinguish a level 3 office visit for an established pt except: At least 6 elements of physical exam At least 1 element of HPI and at least 1 positive or negative response in ROS Medical decision making of low complexity At least one new rx or a rx refill

At least one new rx or a rx refill

EKG finings in a pt with digoxin toxicity would most likely include: Atrioventricular heart block T wave inversion Sinus tachycardia Pointed P waves

Atrioventricular heart block

The most important long term goal of treating HTN is to

Avoid disease-related target organ damage

The most effective nonpharmacologic method to prevent exacerbations in pts with COPD is: Weight loss for those w/a BMI > 25kg/m2 Avoid exposure to children or day-care centers Brisk walking for at least 5 mins 3-5x/day as tolerated Avoid exposure to pulmonary irritants, such as cigarette smoke

Avoid exposure to pulmonary irritants, such as cigarette smoke

4. A 92-year-old man comes to the office because his wife believes that his memory loss is compromising his ability to drive. He has not had any motor vehicle violations, and he thinks he is a good driver. History includes hypertension. Score is 22 of 30 on the Montreal Cognitive Assessment (MoCA); neuropsychologic testing is consistent with mild dementia. Which of the following is most appropriate? A)Tell the patient that he should stop driving. B)Refer the patient to the Department of Motor Vehicles (DMV) for a performance-based road test. C)Monitor the patient's cognitive impairment every 6 months; report further impairment to the DMV. D)Notify the DMV that the patient's driver's license must be revoked.

B)Refer the patient to the Department of Motor Vehicles

Testing for Type 2 DM in asymptomatic, undiagnosed individuals older than 45 years should be conducted every-- A. Year B. 3 Year C. 5 Year D. 10 Years

B. 3 Year

A 68 yo woman presents w/HTN and BP 152-158/92-96 over 2 months. EKG is normal and w/o proteinuria. BMI 26.4, no S3/S4 or murmur and a PMI at 5th intercostal space, mid-clavicular line. Which is the best intervention A. Initiate therapy with metoprolol B. Initiate therapy with hydrochlorothiazide C. Initiate therapy with methyldopa D. Continue to monitor BP, and start drug therapy if evidence of target organ damage

B. Initiate therapy w/hydrochlorothiazide

In COPD, ipratropium bromide (Atrovent) is rx'ed to achieve what effect? Increase mucociliary clearance Reduce alveolar volume Bronchodilation Mucolytic action

Bronchodilation

Which of the following should be the goal measurement in treating a 45M with DM and HTN? BP <140/90 hgbA1c = or > 7% trigs 200-300 HDL 35-40

BP <140/90

Jamie, age 18, has had her asthma well controlled by using only a beta-2 adrenergic metered-dose inhaler. Lately, however, she has had difficulty breathing during the night, and her sleep has been interrupted about 3 times a week. What do you do? A ] Prescribe a short course of steroid therapy. B] Prescribe an inhaled steroid. C ] Prescribe a longer acting bronchodilator. D] Prescribe oral theophylline.

B] Prescribe an inhaled steroid.

A physiological murmur has which? Occurs late in systole Is noted in a localized area of auscultation Becomes softer when the pt moves from supine to standing Frequently obliterates S2

Becomes softer when the pt moves from supine to standing

Drug therapy that had previously thought to worsen symptoms in lower-extremity arterial vascular disease includes the use of: Beta2-agonists Calcium channel antagonists Direct thrombin inhibitors Beta-adrenergic antagonists

Beta-adrenergic antagonists

Which of the following classes of meds is commonly recommended as part of first-line therapy in the newly dx'ed DM2? Alpha -glucosidase inhibitor Meglitinide Thiazolidinedione Biguanide

Biguanide

In trying to differentiate between chronic bronchitis and emphysema, you know that chronic bronchitis: A .Usually occurs after age 50 and has insidious progressive dyspnea. B . Usually presents with a cough that is mild and with scant, clear sputum, if any. C . Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note. D . Results in an increased total lung capacity with a markedly increased residual volume.

C . Presents with adventitious sounds, wheezing and rhonchi, and a normal percussion note.

Which of the following can have a favorable effect on a comorbid condition in a person with hypertension? A. Chlorthalidone in gout B. Propranolol with airway disease C. Aldosterone antagonist in heart failure D. Methyldopa on an older adult

C. Aldosterone antagonist in heart failure

When compared with Caucasians, African American tend to have reduced effect with monotherapy with all of the following blood pressure medications except: A. ACEIs B. ARBs C. Calcium channel blockers D. Beta blockers

C. Calcium channel blockers

Which of these patients should be given a decongestant? A. Gerta, a 41-year-old female with GERD B. Christine, a 15-year-old female with pneumonia C. Dan, a 60-year-old male with allergic rhinitis D. Andy, a 26-year-old with cystic fibrosis

C. Dan, a 60-year-old male with allergic rhinitis

The patient has metabolic syndrome. The patient is at increased risk for which condition? A. Anxiety disorder B. Gallbladder disease C. Diabetes mellitus D. Hyperparathyroidism

C. Diabetes mellitus

Which medications for type 2 diabetes mellitus should not be prescribed during pregnancy? A. Insulin B. Metformin (Glucophage) C. Glipizide (Glucotrol) D. Acarbose (Precose)

C. Glipizide (Glucotrol)

Which of the following statement regarding the pathophysiology of heart failure is true: A. incomplete closure of the tricuspid valve. B. near-normal ventricular function C. inadequate cardiac output to meet oxygen and metabolic demands of the body. D. impaired atrial filing and ejection of blood.

C. inadequate cardiac output to meet oxygen and metabolic demands of the body.

3. When a patient is instructed to smell a substance, which of the following cranial nerves (CNs) is being tested? a. CN I b. CN II c. CN III d. CN IV

CN I

Which cranial nerve (CN) is being evaluated when the patient is instructed to shrug his shoulders? a. CN IX b. CN X c. CN XI d. CN XII

CN XI

Acute cerebral hemorrhage is best identified with which? Transesophageal echocardiogram CT Cerebral angiogram MR angiography

CT

You see a 38 yo black male w/HTN who is being tx'ed w/thiazide-type diuretic. Current BP 156/94 and no h/o DM or CKD. You consider adding:

Calcium channel blocker

When compared with Whites, Blacks tend to have a reduced effect w/monotherapy with all of the following BP meds except: Calcium channel blockers

Calcium channel blockers

Which of the following best describes asthma? Intermittent airway inflammation with occasional bronchospasm A disease of bronchospasm that leads to airway inflammation Chronic airway inflammation with superimposed bronchospasm Relatively fixed airway constriction

Chronic airway inflammation with superimposed bronchospasm

Which of the following is the most potent risk factor for lower-extremity vascular occlusive disease? HTN Older age Cigarette smoking Leg injury

Cigarette smoking

In a pt w/HTN, the NP recommends all of the following to potentially reduce BP in a pt w/a BMI of 30 except: 10kg (22lb) weight loss Dietary sodium restriction to 2.4g (6g NaCl) per day Regular aerobic physical activity, such as 30-40 mins of brisk walking most days of the week Consuming at least 1-2 servings of alcohol

Consuming at least 1-2 servings of alcohol

52-year-old male comes to the office for hospitalization f/u after treatment for a PE and DVT in the R leg. He was hospitalized last week for acute SOB and CP after 4-5 days of swelling, redness and pain in his R leg. Medical history includes DMII, HTN, depression and chronic back pain.Social history is significant for working at a restaurant as a cook, laid off during covid pandemic. Now covered by Medicaid. PE RLE is swollen below the knee, mildly red and tender to touch. During his visit the patient tells you he is concerned about the cost of apixaban after he completes his starter pack. His pharmacist told him it would cost him $470 per month to continue it. The pharmacist suggested he try warfarin which costs less than $15 for a one-month supply. Which of the following options provides the most cost-effective management of DVT and PE for this patient? 1. Continue apixaban and stress the importance of taking it. 2. Continue apixaban but assist the man with a medication discount card. 3. Discontinue apixaban after one month and increase the dose of aspirin to 650 mg. 4. Switch him to warfarin, which will be cheaper but requires frequent monitoring. 5. Switch to SQ heparin injections.

Continue apixaban but assist the man with a medication discount card.

In the tx of asthma, leukotriene receptor antagonists should be used as: Controllers to prevent bronchospasm Controllers to inhibit inflammatory responses Relievers to treat acute bronchospasm Relievers to treat bronchospasm and inflammation

Controllers to inhibit inflammatory responses

Tx option in acute and recurrent allergic conjunctivitis include all but: Cromolyn ophthalmic drops Oral antihistamines Ophthalmological antihistomaines Corticosteroid ophthalmic drops

Corticosteroid ophthalmic drops

Which of the following conditions is least likely to contribute to an increased risk of stroke? Hyperlipidemia DM Crohn's HTN

Crohn's

In medical coding, CPT stands for: Current pricing tier Current procedural terminology Clinical practice terminology Compendium of procedures and therapy

Current procedural terminology

fee-for-service system is best defined as which? Up-front payments are made prior to any service A practice gets a set amount each month for all services needed by a patient Payment for each service is based on a sliding scale according to patient income For every procedure, there is an associated payment

For every procedure, there is an associated payment

Which of the following statements about diabetes mellitus is not true? A) Diabetes mellitus is the most common etiology of renal failure in the United States. B) Diabetes mellitus is the most common endocrine disorder in the United States. C) Diabetes mellitus is characterized by impaired insulin secretion and insulin action. D)Diabetes mellitus is curable.

D)Diabetes mellitus is curable.

3. The adult-gerontology primary care nurse practitioner reminds a 17-year-old male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because he is a good driver and he is driving a jeep. According to the health belief model, what chief component does the patient lack? A .Enabling factors. B. Motivation. C .Perceived role conflict. D. Perceived severity.

D. Perceived severity.

Which of the following antihypertensive medications has beneficial effects for an elderly white female with osteoporosis? A.Calcium Channel Blockers B.ACE Inhibitors C.Beta-Blockers D.Thiazide Diuretics

D. Thiazide Diuretics (slow down the kidneys excretion of CA, increse distal tubile ca reabsorption)

A 95 y/o female comes to the clinic with her daughter for a wellness visit. Medical history is HTN, hyperlipidemia, and remote history of chronic back pain. Medications are metoprolol, atorvastatin and acetaminophen as needed. She appears frailer than the last visit, but overall is stable. Her blood pressure today is 150/90. Her daughter feels she is getting confused by her medication regimen and would like to discuss if there are any that can be discontinued. Which medication adjustments are reasonable based on her age and her daughter's concerns? Continue metoprolol but add additional anti-hypertensive. Discontinue atorvastatin. Discontinue prn acetaminophen. Increase dose and frequency of metoprolol. Transition acetaminophen to naproxen.

Discontinue atorvastatin.

A 24-year-old female with no significant PMH presents to the ED with substernal CP that began 4 hours ago, after she are a large hamburger and fries. She describes the pain as burning in nature with no radiation to her back, arm or jaw and is a/w a metallic taste in her mouth. She reports similar symptoms in the past, but milder. There is no family history of cardiac disease. She is not on any medications, has no tobacco, alcohol or drug use and has not had a recent travel history. The patient is sitting comfortably. VS WNL. PE normal. BMI 32. Which of the following is the nest best step in the management of this patient? Discuss lifestyle modifications with the patient. Order a CT pulmonary angiography to evaluate for PE. Order an ECG and troponin to evaluate for MI. Order an abdominal US to look for gallstones. Start the patient on a proton pump inhibitor.

Discuss lifestyle modifications with the patient.

An 82 y/o M who recently moved to the area would like to establish care. He is requesting a refill of his medications. He generally feels fine but does report some lightheadedness, especially when standing up. He had one fall over the past month, but there were no serious injuries except for some large bruises. Medical history is significant for HTN. He takes terazosin 10 mg, HCTZ 12.5 mg and low dose aspirin 325 mf for primary prevention of atherosclerotic vascular disease. PE is normal. His lightheadedness and fall might be attributed to his medications. After reviewing with the patient that terazosin and ASA 325mg are on the BEERS criteria, the patient is hesitant to change his BP medications. He previously experienced side effects with other antihypertensives. Which is the most appropriate next step in prescribing his medications? Document the convo, prescribe him his current medication and request a f/u. Document the convo, refuse to prescribe all his meds and request a f/u. Document the convo, suggest lowering the terazosin dosage and stopping the ASA and request a f/u. Document the convo, suggest prescribing HCTA only and request a f/u. Document the convo, suggest stopping ASA and request a f/u.

Document the convo, suggest lowering the terazosin dosage and stopping the ASA and request a f/u.

A 55 y/o M with a history of newly identified a fib is referred to you for "medical clearance" for surgery. He has a hx of HTN and hypercholesterolemia. He has normal cardiac function otherwise with a normal EF and no valvular disease on ECHO. His a fib has not been addressed since it was discovered by the surgeon at a pre-op visit. His HR is 80 bpm when you see him, his rhythm is irregularly irregular, and he has no signs of HF. Which of the following options would be appropriate for this patient? A Anticoagulate the patient with warfarin or a direct oral anticoagulant (DOAC) and allow him to stay in atrial fibrillation B Place the patient on aspirin and allow him to stay in atrial fibrillation C Give digoxin to cardiovert the patient D Recommend DC cardioversion immediately since sustained normal sinus rhythm yields the best long-term outcomes E A and B

E) A and B

Concerning long-term care coverage, Medicaid: Does not provide any coverage of long-term care expenses Only covers eligible individuals younger than 65 y.o Finances approx. 40% of all long-term care spending Provides coverage only for those with physical disabilities

Finances approx. 40% of all long-term care spending

Which of the following statements is most accurate regarding the use of ED services by Medicaid pts? The majority of ED visits is for nonurgent symptoms Those with Medicaid are twice as likely to use the ED for nonurgent symptoms c/w those w/private EDs are used at similar rates between the two ED visits by Medicaid pts often involve multiple diagnoses c/w those w/private

ED visits by Medicaid pts often involve multiple diagnoses c/w those w/private

Typically, the earliest sign of lower-extremity venous insufficiency is: Edema Altered pigmentation Skin atrophy Shiny skin

Edema

Which is most likely to be found on the funduscopic exam in a pt with untreated primary open angle glaucoma? Excessive cupping of the optic disk Arteriovenous nicking Papilledema Flame-shape hemorrhages

Excessive cupping of the optic disk

You consider prescribing insulin glargine (toujeo, lantus) because of its: Extended duration of action Rapid onset of action Ability to prevent diabetic end-organ damage Ability to preserve pancreatic function

Extended duration of action

You see an obese 25M with acanthosis nigricans and consider ordering: FBS LFT RPR ESR

FBS

The amount of air you can force out of your lungs in one second

FEV1

Which is most consistent with COPD dx? FEV1/forced vital capacity (FVC) ratio equal to or less than 0.70 after properly timed SABA use Dyspnea on exhalation Elevated diaphragms noted on XR Polycythemia noted on CBC

FEV1/forced vital capacity (FVC) ratio equal to or less than 0.70 after properly timed SABA use

The amount of air that can be exhaled forcefully and quickly after inhaling as much as you can

FVC

You are seeing a 17F and consider her risk factors for type 2 DM would include all of the following except: Obesity Native American ancestry Family history of type 1 DM Personal history of polycystic ovary syndrome

Family history of type 1 DM

Which of the following statements concerning funding for Medicaid is accurate? Federal funding of Medicaid for each state is based primarily on state population size The fed government matches at least 50% of state Medicaid spending States are not required to provide funding for Medicaid as long as they meet guidelines to receive federal funding Federal funding typically accounts for less than 20% of all Medicaid funding

Federal funding of Medicaid for each state is based primarily on state population size

78 y/o F admitted to the hospital after a fall. She is found to have a femoral neck fracture and undergoes surgical repair by ortho surgery. You are seeing her post op day one as part of geriatrics co management of her medical problems. PMH HTN, DM, insomnia and anxiety. Meds are aspirin, lisinopril, metformin and sertraline. VS are normal. Physical exam shows a thin female in no apparent distress. She is restless and occasionally inattentive. Cardiac exam is unremarkable. Lungs are clear to auscultation bilatearlly. Skin is dry. Neuro exam is without focal deficits. Results of labs show elevated BUN (45) and Cr (1.5). WBC 6.4 and Hgb 10.2. Which of the following interventions would be your next best step in the management of this patienet? Get the patient up and out of bed every shift Oral Benadryl 12.5 mg at night to help with sleep Oral Ativan 0.5 q6 for anxiety Strict bed rest to minimize post op pain Two liter fluid restriction

Get the patient up and out of bed every shift

Which of the following meds should be used with caution in a person with severe sulfa allergy? Metformin Glyburide Rosiglitazone NPH insulin

Glyburide

Which of the following best describes the physical activity recommendations such as brisk walking for a 55F with new DM2? Goal should be for a total increased physical activity of 150 min/wk or more Increased physical activity is recommended at least 3x/wk with no more than 48h without exercise Some form of resistance exercise such as lifting dumbbells or using an exercise band should be done 2x/week Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of possible risk of vitreous hemorrhage or retinal detachment

Goal should be for a total increased physical activity of 150 min/wk or more Increased physical activity is recommended at least 3x/wk with no more than 48h without exercise Some form of resistance exercise such as lifting dumbbells or using an exercise band should be done 2x/week Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of possible risk of vitreous hemorrhage or retinal detachment

Cardiovascular effects of hyperinsulinemia include: Decreased renal sodium reabsorption Constricted circulating volume Greater responsiveness to angiotensin II Diminished sympathetic activation

Greater responsiveness to angiotensin II

Persons eligible for medicare include all but: People 65 and older People <65 w/certain permanent disabilities Certain people concurrently receiving Medicaid Healthy individuals <65 w/income below 150% of the federal poverty line

Healthy individuals <65 w/income below 150% of the federal poverty line

Cilostazol (Pletal) should be used with great caution in the presence of which of the following diagnoses? DM Heart failure HTN Dyslipidemia

Heart failure

Coverage of services from all of the following healthcare centers is considered mandatory for inclusion in Medicaid by fed law except: Rural health clinic (RHC) Acute care hospital Hospice Federally qualified health center (FQHC)

Hospice

Which of the following is not true concerning the effects of exercise and insulin resistance? Approximately 80% of the body's insulin-mediated glucose uptake occurs in skeletal muscle With regular aerobic exercise, insulin resistance is reduced by about 40% The insulin resistance-reducing effects of exercise persist for 48h after the activity Hyperglycemia can occur as a result of aerobic exercise

Hyperglycemia can occur as a result of aerobic exercise

Which of the following is most likely to appear on a chest radiograph of a person during an acute severe asthma attack? Hyperinflation Atelectasis Consolidation Kerley B signs

Hyperinflation

Which of the following is an unlikely consequence of untreated metabolic syndrome and insulin resistance in a woman of reproductive age? Hyperovulation Irregular menses Acne Hirsutism

Hyperovulation

The pt you are evaluating is having a severe asthma flare. You have assessed that his condition is appropriate for office tx. You expect to find the following on PE: Tripod posture Inspiratory crackles Increased focal fremitus Hyperresonance on thoracic percussion

Hyperresonance on thoracic percussion

You are examining an 18 yo and you note a mid-systolic murmur that gets louder when he stands. This may be: Aortic stenosis Hypertrophic cardiomyopathy A physiological murmur A Still's murmur

Hypertrophic cardiomyopathy

Assessing vision and visual fields involves testing CN: I II III IV

II

You perform an extraocular movement test on a middle-aged patient. He is unable to move his eyes upqard and inward. This indicated a possible paralysis of CN: II III V VI

III

Interventions in microalbuminuria for a person with DM includes which of the following? (more than 1 can apply) Improved glycemia control Strict dyslipidemia control Use of an optimized dose of an ACEI or ARB Use of an ACEI with an ARB

Improved glycemia control Strict dyslipidemia control Use of an optimized dose of an ACEI or ARB

Mr. Samuels is a 58M with DM2 who is using a single 10 unit daily dose of the long-acting insulin glargine. His fasting glucose has been 141-180. Which of the following best describes the next step in his therapy? Continue on the current glargine dose Increase his glargine dose by 4 units per day Increase his glargine dose by 1 units per day Increase his glargine dose by 6 units per day

Increase his glargine dose by 4 units per day

The cornerstone of moderate persistent asthma drug tx is: Oral theophylline Mast cell stabilizers Short-acting beta2-agonists (SABA) Inhaled corticosteroids

Inhaled corticosteroids

Which of the following is the tx objective of using inhaled ipratropium bromide? Anti-inflammatory Increase vagal tone in the airway Inhibit muscarinic cholinergic receptors Increase salivary and mucous secretions

Inhibit muscarinic cholinergic receptors

The use of which med has the potential for causing the greatest reduction in hgba1c? Biguanide Thiazolidinedione Sulfonylurea Insulin form

Insulin form

Which of the following statements best describes the Somogyi effect? Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia Early morning elevated blood glucose levels result in part from growth hormone and cortisol-triggering hepatic glucose release Late evening hyperglycemia is induced by inadequate insulin dose Episodes of postprandial hypoglycemia occur as a result of inadequate food intake

Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia

In medical coding, ICD stands for: Insurance code for diagnoses Integrated clinical dilemmas International classification of diseases Initial classification of the diagnosis

International classification of diseases

Key dx findings in primary open angle glaucoma include: Intraocular pressure greater than 25 mm Hg Papilledema Cup-to-disk ratio greater than 0.4 Sluggish pupillary response

Intraocular pressure greater than 25 mm Hg

Which is true about the need for a prednisone taper? It is needed for tx >4 days It is not needed for tx 7 days or less It is not needed regardless of duration of tx It is needed if the pt is taking concomitant inhaled corticosteroids

It is not needed for tx 7 days or less

The S3 heart sound has which of the following: After it is initially noted, it is a permanent finding It is noted in the presence of poorly controlled HTN It is heard best in early diastole It is a high-pitched sound best heard with the diaphragm

It is noted in the presence of poorly controlled HTN

All of the following are c/w the GOLD COPD recommendation for pulmonary rehab except: It is reserved for very severe COPD Its goals include improvement in overall well-being It is an underused therapeutic option Its components are aimed at reducing the deconditioning common in COPD

It is reserved for very severe COPD

Which of the following is false re: the use of omalizumab (Xolair)? Its use is recommended for pts with mild persistent asthma to prevent asthma flares The med selectively binds to IgE to reduce exacerbations Labeled indication is for pts w/ poorly controlled asthma w/frequent exacerbations Special eval is required prior to its use and ongoing monitoring is needed during use

Its use is recommended for pts with mild persistent asthma to prevent asthma flares

Which asthma medication should never be used as monotherapy?

LABA (Formeterol, Salmeterol, must always be used in combo with ICS)

Which asthma medication should never be used as monotherapy in asthma?

LABA (Formoterol, salmeterol) - must always be in combination with ICS

In evaluating the person with aortic stenosis, the NP anticipates finding EKG changes c/w: Right bundle branch block Extreme axis deviation Right atrial hypertrophy Left ventricular hypertrophy

Left ventricular hypertrophy

62 y/o F with history of chronic congestive heart failure, HTN and hyperlipidemia comes to the clinic for follow-up after a recent hospitalization for an episode of acute CHF one week ago. Since discharge, she has had slightly increasing SOB where she cannot walk her dog without having to stop and rest. She has no medical insurance and pays for all medications out of pocket. Medications on discharge from recent hospitalizations are bumetanide 0.5 mg bid, sacubitril/valsartan 24/26 mg daily, amlodipine 10 mg once daily, simvastatin 80 mg nightly. She tells you that she has not been taking her medication faithfully because of the cost and diffuse body aches. T 36.8, HR 74, RR 18, Bp 152/92, O2 93& on RA, BMI 34. PE is significant for 2+ pitting edema. Otherwise, cardiac exam WNL. Labs: CK 27, Cr 0.8, total cholesterol 226, triglyceride 161, LDL 121. How would you change the medication regimen to improve this patient's adherence? Lisinopril 40 mg daily, amlodipine 10 mg, furosemide 20 mg bid, atorvastatin 40 mg Lisinopril 40 mg daily, amlodipine 10 mg daily, furosemide 20 bid, simvastatin 80 mg Sacubitril/valsartan24/26 mg daily, amlodipine 10 mg daily, bumetanide 0.5 mg bid, atorvastatin 40 mg daily Valsartan 40 mg daily, amlodipine 10 mg, bumetanide 0.5 mg bid, atorvastatin 40 mg Valsartan 40 mg daily, amlodipine 10 mg furosemide 20 mg bid, simvastatin 80 mi daily

Lisinopril 40 mg daily, amlodipine 10 mg, furosemide 20 mg bid, atorvastatin 40 mg

You are evaluating a pt who has rheumatic heart dx. When assessing for mitral stenosis, you auscultate and expect to find the following murmur: Systolic with wide radiation over the precordium Localized diastolic with little radiation Diastolic with radiation to the neck Systolic with radiation to the axilla

Localized diastolic with little radiation

When caring for a pt with a recent TIA, you consider that: Long-term antiplatelet tx is likely indicated This person has a relatively low risk of future stroke Women present w/this disorder more often than men Rehab will be needed to minimize the effects of the resulting neurological insult

Long-term antiplatelet tx is likely indicated

Current limitations of screening smokers with low dose CT include all of the following except: A high false-positive rate Low sensitivity Radiation exposure from multiple CT scans Patient anxiety

Low sensitivity

When c/w screening for breast ca, screening for lung ca results in: Lower number needed to screen to prevent 1 death About the same number needed to screen to prevent 1 death Higher number needed to screen to prevent 1 death Higher percentage of pts identified where cancer can be prevented

Lower number needed to screen to prevent 1 death

Which of the following characteristics applies to type 2 DM? Major risk factors are heredity and obesity Pear-shaped body type is commonly found Exogenous insulin is needed for control of disease Physical activity enhances insulin resistance

Major risk factors are heredity and obesity

Criteria for the diagnosis of type 2 DM include: Classic symptoms regardless of fasting plasma glucose measurement Plasma level of 126 as a random measurement 2hr glucose of 156 after a 75g anhydrous glucose load Plasma level of 126 or greater after an 8 hour or greater fast on more than 1 occasion

Plasma level of 126 or greater after an 8 hour or greater fast on more than 1 occasion

A "dual eligible" beneficiary is an individual who receives Medicaid and: Private insurance Social Security Government welfare benefits Medicare

Medicare

All of the following are 1st-line agenda for use in a middle-aged white man w/o DM except: Lisinopril Hydrochlorothiazide Metoprolol Amlodipine

Metoprolol

According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in severe COPD is to: Minimize the risk of repeated exacerbations Improve cough function Reverse alveolar hypertrophy Help mobilize secretions

Minimize the risk of repeated exacerbations

Which of the following is inconsistent w/the presentation of asthma that is not well controlled? A troublesome nocturnal cough at least 2 nights per week Need for albuterol to relieve SOB at least twice a week Morning sputum production 2 or more exacerbations/yr requiring oral corticosteroids

Morning sputum production

Tx of viral conjunctivitis can include: Moxifloxacin drops Polymyxin B drops Oral acyclovir No abx therapy

No abx therapy

Diagnostic criteria for metabolic syndrome includes: Obligatory finding of persistent hyperglycemia Notation of ethnic-specific waist circumference measurements Documentation of microalbuminuria Family h/o DM2

Notation of ethnic-specific waist circumference measurements

Oxygen therapy in a patient w/ COPD should only be initiated if O2 Sat and PaO2 are what levels?

O2 sat </=88% or paO2</=55%

Oxygen therapy in a patient with COPD should only be initiated if O2 sat and PaO2 are at what levels?

O2 sat: </=88% or if pa)2</=55%

78 y/o M admitted to hospital bc of a 3-day history of worsening confusion and urinary retention. He started on a broad spectrum abx for a UTI. PMH vascular dementia, HTN and DM. Meds are losartan, aspirin and metformin. The nurse calls for an assessment of the patient for agitation. VS are normal. Physical exam shows a confused male, lying in bed with one leg hanging over the bed rail. Cardiopulmonary and abd exams are unremarkable. He is oriented to self, but inattentive and repeatedly tries to get out of bed. Neuro exams are without focal deficits. Results of lab/diagnostic studies show WBC 12.8, BMP unremarkable, urine x growing e. coli and normal CXR. What would the next most appropriate step to order in managing this patient's agitation. Bed rails raised and locked Bilateral posey mitts Haldol 0.5 mg One to one sitter Quetiapine 12.5 mg

One to one sitter

A potential adverse effect from ICS use is: Oral candidiasis Tachycardia GI upset Insomnia

Oral candidiasis

40 y/o F come to clinic with a 3-month history of back pain, which is worsening despite efforts to increase mobility. She is unable to perform at her job as a pharmacy tech. She does not report fever or changes in bowel and bladder habits. The pain does not radiate. There is no leg numbness or weakness. Her medical history is significant for intermittent asthma. Medications are as needed inhaled albuterol or acetaminophen 2-3 times a day for the past three weeks. VS are normal. BMI 20. She appears comfortable while sitting at the exam table. PE, including focused LE neuro exam is significant for diffuse tenderness of the lower back without any point tenderness over the spinous processes. Which of the following is the most appropriate next step in management of this patient. Continue symptomatic treatment with acetaminophen. Order imaging of lumbar spine while continuing supportive care. Reassure her that low back pain is normal in a 40 y/o female. Start PT and reassess the need for imaging if pain persists at a 2-week f/u. Stop acetaminophen and start an NSAID.

Order imaging of lumbar spine while continuing supportive care.

The fastest rate you can force air out of your lungs

PEFR (peak expiratory flow rate)

Spirometry is one type

PFT

What diagnostic test is the golf standard for diagnosing asthma?

PFT (spirometry)

What diagnostic test is the gold standard for diagnosing asthma

PFT -->Spirometry

You examine Jane, a 24 yo who has an acute asthma flare following 3d h/o URI symptoms (clear nasal d/c, dry cough, no fever). She has a h/o moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home, her PEF is 5%% of personal best. In the office, her force expiratory volume at 1 second (FEV1) is 65% of predicted. Her med regimen should be adjusted to include: (no antimicrobial tx should be rx'ed) Theophylline Salmeterol Prednisone Montelukast (singulair)

Prednisone

45 y/o female with DMII presents to clinic for f/u on her DM management. She appears well. Her VS are normal. Blood sugar is 331 and recent HgbA1c was 12%. The patient was asked if she took her glargine and lispro today and if she brought her blood sugar log with her. The woman reports she was unable to afford her glucometer, metformin and insulin previously prescribed to her. What would be the nest best step in the management of this patient's care? Advise the patient to find new insurance that will cover her meds. Prescribe the patient neutral protamine Hagedorn (NPH) and regular insulin and refer her to one of the chain stores that sell their medication for $4/month. Stop the insulin and start the patient on glimepiride in addition to metformin. Stop the insulin and have the woman take metformin only. Tell the patient that she will need to make sacrifices to afford her medications, as it is important, she takes her insulin.

Prescribe the patient neutral protamine Hagedorn (NPH) and regular insulin and refer her to one of the chain stores that sell their medication for $4/month.

All of the following are not typically covered by medicare except: Long term care services Preventative care Hearing exams and hearing aids Route vision care and eyeglasses

Preventative care

The anticipated result of debridement as part of the tx of venous stasis ulcers includes all but: Enhanced tissue granulation Encouragement of epithelialization Reduction of bacterial burden Prevention of peripheral arterial disease

Prevention of peripheral arterial disease

Define chronic bronchitis:

Productive cough for at least 3 months a year for 2 consecutive years

A 36 yo w/asthma also needs antihypertensive tx. Which should be avoided? Hydrochlorothiazide Propranolol Amlodipine Enalapril

Propranolol

Peak expiratory flow meters: Should only be used in the presence of a medical professional Provide a convenient method to check lung function at home Are as accurate as spirometry Should not be used more than once daily

Provide a convenient method to check lung function at home

Which is false regarding Medicaid premiums and cost-sharing? States have limited flexibility to charge Medicaid premiums base don income Preventative services for children are exempt from cost-sharing States can terminate Medicaid coverage if premiums are no paid by an individual Providers cannot deny care to Medicaid patients even if cost sharing amounts are not paid

Providers cannot deny care to Medicaid patients even if cost sharing amounts are not paid

Medicaid is best defined as: An entitlement program to provide healthcare coverage for unemployed families Publicly financed health and long-term care coverage for low-income people Free acute care coverage for those who meet special criteria Publicly supported healthcare for low-income people under the age of 65

Publicly financed health and long-term care coverage for low-income people

Medicare is best defined as: An entitlement program to provide healthcare coverage for low-income elderly persons Publicly supported health insurance program for elderly persons and younger persons with permanent disabilities A health insurance program for persons ineligible for private insurance The nation's insurance program for long-term care coverage in elderly persons

Publicly supported health insurance program for elderly persons and younger persons with permanent disabilities

All of the following are components of the classic ophthalmological emergency except Eye pain Purulent eye discharge Red eye New onset change in visual acuity

Purulent eye discharge

When discussing immunization w/a 67 yo w/COPD, you advise that she: Receive live attenuated influenza virus vaccine Avoid immunization against influenza because of the risk a/w the vaccine Receive inactivated influenza virus vaccine Take an antiviral for the duration of the influenza season

Receive inactivated influenza virus vaccine

Mandatory services" defined by federal law for inclusion in Medicaid include all but: Lab and xray services Family planning services Rehab therapy NP services

Rehab therapy

In ordering imaging studies in a pt w/peripheral vascular disease, the use of radiocontrast medium can potentially result in: Hepatic failure Renal failure Bone marrow suppression Thrombocytopenia

Renal failure

Clinical presentation of type 1 DM usually includes all but: Report of recent unintended weight gain Ketosis Persistent thirst Polyphagia

Report of recent unintended weight gain

A 79-year-old female with HTN and DMII comes to the ED because of a 2-day history of malaise, low grade fevers and myalgias. She appears mildly distressed but has no urinary symptoms. T 39.4, HR 111, RR 16, BP 125/74, O2 94%, 68kg, 165cm, BMI 25. PE reveals an ill appearing female in mild distress, mucous membranes are dry, lungs are clear. Pt is lethargic, arousable and A&Ox3. WBC 16, Hgb 11, Plt 205, Na 136, BUN 26, Cr 0.4. Flu A +. UA: WBC 40, RBC 1, + leukocyte esterase, 1+ ketones, moderate bacteria, glucose 100. Which of the following is the most appropriate course of action given the results of the lab and diagnostic studies? F/u urine culture and abx if positive Start ceftriaxone based on UA findings and narrow coverage based on culture Start oseltamivir Start oseltamivir and ceftriaxone Supportive care

Start oseltamivir

Symptoms of lung cancer caused by a primary tumor include all of the following except Chest discomfort Dyspnea Stridor Hemoptysis

Stridor

A 15 y/o male comes to clinic b/c of a 5-day history of HA. He notes these HA's worsen throughout the day and are resolved with sleep. There is mild light sensitivity, but no sensitivity to sound. There is no associates n/v. HA do not wake him from sleep. Medical history is significant for seasonal allergies and academic underachievement. Medications are ibuprofen as needed taken about once every 2-3 days. VS are normal. PE including full neuro and funduscopic exams are normal for age. The boy's mother expresses concern for a brain tumor and would like imaging to reassure her that this is not the case. You discuss with her the benefits and risks of additional testing. She is still concerned about a brain tumor despite education about lack of "red flags" in his presentations. What is the most appropriate nest step before assessing their comfort with the treatment plan? Avoid discussion of the pros and cons of imaging as it is likely to upset the mother and unlikely to change her mind. Determine the patient does not need treatment at this time and advise to f/u as needed. Order a head CT scan to reassure the mother. Recommend that the patient continues to take ibuprofen as needed. Request that they create a HA journal to track symptoms for two weeks before deciding if imaging is needed.

Request that they create a HA journal to track symptoms for two weeks before deciding if imaging is needed.

Mrs Allen is a 67 yo with DM2 who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphopsia in her L eye. The most likely dx is: Open-angle glaucoma Central retinal artery occlusion Anterior uveitis Retinal detachment

Retinal detachment *immediate referral to optho

The use of which of the following meds is often a/w weight gain? Risperidone (Risperdal) Topiramate (Topamax) Metformin (Glucophage) Sitagliptin (januvia)

Risperidone (Risperdal)

Antiplatelet agents commonly used in secondary prevention of stroke include all but: Aspirin Clopidogrel Aspirin plus extended-release diphyridamole Rivaroxaban

Rivaroxaban

You see a 68 yo woman w/10 yr h/o HTN, DM, and HL. Current meds are hydrochlorothiazide, glipizide, metformin, simvastatin, and baby aspirin. BP is 158/92 (stable over 12 months) and all is unremarkable. Your best next action:

Rx an ACE inhibitor

A patient with group E COPD with high risk of exacerbation and high symptom burden should receive what type of medical management?

SABA + either LAMA+LABA combo or LABA+ICS combo

A patient with group D COPD, with high risk of exacerbation and high symptom burden, should receive what type of medical management?

SABA + either a LAMA+LABA combo or LABA+ICS combo

A combination of asthma, chronic rhinosinusitis combined with nasal polyps, and sensitivity to aspirin is known as

Samter's Triad

A combination of asthma, chronic rhinosinusitis combined with nasal polyps, and sensitivity to aspirin is known as?

Samter's Triad Avoid NSAIDs/ Aspitin, may derive more from LTRA

According to the GOLD COPD guidelines, which of the following meds is indicated for use in all COPD stages? Short-acting inhaled beta2-agonist Inhaled corticosteroids Phosphodiesterase (PDE-4) inhibitor Mucolytic

Short-acting inhaled beta2-agonist

Compared with SABAs, LABAs: Are recommended as first-line therapy in mild intermittent asthma Have a significantly different pharmacodynamic profile Have a rapid onset of action across the drug class Should be added to tx only when ICS use does not provide adequate asthma control

Should be added to tx only when ICS use does not provide adequate asthma control

Which of the following characteristics applies to type 1 DM? Significant hyperglycemia and ketoacidosis result from lack of insulin This condition is commonly diagnosed on routine exam or workup for other health problems Initial response to oral sulfonylureas is usually favorable Insulin resistance is a significant part of the disease

Significant hyperglycemia and ketoacidosis result from lack of insulin

What is the most common cause overall of both chronic bronchitis and emphysema?

Smoking

Clinical presentation of advanced lower-extremity vascular disease includes all of the following except: Resting pain Absent posterior tibialis pulse Blanching of the foot with elevation Spider varicosities

Spider varicosities

A 44 yo has long-standing h/o moderate persistent asthma that is normally well controlled by fluticasone w/salmeterol (Advair) via metered-dose inhaler, 1 puff BID, and the use of albuterol 1-2x/wk PRN wheezing. 3 days ago he developed a sore throat, clear nasal d/c, body aches, and a dry cough. In the past 24 hrs, he has had intermittent wheezing that required albuterol - 2 puffs Q3H which produced partial relief. Your next action is to obtain a: Chest radiograph Measurement of O2 sat Spirometry measurement Sputum smear for WBCs

Spirometry measurement

A 19 yo p/w a red, irritated R eye x48 hours with eyelids that were "stuck together" this morning when he awoke. Exam reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision 20/30, and purulent eye discharge on the R. This presentation is most c/w: Suppurative conjunctivitis Viral conjunctivitis Allergic conjunctivitis Mechanical injury

Suppurative conjunctivitis

In evaluating mitral valve incompetency, you expect to find the following murmur: Systolic with radiation to the axilla Diastolic with little radiation Diastolic with radiation to the axilla Localized systolic

Systolic with radiation to the axilla

Compared with albuterol, levalbuterol has: A different mechanism of action The ability to potentially provide greater bronchodilation with a lower dose An anti-inflammatory effect similar to that of an inhaled corticosteroid A contraindication to use in elderly pts

The ability to potentially provide greater bronchodilation with a lower dose

Which is true re: the use of systemic corticosteroids in the tx of asthma? Frequent short bursts are preferred over daily inhaled corticosteroids The oral corticosteroid should be started at day 3-4 of the asthma flare for optimal effect The oral route is preferred over parenteral tx The adult dose to tx an asthma flare should not exceed the equivalent of prednisone 40mg daily

The oral route is preferred over parenteral tx

Pertaining to the use of sliding-scale insulin in response to elevated blood glucose, which of the following best describes current best practice? The use of this type of sliding-scale insulin therapy is discouraged as this method treats hyperglycemia after it has already occurred Sliding-scale insulin in response to elevated glucose is a safe and helpful method of treating hyperglycemia Delivering insulin in this manner is acceptable within the acute care hospital setting only The use of the ISS is appropriate in the tx of DM1 only

The use of this type of sliding-scale insulin therapy is discouraged as this method treats hyperglycemia after it has already occurred

Federal core groups that states must cover to receive federal matching Medicaid funding include all but: Pregnant women Elderly Children Undocumented immigrants

Undocumented immigrants

Which of the following best describes the role of theophylline in COPD tx? Routinely indicated in moderate to very severe COPD Use limited by narrow therapeutic profile and drug-drug interaction potential A potent bronchodilator Available only in parenteral form

Use limited by narrow therapeutic profile and drug-drug interaction potential

Regarding the use of long-acting beta2 agonists (LABA), which is true? LABAs enhance the anti-inflammatory action of corticosteroids Use of LABAs is a/w a small increase in risk of asthma death LABA use reduces the risk of asthma exacerbations LABAs can be used as monotherapy to relieve bronchospasms in asthma

Use of LABAs is a/w a small increase in risk of asthma death

Loss of corneal reflex is in part seen in dysfunction of CN: III IV V VI

V

You examine a 29 y.o. F who has a sudden onset of R-sided asymmetry. She is unable to close her R eyelid tightly, frown, or smile on the affected side. Her exam is otherwise unremarkable. This presentation likely represents paralysis of CN: III IV VII VIII

VII (à most appropriate dx test is Lyme dx antibody titer)

With a COPD exacerbation, a CXR should be obtained: Routinely in all pts When attempting to R/O a concomitant PNA If sputum volume is increased When work of breathing is increased

When attempting to R/O a concomitant PNA

82 y/o F brought to ED with 3-day history of rash and pruritus. The rash is along her arms and upper chest. She recently started taking a 3-day course of Bactrim for a UTI.PMH DMII, HTN, hyperlidpidemia. She drinks 1-2 glasses of wine a night. She does not have tobacco or recreational drug use. Medications are metformin, simvastatin and lisinopril. She appears uncomfortable but is pleasant and easily engages with you. Skin exam is notable for diffuse maculopapular rash along the upper extremities and upper chest. The patient is given IV Benadryl for pruritus. When you check on the patient in one hour, they are difficult to arouse and confused. The nurse notes normal VS. A brief physical exam shows an older female in mild distress. Cardiac and pulmonary exams are unremarkable. CBC and chem panels are normal. Your resident suggest you screen for delirium. Which of the following information do you need complete the confusion assessment method (CAM). Whether the patient can list 3 days of the week or months of the year backward Whether the patient can state their name, date and the name of the hospital Whether the patient has a history of alcohol misuse or alcohol withdrawal Whether the patient has a baseline cognitive impairment Whether the patient has a similar reaction to Benadryl before

Whether the patient can list 3 days of the week or months of the year backward

After inhaled corticosteroid is initiated, improvement in control is usually seen: On the first day of use Within 2-8 days In about 3-4 weeks In about 1-2 months

Within 2-8 days

When advising a person who will be using orlistat (Xenical, Alli) as part of a weight loss program, the NP provides the following info about when to take the med: Within an hour of each meal that contains fat Before any food with high carbo content Only in the morning, to avoid sleep disturbances Up to 3 hours after any meal, regardless of types of food eaten

Within an hour of each meal that contains fat

In caring for a pt with DM, microalbuminuria measurement should be obtained: Annually if urine protein is present Periodically in relationship to glycemic control Yearly With each office visit r/t DM

Yearly

A young adult presents for reassessment for uncontrolled asthma symptoms. The patient is currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime symptoms more than 3 days/ week, but not daily, and nighttime awakenings 4-5x/ week. The patient's forced expiratory volume (FEV1) is 80% of predicted. The NP upgrades the patient to the next stage of treatment which includes: a) budesonide w/ formoterol b) budesonide with montelukast c) cromolyn or nedocromil d) fluticasone with salmeterol

a) budesonide w/ formoterol

While providing on-call coverage, the AGNP answers a patient's telephone call. This patient-provider encounter is described as: a. formal, legally binding, and one for which the responding clinician is fully accountable. b. limited by the policies of the institution that employs the nurse practitioner. c. limited by the primary health provider's existing legal and ethical accountability to the patient. d. measured by the complexity of the oral interaction and the number of contacts between the parties.

a) formal, legally binding, and one for which the responding clinician is fully accountable.

A 79-year-old woman comes to the office 6 days after discharge from the hospital for HF. It is her 3rd hospitalization with the past year. History includes DM type 2, obesity, HTN, and hyperlipidemia. Current medications are aspirin 81 mg/d, furosemide 40 mg/d, metformin 500mg/d, lisinopril 10 mg & atorvastatin 40mg/d. She has dyspnea on exertion. On exam she has gained 1/6 kg, since discharge. B/P is 142/86, HR is 72, bilateral crackles are heard in both lung bases, and there is lower extremity edema. At the time of discharge which of the following would most significantly help prevent readmission? a- home visits by nurses to provide self-care education and clinical evaluations b- telemonitoring of vital signs and weight reported to providers c- medication reconciliation, patient education, and medication optimization bya pharmacist d- HF education provided by the RN before d/c.

a- home visits by nurses to provide self-care education and clinical evaluations

5. Before placing a patient with onychomycosis on a pulsed dose of itraconazole (Sporanox), which laboratory values does the AGNP obtain? a. Liver function studies. b. Platelet count. c. Renal function studies. d. White blood cell count.

a. Liver function studies.

The NP is assessing a new 55 y/o male patient. The patient has smoked cigarettes for 30 years and is not occasionally coughing up blood-tinged sputum and experiencing increased dyspnea and dull, achy chest pain that does not resolve. Which initial screening test will the NP order? a) Lung/ tumor biopsy b) Chest radiograph c) CT scan d) bronchoscopy

b) Chest radiograph

TZDs are contraindicated in which of the following patient populations? a) alcoholic b) HF pts c) obese pts d) elderly pts

b) HF patients

An elderly male patient is complaining of SOB on minimal exertion. He has a long hx of COPD and HTN. Respirations are 28. Upon auscultation, lung and heart sounds are diminished. Which of the following will the NP avoid when treating the patient? a) anticholinergics b) SABAs c) influenza vaccination d) pneumococcal vaccination

b) Short-acting beta2-agonists (SABAs) -should be avoided in pts with htn and hyperthyroidism-- can lead to tachycardia/ palpitations

On physical examination, a 45-year-old patient who has hypertension is noted to have a few beats of nystagmus on extreme lateral gaze that disappeared when the patient's eyes returned toward midline. Which of the following statements best describes this clinical finding? a. It is the result of bleeding of the retinal artery b. This is a normal finding c. It is a sign of possible brain mass d. This is a borderline result and requires further evaluation

b) This is a normal finding

All of the following results are characteristic of pulmonary function tests in patients with COPD except a) increased total lung capacity (TLD) b) dyspnea c) increase in the residual volume (RV) d) reduction of the forced expiratory volume in 1 second (FEV1)

b) dyspnea

A 65 yr. Asian male comes in for an evaluation after having an episode of pre-syncope. A carotid ultrasound is ordered. The results revealed 55-70% right internal carotid artery stenosis. What might you expect to find on physical examination? a. An elevated systolic blood pressure with a decreased pulse b. A right carotid bruit c. A right and left carotid bruit d. No bruit since bruits are never auscultated with carotid artery stenosis unless the stenosis is >80%

b. A right carotid bruit

Which cranial nerves (CNs) innervate the extraocular muscles of the eyes? a. CNs II, III, and VI b. CNs III, IV, and VI c. CNs IV, V, and VII d. CNs V, VI, and VIII

b. CNs III, IV, and VI

You are examining a patient who has just been diagnosed with Bell's palsy. Which physical sign is not associated with the diagnosis? a. Drooling b. Inability to swallow c. Inability to close the eye on the affected side d. Drooping of the corer of the mouth on the affected side

b. Inability to swallow

To improve the quality of clinical practice, the AGNP: a. charges a fee for patients who arrive late to clinic appointments. b. disseminates research study results to colleagues. à because it improves the quality of care c. expresses opinions about alternative therapies with patients who consider such treatments. d. schedules time during clinic hours to meet with pharmaceutical representatives

b. disseminates research study results to colleagues. à because it improves the quality of care

A 62-year-old man with COPD complains to the NP that his prescription for ipratroprium bromide (atrovent) is not working. He reports that he still feels SOB even after using it 4x/ day for 3 months. Which of the following actions is the next step for the np? a) increase the pt's dose of the ipratropium bromide (atrovent) to 3 inhhalations QID b) continue the ipratropium bromide and start the patient on oxygen by nasal cannula c) continue the ipratropium bromide (atrovent) and add two inhalations of an albuterol (ventolin) inhaler QID d) start the patient on oxygen by nasal cannula at bedtime and PRN during the daytime

c) continue the ipratropium bromide (atrovent) and add two inhalations of an albuterol (ventolin) inhaler QID

Which of the following is a major risk factor for fatal asthma? a) exercising in cold weather b) smoking and vaping c) hospital admission in past year d) allergy to pet dander and dust mites

c) hospital admission in past year

Which cranial nerve (CN) is inflamed when the clinician diagnosis the patient with Bell's palsy? a. CN V b. CN VI c. CN VII d. CN III

c. CN VII

1. The Rinne and Weber tests are used to assess which of the following cranial nerves (CNs)? a. CNs III, IV, and VI b. CN II c. CN VIII d. CNs IX and X

c. CN VIII

A 65-year-old woman complains pain in her right cheek when she chews. She describes the pain as severe lacerating pain that "feels like lightning shooting up (her) face." She denies trauma. She has been evaluated by her dentist; she does not have a temporal-mandibular joint disorder, nor does she have any dental etiology for the pain. Which of the following is most likely? a. Sinus headache b. The onset of Bells' palsy c. Trigeminal neuralgia d. Cluster headache

c. Trigeminal neuralgia

4. The tandem gait is used to test which of the following? a. Cerebellum b. Sacral nerves c. Motor movements d. Sensory input

cerebellum

If A1C is at target, which adjunctive antihyperglycemic therapies may still have benefit in pts with diabetes and CVD? a) sulfonyurea b) dapaglifozin 10mg c) semaglutide 10mg d) b + c e) none of the above

d) B + C (dapaglifozin + semaglutide) SGLT2i + GLP1

Which cranial nerve is responsible for tongue movement? a) CN VIII b) CN IX and CN X c) CN XI d) CNXII

d) CN XII (12)

An obese Asian patient with BMI (body mass index) of 33 complains of fatigue, and excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing to confirm diagnosis can include: A) Fasting plasma glucose level B) Glycated hemoglobin level (A1C) C) Oral glucose tolerance testing D) All of the above

d) all the above

Which of the following murmurs can radiate to the neck? a) mitral stenosis b) mitral regurgitation c) aortic regurgitation d) aortic stenosis

d) aortic stenosis

Which one of the following findings is associated with diabetic retinopathy? a) AV nicking b) copper wire arterioles c) flame-shaped hemorrhages d) microaneurysms

d) microaneurysms

Which of the following cranial nerves (CNs) 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

d. CN V

2. The Romberg test is done to check which of area the central nervous system? a. Frontal lobe b. Temporal lobe c. Midbrain d. Cerebellum

d. Cerebellum

2. An 80 yr. AA male comes in for a follow-up evaluation after being discharged from the hospital with a cryptogenic stroke (means cause is unknown). Diagnostic testing did not reveal carotid artery stenosis or DVT. Echocardiograms did not reveal a patent foramen ovale (PFO). Holter monitoring and a 30-day monitor was negative for arrhythmias. As a NP, you decide to collaborate with the neurologist and cardiologist taking care of your patient. Which one of the following diagnostic tests would you recommend the patient proceed with? a. 30-day heart monitor b. Transthoracic echocardiogram c. Transesophageal echocardiogram d. Reveal Implantable Loop Recorder -

d. Reveal Implantable Loop Recorder -

You examine a 24 yo with mitral valve prolapse. Her PE findings may also include: pectus excavatum Obesity Petite stature Hyperextensible joints

pectus excavatum

Define chronic bronchitis

productive cough for at least 3 months of the year for 2 consecutive years