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A 59-year-old is having a follow-up evaluation two years after the successful conclusion of radiation therapy for leukemia.

1.            A 59-year-old is having a follow-up evaluation two years after the successful conclusion of radiation therapy for leukemia. He tells you that he has been feeling run-down and reports unexplained weight loss and night sweats. Upon examination, you determine that he also has a fever and pain below his ribs and the left side. You know that he is at risk for chronic lymphotic leukemia. Which of the following results is considered the hallmark of this disease?

 

A.            Philadelphia chromosome in leukemic cells

 

B.            Lymphocytosis

 

C.            Non-circulating blast cells in bone marrow

 

D.            Pancytopenia with circulating blasts.

 

2.            A 28-year-old single mother arrives at your office inquiring about alternative options for contraception. The woman mentions that she has been having an oral contraception for the last 10 years but is curious about the hormonal intrauterine device (IUD) option she read about in an article. Which of the following is one of the advantages of using a hormonal IUD?

 

A.            Prevention of depression

 

B.            Prevention of Asherman’s syndrome

 

C.            Increased menstrual loss

 

D.            Spotting

 

3.            You are monitoring a toddler who has serous otitis media. The patients want to understand the treatment their child will receive. Which of the following would be the appropriate way to manage this condition?

 

A.            Oral antibiotics

 

B.            Antihistamines

 

C.            Decongestants

 

D.            Monitor and re-evaluate in 3 months

 

4.            Which of the following seizure patients would most likely benefit from lumbar puncture?

 

A.            Any child with a tonic-clonic seizure

 

B.            An 11 year old with a fever of 101.5 F

 

C.            A four-month-old without fever

 

D.            A two-year-old with a known seizure disorder

 

5.            You take a serological test on a patient with hepatitis. Checking over the results, you discover the patient’s serology is positive for the following: surface antigen of the Hepatitis-B (HbsAg), antibody to the antigen of the hepatitis B virus (Anti-Hbe), immunoglobulin M (IgM0, immunoglobulin G (IgG0. What is the proper diagnosis?

 

A.            Chronic hepatitis B

 

B.            Recovered hepatitis B

 

C.            Acute hepatitis A

 

D.            Acute hepatitis B

 

6.            Robert, a good friend of your, has called you to advice on obtaining a medical certification. He wants to know his various options. Which statement is true regarding the difference between licensure and certification?

 

A.            Certification signifies that a person is qualified to perform a particular role and is granted by a government agency.

 

B.            Licensure signifies mastery of specialized knowledge and is granted by a government agency.

 

C.            Certification signifies mastery of specialized knowledge and is granted by a non-governmental agency.

 

D.            Licensure signifies that a person is qualified to perform a particular role and is granted by a non- governmental agency.

 

 

 

7.            A mother brings her 3-month-old baby to your clinic to screen for failure to thrive (FTT). Which of the following is not a sign or symptom that would cause you to associate the infant with FTT?

 

A.            Absolute length/width are below the 5th percentile

 

B.            Weight falling greater than 2nd percentiles below the standard

 

C.            Avoids eye contact

 

D.            Commonly cries for more food or milk

 

8.            Which of the following is not true of progestin-only birth control?

 

A.            It has excellent reversibility

 

B.            It most likely changes tubal transport of female and male gametes

 

C.            Its mechanism of action affects the cervical mucus and the endometrium

 

D.            It is typically more effective than combination pulls but has more side effects

 

9.            The parents of a 1-year-old patient presents to you with concerns regarding their daughter’s health. At birth, they were told that their daughter had abnormal features and decreased muscle tone. They hope that their daughter would “grow out” of some these defects but, to their disappointment, she has not. They report that their daughter is having trouble walking and sitting up by herself. Furthermore, they state that no matter how much they feed their baby, she is always crying out for more food and, as a result, has been rapidly gaining weight. You suspect a chromosomal condition. Which of the following would be most likely?

 

A.            Prader-Willi Syndrome

 

B.            Hurler syndrome

 

C.            Down syndrome

 

D.            DiGeorge syndrome

 

10.          The mother of a toddler complains that her 2-year-old child is picky eater, and despite evidence of a healthy growth pattern, she is concerned about her child’s appropriate food intake. Which of the following is the most accurate regarding toddler nutrition?

 

A.            Your toddler’s diet is appropriate if he consumes 70 to 100 kcal/kg/day

 

B.            Toddlers should consume more protein and a total of 120 kcal/kg/day

 

C.            Toddlers must consume a least 45 kcal/kg/day

 

D.            Parent of toddlers should insist that their children clean their plate and consume 100 to 110 kcal/kg/day

 

11.          During a check-up with a 6-year-old, you wish to conduct an interview the child and his parents. He is a new patient, and you want to establish the proper doctor-patient relationship. Which of the following is a necessary component of your interview?

 

A.            Assess child’s cholesterol

 

B.            Informing the parents ahead of time if you are recording data

 

C.            Assess liver function

 

D.            Measure the child’s hematocrit

 

12.          According to Jean Piaget, between the age of seven and 11, a child’s psychological development will be marked by:

 

A.            Development of intuitive thought

 

B.            Capability of logical thought

 

C.            Trial and error learning

 

D.            Capable of complex problem solving

 

13.          After years of not conceiving, Kelly and Ed finally have a child, a girl named Beverly. They often check with you about what to expect as Beverly ages. In a month she will be 2 ½ years old. Which of the following is typically present in a 2 ½ -year-old child?

 

A.            All primary teeth have erupted

 

B.            Birth weight has doubled

 

C.            Anterior fontanel is open

 

D.            The child will be in the industry versus inferiority stage of psychosocial development

 

 

 

14.          You are doing a well-child check on an infant. Currently, the baby can lifts his head when on his stomach, laughs aloud, and can crawl to you. When asked to say “mama,” however, the baby just smiles. Based on this description, what is his approximate age?

 

A.            6 months

 

B.            10 months

 

C.            4 months

 

D.            2 months

 

37.          The Bayley-Ill test is the standard for the diagnosis of developmental delays in children until what age/

 

A.            30 months

 

B.            42 months

 

C.            24 months

 

D.            36 months

 

38.          A father brings in his 6-month-old girl, Hannah, because he is concerned that her development has slowed down considerably in the past month. For example, Hannah no longer makes babbling sounds like she used to, and she now drools excessively. She also used to flex her legs and reach for her mother’s hair with her hands, but now her legs and arms are floppy. You eventually diagnose Hannah with a pervasive development disorder that is diagnosed only in females. Which is it?

 

A.            Autistic disorder

 

B.            Asperger’s syndrome

 

C.            Childhood disintegrative disorder

 

D.            Rett’s disorder

 

39.          Mary and David bring their child, Sarah, to your office, and they tell you that they want to begin potty training her. The child is showing signs that she is ready to begin her training. Which of the following signs is the nest indicator that she is ready?

 

A.            The child’s bowel movement are irregular

 

B.            The child’s seems comfortable with wet diapers

 

C.            The child can walk and transfer objects between her hands

 

D.            The child stays dry after naps

 

40.          A mother brings her 5-year-old son in for a check-up. He is about to enter school for the first time and must go through some screenings before the school will permit him to participate. After reviewing the family history, you learn that his grandfather has a myocardial infarction at the age of 50. Which of the following is specifically indicated by this aspect of the patient’s history?

 

A.            Measles, mumps, and rubella immunization

 

B.            Purified protein derivative screening

 

C.            Cholesterol screening

 

D.            Hematocrit screening

 

41.          The parents of 6-year-old Morris are worried about his adjustment to school. He has not exhibited dysfunctional behavior yet, but his older brother, now 20 years old, did. Which of the following is a likely warning sign in younger, school age children?

 

A.            Disinterested in any extra academic activity

 

B.            Cannot make or keep friends

 

C.            Not working to ability

 

D.            Destructive behavior to express self

 

42.          When considering a school-age child’s nutritional development, which of the following is not typical average, annual height gain for the child?

 

A.            2 inches

 

B.            1 ½ inches

 

C.            3 inches

 

D.            2 ½ inches

 

43.          A report of suspected child abuse must be made if certain signs or symptoms are observed. Your suspicion of child abuse would be further supported if the child exhibits bruising and the following except?

 

A.            Soft tissue markings with the outline of a hand

 

B.            Child is beneath 30th percentile for weight

 

C.            Partial thromboplastin time of 90 seconds

 

D.            Prothrombin time of 11 seconds

 

 

 

44.          There are three general strategies when interviewing an adolescent. Which of the following is not one of the strategies used when interviewing adolescents?

 

A.            PACES format

 

B.            SAFETEENS format

 

C.            HEADSS format

 

D.            CAGE format

 

45.          A 17-year-old patient, Maria, comes to your office with her mother. You notice, comparing her to last year, she has lost weight and looks very unhealthy. She reports that she has an eating disorder and wants help. You conduct a brief test and find that her teeth look transparent and that she has cotton-like hairs on her arms. It is determined that she has an eating disorder. Which of the following would not be a good management option for Maria’s condition?

 

A.            Institutionalization

 

B.            Interdisciplinary management

 

C.            Behavior modification

 

D.            Psychotherapy

 

46.          You are examining a boy whose penis has begun to elongate. The physical development is indicative of what Tanner stage?

 

A.            II

 

B.            IV

 

C.            I

 

D.            III

 

47.          When performing a physical exam on an adolescent patient, you should keep in mind that hormone surging can affect which of the following part of the body?

 

A.            Tooth eruption

 

B.            Motor skills

 

C.            Visual acuity

 

D.            Liver function

 

48.          Between what Tanner stages does menarche usually occur in girls?

 

A.            III and IV

 

B.            I and II

 

C.            II and III

 

D.            IV and V

 

49.          You are checking up on a 6-year-old Arnold, whom you saw last month for strep throat. You want to ensure that this patient is not experiencing a complication that can occur as a result of the strep throat infection after approximately 20 days of the infection. Which of the following would indicate the patient is more than likely experiencing this complication?

 

A.            Polymorphous rash

 

B.            Inflammatory changes of the lips

 

C.            Polyarthitis

 

D.            Inflammatory changes of the oral cavity

 

50.          A 14-year-old patient comes to your office showing signs of fever, painful tender joints, and strep throat. Laboratory findings show positive throat culture and a positive rapid strep assay. Based on the findings of this patient, which of the following would not be a good treatment for the patient’s condition?

 

A.            Prophylactic antibiotics for invasive procedures

 

B.            High dose acetyl salicylic acid therapy

 

C.            Aggressive management of the strep infection

 

D.            Bed rest if acute carditis is present

 

 

 

51.          Kawasaki disease is an acute febrile syndrome that causes vasculitis. It is also known for all the following

 

except?

 

A.            A persistent evaluation of average systolic and diastolic blood pressure

 

B.            The leading cause of coronary artery disease in children of an infectious etiology

 

C.            Occurs most commonly in children of Asia ethnicity

 

D.            Most commonly noted in children under the age of two.

 

52.          A diabetic mother, 41 years old bring her 2 week-old male infant into your office. A chest x-ray reveals a boot- shaped heart, with normal size and pulmonary vascular marking. These finding are most indicative of which of the following cardiac defects?

 

A.            Tetralogy of Fallot

 

B.            Atrial Septal Defect

 

C.            Transposition of great arteries

 

D.            Ventricular septal defect

 

53.          James and Devin’s first son, Anderson, is diagnosed with Down syndrome. Amongst their many concerns, they want to know if this could affect Anderson’s physical well-being. Down syndrome is associated with heart conditions. Which of the following is the most common heart defect associated with Down syndrome?

 

A.            Tetralogy of Fallot

 

B.            Patent ductus arteriosus

 

C.            Atrioventricular septal defect

 

D.            Transposition of the great arteries

 

 

 

68.          An adolescent presents with copious mucopurulent discharge from his right eye. Given the most likely diagnosis, which of the following is the most appropriate first-line treatment?

 

A.            Penicillin

 

B.            Zithromax

 

C.            Ceftriaxone

 

D.            Erythromycin

 

69.          You are treating a 9-year-old patient with asthma. Her symptoms, which include coughing and chest tightness, occur three times a week during the day and three times a month during the night. Additionally, she also has a forced expiratory volume in the one second of 80%. Which of the following is the most likely severity level of the asthma condition?

 

A.            Mild persistent

 

B.            Moderate persistent

 

C.            Severe persistent

 

D.            Mild intermittent

 

70.          A 1-month-old patient presents with symptoms of chronic cough, nasal passages filled with mucus, and a respiratory infection. You find an obstructive pattern in the pulmonary function test and try to look for more signs to confirm your suspected diagnosis. Which of the following findings, if encountered at sometime, would not help you confirm the most likely diagnosis?

 

A.            Fever

 

B.            Delayed puberty

 

C.            Large, liquid, bulky, foul stool

 

D.            Salt-tasting skin

 

71.          You are seeing a 2-year-old who has an upper respiratory infection. Findings include a fever of 102 F, grunting, and prolonged expiration. Based on these signs, which of the following would be the most likely laboratory finding for this patient?

 

A.            Slight WBC elevation with eosinophilia

 

B.            Abnormalities typical of obstructive dysfunction

 

C.            Productive cough

 

D.            Chest x-ray with hyperinflated lungs

 

 

 

72.          The nurse practitioner conducts a physical exam on a 15-year-old patient presenting with symptoms of respiratory infection. During ausculatation, she hears decreased breath sounds in the right lower lobe. To confirm this finding, she asks the patient to say “EEE” and you hear “AAA”. What respiratory assessment is the nurse practitioner conducting on the patient?

 

A.            Type and location of breath sounds

 

B.            Egophony

 

C.            Testing for heart murmur

 

D.            Pulmonary function test

 

73.          Which of the following is not a bacterial pneumonia?

 

A.            Klebsiella

 

B.            Haemophilus influenza

 

C.            Pseudomonas

 

D.            Rickettsia

 

74.          Seven-year-old Will is brought to your office after developing a limp. His parents state Will has begun to experience pain in his groin, hip, and left knee since the limp began. Moreover, they express concern about their son’s growth as Will is shorter in stature than most of his peers. Physical examination finding include abduction of the hip joint and passive internal rotation of the hip. Given the patient’s age and presentation, which of the following is the most appropriate form of treatment?

 

A.            Limitation of physical activity

 

B.            Referral to orthopedics

 

C.            Observation

 

D.            Analgesics

 

75.          The parents on a 13 year old girl come to your office concerned about the risk of scoliosis in their daughter given a family history of the condition. The daughter is developing asymmetry in her posture and is slightly shorter in stature than most her peers. Which of the following aspects of the patient’s presentation is not a risk factor for scoliosis?

 

A.            Age

 

B.            Gender

 

C.            Stature

 

D.            Family history

 

76.          Twelve year old Adam comes to your office after having experienced a recent, sudden growth spurt. He complains of pain in the area just below his right knee and reports tenderness when you apply pressure to the area. These findings indicate which of the following as the most likely diagnosis?

 

A.            Osgood-Schlatter disease

 

B.            Slipped capital femoral epiphysis

 

C.            Toxic synovitis

 

D.            Legg-Calve-Perthes disease

 

77.          Which of the following is not a component of the physical examination for developmental dysplasia of the hip?

 

A.            Galeazzi’s sign

 

B.            Barlow’s maneuver

 

C.            Ortalani test

 

D.            Adam’s forward bend test

 

78.          A concerned mother brings her four-year-old son, Kevin, to the office. The mother is worried about Kevin’s weakness and clumsiness compared to other children his age as well as his abnormal posture. Further, she notes unusual movements from her son such as moving his hands up his legs when rising to stand. As you begin laboratory testing to confirm your suspected diagnosis, which of the following would you not expect to see?

 

A.            Decreased creatine kinase

 

B.            Necrotic degenerating fibers

 

C.            Abnormal electrocardiogram

 

D.            Myopathy

 

 

 

79.          Bell’s palsy is associated with the malfunction of which cranial nerve?

 

A.            VII

 

B.            IV

 

C.            VIII

 

D.            XII

 

80.          A mother brings her 6-year-old son, Glenn, to the clinic for a check-up. She is concerned that her son constantly says that he smells “peppermint.” Upon physical examination, you notice the child’s mouth starts twitching to the right. After a minute, the twitching stops and Glenn asks why everybody is looking at him. The child is exhibiting signs of which of the following conditions?

 

A.            Complex partial seizures

 

B.            Clonic seizures

 

C.            Simple partial seizures

 

D.            Tic disorders

 

81.          A 5-month-old infant is brought to your office by her mother, who states that the infant has lately seemed lethargic and has been vomiting and feeding poorly. Upon examination, you note a bulging fontanel and fever. Which of  the following laboratory tests would help confirm your suspected diagnosis?

 

A.            Complete blood count

 

B.            Computed axial tomography scan

 

C.            Erythrocyte sedimentation rate

 

D.            Cerebrospinal fluid analysis

 

82.          Sixteen-year-old Jeffrey complains of having debilitating pain once a week. H states that during or after the episodes of abdominal pain, he gets so nauseous that he has to vomit. The results of a stool sample are guiac negative and do not reveal occult blood. Which of the following is the most likely diagnosis?

 

A.            Basilar migraine

 

B.            Gastroesophageal reflux disease

 

C.            Gastroenteritis

 

D.            Abdominal migraine

 

83.          You are examining Cody, 8 years old, who has recently begun to experience morning headaches followed by vomiting. Cary states that these headaches have become more frequent since they began. You note numerous findings including head tilt, failure to thrive, and loss of fine motor control. Moreover, Cody tests positive when you administer the Babinski reflex test. Which of the following laboratory tests would not confirm the most likely diagnosis?

 

A.            Lumbar puncture

 

B.            Magnetic resonance imaging

 

C.            Electroencephalogram

 

D.            Computerized axial tomography.

 

84.          You are examining a 2-year-old who present with a low grade fever. During physical examination, you note the child is responding as though he has excruciating pain in his back, chest, and abdomen. A lab test reveals his white blood cell count is elevated to 14,000. Which of the following would you also expect to be revealed?

 

A.            Poikilocylosis and basophilic stippling

 

B.            Howell-Jolly bodies

 

C.            Heinz bodies

 

D.            Blast cells

 

85.          You have been seeing Larry and Shawna during Shawna’s pregnancy. You did a genotype test for Shawna, but Larry was adopted and, therefore, has no knowledge his biological parents. Now they report that their child has a strange growth on his forehead as well as a pale coloring to his skin. Which of the following is the most likely diagnosis?

 

A.            Iron deficiency anemia

 

B.            Hemophilia A

 

C.            Thalassemia

 

D.            Sickle cell anemia

 

 

 

86.          You are examining 2-year-old Donald after his parents tell you he has been vomiting and experiencing diarrhea the past week, leading to him losing an alarming amount of weight. Moreover, his gums are blue. During the examination, Donald rapidly jerks his right arm back. When you ask why he did this, he replies that his “arm moved on its own.” Which of the following is the most likely diagnosis?

 

A.            Pyloric stenosis

 

B.            Lead poisoning

 

C.            Appendicitis

 

D.            Gastroenteritis

 

87.          While she is pregnant, you discover that Sharon is a carrier for hemophilia A. She asks you what the chance is that she could pass the disorder on to her daughter. Which of the following should you tell her? A. 10%

 

B.  75%

 

C. 25%

 

D. 50%

 

88.          You are seeing a 24-month-old African-American female whose parents complains that she is “unusually tired” however, she has no history of chronic illness. The child’s history reveals that she was switched to whole milk at 12 months and is currently drinking 32 ounces per day. Upon physical exam, you notice pale conjunctiva, and the laboratory results reveal microcytic hypochromic anemia with normal white blood cell (WBC), platelet, and reticulocyte counts. Which of the following is the most likely diagnosis? A. Iron deficiency anemia

 

B.            Sickle cell anemia

 

C.            Vitamin B12 deficiency

 

D.            Alpha-thalassemia minor

 

89.          Eddie, 15 years old, is diagnosed with Type 1 diabetes mellitus (DM). Which of the following would not

 

be a step to take into consideration when managing Eddie’s DM?

 

A.            Metformin prescription

 

B.            Dietary teachings

 

C.            Beginning insulin

 

D.            Establishing baseline studies such as family history.

 

90.          Which of the following is not a common cause of hypothyroidism in children and adolescents?

 

A.            Pituitary deficiency of thyroid-stimulating hormone

 

B.            Hashimoto’s syndrome

 

C.            Iodine deficiency

 

D.            Graves’ Disease

 

91.          Proportional short stature can be caused by a variety of endocrine diseases. Which of the following is not an endocrine disease that is believes to cause proportional short stature?

 

A.            Hypothyroidism

 

B.            Chromosomal abnormalities

 

C.            Hypopituitarism

 

D.            Growth hormone deficiency

 

92.          Abigail, 13 years old presents with muscle cramps, weight loss, and menstrual irregularities. Further, she states that she experiences chest pain and notices moisture on her skin as well as an increased intolerance for heat. Based on the most likely diagnosis, you expect to see decreased levels of which of the following?

 

A.            Thyroid stimulating hormone

 

B.            Triiodothyronine

 

C.            Free thyroxine index

 

D.            Thyroid resin uptake

 

93.          Which of the following is not a finding of type 1 diabetes mellitus?

 

A.            Dysfunction of peripheral sensory nerves

 

 

 

B.            Generalized pruritus

 

C.            Paraesthesia

 

D.            Nocturnal enuresis

 

94.          The parents of 5 year old Brian are worried that he has begun wetting the bed. As you educate them on enuresis, they ask how many children Brian’s age are affected by this condition. What should you tell them?

 

A.  10%

 

B.  20%

 

C. 3%

 

D. 40%

 

95.          Which of the following typically causes urinary tract infections in childhood?

 

A.            Urinary stasis

 

B.            Escherichia coli

 

C.            Obstructive lesions

 

D.            Staphylococcus aureus

 

96.          You have assisted Thomas and Myra through Myra’s first pregnancy. The birth of their son, Chad, was uncomplicated, but during the examination of the infant, it was discovered that the boy’s urethra was ventral side of the penis. Which of the following is the least effective cause of treatment?

 

A.            Refer to an urologist

 

B.            Refer for surgery in six-twelve months

 

C.            Do not perform circumcision

 

D.            Refer to emergent surgical intervention

 

97.          A mother and her 13-year-old daughter come to your clinic reporting that the daughter complains of painful menstrual cramps and back pain requiring her to miss school several days each month. You suspect a diagnosis of dysmenorrhea. Which of the following is not an example of supportive treatment of this diagnosis?

 

A.            Heat application

 

B.            Psychological counseling

 

C.            Steroidal anti-inflammatory drugs

 

D.            Ibuprofen

 

98.          At what age should a child with cryptorchidism be referred to an urologist if the testes remain undescended?

 

A.            9 months

 

B.            1 year

 

C.            2 years

 

D.            6 months

 

99.          Jen comes to your office to inquire about birth control. She explains that she does not want to start a family, she is merely looking for a birth control method that lasts the longest with relatively low maintenance for use. Asking about her medical history, you learn that there have been instances of endometrial cancer in her family. Given this information, which of the following contraceptive options is the best recommendation for Jen?

 

A.            Nuvaring

 

B.            Depo-Provera

 

C.            Intrauterine device

 

D.            Oral contraceptives

 

100.        Carolyn, 36 years old asks you about a form of contraceptive that is effective but also easily reversed. You recommend Ortho Evra, which has a failure rate of less than one percent and is a patch that can be removed to end its side effects. What is Ortho Evra’s mechanism of action?

 

A.            Causes lysis of the blastocyst

 

B.            Prevents implantation due to local foreign body inflammatory responses

 

C.            Inhibits ovulation by releasing synthetic estrogen and progestin

 

D.            Destroys sperm cells with nonoxynol-9

 

 

 

110.        Your patient, Carl, is in your office for an examination. When undergoing the physical exam, his nose starts to bleed. Carl says he thinks the weather is causing him to have more and more frequent nose bleeds. If Carl’s nosebleed is not an atypical incidence, from which of the following sites would you most expect the nose bleed to originate?

 

A.            Vestibular fold

 

B.            Naspharynx

 

C.            Posterior septum

 

D.            Anterior septum

 

111.        After performing an eye exam on 38-year-old Megan, who was recently diagnosed with type 2 diabetes, you conclude that she is at risk for retinal vein occlusion. While performing a fundoscopic exam on Megan, how should normal retinal veins compare to arteries?

 

A.            Veins and arteries are equal in width, but the veins are darker than the arteries in color

 

B.            Arteries are less bright and wider than the veins

 

C.            Veins and arteries are the same shade of color, but the veins are narrower than the arteries

 

D.            Arteries are a brighter red and narrower than the veins

 

112.        Which of the following is not a treatment for otitis externa?

 

A.            Nosteroidal anti-inflammatory drugs, topical corticosteroids for pain control

 

B.            Cleansing and debridement of the ear

 

C.            Antiemetic

 

D.            Topical otic drops

 

113.        An 18-year-old girl presents with fever, drastic weight loss, and a general feeling of malaise. During an otoscopic exam, you find white tonsillar exudates. Upon physical examination, you notice a mass in the girl’s upper left quadrant. What tests should you order to confirm the most likely diagnosis?

 

A.            Oral culture

 

B.            Throat swab

 

C.            Computed tomography scan

 

D.            Monospot

 

126.        You just referred 19-year-old Emily for a cast on her sprained ankle. Which grade of ankle sprain would she have to necessitate a referral?

 

A.            Grade 2

 

B.            Grade 5

 

C.            Grade 3

 

D.            Grade 4

 

127.        Which of the following, if found, would help differentiate rheumatoid arthritis from osteoarthritis?

 

A.            Nodes in the proximal interphalangeal joints

 

B.            Swelling and edema

 

C.            Nodes in the metacarpophalangeal joints

 

D.            Node in the distal interphalangeal joints

 

 

 

128.        A 32-year-old man comes to your office limping and complaining of pain in his knee. He had been playing basketball and he believes that he hurt it after a particularly unruly game. You flex his knee 90 degrees, put pressure on his heel with one hand, while rotating the lower leg internally and externally. Which of the following tests have you performed?

 

A.            Apley’s grind test

 

B.            Phalen’s test

 

C.            Lachman’s test

 

D.            McMurray’s test

 

129.        You are treating Bruce, 38 years old, who was confirmed positive for HIV. Bruce now returns to your office with fever and a non-productive cough. Moreover, he complains of shortness of breath and states that he has begun to experience unintentional weight loss and night sweats. Based on Brice’s signs and symptoms, you suspect a diagnosis of AIDS. Which of the following laboratory tests would confirm this diagnosis?

 

A.            CD4 count

 

B.            Western Blot

 

C.            ELISA

 

D.            Gram stain

 

130.        John, a 21-year-old male, is a college student who comes to your office complaining of painful urination. He reports that this morning he was “grossed out” when he saw yellow and green penile discharge. A gram stain of the discharge shows gram-negative diplococcic and white blood cells. Which of the following is the best treatment for John’s condition?

 

A.            Cryoanesthesia

 

B.            Benzathine penicillin

 

C.            Ceftriaxone

 

D.            Podophylin

 

136.        David, a 42-year-old, lives alone. He comes in complaining of lower back pain, fever, and testicular pain. He shows signs of scrotum edema. Although this condition is usually caused by Chlamydia, you know that is not the cause here. Which of the following is the most likely cause in this case?

 

A.            Septicemia

 

B.            Neisseria gonorrhoeae

 

C.            Bacterial prostatitis

 

D.            Bacterial ascension from the bladder

 

137.        A new patient of yours is extremely concerned about developing osteoporosis. She has come to you to learn of there are any effective ways to increase calcium in her diet. Which of the following options would be the least helpful addition to her diet?

 

A.            Tofu

 

B.            Broccoli

 

C.            Tump greens

 

D.            Sardines

 

138.        You are counseling a couple who is employing a surrogate to carry and deliver their baby. They are concerned because their surrogate has developed strange food cravings, including a craving to eat clay. Which of the following results drawn from the surrogate would be most expected if her condition was the results of hemoglobinopathy?

 

A.            Low hemoglobin and high total iron binding capacity

 

B.            Low hemoglobin and normal total iron binding capacity

 

C.            Low hemoglobin and normal ferritin

 

D.            Low hemoglobin and serum ferritin is high

 

 

 

145.        Your patient has a history of alcoholism in his family. He is concerned by this history and asks for your advice. Which of the following is a false statement regarding alcoholism and family issues?

 

A.            Alcoholism is a treatable disease

 

B.            Al-Anon is a psychotherapy program for families of alcoholics

 

C.            Behavioral approaches to management are usually useful

 

D.            Alcoholics Anonymous is an effective evidence-based 12-step program for alcoholics

 

146.        You are caring for a patient with Alzheimer’s disease. Which of the following is most helpful in assisting with memory impairment while improving cognitive clarity?

 

A.            Trihexiphenidyl (Artane)

 

B.            Donepezil (Aricept)

 

C.            Pramipexole (Mirapex)

 

D.            Valporic Acid (Depakene)

 

 

 

147.        Scientist do not yet fully understand what causes Alzheimer’s disease, but it is clear that this disease develops because of a complex series of events in the brain over a long period of time. The likely causes of Alzheimer’s includes genetic, environmental, and lifestyle factors. One theoretical cause is an improper balance and function of neurotransmitters in the brain. Which of the following conditions is considered a casual factor of this aspect?

 

A.            Dopamine deficiency

 

B.            Acetylcholine deficiency

 

C.            Serotonin excess

 

D.            Excessive norepinephrine

 

148.        Daniel, a 57-year-old male, presents to your office with a slow but noticeable tremor. He complains that the tremor gets worse whenever he is particularly stressed. He also states that his body has become increasingly rigid and that he is having difficulty swallowing. You notice that Daniel’s blinking very slowly and inconsistently, but, when you tap the bridge of his nose repetitively, he responds with sustained blinking. Of the following disorders, which would best account for Daniel’s condition?

 

A.            Multiple sclerosis

 

B.            Parkinson’s disease

 

C.            Trigeminal neuralgia

 

D.            Bell’s palsy

 

 

 

169.        You are treating a Guatemalan patient who speaks only Spanish. According to the standards of Culturally and Linguistically Appropriate Services, it is necessary to provide all of the following for the patient except:

 

A.            Interpreters

 

B.            Verbal and written notices in the patient’s preferred language

 

C.            Family members and friends who are present to assist with interpretation

 

D.            Bilingual staff

 

170.        You are treating a schizophrenic patient whom you suspect is a danger of hurting himself and/or others as a result of his condition. Under which of the following procedures are you required to administer proper treatment to the patient?

 

A.            Involuntary commitment

 

B.            Report the patient to the health department

 

C.            Crisis intervention

 

D.            Use of restraints

 

171.        You are treating a patient who requires surgery and are ensuring that measures are taken to prevent harm being done to the patient. Which of the following key ethical principles is associated with this duty?

 

A.            Beneficience

 

B.            Utilitarianism

 

C.            Nonmaleficence

 

D.            Justice

 

172.        You are treating a patient who dies unexpectedly following a surgical following a surgical procedure. As a nurse practitioner, in which of the following components of the investigation are you most likely to take part to assess the incidence?

 

A.            Risk management

 

B.            Experimental research

 

C.            Root cause analysis

 

D.            Quality assurance 173.

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