AANP 2021 Study Guide Exam 157 Questions with Answers,100% CORRECT

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AANP 2021 Study Guide Exam 157 Questions with Answers Measles (Rubeola) - CORRECT ANSWER What RNA virus is associated with cough, coryza, and conjunctivitis with photophobia, rash that starts on ... head or face? Ortolani maneuver - CORRECT ANSWER technique for checking hip integrity. unequal movement suggests the hip is dislocated varicocele - CORRECT ANSWER enlarged, dilated veins near the testicle bladder cancer - CORRECT ANSWER cancerous tumor that arises from the cells lining the bladder; major sign is hematuria, smoking or industrial chemicals can cause Roseola infantum - CORRECT ANSWER rash starts on the trunk and goes to the extremities Rash comes out when the fever breaks endovenous laser therapy (EVLT) - CORRECT ANSWER treatment of large varicose veins in the legs in which a laser fiber is inserted directly into the affected vein to heat the lining within the vein, causing it to collapse, shrink, and eventually disappear; also called endovenous laser ablation (EVLA) B12 deficiency - CORRECT ANSWER Methylmalonic acid and Homocystein level cervical dysplasia - CORRECT ANSWER the presence of precancerous changes in the cells that make up the inner lining of the cervix, white, sharply demarcated lesion of cervix polycythemia vera - CORRECT ANSWER general increase in red blood cells (erythremia), pruritis after a shower L5-S1 - CORRECT ANSWER weak plantarflexion roseacea - CORRECT ANSWER topical metronidazole Constructive pericarditis - CORRECT ANSWER Pericardial knock Restrictive Pericarditis - CORRECT ANSWER S3 Cluster Headache - CORRECT ANSWER Unilateral severe orbital, supraorbital, or temporal pain. More common in males. Restlessness, tearing of eyes, nasal congestion, rhinnorrhea, fullness of ear, tx-O2 100% CA 125 - CORRECT ANSWER Ovarian cancer Deficiency of Niacin - CORRECT ANSWER Dermatitis, diarrhea, dementia Pertussis treatment in children - CORRECT ANSWER Azithromycin HLA-DQA or HLA-DQB - CORRECT ANSWER gene for susceptibility for DM 1 Glyburide - CORRECT ANSWER Most likely sulfa to cause hypoglycemia Prehn sign - CORRECT ANSWER elevation of testicles "feels better, less pressure" Dengue fever - CORRECT ANSWER Supportive Care Hypoparathyroidism - CORRECT ANSWER Low serum mag Lovastatin - CORRECT ANSWER First choice for children Vit D dosage in older adults - CORRECT ANSWER 800 units/day Allergy med that won't cause dizziness - CORRECT ANSWER Loratadine Meriere's disease first line treatment - CORRECT ANSWER Antihistamines of Benzo (diazepam) Rhinosinutis can cause? - CORRECT ANSWER Orbital cellulitis Hemophilia B - CORRECT ANSWER Prolong PTT Fibroadenoma - CORRECT ANSWER Most common breast mass from 25-40 years old Treponema pallidum - CORRECT ANSWER syphilis Wermer syndrome - CORRECT ANSWER tumors on parathyroid glands Polycythemia vera - CORRECT ANSWER condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels, splenomegaly, pruritis after showering Lyme disease - CORRECT ANSWER bullseye rash, alopecia areata - CORRECT ANSWER Autoimmune disorder that causes the affected hair follicles to be mistakenly attacked by a person's own immune system; usually begins with one or more small, round, smooth bald patches on the frontal bone of the scalp. Biguanides (Metformin) - CORRECT ANSWER Works by suppressing hepatic gluconeogenesis and enhancing insulin sensitivity of muscle and fat Sulfonylureas - CORRECT ANSWER Work by stimulating insulin secretion from the pancreas Hutchinson sign - CORRECT ANSWER zoster eruption on the tip of the nose When should screening for diabetes start? - CORRECT ANSWER 45 years old if no symptoms present Reed-Sternberg cells - CORRECT ANSWER Hodgkin lymphoma (HL) histologic morphology Sever disease (calcaneal apophysitis) - CORRECT ANSWER A traction-type injury, or osteochondrosis, of the calcaneal apophysis seen in young adolescents. Metformin can cause wha - CORRECT ANSWER B12 deficiency then depression, fatigue, insomnia Cateracts - CORRECT ANSWER clouding of the lens, yellow tinted vision Lewy body dementia - CORRECT ANSWER A form of dementia characterized by an increase in Lewy body cells in the brain. Symptoms include visual hallucinations, momentary loss of attention, falling, and fainting, but also parkinsonian motor features such as bradykinesia, resting tremor, rigidity, and gait difficulty Ramsey Hunt Syndrome - CORRECT ANSWER Reactivation of cranial nerve VII, facial paralysis, ear pain, vesicular eruption in the auricle and ear canal Why would you give meningococcal vaccine before 11th birthda? - CORRECT ANSWER Sickle cell anemia (no functioning spleen) Emphysema - CORRECT ANSWER Structural changes that occur distal to the terminal bronchioles Pinworm treatment - CORRECT ANSWER Albendazole or pyrantel pamoate or albendazole PO Primary achalasia - CORRECT ANSWER loss of peristalysis in distal esophagus and failure of LES relaxation with swallowing Polymyositis treatment - CORRECT ANSWER 1. steroids 2. followed by methotrexate (methotrexate for long-term immunosuppressant therapy) CLL (chronic lymphocytic leukemia) - CORRECT ANSWER -Chronic with lengthy survival -Primarily a diagnosis of the elderly -Usually B cells -WBC more mature and not functioning properly Vitamin D deficiency - CORRECT ANSWER Less than 12 mg/ml Acute urticaria - CORRECT ANSWER fenofenadine, cetirizine, loratadine, first line (second-generation H1 antihistamines) ankylosing spondylitis - CORRECT ANSWER can cause uveitis tinea cruris - CORRECT ANSWER Jock itch, terbinafine or butenafine first line (topical) Diagnosing asthma - CORRECT ANSWER spirometry Hypoparathyroidism - CORRECT ANSWER hypocalcemia and hyperphosphatemia Screening for gestational diabetes - CORRECT ANSWER Between 24-28 weeks Indication for PM? - CORRECT ANSWER Asymptomatic Mobitz II second-degree AV block-risk of progressing to 3rd degree HB Horner syndrome - CORRECT ANSWER ptosis, miosis, anhidrosis Binocular diplopia, horizontal diplopia on gaze towards affected side? what cranial nerve and muscle? - CORRECT ANSWER Abducens nerve, lateral rectus muscle First line treatment for pertussis? - CORRECT ANSWER Azithromycin Lichen planus - CORRECT ANSWER Pruritic, purple, polygonal planar papules and plaques (6 P's), treatment-topical steroids (topical fluocinonide) Expected clinical finding with high triglycerides? - CORRECT ANSWER Eruptive xanthomas Rotterdam criteria - CORRECT ANSWER Diagnosis of PCOS (2 out of 3) - amenorrhea/anovulatory cycles, signs of hyperandrogenism (hirsutism, acne, alopecia, virilization, infertility), polycystic ovaries on US Marfan syndrome - CORRECT ANSWER Aortic regurgitation Shigella - CORRECT ANSWER Treatment-azithromycin De Quervain thyroiditis - CORRECT ANSWER caused by neutrophilic inflammation of the thyroid gland. It is typically viral in origin, and is preceded by an upper respiratory infection Acromegaly - CORRECT ANSWER -abnormal enlargement of the extremities -insidious onset, with a time to diagnosis on the order of 6-10 years. The classic facial findings, which include enlargement of the supraorbital ridges, mandible and a widened nose glucose-6-phosphate dehydrogenase (G6PD) deficiency - CORRECT ANSWER avoid antimalarial drugs, sulfonamides (sulfamethoxazole), nitrofurans (nitrofurantoin), methylene blue, vitamin K, and phenazopyridine Eosinophilic esophagitis - CORRECT ANSWER dysphagia to solid foods Retropharyngeal abscess is a deep neck space infection - CORRECT ANSWER sore throat, difficulty swallowing, or difficulty breathing with possible signs of fever and systemic toxicity. Examination of the oral pharynx may demonstrate midline or unilateral swelling or bulging of the posterior pharyngeal wall -CT scan of the neck with intravenous contrast Vascular dementia - CORRECT ANSWER seen in patients with risk factors such as hyperlipidemia, hypertension and diabetes. Patients with vascular dementia have patchy cognitive impairment, often with focal neurologic signs and symptoms. Onset may be abrupt, with a stepwise decline. Patients who have had a stroke are at increased risk for vascular dementia Tinea versicolor, also called pityriasis versicolor - CORRECT ANSWER macules, patches, scales, or thin plaques, that may be hypo- or hyperpigmented or may be slightly erythematous -Ketoconazole 2% shampoo Celiac disease - CORRECT ANSWER -autoimmune disorder of the gastrointestinal tract caused by exposure to dietary gluten in genetically susceptible individuals -dermatitis herpetiformis, a pruritic vesicular rash on extensor bony surfaces, is pathognomonic for celiac disease. -IgA tissue transglutaminase is currently the test of choice for serologic diagnosis and for monitoring of celiac disease Pemphigus vulgaris - CORRECT ANSWER Nikolsky's sign (separation of epidermis caused by rubbing of the skin) -severe, rare autoimmune disease that causes blistering of the mucosa, skin, or both herpetic whitlow - CORRECT ANSWER viral infection of the distal finger, typically between the fascial planes surrounding the nail. This infection is caused by the herpes simplex virus -symptomatic management cluster headache - CORRECT ANSWER The classic presentation of a cluster headache is severe orbital, temporal, or supraorbital pain that is accompanied by autonomic symptoms such as ipsilateral ptosis, miosis, nasal congestion, rhinorrhea, lacrimation, or conjunctival injection. Restlessness and agitation often accompany the headache with patients pacing or rocking back and forth. Typical headache attacks last for between 15-180 minutes and occur between 1-8 times throughout the day atrial septal defect - CORRECT ANSWER widely split and fixed S2 is very common in large left-to-right shunts Still's murmurs - CORRECT ANSWER typically a grade 1 or grade 2 systolic murmur, most often loudest in the lower left sternal border or apex. The murmur may be noted when the patient is supine, compared to when the patient is sitting. Fever or anxiety may result in a louder murmur Polymyalgia rheumatica (PMR) - CORRECT ANSWER acute proximal muscle pain and stiffness. Age of onset is > 50 years. Areas commonly affected are the muscles of the shoulder and pelvic girdle. -Treatment is corticosteroids, usually prednisone 10-20 mg per day. Aortic regurgitation - CORRECT ANSWER low diastolic blood pressure Hyperaldosteronism - CORRECT ANSWER -excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium, hypertension common -Treatment is with high-dose spironolactone or eplerenone (aldosterone antagonist) to normalize potassium levels What is the most common type of elbow dislocation? - CORRECT ANSWER Posterolateral Which of the following lab findings would you expect to find in a patient with beta-thalassemia? - CORRECT ANSWER Codocytes Ankylosing spondylitis - CORRECT ANSWER -It typically has a slow onset, with the pain being worse in the morning that improves with activity. -notable fusion of the sacroiliac joints and eventual ossification of the annulus fibrosus, which results in the classic "bamboo spine" appearance on X-ray. Protracted bacterial bronchitis - CORRECT ANSWER -chronic wet cough for more than 4 weeks, the absence of other signs or symptoms that indicate another cause, normal chest radiographs, minimal systemic effects, minimal improvement with bronchodilators, and resolution of the cough within 2 weeks of starting an antibiotic Rheumatoid arthritis - CORRECT ANSWER symmetric polyarthritis of small joints. Rheumatoid arthritis is more common in women than men with a peak onset of 40-50 years in women and 60-80 years in men. Clinical manifestations include early morning stiffness and pain of the affected joints that persists beyond 30 minutes. The stiffness recurs after periods of inactivity or after strenuous activity. -The laboratory workup for rheumatoid arthritis includes ESR and CRP levels, presence of antibodies to cyclic citrullinated peptide (anti-CCP) bodies, rheumatoid factor, a CBC, kidney function, and hepatic enzymes Lynch syndrome - CORRECT ANSWER hereditary nonpolyposis colorectal cancer (HNPCC), is the most common cause of hereditary colon cancer. Men and women with Lynch syndrome are more likely to get colon cancer or other cancers, such as stomach, liver, kidney, and brain cancer, before the age of 50 Multiple myeloma - CORRECT ANSWER Men are slightly more affected than women. Multiple myeloma should be suspected in any patient presenting with one or more of the following: bone pain resulting from lytic lesions, hypercalcemia, kidney injury, or anemia. Elevated serum protein levels can also be seen in patients with multiple myeloma. -protein electrophoresis and free light chain assay Acute mastoiditis - CORRECT ANSWER Streptococcus pneumoniae is the most common cause of mastoiditis. Mastoiditis presents with fever, headache, and otalgia. Patients will often have a preceding history of acute otitis media which has not resolved after 2 or more weeks. Physical examination reveals postauricular erythema and tenderness, as well as protrusion of the auricle. In addition, the tympanic membrane is erythematous, bulging, and has decreased mobility. A 65-year-old man presents for follow-up after an upper endoscopy. He has a 10-year history of cirrhosis. The upper endoscopy revealed small esophageal varices with red signs. There was no active bleeding seen and no band ligation was performed. Based on his history of cirrhosis and findings on endoscopy, what would be the most appropriate next step in the management of this patient? - CORRECT ANSWER Start nadolol- or other non-selective beta blocker-reduces portal venous inflow Proprioceptive sensitivity loss - CORRECT ANSWER high-stepping and stamping gait, increased risk of falls niacin (vitamin B3) deficiency - CORRECT ANSWER -dementia, dermatitis, and diarrhea -Isoniazid (INH) biochemically competes with niacin and inhibits the conversion of tryptophan to niacin, resulting in niacin deficiency. venous hum - CORRECT ANSWER Common innocent murmur. It is low-pitched and is best heard in the right or left supraclavicular or infraclavicular areas. The low-pitch quality allows for the murmur to be best heard with the bell of the stethoscope. A 53-year-old man presents with weight loss, anorexia, abdominal pain, jaundice and early satiety. Which of the following is the most appropriate initial diagnostic test to diagnose and stage pancreatic cancer? - CORRECT ANSWER CT scan What is the most common form of psoriasis? - CORRECT ANSWER Psoriasis vulgaris primary hyperparathyroidism - CORRECT ANSWER asymptomatic hypercalcemia, which is typically detected as an incidental finding on routine blood testing. Manifestations of hypercalcemia include paresthesias, muscle cramps, fatigue, and depression. Cardiovascular symptoms may include hypertension, palpitations, prolonged PR interval, shortened QT interval, bradydysrhythmias, and heart block systolic murmur at the apex. The murmur is associated with a midsystolic click - CORRECT ANSWER -Mitral valve prolapse occurs due to a mitral valve leaflet abnormality. The associated murmur is systolic with a mid- to late-systolic click, heard best at the apex of the heart. Symptoms can include palpitations, depression, anxiety, fatigue, or syncope -procedural antibiotic prophylaxis is indicated to avoid infective endocarditis A 66-year-old man presents to the clinic for his annual wellness visit. Which of the following factors places the patient at risk for hypertension? - CORRECT ANSWER A1C of 8% Which of the following is the most sensitive diagnostic test for genital herpes simplex virus infection? - CORRECT ANSWER Polymerase chain reaction-based testing A 16-year-old boy presents with a scalp rash. On examination, it is a 5 x 5 cm boggy and thickened area of the right parietal cap with an overlying scaly and crusty plaque and hair loss. The lesion appears yellowish-green under a Wood lamp. What is the treatment of choice for this lesion? - CORRECT ANSWER Oral griseofulvin, dx: is best treated with oral griseofulvin. A kerion is an abscess caused by a fungal infection most commonly on the scalp but may also present on the upper limbs and the face. It appears as a boggy, pus-filled lesion with significant inflammation. The overlying skin often has an eczematous, itchy rash as well as hair loss. The patient may also have nearby lymphadenopathy, fevers, and malaise. A 34-year-old man presents to your office with complaints of a dry, nonproductive cough for the past 10 weeks. He also reports clear nasal drainage and frequent watery eyes. He is a nonsmoker, reports no past medical history, and takes no prescription medications. On physical examination, you notice a cobblestone appearance and clear exudate to the oropharynx. His lung fields are clear to auscultation. Which of the following is the most likely diagnosis in this patient? - CORRECT ANSWER Upper airway cough syndrome Which of the following tests would confirm a diagnosis of systemic lupus erythematosus (SLE)? - CORRECT ANSWER Anti-double stranded deoxyribonucleic acid (DNA) antibody A 56-year-old man underwent a prolonged pelvic surgery. Two weeks later, he reports frequent tripping over his right foot. Strength examination of the right foot reveals: 5/5 plantar flexion, 5/5 ankle inversion, 3/5 ankle eversion, and 2/5 dorsiflexion. Light touch sensation is diminished over the lateral but not medial shin. Ankle and knee reflexes are intact. Injury to which one of the following nerves is most likely causative? - CORRECT ANSWER Common peroneal A three-week-old infant presents to the clinic with his parents who state he is not gaining weight and is feeding poorly. Cardiac auscultation and exam reveal a 2/6 mid-frequency holosystolic murmur heard best at the fourth left intercostal space, a diastolic rumble, and a prominent apical impulse displaced laterally. Tachypnea and tachycardia are also noted. Which of the following is the most likely diagnosis? - CORRECT ANSWER Large ventricular septal defect Which of the following cardiac auscultation findings is most consistent with mitral valve regurgitation? - CORRECT ANSWER Soft S1 and a loud, blowing holosystolic murmur pheochromocytoma - CORRECT ANSWER -A tumor of the adrenal glands that produces catecholamines and is another form of secondary hypertension -Clinical findings include bilateral headache, hypertension, hypermetabolic state, hyperhidrosis, hyperglycemia, and palpitations A 65-year-old woman presents to the clinic for a well visit. She is not on hormone replacement and is a current smoker with a 40 pack-year history. She is 5'2" tall and weighs 115 pounds. The nurse practitioner recommends a bone densitometry measurement and assesses for risk factors related to bone loss. Which of the following is a clinical manifestation of age-related osteoporosis? - CORRECT ANSWER Vertebral fracture Which of the following historical findings will most likely lead to a diagnosis of panic disorder? - CORRECT ANSWER Chest pain Aortic stenosis - CORRECT ANSWER harsh systolic murmur that is best heard at the second right intercostal space and apex of the heart. The murmur is crescendo-decrescendo in pattern, radiates to the carotids, and softens with standing. Dizziness and syncope are ominous symptoms of aortic stenosis and indicate decreased cardiac output. Valve replacement is the standard treatment for symptomatic aortic stenosis, thus referral to surgery is necessary. Which of the following is characterized by macrocytic anemia with increased reticulocytes and Heinz bodies? - CORRECT ANSWER Glucose-6-phosphate dehydrogenase deficiency Porphyria cutanea tarda - CORRECT ANSWER that presents with chronic photosensitivity with the development of blistering and friable lesions on sun-exposed areas of the skin and may manifest as hair loss in women. 67% of patients who have the condition have hepatitis C viral infection Polyarteritis nodosa - CORRECT ANSWER -rare systemic necrotizing vasculitis of medium-sized vessels and suggests multiple pathogenic processes, including immune mechanisms -Clinical onset is insidious, with fever, malaise, weight loss, and generalized weakness, and may exhibit pain in the extremities or neuropathy. The most common skin presentation is ulceration of the lower extremity, usually near the malleoli A 19-year-old woman presents with a recurrent outbreak of orolabial herpes simplex virus. Which of the following is mostly likely to trigger a recurrence of orolabial herpes simplex virus infection? - CORRECT ANSWER Ultraviolet radiation exposure A five-year-old girl is brought to the clinic for evaluation of petechiae. The parents deny fever, decreased appetite, bone or joint pain, or weight loss. She did have a cold and runny nose about a month ago. On physical exam, the girl appears well with normal vital signs, petechiae and purpura on the upper and lower extremities. There are no signs of mucosal bleeding with normal lymph nodes, liver, or spleen. Laboratory studies reveal platelet count of 60,000/microL and an otherwise normal complete blood count. Which of the following is the most likely diagnosis? - CORRECT ANSWER Immune thrombocytopenia Thrombotic thrombocytopenic purpura - CORRECT ANSWER presents with thrombocytopenia, but other manifestations include schistocytes on the peripheral smear, anemia, and neurologic abnormalities, which were not present on the patient. A 33-year-old woman presents to the clinic with a three-month history of amenorrhea. Her cycles are typically 26-28 days. Her follicle stimulating hormone, thyroid stimulating hormone, and luteinizing hormone levels are within normal limits, and her pregnancy test is negative. What is the best medication for this condition? - CORRECT ANSWER Medroxyprogesterone 10 mg daily for 10 days is a progesterone challenge to induce bleeding. A 64-year-old woman with a 50 pack-year history of smoking cigarettes presents with a four-day history of a productive cough with shortness of breath and wheezing. She is coughing up copious "green" mucus. She has no other health issues, but she has had two other exacerbations this year. She is diagnosed with an exacerbation of her chronic bronchitis. Which of the following is the best treatment for this patient? - CORRECT ANSWER Clarithromycin 500 mg twice daily for seven days is the recommended treatment for a moderate to severe exacerbation of chronic bronchitis in a patient with no other comorbidities. A 14-year-old girl is brought in by her mother with concerns for acne. She has tried over-the-counter acne preparations but continues to have skin lesions. On exam, there are multiple closed comedones scattered across the forehead, nose, and chin area without much inflammation. There are no pustular lesions. Which of the following would be the best initial pharmacotherapeutic treatment? - CORRECT ANSWER A topical retinoid, such as tretinoin, is the appropriate first-line treatment for noninflammatory acne vulgaris Analysis of a peripheral blood smear reveals a normocytic, normochromic anemia with blast cells and Auer rods. This is most consistent with what diagnosis? - CORRECT ANSWER AML A 24-year-old man presents with left eye pain and redness. He reports the symptoms started this morning. He does not recall injuring his eye. He is a contact lens wearer and reports infrequent cleaning and keeping them in for longer than the recommended time. He was able to remove the contact this morning with no difficulty. He reports clouding of vision in the left eye and an inability to hold his eyelid open secondary to the discomfort. On physical examination, his vital signs are normal. He has marked erythema to the left eye with excessive tearing. Both pupils are equal, round, and reactive to light. There is a corneal opacity noted in the left eye on examination with a penlight. This opacity stains with fluorescein dye. There is a small amount of purulent discharge noted to the medial canthus of the left eye. What is the most likely diagnosis in this patient? - CORRECT ANSWER Keratitis A 25-year-old woman with a new diagnosis of celiac disease presents to the clinic with abdominal pain and diarrhea. Which of the following foods should the patient remove from her diet completely? - CORRECT ANSWER Wheat, rye, barley A 55-year-old woman presents to the clinic for follow-up on lab work for her recently diagnosed glomerulonephritis. She has a normal serum creatinine of 0.9, proteinuria of 4.0 g/day, and no edema on physical exam. Which of the following is the best treatment for this patient? - CORRECT ANSWER Prednisone 1 mg/kg/day for 12 weeks A 60-year-old woman presents to the clinic complaining of severe vulvar itching and burning that has persisted for 8 months. She reports she has been treated with diflucan three separate times and terconazole externally without complete resolution of symptoms. Physical exam reveals labial agglutination, ivory white plaques with purpura, and excoriations in a figure-eight pattern around the vulva and perianal area. Wet prep shows negative whiff, negative hyphae, negative clue cells, and positive lactobacillus. Which of the following is the most likely diagnosis? - CORRECT ANSWER The classic lichen sclerosus physical findings are thin fragile skin with white plaques. Other major findings often include purpura, fissures, excoriations from scratching, a "cigarette paper" appearance, and labial agglutination. Phimosis may also be present over the clitoral hood and urethra. The lesions often have a figure-eight formation around the vulva and perianal region. PMS treatment vitamin - CORRECT ANSWER According to the International Society for Premenstrual Disorders, calcium supplementation has the strongest empirical evidence as a dietary supplement in treating PMS. The mechanism of action may be to regulate periovulatory calcium homeostasis. Calcium 600 mg twice a day has been shown to improve the emotional and physical symptoms experienced by women with PMS the characteristic skin rash of Lyme disease - CORRECT ANSWER Erythema migrans Which of the following laboratory results is consistent with Addison disease? - CORRECT ANSWER Increased ACTH level and decreased cortisol level A 43-year-old woman presents to the clinic for her annual physical. She reports some concerns about changes in weight, depression, irregular menses, and increased sweating. She has a history of chronic low back pain and asthma. On exam, you note a buffalo hump, hirsutism, acne, and hyperhidrosis. Her blood pressure is found to be elevated at 171/96 mm Hg. Which of the following findings is most likely to be increased with the suspected condition? - CORRECT ANSWER Cushing syndrome is caused by an increase of adrenocorticotropic hormone in the body. A nurse practitioner is lecturing a class of students on different eye disorders. Which of the following are more likely to cause bacterial conjunctivitis in the pediatric population? - CORRECT ANSWER Streptococcus pneumoniae A 32-year-old woman presents to the clinic with a six-month history of painful intercourse. She reports never having intercourse until six months ago on her wedding night and describes burning pain upon penetration that lasts for several hours. She reports having regular menstrual cycles every four weeks and menarche at 13 years of age. She has never used tampons. Physical examination reveals normal vagina mucosa. She reports pain upon separation of the labia minora and when a cotton swab is lightly pressed over her posterior introitus. Laboratory testing including a vaginal pH, wet mount, and yeast culture was negative. Which of the following is the best treatment option? - CORRECT ANSWER Duloxetine is a selective norepinephrine reuptake inhibitor that has shown to improve symptoms of vulvodynia A 35-year-old woman presents to the clinic with left eye pain and photophobia that started this morning. She wears contact lenses regularly. Fluorescein testing reveals a corneal abrasion. Which of the following is indicated in the management of this patient? - CORRECT ANSWER Ciprofloxacin 0.3% ophthalmic ointment A 48-year-old man complains of weakness and general malaise that has occurred for about 3 months. He denies any recent illness and does not take any medications. Physical examination reveals a pale looking man in no acute distress. His heart rate is 110 beats per minute without a murmur and his abdominal examination reveals hepatosplenomegaly. Laboratory findings are significant for a WBC of 62,000 and hemoglobin is 8.3, A cell differential reveals a predominance of myeloblasts and promyelocytes with Auer rods present. What is the most likely diagnosis? - CORRECT ANSWER Acute myeloid leukemia Which of the following is the most common type of invasive breast cancer in women? - CORRECT ANSWER Infiltrating ductal A 38-year-old woman with no significant history presents to the clinic with complaints of amenorrhea for the past 14 months, night sweats, and hot flashes. The clinician is concerned for premature ovarian failure. Which of the following places the patient most at risk for this diagnosis? - CORRECT ANSWER Family history A six-year-old girl presents with sore throat and fever for the past three days. Physical exam reveals a faint, generalized rash on the face and chest that feels rough upon palpation. The rash spares the circumoral area. Exam of the oral cavity reveals a bright red tongue with white papillae. What is the most likely diagnosis? - CORRECT ANSWER Scarlet fever A 50-year-old woman presents to the clinic with reports of insomnia and fatigue. She is perimenopausal and shares that she has been experiencing worsening and bothersome hot flashes on a nightly basis. Her medical history includes venous thromboembolism of the right calf and controlled hypertension. She currently takes lisinopril 20 mg and a multivitamin. Which of the following is the most appropriate therapy for her symptoms? - CORRECT ANSWER Venlafaxine 37.5 mg daily A 14-day old boy is brought to clinic for a well-child check. The boy was born full-term via normal spontaneous vaginal delivery to a G2, P2 mother who had limited prenatal care. There were no complications at delivery. The boy has not yet regained birth weight and has been breastfeeding poorly. On physical examination, you note bluish discoloration of the lips and oral mucosa, clear breath sounds and a harsh left upper sternal border murmur. Which of the following chest X-ray findings is consistent with Tetralogy of Fallot? - CORRECT ANSWER Lack of vascular congestion A 28-year-old woman at 36 weeks gestation presents to the clinic with rectal itching and discomfort when sitting for the past week. She has pain with bowel movements and has noticed bright red blood on the toilet paper after defecation. She has had constipation throughout most of her pregnancy. Physical exam reveals a visible hemorrhoid that prolapses with Valsalva maneuver then retracts spontaneously. Which of the following is the best treatment option for symptomatic relief in this patient? - CORRECT ANSWER Docusate sodium A 38-year-old woman presents with lower abdominal pain and bloating for the past year. She describes her abdominal pain as mild cramping that occurs 3-4 times per week and is partially relieved with a bowel movement. She reports having a bowel movement 2-3 times per week and describes the stool as hard and difficult to pass. She reports no blood in her stool. She reports no recent weight loss. She has no pertinent past medical history and takes no medications. She has been following a gluten- and lactose-free diet for the past 6 months with mild improvement in bloating and abdominal pain. She started taking a daily 17 g dose of polyethylene glycol with no improvement in the frequency or consistency of her bowel movements. Her grandfather had colon cancer diagnosed at the age of 67. She reports no other relevant family history. On physical examination, her vital signs are normal. Her abdominal examination is unremarkable. Results from a thyroid-stimulating hormone, complete blood count, and chemistry panel are normal. What would be the most appropriate next step in the management of this patient's condition? - CORRECT ANSWER The patient is likely presenting with irritable bowel syndrome with constipation (IBS-C). She was refractory to dietary modifications and the osmotic laxative polyethylene glycol. The next most appropriate step in the management of this patient's condition would be to initiate lubiprostone You are seeing a 74-year-old woman with lung cancer. Her family is concerned because her appetite has been extremely decreased over the past couple months. They have been offering her additional calories, but she does not seem to be gaining weight. Which of the following medications can be offered to this patient to help stimulate her appetite? - CORRECT ANSWER Megestrol acetate An 8-year-old girl is diagnosed with childhood absence epilepsy. Which of the following is the first-line pharmacologic treatment for this type of seizure disorder? - CORRECT ANSWER Ethosuximide Which one of the following triptans has been found to be effective in preventing menstrual migraine? - CORRECT ANSWER Frovatriptan Which of the following labs should be ordered first when a patient has suspected acromegaly? - CORRECT ANSWER Insulin-like growth factor 1 Which antiepileptic medication commonly causes hyponatremia at therapeutic doses? - CORRECT ANSWER Oxcarbazepine You suspect a new patient has systemic lupus erythematosus based on symptomatology and physical exam. What laboratory tests in addition to an ANA should be ordered to help confirm the diagnosis? - CORRECT ANSWER Anti-Smith antibody and anti-double-stranded DNA What is the most common cause of acquired aortic valve stenosis in the United States? - CORRECT ANSWER Degenerative calcific changes A 40-year-old woman presents to the clinic for a routine checkup. Her complete blood count reveals a platelet count of 468,000/µL. Which of the following may explain this abnormal finding? - CORRECT ANSWER Iron deficiency anemia What is the recommended first-line treatment for pneumocystis pneumonia? - CORRECT ANSWER Trimethoprim-sulfamethoxazole Koilonychia is most consistent with a deficiency in which of the following? - CORRECT ANSWER Iron An 18-year-old woman presents to the clinic for vaginal itching, irritation, and odor. She used an over-the-counter treatment for yeast infection that did not resolve the problem. Speculum exam reveals green, frothy discharge and a strawberry cervix. Wet prep results are pH 6.0, positive amine, positive trichomonads, negative hyphae, and positive leukocytes. Which of the following is the correct pharmacologic treatment? - CORRECT ANSWER Tinidazole 2 g orally in a single dose Which of the following is the recommended first-line treatment for complex recurrent aphthous stomatitis in children? - CORRECT ANSWER Oral prednisone A 26-year-old woman presents to the office requesting substance abuse treatment. She says that she has been injecting heroin daily for the past three years, numerous attempts at quitting on her own have been unsuccessful, and she has never tried any pharmacotherapy to address her symptoms. Which of the following is the most appropriate therapy? - CORRECT ANSWER Buprenorphine A 48-year-old woman presents to the clinic complaining of abdominal pain, bloating, and flatulence for 5 days. Which of the following tests will confirm a diagnosis of small intestine bacterial overgrowth? - CORRECT ANSWER Carbohydrate breath test Which lab marker elevation has the highest positive predictive value for a biliary etiology in patients diagnosed with acute pancreatitis? - CORRECT ANSWER Alanine aminotransferase ALT Which of the following diagnostic tests should be ordered if you suspect suppurative thyroiditis in an adolescent patient? - CORRECT ANSWER Ultrasonography The type of urinary incontinence that involved detrusor instability is: - CORRECT ANSWER Urge incontinence X-ray views after falling on shoulder - CORRECT ANSWER AP, scapular Y, axillary [Show More]

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