True or false:

Causes of peripheral vertigo include: migraines, brainstem ischemia, cerebellar infarctions/hemorrhages, chiari malformation, or MS.

False-

Causes of CENTRAL vertigo include: migraines, brainstem ischemia, cerebellar infarctions/hemorrhages, chiari malformation, or MS.

***Causes of peripheral vertigo include: benign paroxysmal positional vertigo, vestibular neuritis, herpes zoster oticus, Meniere's, concussion, fistulas, neuroma, aminoglycoside toxicity, or OM.

How long does vertigo last?

a. 5 mintues

b. 5 hours

c. it varies

d. permanently

When vertigo lasts only 1 minute or less, it is most likely what kind of vertigo?

a. Meniere's-related

b. Central vertigo

c. migraine-related

d. peripheral/benign paroxysmal positional

d. peripheral/benign paroxysmal positional

When vertigo lasts several minutes to an hour, it is most likely what kind of vertigo?

a. Meniere's-related

b. Central vertigo

c. migraine-related

d. peripheral/benign paroxysmal positional

When vertigo is recurrent, lasting several minutes each, is most likely what kind of vertigo?

a. Meniere's-related

b. Central vertigo

c. migraine-related

d. peripheral/benign paroxysmal positional

Vertigo sx c/b vestibular neuritis, MS, infarction of the cerebellum/brainstem typically last:

a. 1 minute or less

b. 5 minutes or less

c. several minutes to an hour

d. days

Which cranial nerves help to maintain gaze during head movement?

a. CN III

b. CN IV

c. CN VI

d. all of the above

Acute unilateral vestibular lesions will cause _____________ vestibular activity and ___________ nystagmus.

a. symmetrical; horizontal

b. asymmetrical; beating

c. symmetrical; beating

d. asymmetrical; horizontal

With a normal Weber hearing test, the sound should:

a. localize to affected ear

b. localize to unaffected ear

c. be equal in both ears

d. none of the above

With sensorineural hearing loss, the sound from a Weber hearing test, should:

a. localize to affected ear

b. localize to unaffected ear

c. be equal in both ears

d. none of the above

With conductive hearing loss, the sound from a Weber hearing test, should:

a. localize to affected ear

b. localize to unaffected ear

c. be equal in both ears

d. none of the above

With sensorineural hearing loss, the sound from a Rinne hearing test, should:

a. localize to affected ear

b. localize to unaffected ear

c. be equal in both ears

d. diminished in both ears

What indicates a normal Rinne test?

a. AC>BC

b. BC>AC

What indicates conductive hearing loss on a Rinne test?

a. AC>BC

b. BC>AC

Dx of suspected central lesion includes obtaining an M___________ and/or M__________.

If nystagmus worsens with Frenzel goggles or remains the same in all directions of gaze, the likely culprit is a ___________ lesion.

a. central

b. peripheral

c. vestibular

d. any of these

If nystagmus improves with changes in directions of gaze, the likely culprit is a ___________ lesion.

a. central

b. peripheral

c. vestibular

d. any of these

What kind of vertigo?

Sx d/t endolymphatic compartment distention; sx are episodic, lasting 20 mintues to hours, typically involving sensorineural hearing loss, tinnitis, and unilateral aural pressure; tx with low sodium diet, diuretic (acetazolamide), or intratympanic corticosteroid injection (refractory cases):

a. Meniere's-related

b. labrynthitis

c. benign Paroxysmal positional vertigo (BPPV)

d. migraine-related

e. acoustic neuroma

What kind of vertigo?

Acute onset of severe vertigo lasting several days w/ hearing loss and tinnitis on affected side; tx w/ diazepam or meclizine, add antibiotic if febrile:

a. Meniere's-related

b. labrynthitis

c. benign Paroxysmal positional vertigo (BPPV)

d. migraine-related

e. acoustic neuroma

What kind of vertigo?

Sx lasting several minutes and occuring in clusters over several days; associated w/ head movement; need MRI to r/o central lesions w/ recurrent sx; tx w/ PT manuevers to r/o otoconia w/in semicircular canal:

a. Meniere's-related

b. labrynthitis

c. benign Paroxysmal positional vertigo (BPPV)

d. migraine-related

e. acoustic neuroma

What kind of vertigo?

Sx usually occur w/ headache and consist of sensitivity to light, smell, sound, and motion; often have hx of motion sickness; triggers can include food, lack of sleep, anxiety, hormones, and ETOH; tx by treating triggers or anti-migraine meds:

a. Meniere's-related

b. labrynthitis

c. benign Paroxysmal positional vertigo (BPPV)

d. migraine-related

e. acoustic neuroma

What kind of vertigo?

One of the most common intracranial tumors; majority is unilateral in nature w/ hearing loss; may be sudden; continuous dysequilibrium, episodic vertigo; dx w/ MRI; tx w/ surgery, SRS, and/or chemo:

a. Meniere's-related

b. labrynthitis

c. benign Paroxysmal positional vertigo (BPPV)

d. migraine-related

e. acoustic neuroma

____% of cases of syncope are reflex related (neurally-mediated, orthostatic hypotension, vasovagal).

a. 1

b. 18

c. 23

d. 58

____% of cases of syncope are cardiac-related (brady or tachy arrythmyias.

a. 1

b. 18

c. 23

d. 58

____% of cases of syncope are neurologic or psychiatric in nature.

a. 1

b. 18

c. 23

d. 58

____% of cases of syncope are unexplained.

a. 1

b. 18

c. 23

d. 58

What testing should be included in the w/u for syncope?

a. CBC

b. FOBT

c. ECG

d. all of the above

identify the underlying cause

***metabolic causes (hypoxia, hypoglycemia, anemia); drug-related causes (diuretics, anti-HTN, antidepressants); orthostatic causes (volume depletion, autonomic neuropathy)

What tx options are appropriate for a syncope pt w/ cardiomyopathy? (select all that apply)

a. surgery

b. BBs

c. CCBs

d. pacemaker

What tx options are appropriate for a syncope pt w/ arrhythmias? (select all that apply)

a. surgery

b. meds

c. pacemaker

d. ablation

What tx options are appropriate for a syncope pt w/ reflex syncope (aka vasovagal)? (select all that apply)

a. counter pressure

b. volume support

c. BBs

d. all of the above

d. all of the above

***although the evidence to support BB use is limited

What medications can be used to tx reflex syncope? (select all that apply)

a. midodrine

b. paroxitine

c. disopyramide

d. theophylline

e. ACE inhibitors

a, b, c, d, e

***most evidence for the use of these medications is anecdotal at best

When can a pt drive after tx w/ medications for cardiac arrhythmia-related syncope?

a. immediately/no restrictions

b. after 1 month

c. after 3 months

d. after 1 week

When can a pt drive after a pacemaker implant?

a. immediately/no restrictions

b. after 1 month

c. after 3 months

d. after 1 week

When can a pt drive after tx w/ catheter ablation?

a. after success is established

b. after 1 month

c. after 3 months

d. after 1 week

When can a pt drive after ICD implant?

a. after success is established

b. after 1 month

c. after 3 months

d. after 1 week

When can a pt drive after a single, mild episode of syncope?

a. immediately/no restrictions

b. after 1 month

c. after 3 months

d. after 1 week

When can a pt drive after dx of recurrent/severe reflex syncope?

a. after sx are controlled

b. after 1 month

c. after 3 months

d. after 1 week

When can a pt drive after an episode of unexplained syncope?

a. immediately/no restrictions

b. after 1 month

c. after 3 months

d. after 1 week

What is the recommended dosage for nicotine gum for a pt who smokes >25 cigarettes per day?

a. 2 mg

b. 4 mg

c. 6 mg

d. 8 mg

What is the recommended dosage for nicotine gum for a pt who smokes <25 cigarettes per day?

a. 2 mg

b. 4 mg

c. 6 mg

d. 8 mg

What are the 3 general classes of FDA-approved drugs for smoking cessation?

a. nicotine replacement therapy, psychotropics, partial nicotinic receptor antagonist

b. nicotine replacement therapy, antipsychotics, partial nicotine receptor agonist

c. nicotine replacement therapy, psychotropics, partial nicotinic receptor agonist

d. nicotine replacement therapy, antipsychotics, partial nicotinic receptor antagonist

What is an example of a psychotropic approved for smoking cessation?

a. varenicline (Chantix)

b. nicotine gum/patch/lozenge/nasal spray/inhaler

c. bupropion (Zyban)

d. buspirone (buspar)

What is an example of a partial nicotinic receptor agonist approved for smoking cessation?

a. varenicline (Chantix)

b. nicotine gum/patch/lozenge/nasal spray/inhaler

c. bupropion (Zyban)

d. buspirone (buspar)

How much nicotine does step 1 of NicoDerm CQ contain?

a. 3 mg

b. 7 mg

c. 14 mg

d. 21 mg

How much nicotine does step 2 of NicoDerm CQ contain?

a. 3 mg

b. 7 mg

c. 14 mg

d. 21 mg

How much nicotine does step 3 of NicoDerm CQ contain?

a. 3 mg

b. 7 mg

c. 14 mg

d. 21 mg

For a light smoker (<10 cigarettes per day), what is the recommended dosing and steps for NicoDerm CQ?

a. 21 mg x6 wks, 14mg x2 wks, 7mg x2 wks

b. 14mg x6 wks, 7mg x2 wks

For a heavy smoker (>10 cigarettes per day), what is the recommended dosing and steps for NicoDerm CQ?

a. 21 mg x6 wks, 14mg x2 wks, 7mg x2 wks

b. 14mg x6 wks, 7mg x2 wks

Patients given varenicline (Chantix) should be started on the medication ________ prior to their quit date.

a. 4 weeks

b. 3 weeks

c. 2 weeks

d. 1 week

Patients given varenicline (Chantix) should be started on ____mg daily on days 1-3, ____mg BID on days 4-7, and ___mg BID from day 8 until completion of therapy.

a. 0.5; 0.5; 0.5

b. 1; 0.5; 1

c. 0.5; 0.5; 1

d. 1; 1; 1

Patients given varenicline (Chantix)

can receive the medication for up to how many weeks?

a. 9 weeks

b. 10 weeks

c. 11 weeks

d. 12

Patients given bupropion SR (Zyban) should be started on the medication ________ prior to their quit date.

a. 1-2 weeks

b. 3-4 weeks

c. 1-2 days

d. 3-4 days

Patients given bupropion SR (Zyban) should be started on ____mg PO every morning for _____ days, then given ____mg PO BID until completion of therapy.

a. 150; 7; 150

b. 150; 3; 150

c. 75; 7; 150

d. 75; 3; 150

Patients given bupropion SR (Zyban) can be treated w/ the medication for ____-____ weeks.

a. 1-2

b. 5-6

c. 8-10

d. 7-12

True or false:

You must draw labs for Zyban until the therapeutic plasma level is acheived.

True or false:

Zyban does not increase the risk of seizures and is safe to give pts w/ a hx of epilepsy, anorexia/bulimia, cirrhosis, or ETOH/sedative withdrawal.

Which stage of rosacea?

Episodic flushing and blushing only. 

a. episodic erythema

b. stage I

c. stage II

d. stage III

Which stage of rosacea?

Persistent, deep erythema w/ telangiectases and papules, pustules, and nodules. 

a. episodic erythema

b. stage I

c. stage II

d. stage III

Which stage of rosacea?

Persistent erythema w/ telangiectases.

a. episodic erythema

b. stage I

c. stage II

d. stage III

Which stage of rosacea?

Persistent, deep erythema w/ telangiectases and papules and tiny pustules.

a. episodic erythema

b. stage I

c. stage II

d. stage III

Which of the 4 diagnostic features, along with central facial distribution, must be present in order to dx rosacea?

(select all that apply)

a.flushing

b.comedomes

c.non-transient erythema

d. papules

e.greasy scales

f. telangiectasia

a, c, d, f

***you would see comedomes w/ acne and greasy scales w/ seborrhea psoriasis, not w/ rosacea

What lab work should you obtain for suspected rosacea to r/o staph aureus infection?

a. CBC

b. skin/wound culture

c. bacterial culture

d. all of the above

metronidazole gel or cream (0.75%) BID, w/ improvement in 4-8 weeks

***may also use clindamycin 1%, azelaic acid 15%, or erythromycin gel

What is the systemic drug of choice for the tx of rosacea?

Which skin condition has a herald patch followed by a christmas tree-shaped distribution?

a. psoriasis

b. rosacea

c. pityriasis rosea

d. contact dermatitis

True or false:

The tx of pityriasis rosea involves systemic and topical antifungals with antihistamines for pruritis.

What is the preferred tx for uncomplicated cellulitis?

a. refer to ED

b. vancomycin

c. clindamycin

d. bactrim

d. bactrim

***referral to ED is not necessary unless there is an emergent reason or suspected sepsis; vancomycin and clindamycin are reserved for complicated cases of cellulitis

What is the treatment of choice for uncomplicated folliculitis?

a. topical benzoyl peroxide 5% BID x10d

b. dicloxacillin 250mg QID x10d

c. cephalexin 500mg BID x10d

d. I&D

What is the treatment of choice for complicated folliculitis (i.e. furuncles/carbuncles)?

(select all that apply)

a. topical benzoyl peroxide 5% BID x10d

b. dicloxacillin 250mg QID x10d

c. cephalexin 500mg BID x10d

d. I&D

True or false:

Erythema multiforme minor often involves target-shaped lesions of papules and epidermal detachment.

False-

erythema multiforme minor often involves target-shaped lesions of papules; erythema multiforme major involves at least one mucous membrane

***SJS, once thought to be a major form of EM, is now classified as toxic epidermal necrolysis (TEN) and involves epidermal detachment

Which tinea?

Triad of scalp scaling, alopecia, and cervical adenopathy.

a. tinea curis

b. tinea capitis

c. tinea pedis

d. tinea corporis

Which tinea?

Two forms: gray patch and black dot.

a. tinea curis

b. tinea capitis

c. tinea pedis

d. tinea corporis

Which tinea?

Pruritic and typically begins in the webbing of the feet.

a. tinea curis

b. tinea capitis

c. tinea pedis

d. tinea corporis

Which tinea?

a. tinea curis

b. tinea capitis

c. tinea pedis

d. tinea corporis

Which tinea?

Tx w/ griseofulvin.

Which tinea?

Tx w/

Which tinea?

Tx w/

Which tinea?

Tx w/

What is the tx of choice for dog/cat/human/animal bites?

a. augmentin

b. bactrim

c. doxycycline

d. clindamycin

True or false:

If a bite pt's tetanus status is unknown, you should administer just a Td.

What is the most common autoimmune/inflammatory reason for a FUO in an adult?

a. Takayasu's arteritis

b. Kikuchi's disease

c. familial mediterranean fever

d. polymyalgia rheumatica

What is the most common presentation of a FUO?

a. rare illness presenting atypically

b. common illness presenting atypically

c. rare illness presenting typically

d. common illness presenting typically

What is the best intervention to induce diagnosis?

a. antibiotics

b. corticosteroids

c. analgesics

d. all of the above

What is the most likely dx for an elderly woman w/ FUO c/o unilateral headache w/ labs showing an elevated 

ESR and anemia?

a. temporal arteritis

b. polymyalgia rheumatica

c. periarteritis nodosa

d. Still's dz

What is the most likely dx for a woman w/ FUO c/o bilateral headache, lumbar pain, and joint/muscle stiffness in the morning w/ labs showing an 

ESR >50?

a. temporal arteritis

b. polymyalgia rheumatica

c. periarteritis nodosa

d. Still's dz

What type of cancer commonly causes a FUO?

a. renal cell carcinoma

b. ductal cell carcinoma

c. lung carcinoma

d. lymphoma

On average, in a patient w/ relative bradycardia, how much lower than normal will the HR be with any fever >102 degrees?

a. 5 bpm

b. 10 bpm

c. 15 bpm 

d. 20 bpm

b. 10 bpm

***for a fever of 102, the normal HR response is <110, but in a pt w/ relative bradycardia, the HR is <100; for a fever of 103, the normal HR response is 120, but in a pt w/ relative bradycardia, the normal HR response is <110; etc. 

True or false:

Animal control should not be contacted if your own pet bites you.

False-

animal control should be contacted regarding ALL animal bites, even bites by known animals; however, many of these bites go unreported

For rabies prophylaxis after an animal bite, what needs to be done on day 0? 

a. 5 rabies vaccines IM

b. 20 IU/kg of human rabies immune globulin + 1 rabies vaccine IM

b. 1 rabies vaccine IM

d. 10 IU/kg of human rabies immune globulin + 1 rabies vaccine IM

On what days do the remaining 4 rabies vaccines need to be given (for a total of 5 rabies vaccines)?

a. days 2, 6, 13, and 26

b. days 3, 7, 14, and 28

c. days 4, 8, 15, and 30

d. days 5, 9, 16, and 32

True or false:

Rabies prophylaxis is safe during pregnancy.

Which patients would be suitable for hospital admission following an animal or human bite? (select all that apply)

a. a pt w/ HIV

b. a pt w/ S/S of a systemic infection after failed O/P tx

c. a pt w/ a bite requiring reconstructive surgery

d. a healthy adolescent w/ a local infection

e. a pt w/ a bite injury to the tendon in the R hand

f. a homeless man

a, b, c, e, f

***bites that should be considered for I/P tx would include: immunocompromised pts, failed O/P tx, S/S of systemic infection, bites to tendons or requiring surgery, pt who have poor social/home situations

True or false:

Acoustic neuromas are one of the most rare intracranial tumors.

false-

Acoustic neuromas are one of the most common intracranial tumors.

True or false:

After a suspected venomous snake bite, you should immediately attempt to suck out the venom, place a tourniquette around the affected area, and place the area in cold water. 

True or false:

After a venomous snakebite, exicision is not recommended d/t the increase risk of injury and infection and surgical interventions are rarely necessary.

Prior to arriving at the hospital for a snakebite, you should do which of the following? (select all that apply)

a. place a tourniquette around the area

b. elevate the area to heart level

c. wash the area

d. try to suck out the venom

b and c

***tourniquettes should not be used b/c they trap the venom in soft tissue and sucking out the venom has not been shown to efficacious 

True or false:

Every suspected venomous snakebite pt received antivenin at the ED.

Which snakebite pt can be discharged from the ED?

a. a pt w/ a "dry bite" who did not receive antivenin

b. a pt who received an envenomous bite but who is not exhibiting any systemic effects

c. a pt exhibiting anaphylaxis

d. all of the above

Which snakebite pt should be admitted to the floor for observation?

a. a pt w/ a "dry bite" who did not receive antivenin

b. a pt who received an envenomous bite but who is not exhibiting any systemic effects

c. a pt exhibiting anaphylaxis

d. all of the above

b. a pt who received an envenous bite but who is not exhibiting any systemic effects

***this pt should be observed for =/>24 hours for delayed systemic effects

Which snakebite pt should be admitted to the ICU?

a. a pt w/ a "dry bite" who did not receive antivenin

b. a pt who received an envenomous bite but who is not exhibiting any systemic effects

c. a pt exhibiting anaphylaxis

d. all of the above

c. a pt exhibiting anaphylaxis

***a pt w/ a snakebite exhibiting systemic effects should also be admitted to the ICU

What is the recommended tx for a brown recluse spider bite?

a. dapsone and/or erythromycin/keflex

b. dapsone and antivenom

c. erythromycin/keflex and antivenom

d. antivenom only

a. dapson and/or erythromycin/keflex

***there is no antivenom for the brown recluse spider in the U.S.

True or false:

A pt can resume regular, strenuous exercise immediately following tx for a brown recluse spider bite.

What medications may be used for the tx of a black widow spider bite? (select all that apply)

a. dapsone

b. calcium gluconate

c. valium

d. erythromycin or keflex

e. nipride

b, c, and e

***nipride may be used if HTN occurs; dapsone and erythromycin/keflex are tx for brown recluse bites and are not indicated for black widow bites b/c of the reduced risk of infection/necrosis

Full thickness tissue loss in which slough (yellow, tan, gray, green or brown), eschar (tan, brown, or black), or both in the wound bed cover the base of the ulcer is called______          

    a. Stage III                          

    b. Stage IV                         

c. Unstageable 

d. Stage II

When educating your patient with a history of seizures you would remind him that which of the following could lower his seizure threshold:                    

    a. High sodium 

    b. Marijuana      

    c. Alcohol            

    d. Anxiety

A patient has a partial thickness wound on the upper extremity caused by trauma. There is minimal drainage and no erythema in the periwound skin. The best management for this wound would include which of the following dressings?          

    a. Calcium alginate                         

    b. Dry gauze       

    c. Hydrocolloid 

    d. Silver-impregnated foam

    In prescribing prednisone for a patient with Bells Palsy, the nurse practitioner considers that its use:

    a. Has not been shown to be helpful in approving outcomes in this condition

    b. should be initiated as soon as possible at 60mg daily for 5 days

    c. May prolong the course of the disease

    d. It is likely to help minimize ocular symptoms

True or false:

A pressure ucler needs at least 24 hours to form.

Mr. Depp is a 44 year old patient whom you are treating for bothersome symptoms of essential tremor that impact his quality of life. As the provider you would most likely prescribe which of the following pharmacologic therapy?

    a. propranolol

    b. amitriptyline

    c. amlodipine

   d. any of the above could be prescribed

A 27 year old female patient with epilepsy is well controlled with phenytoin (Dilantin). She requests information about contraception. The nurse practitioner should instruct her that while taking phenytoin:

a. The effectiveness of an oral contraceptive may be reduced

    b. She should use a very low dose estrogen oral contraceptive

    c. She should use another anticonvulsant along with the phenytoin

    d. Bilateral tubal ligation is recommended

Alcoholism and nutritional deficiencies are most commonly associated with:

    a. Autonomic neuropathy

   b. Sensorimotor polyneuropathy

    c. Sensory neuropathies

    d. Motor neuropathies

What is the initial symptom seen in the majority of patients with Parkinson's disease?

   a. Rigidity

    b. Bradykinesia

    c. Resting tremor

    d. Flexed posture

Which of the following statements is incorrect regarding Huntington Disease?

   a. Chorea and dementia are prominent

    b. The disease is usually fatal within 8-10 years

    c. The disease affects all ethnic groups

    d. Onset is typically between 30- 50 years of age

A 22 year old female presents with a 3 year history of recurrent, pulsating headaches with vomiting and photophobia. The headaches, which generally last 3 hours, can be aborted by resting in a dark room. She can usually tell she is going to get a headache. She states "I see squiggles before my eyes for about 15 minutes". Her physical exam is unremarkable. This presentation is most consistent with:

    a. Tension type headache

    b. Migraine without aura

    c. Migraine with aura

    d. Cluster headache

The typical description of a tension headache is:

    a. Periorbital pain, sudden in onset, often explosive in quality, throbbing

    b. Bilateral occipital, or frontal tightness or fullness with waves of aching pain

    c. Hemicranial pain that is accompanied by vomiting and photophobia

    d. Steadily worsening pain that interrupts sleep and is exacerbated by orthostatic changes

A 34 year old woman has just been diagnosed with multiple sclerosis (MS). When providing primary care for this patient you consider that MS most commonly:

    a. Has a predictable course of progressive decline in intellectual and motor function

    b. Manifests with a classic pattern of headache, hemiparesis, and ataxia

    c. Is seen with a variable pattern of exacerbation and remissions

    d. Is accomplished by classic central nervous system lesions detectable on skull films

A patient presents with a painful, chronic ulcer on the lateral aspect of the foot. The ulcer measures 2.0 cm long by 2.0 cm wide by 1.0 cm deep and has no exudate. There are also small areas of necrosis noted over the nail beds of the 4th and 5th digits. Which of the following ulcer etiologies is most likely the cause?

    a. Venous

    b. Diabetic

    c. Arterial

    d. Pressure

Which of the following be inconsistent with a psychogenic non-epileptic seizure (PNES) :

    a. Typically eyes closed

    b. Often prolonged, waxing and waning

    c. Suggestible

    d. Rhythmic jerking of the body

A heavily draining cavity wound with granulation tissue along the sidewalls and stringy slough covering the base would be best managed locally by:

    a. An alginate dressing

    b. Woven gauze dressing

    c. A hydrocolloid dressing

    d. A transparent film dressing

    Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through the underlying fascia:

    a. Stage I

    b. Stage II

    c. Stage III

    d. Stage IV

The overall goal of therapy for the patient with Parkinson's disease is:

    a. To halt the progression of the disease

    b. Symptom management to keep the person functioning independently as much as possible

    c. To prevent complications of the disease

    d. To ease the depression associated with the disease

A young adolescent is accompanied to the clinic by her mother who states the school reports that the girl stares off into space a lot and does not seem to pay attention during these brief periods, which typically last less than a minute. The neurologic exam is within normal limits The nurse practitioner suspects:

    a. Generalized Tonic Clonic seizure

   b. Atonic seizure

    c. Absence seizure

    d. Focal seizure without dyscognitive features

    A patient with a stage IV pressure ulcer has a granular wound bed with no measurable depth. This ulcer should now be classified as:

    a. A stage II pressure ulcer

    b. A healing stage IV pressure ulcer

    c. A stage III pressure ulcer

    d. An unstageable ulcer

Risk factors for transient ischemic attack (TIA) include all of the following except:

    a. Atrial fibrillation

    b. Carotid artery disease

    c. Oral contraceptive use

    d. Pernicious anemia

An elderly lady comes to the clinic complaining of having difficulty when she tries to do her needlework. She walks straight, although somewhat slowly, and no rigidity is noted on movement. She states the shaking in her hands stops when she holds her hands in her lap. The nurse practitioner makes a tentative diagnosis of:

    a. Parkinson's disease

    b. Transient ischemic attack

    c. Benign essential tremor

    d. Focal seizure with dyscognitive features

You examine a 29-year old woman who has a sudden onset of right sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her examination is otherwise unremarkable. This presentation likely represents paralysis of CN:

    a. III

    b. IV

    c. VII

    d. VIII

    Non-blanchable erythema can be the first sign of tissue destruction in pressure ulcer ________

    a. Stage I

    b. Stage II

    c. Stage III

    d. Stage IV

A 32 y/o female patient is brought to the emergency department by her husband because of symptoms that began as numbness and tingling in both feet and progressed over several days to weakness and gait instability. The symptoms began 10 days following a viral illness. She also has a 5 year history of type 2 DM. On admission, the patient is unable to walk. Physical examination shows sinus tachycardia and weakness in upper and lower extremities bilaterally. This clinical presentation is most consistent with what diagnosis?

    a. Myasthenia gravis

    b. Multiple sclerosis

    c. Gillain-Barre syndrome

    d. Wernicke encephalopathy

A patient returns to the clinic for a follow-up visit. She has a history of focal seizures without dyscognitive features. When questioning the patient regarding the recurrence of seizures, the nurse practitioner would identify the recurrence of this seizure activity if the patient reported:

    a. Short episodes where she loses consciousness, but does not fall

    b. No loss of consciousness but jerking and tingling of her right leg, then right hand

    c. Auditory hallucination, unconsciousness, and urinary incontinence

   d. Short period of unconsciousness, followed by period of confusion

The Ankle Brachial Index is a quick, non-invasive test used to evaluate:

   a. Lymphatic Obstruction

   b. Venous Insufficiency

     c. Protective Sensation

    d. Arterial Blood Flow

    Thymectomy is usually recommended in early treatment of which disease?

    a. Parkinson's Disease

    b. Multiple Sclerosis

    c. Myasthenia Gravis

    d. Huntington's Chorea

Which of the following are the appropriate empiric antibiotics to administer to a 67 year old man with suspected bacterial meningitis

   a.  Vancomycin alone

   b. Vancomycin and Ceftriaxone

    c. Vancomycin and Ceftriaxone and Amoxicillin

   d. Vancomycin and Ceftriaxone and Ampicillin

An 18 year old college freshman is brought to the student health center with a chief complaint of a two day history of progressive headache and intermittent fever. On physical examination he had a positive Kernig and Brudzinski signs. The most likely diagnosis is:

    a. Viral encephalitis

    b. Bacterial meningitis

    c. Acute subarachnoid hemorrhage

  d. Chronic epidural hematoma

Which assessment findings would you expect in a patient with Parkinson's disease?

    a. Frequent blinking and inability to swallowing

    b. Exaggeration of rapid successive movement and loss in automatic movements

    c. Increased swinging of arms while walking and a flexed posture

    d. Loss in automatic movements and impairment of rapid successive movements

A 70 year old patient presents with a 5 week history of recurrent headaches that awaken him during the night. The pain is severe, lasts about 1 hour, and he describes it as a "hot poker behind my left eye". Additional symptoms include lacrimation and nasal discharge. His physical exam is within normal limits. The clinical presentation is most consistent with:

    a. Migraine headache with aura

    b. Cluster headache

    c. Migraine headache without an aura

   d. Increased intracranial pressure

Treatment options in cluster headache include:

    a. Sumatriptan 6mg SQ

    b. Oxygen

    c. Zolmitriptan 10mg PO

  d. All of the above

Which of the following observations is not characteristic of a venous ulcer?

    a. Shallow wound base

    b. Crusted wound borders

    c. Significant edema and blisters

   d. Round symmetrical wound border

A parent, whose son was recently diagnosed with Tourette's syndrome asks the nurse practitioner about the condition. The nurse practitioner understands that:

    a. Tourette's syndrome is quickly diagnosed

   b. Tics occur once a day and they change over time

   c. Children rarely will have attention deficit hyperactivity disorder (ADHD) in conjunction with Tourette's syndrome

    d. Tics are commonly neuromuscular, such as facial grimacing, tongue protruding, neck twitching; rarely are tics vocal

A 34 year old woman present with fatigable muscle weakness with climbing stairs or blow drying her hair. This is associated with some shortness of breath, which improves with rest. This is consistent with which diagnosis:

    a. Acute stroke

    b. Peripheral Neuropathy

   c. Myasthenia Gravis

    d. Parkinson disease

You are evaluating a diabetic patient who complains of lightheadedness, heat intolerance, abnormal sweating, and dry eyes and mouth. Physical examination and routine labs are normal. This patient could be describing symptoms of:

    a. Autonomic neuropathy

    b. Mononeuropathy of diabetes

    c. Sensory neuropathy

    d. Peripheral neuropathy

You have a 22 year old female patient with a two year history of recurrent, unilateral, pulsating headaches with vomiting and photophobia. The headaches, which generally last 3 hours can be aborted by resting in a dark room. Her physical examination is unremarkable. This representation is most consistent with:

    a. Tension type headache

    b. Migraine without aura

    c. Migraine with aura

    d. Cluster headache

Treatment options in Parkinson's include all of the following except?

    a. Levodopa

    b. Chlorpromazine

    c. Ropinirole

    d. Pramipexole

    A 24 year old man diagnosed with Huntington Disease is noted to have disabling chorea. Which of the following is most likely to be helpful for the choreiform movements?

    a. Haloperidol, one to three per day

    b. Carbidopa/levodopa three times a deep

    c. Fluoxetine daily

    d. Deep brain stimulation of the subthalamus

Many visits to emergency departments by adults are prompted by headaches. One symptom that may help the nurse practitioner differentiate a headache that is life threatening is:

    a. It is preceded by an "aura"

    b. It occurs mainly behind one eye and tends to be grouped

    c. The onset is sudden and is accompanied by nuchal rigidity

    d. The headache occurs mainly on awakening

The nurse practitioner is evaluating an elderly patient's tremor. Which assessment is characteristic of an essential tremor rather than a Parkinsonian tremor?

    a. The handwriting is not affected

   b. The tremor occurs with purposeful movements

   c. The tremor occurs at rest

   d. The tremor gets worse with Beta blockers or alcohol

Many patients who suffer from recurrent headaches have similar symptoms with each episode. Which of the follow would be a sign that a headache may be from a more serious cause?

    a. It occurs on the right side

    b. Rhinorrhea occurs with the headache

    c. Headache that continuously becomes more and more painful

    d. The patient is able to sleep through the pain of the headache

The nurse practitioner gently flexes a patient's neck in the direction of the chin touching the chest. If there is pain and resistance to the flexion and the hips and knees flex at the same time, the nurse practitioner accurately describes this finding as a:

    a. Phalen's sign

    b. Romberg's sign

    c. Kernig's signul

    d. Brudzinski's sign

When evaluating a patient with bacterial meningitis, the NP expects to find cerebrospinal fluid (CSF) results of:

    a. Low protein

    b. Predominance of lymphocytes

    c. Glucose at about 30% of serum levels

    d. Low opening pressure

    Each of the following are correct regarding mononeuropathies EXCEPT:

    a. Involvement of a sensory or mixed nerve with pain commonly felt distal to the lesion

   b. Symptoms always develop with entrapment neuropathies

    c. Mononeuropathies may resolve rapidly and spontaneously, or become progressively more disabling and distressing in other cases

    d. The precise neurologic deficit depends on the nerve involved

All of the following regarding Wernicke Encephalopathy are correct EXCEPT:

    a. Characterized by confusion, ataxia, and nystagmus leading to ophthalmoplegia (lateral rectus muscle weakness, conjugate gaze palsies)

   b. Peripheral neuropathy may also be present

    c. Results from a Vitamin D deficiency

    d. Occurs commonly in alcoholics

A 62 year old man with hypertension and diabetes presents with acute right face, arm, leg weakness, slurred speech and right sided hyper-reflexia. These symptoms are consistent with what diagnosis?

    a. Acute stroke

    b. Myasthenia gravis

    c. Inflammatory myopathy

    d. Huntington Disease

A 30 female patient has several episodes of incontinence, weakness, visual loss, and some ataxia. Physical exam reveals slight swelling of the optic disc on funduscopic exam, difficulty in walking heel to toe, lower extremity weakness, 2+ deep tendon reflexes. The nurse practitioner suspects:

    a. Multiple sclerosis

    b. Parkinson's disease

    c. Amyotrophic lateral sclerosis

    d. Post-polio syndrome

Lipid abnormalities associated with PCOS include:

 a. High LDL

 b. High triglycerides

 c. Both A and B

 d. None of the above

An urgent care nurse practitioner is assessing a 45 year-old Caucasian woman with a BMI of 32 for complaints of intermittent right upper quadrant pain that is precipitated by fatty meals over the past few weeks. On examination, the patient's heart and lung sounds are normal. There is no pain over the costovertebral angle (CVA). During abdominal examination, the bowels sounds are hyperactive. Murphy's sign is positive. Which of the following is best described?

 a. Acute cholecystitis

 b. Acute appendicitis

 c. Acute gastroenteritis

 d. Acute diverticulitis.

What are the two most common pathogens in community-acquired UTIs?

 a. Klebsiella pneumonia and Proteus Mirabilis

 b. Staphylococcus saprophyticus and Escherichia coli

 c. Proteus mirabilis and Staphylocococcus saprophyticus

 d. Escherichia coli and Proteus mirabilis

Lactulose may be ordered in a patient with liver disease in order to treat which common complication:

 a. Abnormal prothrombin time

 b. Constipation

 c. Encephalopathy

 d. Infection

Polycystic Ovarian Syndrome is characterized by oligoovulation, multiple small ovarian cysts and sign of _____________ excess:

 a. Androgen

 b. Estrogen

 c. Progesterone

 d. Glucose

Which of these statements regarding the risk/prevalence of interstitial cystitis (IC) is true?

 a. Women develop IC more commonly than men.

 b. IC is not considered a pain syndrome; it is a dysfunctional bladder syndrome.

 c. Persons of Asian descent are more likely to develop IC.

 d. Most patients develop symptoms in the sixth decade of life.

In treating the patient with Interstitial Cystitis (IC), you advise the her to avoid triggers and may also prescribe medications. Which of the following would be least effective at relieving her symptoms?

 a. Amitriptyline (Elavil)

 b. Pentosan Polysulfate sodium (Elmiron)

 c. Hydroxyzine (Atarax)

 d. Ciprofloxacin (Cipro)

An acute febrile illness with jaundice, anorexia, malaise, and an incubation period of 45-160 days, having a chronic and an acute form; and transmitted by parenteral, sexual, and perinatal routes describes:

 a. Hepatitis A

 b. Hepatitis B

 c. Hepatitis C

 d. Hepatitis D

A 36 y/o afebrile woman without health problems presents with dysuria and frequency of urination. Her UA findings include results positive for nitrates and leukocyte esterase. You evaluate these results and consider that she likely has:

 a. A gram negative (-) UTI

 b. Cystitis caused by staphylococcus saprophyticus

 c. Purulent vulvovaginitis

 d. Urethral syndrome

You overhear the patients at the Hepatitis clinic talking in the waiting room. Your patient who was recently diagnosed Hepatitis C asks how she can prevent transmission to others. From the advice she receives (below), which is the correct statement?

 a. "Do not donate blood until 1 year after diagnosis."

 b. "A vaccine is available to prevent transmission."

 c. "There is no possibility of transmission through razors or toothbrushes."

 d. "Abstain from sex during your period."

Your most important tool for the proper and efficient diagnosis of an abdominal complaint is:

 a. Rapid access to radiologic imaging

 b. Meticulous history and physical exam

 c. Rapid access to Laboratory studies

 d. Access to prior medical records

A 28 yr old male reports severe colicky pain consistent with a renal calculi in the distal ureter. Which test would be best to rule in/rule out this differential diagnosis?

 a. Non contrast CT

 b. Urinalysis

 c. Pelvis MRI

 d. Renal ultrasound

A 55 y/o male has dysuria, urgency, perennial pain, and a temperature of 101 degrees F. What is the most likely diagnosis:

 a. Uncomplicated UTI

 b. Epididymitis

 c. Urethritis

 d. Acute bacterial prostatitis

You suspect acute pyelonephritis in an otherwise healthy 31 year old woman who is in gestational week 27. She reports feeling nauseous for 3 days, feverish and has vomited 3 times in the last 24 hours. Your most appropriate intervention is:

 a. Prescribe oral anti emetic such as Zofran (pregnancy class B) and an antibiotic such as Macrodantin (pregnancy class B)

 b. Admit her to the hospital for further evaluation, hydration and antibiotics

 c. Give her IV hydration in your clinic

 d. Both A and C

A 29 year old female is being seen for new onset abdominal pain. She denies prior history of any medical conditions, denies surgeries, is taking no medications. She is a life long non- smoker, drinks one glass of wine on 2-3 days a week, and denies smoking. She complains of a constant "achey" pain in the LLQ, and rates it a 4 to 6 out of 10 in intensity. She denies diarrhea, constipation or vomiting. She has had nausea over the past several days. Tests ordered so far include CBC, ESR, pancreatic enzymes, metabolic profile and clotting panel; all these tests are within normal limits. Which of the following would be the next best test to provide necessary information to safely move forward with her care:

 a. A CT of the abdomen

 b. A Beta hCG

 c. A x-ray of the abdomen, flat and upright

 d. An ultrasound of the abdomen.

In PCOS, a weight loss of 5-7% can trigger resumed menses and increase ____________.

 a. Energy

 b. Fertility

 c. Exercise tolerance

 d. Libido

A 50 year old man is diagnosed with kidney stones related to his renal tubules being unable to reabsorb filtered calcium efficiently and hypercalciuria. Which medication will the nurse practitioner order for long term therapy?

 a. HCTZ (hydrochlorothiazide)

 b. Potassium citrate (Urocit-K)

 c. Allopurinol (Zyloprim)

 d. Bethanechol (Urecholine)

The elderly, children, and the immunocompromised may present with abdominal pain complaints that are:

 a. Atypical

 b. Blunted

 c. Over expressed

 d. No different from other patient populations

A 37 year-old has routine blood work performed during an annual exam. He is found to have elevated liver enzymes. On exam he has a tender, enlarged liver. How should the nurse practitioner proceed?

 a. Repeat the liver enzymes today.

 b. Order a hepatitis panel.

 c. Have patient return in one week for recheck.

 d. Order a CBC.

The patient with Hepatitis A could exhibit which of the following symptoms:

 a. increased appetite

 b. diarrhea

 c. distaste for cigarettes

 d. both b and c

Women with PCOS often develop a condition of unwanted male pattern hair growth called:

 a. Hirsutism

 b. Hirudinea

 c. Acanthosis Nigricans

 d. Acanthocyte

Which of the following increases a patients risk for developing pancreatitis?

 a. Smoking cigarettes

 b. Having an ERCP test performed

 c. Drinking alcohol

 d. All of the above

A 47 year old sexually active male patient is being evaluated for dysuria, fever, and perineal pain. The physical exam by the nurse practitioner reveals a distended bladder and an enlarged prostate that is exquisitely tender upon exam. Further workup could include all of the following except:

 a. A urine culture

 b. Prostate massage

 c. Cultures for gonorrhea and chlamydia

 d. A blood urea nitrogen (BUN) and creatinine

All of the following should be referred to an internist for management due to the high rate of chronic hepatitis except:

 a. Hepatitis A

 b. Hepatitis B

 c. Hepatitis C

 d. Hepatitis D

Patients' who are diagnosed with polycystic ovarian disease should be taught that they are at an increased risk for developing which of the following?

 a. Diabetes Mellitus

 b. endometrial cancer

 c. Cardiovascular disease

 d. All of the above

Which of the following would not be an appropriate antibiotic for empiric treatment of acute prostatitis:

 a. Nitrofurantoin 100mg qid

 b. Trimethoprim/sulfamethoxazole (DS) q 12 hours

 c. Levofloxacin 500 mg qd

 d. Ciprofloxacin 500mg q 12 hours

A 22 year old male patient with HIV completed the 3 injection HBV vaccine 2 months ago. You have checked his response and the laboratory result shows him to be Anti-HBs negative. At this point you would:

 a. Give him a booster

 b. Repeat the 3 shot vaccine and double the dose

 c. Wait 3 months then retest for Hepatitis B surface antibody development

 d. Do nothing, he is immunocompromised and cannot develop the antibodies against HBV

You should associate a positive iliopsoas muscle test result with the following condition:

 a. Cirrhosis

 b. Urinary tract infection

 c. Autoimmune diseases

 d. Acute abdomen

A 31 year old female presents to her physician complaining of increased facial and chest hair, deepening of her voice, irregular menses, and acne. Which of the following is the most likely cause of this clinical presentation?

 a. Polycystic ovarian disease

 b. Metastatic breast cancer

 c. Type II diabetes mellitus

 d. Rheumatoid arthritis

PCOS is generally associated with insulin ___________:

 a. underproduction

 b. Overproduction

 c. Mutation

 d. Resistance

What is the usual clinical presentation of an adult patient with cystitis?

 a. Urinary hesitancy, dribbling and gross hematuria.

 b. Acute onset of chills, fever, and flank pain.

 c. Complaints of dysuria, urgency, frequency, nocturia, and suprapubic pain

 d. Signs and symptoms of irritability, decreased appetite, and vomiting

This medication can be used with oral contraceptives in the PCOS patient as an anti-androgen treatment:

 a. Lupron

 b. Depo-Provera

 c. Glucophage

 d. Spironolactone

A 30 year old is noted to have a UTI with E coli growing on culture. Her NP knows that an upper urinary tract infection leads to increase complications. Which of the following is a common manifestation of an infection of the upper structures of the urinary tract rather than simple cystitis?

 a. Fever

 b. urgency

 c. Hesitancy

 d. Dysuria

A 46 year old man with a history of renal calculi presents to the ED with complaints of severe left flank pain radiating to his groin area. The pain is so severe he is unable to sit still and his skin is pale. He has not tried to take anything for this pain and he has never had this type of pain before. He is also experiencing nausea and vomiting, and his temperature is 99 degrees F. What is the best initial therapy that the nurse practitioner can provide?

 a. Morphine sulfate 2-5 mg IV

 b. Toradol 15 mg IV

 c. Begin Cephalexin

 d. Give A and B together

Which of the following is most commonly associated with pancreatitis?

 a. Gallstones and alcoholism

 b. Hypertriglyceridemia and cholecystitis.

 c. Appendicitis and renal stones

 d. Viral infection and cholecystitis.

A 72 year old man has chronic bacterial prostatitis (type II). What is the initial drug treatment of choice for this patient?

 a. nitrofurantoin (Macrodantin)

 b. Amoxicillin (Amoxil)

 c. Coxycycline (Vibramycin)

 d. Ciprofloxacin (Cipro)

Of the following complaints, which would not be a typical symptom for the patient with interstitial cystitis?

 a. Pelvic pain or discomfort that is worse with a full bladder

 b. Urinary urgency

 c. swelling of the groin (inguinal) nodes

 d. urinary frequency

Cullen's sign would most likely be associated with which of the following:

 a. Severe appendicitis

 b. Acute pancreatitis

 c. SecondaryPeritonitis

 d. Acute hepatitis

With genitourinary tract exposure to the spermicide nonoxynol-9, a woman is likely at increased risk for:

 a. Cervical stenosis

 b. Uncomplicated UTI

 c. complicated UTI

 d. Ovarian malignancy

Which symptom below is NOT classic of gall bladder disease?

 a. Intense, dull pressure in the mid abdomen.

 b. Pain that radiates into the chest, back, or right shoulder blade.

 c. Pain that worsens after a fatty meal

 d. Pain that occurs when the stomach empties

A patient had an acute onset of right upper quadrant pain that has lasted for the past 3 days. He has low-grade fever. Which lab test(s) will be elevated if he has pancreatitis?

 a. CBC

 b. Serum amylase

 c. ALT and AST

 d. CRP

Glucophage can be used as a treatment for PCOS. The prescriber should remember that a patient taking this medication should be checked every 3 - 6 months for the side effect of:

 a. hyperglycemia

 b. elevated TSH

 c. decreased estrogen

 d. lactic acidosis

Appropriate triple therapy treatment for Helicobacter pylori is:

a. Combination of H2-blockers, antacids, and omeprazole

b. Combination of lifestyle changes, Pepto-Bismol, and cimetidine

c. Combination of PPI, amoxicillin, and clarithromycin

d. Combination of H2 blocker, amoxicillin, and antacid

Aminosalicylates (Mesalamine) are primary therapy for:

a. Peptic ulcer disease

b. Mild ulcerative colitis

c. Pancreatitis

d. Hepatitis C

You observe your male patient with complex regional pain syndrome not wearing his right jacket sleeve. The patient reports intense, right arm pain on light touch. You as the provider recognize this pain as:

a. Allodynia

b. Hypoalgesia

c. Neuritis

d. Paresthesia

Billy is a 13 year-old who has constant periumbilical pain shifting to the right lower quadrant, one episode of vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect:

a. Appendicitis

b. Gastroenteritis

c. Acute pancreatitis

d. Rocky mountain spotted fever

A 43 year old patient has a severe exacerbation of his ulcerative colitis. Of the following treatment recommendations, which one is not appropriate for this patient?

a. NPO for 24 to 48 hours or until there is clinical improvement

b. Obtain plain abdominal x-rays (flat and upright) to evaluate for colon dilation

c. Obtain stool cultures for C-difficile, CMV

d. Order an opioid for pain management

Your patient complains of burning, stabbing, constant pain in his toes ever since he had chemotherapy for lung cancer. You suspect:

a. Neuropathic pain

b. Reflex sympathetic dystrophy

c. Nociceptive pain

d. Psychogenic pain

An 83 year-old patient is diagnosed with diverticulitis. Where is her pain typically located?

a. Epigastric area

b. Right or left lower quadrant

c. Left low quadrant

d. Right lower quadrant

After treating a patient for Helicobacter pylori infection, all of the following test would show if H pylori has been successfully cleared except:

a. A fecal antigen assay

b. A urea breath test

c. A serum antibody test

d. A repeat endoscopy with biopsy

A 34 year old male stock broker complains of gnawing epigastric pain for the past 2 weeks that sometimes wakes him from sleep. He is otherwise healthy, smokes less than a ½ pack per day, and his only medication is ibuprofen 600mg once per week. Given this history you suspect peptic ulcer disease:

a. In the gastrum related to H pylori

b. In the duodenum related to H pylori

c. In the gastrum related to NSAID use

d. In the duodenum related to NSAID use

True or false:

A patient with a suspected small bowel obstruction reports her symptoms began 6 hours ago. The fact that she is still passing small amounts of fecal matter and flatus means her bowel cannot be completely obstructed.

A 42 year old patient is being treated for his third flair of ulcerative colitis in the last 10 months. He takes Mesalamine daily. Prednisone was prescribed for this flair and his symptoms did initially improve. He has unsuccessfully tried to taper his prednisone for the last 2 weeks noting a worsening of his symptoms whenever his dose drops below 20mg daily. What is the most appropriate next step:

a. Send patient to surgeon for consideration of colectomy

b. add infliximab to his treatment regimen

c. add sulfasalazine to his treatment regimen

d. add folic acid to his treatment regimen

You suspect your patient has a peptic ulcer. You educate your patient by telling him that peptic ulcer disease has been found to be most commonly associated with: 

a. Anxiety and panic attacks. 

b. Long-term use of NSAIDs. 

c. Infection by Helicobacter pylori. 

d. A family history of peptic ulcers

Redcurrant Jelly" stools are most consistent with: 

a. strangulated bowel loop

b. rectal malignancy

c. diverticulitis

d. bowel intussusception

A 38 year-old white female with a BMI of 32 complains of colicky pain in the right upper quadrant of her abdomen that gets worse if she eats fried food. During physical examination, the nurse practitioner presses deeply on the left lower quadrant of the abdomen then releases pressure quickly. What is the name of this examination? 

a. Rebound tenderness 

b. Rovsings's sign 

c. Murphy's sign 

d. Psoas test

You would suspect a Mallory-Weiss tear in a patient with GI bleeding who has a history of: 

a. PUD and reports taking NSAIDS the last 5 days 

b. colonic vascular ectasias and has been on coumadin for a DVT 

c. diverticuli with recent history of constipation and increased straining 

d. increased alcohol intake and reports severe vomiting 6 hours ago

Your patient has an extended exacerbation of Crohns' disease. Which laboratory test value(s) would you expect to be decreased? 

a. Sedimentation rate 

b. Liver enzyme levels 

c. Vitamins A, B complex, and C levels 

d. Bilirubin level

Which of the following findings is NOT associated with diverticulitis

a. Left lower quadrant abdominal pain

b. A tender mass in the left lower quadrant

c. An elevated temperature

d. A history of irritable bowel syndrome

All of the following treatments are appropriate for the patient with a bowel obstruction except: 

a. Fluid resuscitation

b. Electrolyte repletion

c. Ocreotide

d. Exploratory Laparotomy

Paracentesis reveals ascitic fluid with LDH of 60 units/L, normal amylase, protein 1 gm/dL and a PMN count of 325 cells/mm3. What is the most likely diagnosis based on these findings:

a. Pancreatitis

b. Cirrhosis

c. Sepsis

d. Peritonitis

You are attempting to determine if your acutely ill patient has ascites related to alcoholic hepatitis or primary peritonitis. Which of these tests would be best at differentiating between the two:

a. CT of the abdomen

b. CBC

c. Paracentesis

d. Abdominal Ultrasound

Palliative care should begin: 

a. When the patient has 6 months or less to live 

b. When a chronic disease is diagnosed 

c. When the patient requests it 

d. When the patient has less than 3 months to live

Which of the following statements regarding the epidemiology of inflammatory bowel disease is correct?

a. Oral contraceptive use decreases the incidence of Crohn's disease.

b. Persons of Asian descent have the highest rates of ulcerative colitis and Crohns disease.

c. Smoking may decrease the incidence of ulcerative colitis.

d. Typical age of onset for Crohn's disease is 40-50 years old.

What would be an equianalgesic dose of oral morphine for a patient who is currently taking 2 tablets of Percocet (5mg oxycodone/325 mg acetaminophen) every 4 hours? (do not reduce for incomplete cross tolerance)? 20mg oral oxycodone = 30mg oral morphine

a. Sustained release morphine 60mg every 12 hours

b. Sustained release morphine 30mg every 6 hours

c. Sustained release morphine 45mg every 12 hours

d. Sustained release morphine 30mg every 12 hours

Your patient presents with recent onset of mild to moderate pain of the right ankle. You diagnose an ankle sprain. The most appropriate medication go give for pain would be:

a. Morphine

b. Hydromorphone

c. Gabapentin

d. Vicodin

In a patient with active bleeding from an esophageal varice, the most appropriate initial treatment would be:

a. Beta blocker

b. Endoscopic variceal ligation

c. Transjugular intrahepatic portasystemic shunt

d. Sclerotherapy.

In a patient with a suspected complete bowel obstruction, you realize that a general rule of thumb is "The longer the interval between the onset of symptoms and the appearance of nausea and vomiting __________________________: 

a. The more distal the obstruction

b. The more severe the obstruction

c. The better the prognosis is for the patient

d. The more likely the complaint is psychosomatic

An otherwise health 57 year old patient reports to the primary care office with a new complaint of large volume painless rectal bleeding. She denies diarrhea, constipation, nausea, vomiting or fever. She has had some mild LLQ pain. The source of this bleeding is most likely:

a. A diverticuli

b. Infectious colitis

c. Rectal tear

d. Ulcer in the right colon

The most common source of upper GI bleeding is:

a. Vascular ectasia

b. Esophageal varice

c. Ulcer

d. Neoplasm

The most common type of closed loop bowel obstruction is caused by a:

a. Bezoar

b. Intussusception

c. Fecolith

d. Volvulus

Your 58 year-old male patient has a negative prostate exam by digital rectal exam, however he has a positive FOBT (fecal occult blood test) at his annual physical. The next appropriate test to determine the source of bleeding would be:

a. CBC

b. EGD

c. Colonoscopy

d. Capsule endoscopy

Your patient has intermittent dark tarry stools. You suspect a GI bleed and have ordered an EGD and Colonoscopy. Both tests return unremarkable for bleeding. Your next best step would be:

a. Repeat EGD

b. Capsule endoscopy

c. Repeat Colonoscopy

d. CT of the abdomen and pelvis

You are seeing a patient presents with symptoms consistent with a flair of her ulcerative colitis. Which of the following tests would be inappropriate in this situation:

a. Barium enema

b. Sigmoidoscopy

c. Colonoscopy

d. Abdominal X-Rays

Of the following, which would NOT be an appropriate measure in treating the patient with peritonitis:

a. Paracentesis prior to antibiotic administration

b. Aminoglycoside antibiotic after paracentesis

c. Repeat paracentesis 48 hours after antibiotic started

d. 3rd generation cephalosporin antibiotic after paracentesis.

A technetium labeled RBC scan would be most helpful in the diagnosis of:

a. Diverticulitis

b. Peritonitis

c. Inflammatory bowel disease

d. Obscure GI bleed

A 36 year old male completed triple therapy for H-Pylori peptic ulcer disease. You ordered a urea breath test which returned positive showing the H pylori was not eradicated. Your next step should be: 

a. Retest with a fecal antigen test 

b. Prescribe quadruple therapy 

c. Prescribe another course of triple therapy but changing the clarithromycin to metronidazole 

d. Realize some patients never clear the H pylori and prescribe a daily PPI

Testing of your patient with suspected bowel disease reveals transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect: 

a. Crohn's disease 

b. Ulcerative colitis

c. Infectious colitis

d. Ischemic colitis

The most common cause of mechanical bowel obstruction in all ages is: 

a. Volvulus

b. Adhesions

c. Cancer

d. Hernia

In a 68 year old patient who requires an anti inflammatory for arthritis but has a history of peptic ulcer disease 2 years ago, the best choice would be:

a. Naproxen

b. A 'coxib' (Cox-2 inhibitor)

c. Prednisone low dose

d. Aspirin low dose

A 24 year old male has recently returned from a weekend camping trip with friends. He has ulcerative colitis and history of migraine headaches. He reports a two-day history of headache, nausea, and vomiting with weakness. Which of the following is least likely as a possible cause? 

a. Migraine headache 

b. Exacerbation of ulcerative colitis 

c. Acute gastroenteritis 

d. Norovirus

Duodenal and gastric ulcers have many of the same manifestations. Which of these symptoms is more common with duodenal ulcers?

a. Epigastric or abdominal pain

b. Vomiting

c, Intermittent Dyspepsia

d. Pain that wakes the patient from sleep

1. The nurse practitioner would test the obturator and iliopsoas muscles to evaluate a possible case of which of the following conditions?

a. acute cholecystitis

b. acute appendicitis

c. inguinal hernia

d. gastric ulcer

Your 26 year-old patient is status post elective tubal ligation. She now complains of increased intermittent abdominal pain, constipation, vomiting, and abdominal distention. You suspect: 

a. Peptic ulcer disease 

b. Crohns disease 

c. Diverticulosis 

d. Small bowel obstruction

In a patient with known esophageal varices, the following medication would be the best choice to reduce portal pressure:

a. Octreotide

b. Fluroquinolones

c. Third generation Cephalosporin

d. Lactulose