Which behavior is most characteristic of early adolescence?

a. Arguing with parents and teachers

b. Assimilating adult roles and thinking
c. Exhibiting fatigue more frequently
d. Experimenting with sex and risky behaviors

What is an important part of patient care that can minimize the risk of a formal patient complaint
even when a mistake is made?

Ensuring informed consent for all procedures

Maintaining effective patient communication
Monitoring patient compliance and adherence
Providing complete documentation of visits

A patient expresses concern that she is at risk for breast cancer. To best assess the risk for this
patient, what is the best initial action?

a. Ask if there is a family history of breast cancer.

b. Gather and record a three-generation pedigree.
c. Order a genetic test for the breast cancer gene.
d. Recommend direct-to-consumer genetic testing.

A patient diagnosed with atopic dermatitis asks what can be done to minimize the recurrence of
symptoms. What will the provider recommend?

a. Calcineurin inhibitors
b. Lubricants and emollients
c. Oral diphenhydramine
d. Prophylactic topical steroids

A patient sustains chemical burns on both arms after a spill at work. What is the initial action by
the health care providers in the emergency department (ED)?
 a. Begin aggressive irrigation of the site.
b. Contact the poison control center.
c. Remove the offending chemical and garments.
d. Request the Material Safety Data information.

A patient is taking a sulfonamide antibiotic and develops a rash that begins peeling. Which type
of rash is suspected?

a. Erythema multiforme
b. Stevens-Johnson
c. Urticaria
d. Wheal and flare

A patient sustains an ocular injury in which a shard of glass from a bottle penetrated the eye
wall. The emergency department provider notes that the shard has remained in the eye. Which
term best describes this type of injury?

a. Intraocular foreign body

b. Penetrating eye injury
c. Perforating eye injury
d. Ruptured globe injury

During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the
top of one ear auricle and suspects skin cancer. What will the provider tell the patient about this
lesion?

a. A biopsy should be performed.

b. Immediate surgery is recommended.
c. It is benign and will not need intervention.
d. This is most likely malignant.

A patient experiencing an inflamed pterygia lesion has been prescribed loteprednol topical
steroid drops for 7 days. The patient shows no improvement in symptoms. What is the next
course of action?
 a. Consult with an ophthalmologist.
b. Continue the medication for 7 more days.
c. Prescribe a systemic corticosteroid.
d. Refer the patient to the emergency department.

A patient who has Class II heart failure is taking an ACE inhibitor and reports a recurrent cough
that does not interfere with sleep or activity. What will the provider do initially to manage this
patient?

a. Assess serum potassium and sodium immediately

b. Discontinue the ACE inhibitor and prescribe an ARB
c. Provide reassurance that this is a benign side effect
d. Withhold the drug and evaluate renal and pulmonary function

A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies
headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any
medications. What will the provider do next to evaluate this patient?

a. Assess serum cortisol levels

b. Continue to monitor blood pressure at each health maintenance visit
c. Order urinalysis, CBC, BUN, and creatinine
d. Refer to a specialist for a sleep study

A patient who has been diagnosed with heart failure for over a year reports being comfortable
while at rest but experiences palpitations and dyspnea when walking to the bathroom. Which
classification of heart failure is appropriate based on these symptoms?

a. Class I
b. Class II
c. Class III
d. Class IV

A patient presents with a cough and fever. The provider auscultates rales in both lungs that do
not clear with cough. The patient reports having a headache and sore throat prior to the onset of
coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these
findings, which organism is the most likely cause of this patient’s pneumonia?

a. A virus
b. Mycoplasma
c. S. pneumoniae
d. Tuberculosis

A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and
chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute.
Which diagnostic test will confirm the presence of a pulmonary embolism (PE)?

a. Arterial blood gases (ABGs)

b. Computed tomography (CT) angiography
c. D-dimer
d. Electrocardiogram (ECG)

A patient with a central line develops respiratory compromise. What is the initial intervention for
this patient?

a. Lung ultrasonography (US) to determine the cause

b. Obtaining cultures and starting antibiotics
c. Prompt removal of the central line
d. Rapid assessment and resuscitation

A patient is diagnosed with mild to moderate ulcerative colitis. Which medication will be
prescribed initially to establish remission?

a. Azathioprine
b. Budesonide
c. Infliximab
d. Sulfasalazine
A patient recovering from chronic alcohol abuse reports nausea, vomiting, diarrhea, and
abdominal discomfort. A physical examination is negative for jaundice or ascites. What will the
provider do initially?

a. Obtain a bilirubin level and prothrombin time

b. Order a complete blood count and liver function tests
c. Reassure the patient that this is likely a viral gastroenteritis
d. Refer the patient to a specialist for evaluation and treatment

A patient reports lower abdominal cramping and occasional blood in stools. The provider
suspects inflammatory bowel disease. Which test will the provider order to determine whether
the patient has ulcerative colitis (UC) or Crohn’s disease (CD)?

a. Barium enema
b. Colonoscopy
c. Genetic testing
d. Small bowel series

A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract
infection. After treatment for the urinary tract infection (UTI), what testing is indicated for this
patient?

A. 24-hour urine collection to evaluate for glomerulonephritis

B. Bladder scan
C. Repeat urinalysis
D. Voiding cystourethrogram

Tom is a 22 y/o male who comes to the clinic with a chief complaint of pain during erections. He
notes that he has palpable nodules and his penis is “crooked.” The most likely diagnosis is:

A. Peyronie’s Disease
B. Erectile Dysfunction
C. Phimosis
D. Cryptorchidism
A young adult male reports a dull pain in the right scrotum and the provider notes a bluish color
showing through the skin on the affected side. Palpation reveals a bag of worms on the proximal
spermatic cord. What is an important next step in managing this patient?

A. Anti-infective therapy with ceftriaxone or doxycycline

B. Consideration of underlying causes of this finding
C. Reassurance that this is benign and may resolve spontaneously
D. Referral to an emergency department for surgical consultation

A patient has been taking terazosin daily at bedtime to treat benign prostatic hyperplasia (BPH)
and reports persistent daytime dizziness. What will the provider do?

A. Prescribe finasteride instead of terazosin

B. Recommend taking the medication in the morning
C. Suggest using herbal preparations
D. Switch the prescription to doxazosin

Lolly is a 20 y/o female who has just been started been started on birth control pills (BCPs). The
NP is educating Dolly on danger signs that could lead to a thromboembolic event. Which of the
following are indications of such an event:

A. Abdominal Pain
B. Chest Pain
C. Headaches
D. Eye Problems (Change in vision)
E. All the Above
F. A, B, & D only

A primary care provider sees a new patient who reports having a diagnosis of chronic kidney
disease for several years. The patient is taking one medication for hypertension which has been
prescribed since the diagnosis was made. The provider orders laboratory tests to evaluate the
status of this patient. Which laboratory finding indicates a need to refer the patient to a
nephrologist?

A. Albumin/creatinine ratio (ACR) of 325 mg/g

B. Blood pressure of 145/85 mm H
 C. Glomerular filtration rate (eGFR) of 35
D. Urine red blood cell (RBC) count of 15/hpf

Lucy a 26 y/o female presents to the clinic with a chief complaint of a very pruritic, reddened
vulvogaginal area (“strawberry cervix”). She has dysuria and copious gray-green and bubbly
discharge. Lucy’s most likely diagnosis is:

A. Bacterial Vaginitis
B. Trichomonal Vaginitis
C. Atrophic Vaginitis
D. Candidal Vaginitis

An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema
of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric
reflex. What is the most important intervention?

A. Doppler ultrasound to assess testicular blood flow

B. Immediate referral to the emergency department
C. Prescribing anti-infective agents to treat the infection
D. Transillumination to assess for a “blue dot” sign

Elijah is a 72 y/o African American male who presents to the clinic with the following symptoms: lo
perineal pain, weak urinary stream and multiple trips to the bathroom during the night.

Which of the following are risk factors for Elijah’s diagnosis:

A. Obesity
B. African American
C. Family History
D. Age > 50 y/o
E. All the Above
F. A, B & C only
Paula is a 68 y/o female who presents to the clinic with the following symptoms: bloating and
abdominal discomfort, low back pain, pelvic pain, frequency and constipation. The most likely
cause of these symptoms is:

A. Ovarian Cancer
B. Uterine Cancer
C. Urethral Cancer
D. None of the above

An older male patient reports gross hematuria but denies flank pain and fever. What will the
provider do to manage this patient?

A. Monitor blood pressure closely

B. Obtain a urine culture
C. Perform a 24-hour urine collection
D. Refer for cystoscopy and imaging

Derrick is an 18 y/o male who comes to the clinic with a chief complaint of a palpable nodule on his left
testicle. He notes that it hurts and that it is larger than his right testicle. The “gold standard” for
diagnosis of Derrick’s complaint is:

A. CAT scan

B. Testicular biopsy

C. PSA test

D. Transillumination

Cryptorchidism increases the risk of Testicular Cancer.

True

False

Antacids impair iron absorption.

True
 False

A patient being treated for cancer has had chemotherapy within the past 2 weeks and comes to
the primary care clinic with a fever of 38.5°C. What is the initial action?

A. Obtain a STAT complete blood count (CBC) with differential.

B. Order a chest radiograph.
C. Order blood and urine cultures.
D. Prescribe empirical antibiotics.

A patient is noted to have prolonged bleeding after an intravenous needle is removed. A

subsequent laboratory test reveals a prolonged activated partial thromboplastin (aPTT) time with
a normal prothrombin time (PT). Based on this result, the provider may suspect alteration in
function of which factor?

A. Factor V
B. Factor VII
C. Factor VIII
D. Factor X

Normocytic anemia has a Mean Corpuscular Volume (MCV) of:

A. <80 fL
B. 80-100 fL
C. >100 fL
D. None of the above

A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks
about a family history of bleeding disorders. The patient reports no female relatives who had
excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both
had postsurgical complications related to bleeding. Based on this history, which diagnosis is
possible?

A. Hemophilia
B. Thrombocytopenia
 C. Thrombophilia
D. Von Willebrand disease

Diane is a 40 y/o female who comes to your clinic with a chief complaint of “fatigue. “During the HPI she
tells The NP that she is no longer able to walk a couple of blocks with her neighbor. She states that she
feels her heart “racing” at times; she sometimes feels dizzy, and often has notices that her breathing
increases. This has been going on for a month. The NP draws some stat labs on her and the results are
as follows: Hgb is 8.4, HCT is 33, RBCs are 3.7 and MCV is 68.

All of the following could be the causes of Diane’s anemia except:

A. Iron deficiency
B. Thalassemia
C. Sideroblastic
D. ETOH abuse

A patient has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider
notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a white blood cell
(WBC) of 30,000 cells/mm3 and near normal red blood cell (RBC) and platelet counts. What
will the provider do next to manage this patient?

A. Order coagulation studies to evaluate for coagulopathies

B. Perform biochemical studies to look for hyperuricemia
C. Refer to a specialist for a bone marrow aspirate and biopsy
D. Repeat the complete blood count in 2 weeks

Alice is an 81 y/o female who lives alone and presents to the clinic with the following symptoms: Tingling
and numbness is hands and feet, difficulty walking and problems with fine motor skills. During the
physical exam the NP notices that the Alice’s reflexes are sluggish.

The NP would order which of the following tests to confirm their working diagnosis?

A. Homocysteine level
B. Schilling test
C. Peripheral Blood Smear
D. All the Above
All of the following would be appropriate tests for diagnosing anemia except:

A. RBC
B. MCV
C. WBC
D. RDW

A patient reports a neck mass that has been present intermittently for 5 or 6 weeks which varies
in size. The provider palpates a lymph node measuring 1.25 cm. Which test will provide proper
histologic diagnosis for this patient?

A. Bone marrow aspirate

B. Computed tomography (CT) scan with intravenous (IV) contrast
C. Lymph node biopsy
D. Positron emission tomography (PET) scan

A 30-year-old male patient is diagnosed with Hodgkin lymphoma. Initial lab work reveals a
WBC of 20 ´ 109/L, hemoglobin of 10.1 gm/dL, a serum albumin of 3 g/dL, and lymphopenia of
0.5 ´ 109/L. Staging studies identify stage III disease. What is this patient’s prognostic score?

A. 2
B. 3
C. 4
D. 5

Diane is a 40 y/o female who comes to your clinic with a chief complaint of “fatigue. “During the HPI she
tells The NP that she is no longer able to walk a couple of blocks with her neighbor. She states that she
feels her heart “racing” at times; she sometimes feels dizzy, and often has notices that her breathing
increases. This has been going on for a month. The NP draws some stat labs on her and the results are
as follows: Hgb is 8.4, HCT is 33, RBCs are 3.7 and MCV is 68.

If Diane has iron deficiency anemia the NP would expect the following lab results:

A. RDW high/ MCV low

B. RDW high, MCV high
C. RDW normal (50% of time)/MCV low
 D. None of the above

A 60-year-old female patient has recently lost weight and a physical examination reveals a
beefy-red, sore tongue, with no neurological findings. Based on these clinical findings, what will
the provider anticipate finding in the laboratory data?

A. Decreased homocysteine levels

B. Leukopenia and thrombocytopenia
C. Low hemoglobin and elevated MCV
D. Normal methylmalonic acid level

Management of Metabolic Syndrome includes which of the following:

A. Exercise
B. Weight Loss
C. Lipid Management
D. Aspirin to decrease cardiovascular risk.
E. All the Above
F. A, B & C only

A woman who has hirsutism with acne, and oligomenorrhea will most likely be treated with which
medication to control these symptoms?

a. Finasteride

b. Levonorgestrel

c. Norgestimate

d. Spironolactone

A patient diagnosed with type 2 diabetes mellitus becomes insulin dependent after a year of
therapy with oral diabetes medications. When explaining this change in therapy, the provider
will tell the patient
 a. it is necessary because the patient cannot comply with the previous regimen.
b. that strict diet and exercise measures may be relaxed with insulin therapy.
c. the use of insulin therapy may be temporary.
d. this is because of the natural progression of the disease.

The diagnosis of hyperthyroidism is based on several tests including a decreased TSH.

True

False

Lifestyle interventions that result in weight loss and increased physical activity can prevent or
delay Type 2 DM.

True

False

During pregnancy Free T3 and Free T4 are not changed by TSH.

True

False

All of the following are diagnostic criteria for Type I Diabetes except:

A. Polyuria
B. Polydipsia
C. Polyphagia
D. Weight gain

A HgbA1c of 6.0% is most representative of which blood glucose level:

 A. 126 mg/dL
B. 132 mg/dL
C. 138 mg/dL
D. 144 mg/dL

Normocytic anemia has a Mean Corpuscular Volume (MCV) of:

A. <80 fL
B. 80-100 fL
C. >100 fL
D. None of the above

Bobby is a 20 y/o African American male who comes to the clinic with the following presentation. His
BMI is >85% for his age and sex. His PMH indicates hypertension, hyperlipidemia, and acanthosis
nigricans. Based on his PMH and presenting symptoms the NP would most likely be inclined to identify
him as having:

A. Pheochromocytoma

B. Type 1 Diabetes Mellitus

C. Type 2 diabetes

D. None of the above

Type 1 Diabetes Mellitus is the result of insulin resistance.

True

False

A patient experiences a carpal spasm when a blood pressure cuff is inflated. Which diagnostic
testing will the provider consider evaluating to determine the cause of this finding?

a. Calcitriol level
b. C-reactive protein
 c. Magnesium and vitamin D
d. Protein electrophoresis

Diagnostic studies for Type II Diabetes Mellitus would include which of the following:

A. HbA1C (>6.5%)
B. Fasting Plasma Glucose (= to or >126 mg/dL)
C. Random Plasma Glucose (>200 mg/dL)
D. All the above
E. None of the Above

Basal insulin controls glucose production between meals and overnight.

True

False

A patient has low serum calcium associated with low serum albumin. What is the recommended
treatment for this patient?

a. Calcium supplementation only

b. Correction of other serum electrolytes
c. Thiazide diuretics and sodium restriction
d. Vitamin D and calcium supplementation

In Cauda Equina Syndrome, which nerve roots comprise the “horses tail?”

A. L3 - L5
B. L1 – S2
C. L5 –S4
D. S2 - S4

Amanda is a 30 y/o female who comes to the clinic with a chief complaint of bilateral pain,
swelling and warmth in her hand, knees and feet. Some of her systemic complaints are: fatigue,
malaise, anorexia, weight loss, and fever. After doing her physical exam the NPs primary
diagnosis is:

A. Systemic Lupus Erythematosus

B. Rheumatoid Arthritis
C. Psoriatic Arthritis
D. Osteoarthritis

Amanda is a 30 y/o female who comes to the clinic with a chief complaint of bilateral pain, swelling and
warmth in her hand, knees and feet. Some of her systemic complaints are: fatigue, malaise, anorexia,
weight loss, and fever.

In light of Amanda’s current diagnosis the NP knows that in the later stages of her disease she
may well develop:

A. Boutonniere Deformities
B. Swan Neck Deformities
C. Ulnar Deviation of the metacarpophalangeal joints
D. All the Above

Loss of Achilles tendon reflex most likely indicates a lesion at L5 –S1.

True

False

A postmenopausal female patient has a blood test that reveals hyperuricemia, although the
patient has no symptoms of gout. What will the provider do initially?

A. Ask the patient about medications and medical history

B. Begin therapy with colchicine and an NSAID
C. Recommend a low-purine, alcohol-restricted diet
D. Treat for gout prophylactically to prevent a flare

Which of the following are differentials to consider for osteoarthritis of the shoulder:
 A. Rotator Cuff injury
B. Rheumatoid Arthritis
C. Impingement Syndrome
D. All the Above

Jason comes to the clinic with a knee injury that occurred while he was playing football. The NP
examines the knees, performs the appropriate orthopedic maneuvers and thinks that Jason may
have a torn meniscus. Her next step would be to order which test:

A. Plain X-ray
B. MRI
C. CT Scan
D. None of the Above

Which of the following are risk factors for osteoarthritis?

A. Age
B. Obesity
C. Sports participation
D. History of joint injury
E. All the above
F. A, B, & D only.

A patient experiencing shoulder pain is seen by an orthopedic specialist who notes erythema,
warmth, and fluctuance of the shoulder joint. What is the next step in treatment for this patient?

A. Admit to the hospital for intravenous antibiotics.

B. Inject lidocaine into the joint and reassess in 5 to 10 minutes.
C. Order a plain radiograph of the shoulder to identify possible fracture.
D. Perform a shoulder ultrasound to further evaluate the cause.
A provider discovers a bone tumor as an incidental finding on a radiograph in a patient who has
sustained an injury to a ligament. The patient has not had pain prior to the injury. What will the
provider do next?

Consult with an orthopedic specialist

Order a chest CT and full body scan
Refer the patient to for a bone biopsy
Repeat the radiograph in 3 to 6 months

Andy is a 27 y/o marathoner who tripped and fell during a race. He was transported to the clinic,
where an x-ray of his femur was noted to have the following: fracture of the bone with separation
in 3 places, and broken skin at the level of the first bone fragment. The NP would diagnose his
fracture as:

A. Closed, complete
B. Closed, incomplete
C. complete, open
D. Complete, closed

Andy is a 27 y/o marathoner who tripped and fell during a race. He was transported to the clinic, where an
x-ray of his femur was noted to have the following: fracture of the bone with separation in 3 places, and
broken skin at the level of the first bone fragment.

Factors affecting Andy’s healing of his fracture would include which of the following:

A. Amount of local damage

B. Proximity of bone fragments
C. Blood supply to fracture
D. His age
E. All the Above
F. A, B, & C only

A patient has pain on the plantar aspect of the heel with weight bearing after rest. The pain is
worsened with dorsiflexion of the foot. What is the initial treatment for this patient?

A. A series of steroid injections

 B. Avoiding all high-impact activities
C. Night splints
D. Wearing flat shoes only

Gaetano is a 76 y/o male who comes to the clinic with an acute headache that is located along his
temple. He sometimes has jaw claudication and complains of transient loss of vision. Based on
these symptoms the diagnosis is:

A. Temporal Arteritis
B. Trigeminal Neuralgia
C. Transient Ischemic Attack
D. Bell’s Palsy

Tension Headaches are characterized by all of the following except:

A. Serotonin uptake
B. Sleep cycle disturbances
C. Appetite changes
D. Recent or remote memory loss

Dylan is a 32y/o male who reports to the clinic with a 5-week history of low back pain. States he
was out pulling weeds from his garden when he felt a sharp pain as he pulled up a bunch of
weeds. He denies any bowel or bladder dysfunction. His back pain would be classified as:

A. Acute
B. Subacute
C. Chronic
D. None of the Above

Triggers for Migraine Headaches include which of the following:

A. Alcohol
B. Diet
 C. Stress
D. Menstruation
E. All of the above

Migraine headaches would fall under which general category?

A. Tension
B. Muscular
C. Vascular
D. Traction

A patient with Alzheimer’s disease (AD) is taking donepezil to treat cognitive symptoms. The
patient’s son reports noting increased social withdrawal and sleep impairment. What is the initial
step to manage these symptoms?

A. Encourage activity and exercise.

B. Prescribe a selective serotonin reuptake inhibitor (SSRI).
C. Recommend risperidone.
D. Referral to a neurologist for evaluation.

A 35-year-old patient reports suddenly experiencing an asymmetric smile along with drooping
and tearing in one eye. The patient has a history of a recent viral illness but is otherwise healthy.
During the exam, the provider notes that there is unilateral full-face paralysis on the right side.
What is the initial intervention for this patient?

A. Perform confirmatory diagnostic tests.

B. Prescribe oral corticosteroids.
C. Recommend wearing an eye patch.
D. Refer the patient to a neurologist.

A previously lucid patient with early-stage Alzheimer’s disease is hospitalized after a surgical
procedure and exhibits distractibility and perceptual disturbances that occur only in the late
afternoon. The patient has difficulty sleeping at night and instead sleeps much of the morning.
What is the likely cause of these symptoms?
A. Hyperactive delirium
B. Hypoactive delirium
C. Sundowner syndrome
D. Worsening dementia