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Advanced Practice in Primary Care
Question 1 The presence of which of the following would be supportive diagnosis of pheochromocytoma? a. Positive findings of a renal mass on CT scan of abdomen and pelvis b. Improved muscle strength after pyridostigmine administration c. Low levels of metanephrines in serum d. Elevated metanephrines in serum and urine ANS: d Question 2 You order a CXR (P-A view) for a patient with dyspnea and decreased breath sounds on auscultation. Based on the radiographic image that appears below, you would diagnose; a. Right pleural effusion b. Right lung pneumonia c. Right pneumothorax d. Pericardial effusion e. Left pleural effusion ANS: a Question 3 The 2D-echocardiogram reads EF= 30 - 35%. The FNP would document this as: a. Heart failure with reduced ejection fraction
b. Right heart failure c. NYHA Class-III d. Diastolic heart failure e. Heart failure with preserved ejection fraction ANS: a Question 4 Entresto was the #1 FDA approved combined medication for the treatment of HFrEF or systolic heart failure. However, it should not be administered concomitantly with: (select only 1 answer) a. Antibiotic b. Beta blocker c. ACEIV d. Antihistamine medication ANS: c Question 5 A young patient with a 3-day sore throat, fever, minimal cough, yellow to greenish pharyngeal exudate, and anterior cervical lymphadenopathy is undergoing testing. Which of the following would be supportive of the most likely diagnosis? a. Positive RADT V b. Positive IgG antibodies against diphtheria toxoid = 0.1 IU/mL. c. Positive EBV antibodies d. Positive culture for B. pertussis ANS: a Question 6 A middle-aged female presents with complaints of fatigue, constipation, and cold intolerance. She feels like "dragging" herself around every day and has noticed shortness of breath when attempting to walk faster. and while laying down in bed. She has a hoarse voice but is afebrile with soft blood pressure, and slightly bradycardic. Her neck appears diffusely enlarged at the base on examination, and according to the patient, it has been going on for a few years now, but it seems bigger now. The FNP suspects Hashimoto's thyroiditis. Which of the following would be next to do as initial testing? (Select only 1 answer) a. Measurement of serum TSH b. Measurement of free T4 & T c. Thyroid ultrasound d. Measurement of TPO antibodies e. Measurement of free T ANS: a Question 7
Considering your knowledge about microvascular and macrovascular manifestations of Diabetes mellitus. Which of the following A, B, C, or D would correspond to a patient with diabetic retinopathy? A. B. C. a. A b. B c. C d. D ANS: B Question 12 A diabetic patient on insulin treatment is concerned with elevated blood sugar in the mornings. Evaluation of blood sugars at 3:00 am for 4 consecutive days reveals glucose levels ranging 45 - 59 mg/dL while in the mornings they range 248 - 300 mg/dL. Based on the information provided the FNP would; a. remove night dose of insulin or add a snack b. continue observing without making any changes at this time
c. increase the dose oral antiglycemic medication d. increase night dose of insulin ANS: a Question 13 An adult male patient with T1DM for the last 11 years, presents with concerns of elevated morning blood sugars for several days now, ranging 300 mg/dL to 402 mg/dL Blood sugar recorded in his electronic device showed already elevated blood sugars around 3.00 am for the last 5 days. Based on the information provided you would: a. adjust insulin treatment by adding or increasing night dose of insulin v b. extend evaluation for a few more days to decide whether or not it merits to adjust insulin regime. c add oral antiglycemic such as a biguanide d. adjust insulin treatment by decreasing night dose of insulin ANS: a Question 14 Possible physical findings of acute otitis media with or without effusion may include all of the following EXCEPT: a. Bulging of the lower 2 quadrants of the tympanic membrane b. Erythema of the tympanic membrane c. Blurred or erased tympanic membrane landmarks d. Mild to moderate intensity discomfort while pulling the auricle upward and backward. ANS: d Question 15 Artesans that work with blown glass and pottery are at higher risk for contracting silicosis. To halt possible complications, these individual should undergo: a. treatment with corticosteroids as needed b. annual evaluation for lung malignancy with CT scan or higher resolution diagnostic test. c. annual evaluation for tuberculosis with purified protein derivative test d. treatment with corticosteroids every 3 months ANS: c Question 16 Workers employed in high-tech fields such as aerospace and nuclear plants as well as in dental material sites are at high risk for suffering which type of pneumoconiosis? a. Asbestosis b. Black lung disease c. Berylliosis d. Silicosis ANS: c
a. a 3-drug regime that includes Rifampin, Isoniazid (INH), and fluoroquinolones b. a 3-drug regimen that includes Rifampin, Isoniazid (INH), and Ethamibuiol c. a dual drug regimen that includes Rifampin, Isoniazid (INH) d. a 4-drug regimen that includes Rifampin, Isoniazid (INH), Pyrazinamide, and Ethambutol ANS: d Question 21 Match the following: The FNP would consider Treatment with rifampin: would require patient education for expected red-orange color of the urine Treatment with ethambutol: would require ophthalmological referral Treatment with isoniazid: should be combined with pyridoxine to prevent peripheral neuropathy Question 22 After reviewing the 12-Lead ECG (see below) for a patient with no current symptoms but with medical history significant for controlled HTN and previous percutaneous coronary angioplasty for which he takes lisinopril 10 mg PO daily, metoprolol-XL 100 mg PO daily, and HCTZ 12. PO daily, the FNP should a. administer one dose of aspirin 325 mg orally b. instruct the patient to return for follow-up every 3 - 6 months or earlier if deemed necessary c. hold lisinopril only
d. hold medication all medication for now e hold HCTZ only f. refer the patient to the nearest emergency room for cardiac evaluation g. hold metoprolol only ANS: b Question 23 The EKG below shows: a. Second degree AVB type 1 b. Second degree AVB type 2 c. Normal sinus rhythm d. First degree AVB e. Atrial fibrillation ANS: b Question 24 The 12-Lead ECG below shows: a. Atrial fibrillation b. Second degree AVB Mobitz-
Which of the following should the FNP use to evaluate an adult patient that complaints of progressive visual loss with blind or dark spots and distorted lines? a. Amsler grid b. Tonometer c. Snellen chart d. Fluorescent dye and a Wood's lamp e. E-card ANS: a Question 28 A patient with history of HTN, presents to the clinic complaining of severe headaches, eye pain, and very blurry vision. Funduscopic examination appears below. The FNP would document this finding as: a. macular degeneration b. presence of cotton wool spots c. retina detachment d. Papilledema ANS: d Question 29 The patient is an adult obese female with a long standing history of polyuria, polydipsia, weight loss, and peripheral neuropathy with right plantar ulcers that complaints of progressive visual loss and diplopia as well as recurrent vulvar candidiasis. She is afebrile with regular pulse. and normotensive. Cervical acanthosis nigricans is present. Based on the information provided, which of the following funduscopic views could correspond to this case. A.
a. A b. B c. C ANS: c Question 30 All following are considered microvascular changes from hypertension, EXCEPT: a. Presence of cotton wool spots b. Neovascularization c. Blot and flame hemorrhages d. Arterio-venous nicking e. Silvery or copper wiring of the arterioles ANS: b Question 31 A female patient presents to the clinic with left ear hearing loss 2 weeks after hospital discharge for complicated urinary tract infection treated with tobramycin. What are expected results for the Rinne and Weber tests? a. Left ear: AC < BC and Weber lateralizes to the left ear b. Left ear. AC > BC and there is no lateralization during Weber test c. Left ear: AC < BC and Weber lateralizes to the right ear d. Left ear. AC > BC and Weber lateralizes to the right ear ANS: d Question 32 Which of the following would be an expected finding in a middle-aged patient with hearing loss in his right ear secondary to membrane perforation from a cholesteatoma? a. Right ear: AC < BC and Weber lateralized to the left ear
a. Entropion b. Acute closed-angle glaucoma c. Allergic conjunctivitis d. Ectropion ANS: d Question 36 An adult male patient with history of HTN and coronary artery disease was recently diagnosed with T2DM. Two months after, he presents to the clinic with abdominal cramps and myalgias. The FNP most likely would attribute these complaints to: a. Metformin b. Metoprolol c. Lisinopril d. Amlodipine ANS: a Question 37 Which of the following antiglycemic drugs classes are considered to be cardioprotective in patients with heart failure? a. Glycogen-like peptide-1 receptor agonist b. Biguanides c. Sodium-glucose cotransporter-2 (SGLT2) inhibitors v d. Dipeptidyl-peptidase 4 (DPP4) inhibitors. e. Sulfonylureas ANS: c Question 38 The following patient (see picture below) carries a high risk for corneal abrasion, ulceration, and perforation and would be referred to ophthalmology promptly with diagnosis of: a. Ectropion b. Blepharitis c. Entropion
d. Bacterial conjunctivitis ANS: c Question 39 A male patient that works as a gardener presents with discomfort in his right eye associated with blurred vision. He is wearing sunglasses to avoid the light and refers that his symptoms started the day before. He denies using contact lenses. On examination, the eye appears red, teary (water-like consistency). After using a fluorescent dye, you notice a dendritic lesion on the cornea. Base on the case scenario, the FNP would prescribe: a. Topical timolol b. Topical atropine c. Topical acyclovir d. Topical ciprofloxacin ANS: c Question 40 A young adult male using contact lenses regularly for corrective vision, now presents to the clinic with this lesion (see picture) below. In addition to referral to ophthalmology and recommendations to not wear contact lenses, The FNP would prescribe topical medication targeting which microorganism? Eye with keratitis infection due to contact lens use | Download Scientific Diagram a. Herpes simplex b. Streptococcus beta-hemolyticus c Staphylococcus aureus d. Pseudomonas aeruginosa ANS: Question 41 A patient with chronic kidney disease that debuts with acute pericarditis should be treated with: a. Colchicine b. indomethacin c. aspirin d. Steroids ANS: d Question 42 An adult male patient with tall body habitus, presents with shortness of breath. Radiographic image appears below. The FNP would:
c. Low-dose inhaled corticosteroid alone d. Low-dose inhaled corticosteroid combined with long-acting beta 2 agonist (formoterol preferably) as needed ANS: d Question 46 As per GINA 2021, which of the following is recommended as first-line treatment for asthma with symptoms occurring twice per month or more but less than 4 - 5 days per week? a. Combination of Beclomethasone dipropionate and Albuterol inhaled as needed b. Combination of Budesonide/ Formoterol inhaled as needed c. Combination of Fluticasone propionate and Levalbuterol inhaled as needed d. Combination of Mometasone and Albuterol inhaled as needed ANS: b Question 47 The American Thoracic Society recommends which of the following as first-line treatment for the management of exercise-induced asthma? a. Low-dose inhaled corticosteroid b. Short-acting beta 2 agonist (SABA) 5 - 20 minutes before exercise c. Inhaled anticholinergic (Ipratropium) before exercise d. Long-acting beta 2 agonist (LABA) ANS: b Question 48 For an older patient with allergy to PCN who has significant cardiac history as well as T2DM that presents with moderate to severe pneumonia but intact mentation, and has good family support, you would consider to prescribe: a. Monotherapy with a macrolide b. Monotherapy with tetracycline c. Therapy with pencilin combined with clavulanic acid d. Monotherapy with oral fluoroquinolone ANS: d Question 49 A young male patient with history of personal and family asthma reports having daily symptoms requiring SABA treatment that results in some limitation of his normal activity. PFT displays FEV1 > 60% but < 80% of predicted. You would classify this patient's asthma as: a. Severe persistent asthma b. Intermittent asthma c. Moderate persistent asthma d. Mild persistent asthma ANS: c
Question 50 Match the following: Aortic insufficiency: diastolic murmur auscultated at the 2nd ICS to the right of the sternum Mitral regurgitation: systolic murmur auscultated at the 5th ICS to the left of the sternum, midclavicular line Mitral stenosis: diastolic murmur auscultated at the 5th ICS to the left of sternum, midclavicular line Aortic stenosis: systolic murmur auscultated at the 2nd ICS to the right of the sternum Question 51 Chronic bronchitis is defined as: a. Minimal secretion of bronchial mucus from cilia destruction b. Abnormal, permanent enlargement of the alveoli c. Productive cough for 3 months or more that last 2 consecutive years d. Narrowing of the airways from a hypersensitivity response ANS: c Question 52 Which of the following would be first-recommended treatment in hypertension with coexisting diabetes and chronic kidney disease? a. HCTZ b. Potassium-spearing diuretic c. Beta blocker d. Calcium channel blocker e. ACEI or ARB ANS: e Question 53 Which of the following medication classes you would avoid to treat hypertension in a patient with hx of T2DM and asthma? a. Thiazide diuretics b. Calcium channel blockers c. Beta blockers d. Angiotensin receptor blockers ANS: c Question 54 An adult patient with history of HTN, smoker, arthritis, and cardiomyopathy with subsequent permanent pacemaker 3 years ago now presents with fevers and malaise. The FNP auscultates and new onset murmur at the 5th ICS to the left of the sternum, midclavicular line that radiates to the axilla. Based on the case scenario, what is your presumptive diagnosis? a. Infective endocarditis b. Mitral valve stenosis
b. Short rapid acting insulin starting at 2 Units/ Kg/ day divided in 2 doses (half dose in the morning and the remaining half in the afternoon) c Short rapid acting insulin starting at 0.5 Units/ Kg/ day divided in 2 doses (2 thirds of the dose in the morning and the remaining third in the afternoon) d. Glargine insulin 10 Units subcutaneously at night ANS: c Question 58 An adult patient with mild febrile episodes associated with chills, and upper respiratory symptomatology that includes productive cough with rusty-colored sputum is found to have a consolidation in the middle lobe of the right lung. The FNP would diagnose this patient with: a. aspiration pneumonia b. typical bacterial pneumonia c atypical bacterial pneumonia d. fungal pneumonia ANS: c Question 59 During physical examination of a young male patient, you find arcus juvenilis. This finding will prompt you to evaluate: a. Visual acuity b. lipid propfile c. red-orange light reflex to rule out cataracts d. extraocular movements ANS: b Question 60 For an older individual with a metastatic cancer and established history of T2DM you would set A1c goal at: a. between 5.5 - 5.7% b. <8%く c. < 7% d. < 6 ANS: b Question 61
a. Stye b. Chalazion c. Hordeolum d. Blepharitis e. Pinguecula ANS: b Question 62 A patient presents with complaints of left eye pain for the last 2 days and no visual changes or fevers. Objective findings appear on the picture below. Based on the information provided, what is your most likely diagnosis? a. Blepharitis b. Hordeolum ANS: b Question 63 A patient treated with Sulfonylureas should be educated on: a. signs and symptoms of hypoglycemia b. initial period of abdominal cramps and possible weight loss c signs and symptoms of heart failure d. signs and symptoms of lactic acidosis ANS: a Question 64 Match the following: Hyperkalemia: Electrocardiographic changes manifested as peaked "T" waves Hypocalcemia: Trousseau sign Hypomagnesemia: Electrocardiographic changes manifested as prolonged QT interval Hyponatremia: Subtle changes in mentation with gait disturbance
