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A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?

Question 27

A 72 year old female patient reports a 6 month   history of gradually progressive swollen and painful distal interphalangeal   (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte   sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor   (RF) are all minimally elevated. What is the most likely diagnosis?

· Question 28

A patient taking levothyroxine is being   over-replaced. What condition is he at risk for?

· Question 29

Which of the following is the most common cause of low   back pain?


Lumbar     disc disease


Spinal     stenosis


Traumatic     fracture



· Question 30

Which is the most common cause of end-stage renal disease   in the United States?

· Question 31

A 77-year-old female presents to the office complaining a   sudden swelling on her right elbow. She denies fever, chills, trauma, or   pain. The physical exam reveals a non-tender area of swelling over the   extensor surface over the right elbow with evidence of trauma or irritation.   The nurse practitioner suspects:




Ulnar     neuritis


Septic     arthritis


Olecranon     bursitis

· Question 32

A 60 year old female patient complains of sudden onset   unilateral, stabbing, surface pain in the lower part of her face lasting a   few minutes, subsiding, and then returning. The pain is triggered by touch or   temperature extremes. Physical examination is normal. Which of the following   is the most likely diagnosis?

· Question 33

Beth, age 49, comes in with low back pain. An x-ray of the   lumbosacral spine is within normal limits. Which of the following diagnoses   do you explore further?

· Question 34

A patient exhibits extrapyramidal side effects of   antipsychotic medications. Which of the following symptoms would lead you to   look for another diagnosis?

· Question 35

Phalen’s test, 90°wrist flexion for 60 seconds, reproduces   symptoms of:

· Question 36

Jennifer says that she has heard that caffeine can cause   osteoporosis and asks you why. How do you respond?

· Question 37

The most common cause of elevated liver function tests is:

· Question 38

Reed-Sternberg B lymphocytes are associated with which of   the following disorders:


Aplastic anemia


Hodgkin’s lymphoma


Non Hodgkin’s lymphoma


Myelodysplastic syndromes

· Question 39

Which of the following is a potential acquired cause of   thrombophilia?




Protein C deficiency


Factor V Leiden


Antiphospholipid antibodies

· Question 41

A 75-year-old female is diagnosed with primary   hyperparathyroidism and asks the nurse practitioner what the treatment for   this disorder is. The nurse practitioner explains:

Primary     hyperparathyroidism is treated with Vitamin D restriction

Primary     hyperparathyroidism is treated with parathyroidectomy

Primary     hyperparathyroidism is treated with daily magnesium

Primary     hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)

· Question 42

Diagnostic confirmation of acute leukemia is based on:


· Question 43

A 25 year old overweight patient presents with a   complaint of dull achiness in his groin and history of a palpable lump in his   scrotum that “comes and goes”. On physical examination, the nurse   practitioner does not detect a scrotal mass. There is no tenderness, edema,   or erythema of the scrotum, the scrotum does not transilluminate. What is the   most likely diagnosis?

A. Testicular   torsion

  B. Epididymitis

  C. Inguinal hernia

  D. Varicocele

· Question 44

Dave, age 38, states that he thinks he has an ear   infection because he just flew back from a business trip and feels unusual   pressure in his ear. You diagnose barotrauma. What is your next action?

A. Prescribe nasal steroids and oral decongestants
  B. Prescribe antibiotic eardrops
  C. Prescribe systemic eardrops
  D. Refer David to an ear, nose, and throat specialist

· Question 45

Which of the following antibiotics should not be   prescribed for a pregnant woman in the 3rd trimester?

· Question 46

The physiological explanation of syncope is:

· Question 47

A 20 year old male patient complains of “scrotal   swelling.” He states his scrotum feels heavy, but denies pain. On   examination, the nurse practitioner notes transillumination of the scrotum.   What is the most likely diagnosis?

· Question 48

A 32 year old male patient complains of urinary   frequency and burning on urination for 3 days. Urinalysis reveals   bacteriuria. He denies any past history of urinary tract infection. The   initial treatment should be: nclude nitrofurantoin monohydrate/macrocrystals,   trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin. 



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