NURS5433/ NURS 5433 Midterm Exam – Family II (FNP 2) 2026/ 2027 Edition | UTA Latest Update | Practice Questions & Verified Answers

NURS5433/ NURS 5433 Midterm Exam – Family II (FNP 2) 2026/ 2027 Edition | UTA Latest Update | Practice Questions & Verified Answers Q: Describe the symptoms of Blepharitis? Answer •Crusty, irritated and redness on the eye lid margin •Buildup of debris close to the root of the eyelash •Dry eye symptoms such as red eyes or foreign body sensation. Q: What is the Pharmacological treatment for resistant or persistent infection of Blepharitis? (2) Answer 1. Doxycycline 100mg PO BID 2. Tetracycline 250mg QID Q: A 40 year old woman comes with complaints scaling, crusting and redness in her eyelid. She said she is having trouble driving when it's sunny out, which of the following medications would you recommend to start with first? A. Doxycycline 100mg PO BID B. Tetracycline 250mg QID C. Cold moist compress to reduce inflammation D. Lid scrub wit baby shampoo Answer D. Lid scrub wit baby shampoo Q: Which condition is most often associated with Posterior Blepharitis? A. Seborrhea B. Rosacea C. Astigmatism D. Conjunctivitis Answer B. Rosacea Q: A painful, red swelling at the eyelid margin is most bc consistent with: A. Hordeolum B. Chalazion C. Conjunctivitis D. Cataract Answer A. Hordeolum Q: The preferred management for a hordeolum includes: A. Topical steroids B. Warm compresses C. Oral antivirals D. Eyepatch Answer B. Warm compresses Q: What is the difference between a Hordeolum and a Chalazion? Answer A hordeolum is painful and is usually on the lid margin. A chalazion usually points inside the lid and is usually painless Q: A 7-year-old presents with red eyes, purulent discharge, and eyelids matted shut in the morning. There is no significant itching what is most likely type of conjunctivitis? A. Allergic B. Viral C. Bacterial D. Herpetic Answer C. Bacterial Q: Which symptom is most characteristic of allergic conjunctivitis? A. Pre auricular lymphadenopathy B. Bilateral itching and watery discharge C. Thick yellow discharge D. Unilateral redness with crusting Answer B. Bilateral itching and watery discharge Q: A patient presents with watery eye discharge pre-auricular lymphadenopathy and a gritty sensation in the eye which type of conjunctivitis is most likely? A. Allergic. B. Viral. C. Bacterial. D. Fungal. Answer B. Viral Q: Herpetic viral conjunctivitis is distinguished from other types of conjunctivitis by which diagnostic finding? Answer Dendritic lesions on fluorescein stain Q: What diagnostic exam is done to check optic nerve function and anterior chamber inflammation? Answer Dilated Pupil Exam Q: Which two antibiotics are used for systemic chlamydia, and gonococcal conjunctivitis? Answer 1. Ceftriaxone 2. Doxycycline Q: Which of the following antibiotics is not recommended for cellulitis orbital and periorbital? A. Cephalosporin B. Ampicillin-clavulanic acid C. Penicillin D. Levofloxacin E. Ciprofloxacin Answer C. Penicillin Q: What are the medications Rimexolone and Loteprednol used for? Answer Topical steroid therapy for Pingueculum and Pterygium Q: What is the primary difference between a pingueculum and a pterygium? A. Pingueculum causes vision loss, pterygium does not B. Pingueculum is bilateral, pterygium is always unilateral C. Pingueculum does not cross the cornea, pterygium extended onto the cornea D. Pterygium is yellowish, pingueculum is vascular and red Answer C. Pingueculum does not cross the cornea, pterygium extended onto the cornea When is surgical removal for. Pingueculum and Pterygium required? Answer When vision is impaired A patient presents with a yellowish raised lesion on the nasal conjunctiva that does not affect. What is the most likely diagnosis? A. Pingueculum B. Pterygium C. Cataract D. Conjunctival hemorrhage Answer A. Pingueculum First line treatment for bacterial conjunctivitis includes A. Oral doxycycline B. Corticosteroid drops C. Erythromycin ointment D. Artificial tears C. Erythromycin ointment A fluorescien stain is used to diagnose: A. Corneal abrasion B. Blepharitis C. Cataracts D. Macular degeneration A. Corneal abrasion Emily has chronic dry eye. The doctor suggested using Cyclosporine ophthalmic emulsion for her eye but it did not work. Which of the following should the NP consider trying next? SATA A. Topical corticosteroids B. Systemic anti-inflammatory agents C. Surgery D. Autologous serum E. Systemic omega 3 fatty acids F. Impermanent punctal occlusion G. Refer to an ophthalmologist D. Autologous serum F. Impermanent punctal occlusion G. Refer to an ophthalmologist Cyclosporine ophthalmic emulsion is a level 2 treatment, she should move in to level 3 since level 2 did not work. Cataracts typically presents with: A. Eye discharge B. Sharp eye pain C. Halos around lights D. Tearing and itching C. Halos around lights D Diminished red reflex and the presence of a white reflex is associated with which eye disorder? Cataracts Which of the following organism is not the top 3 for bacterial conjunctivitis? A. Staphylococcus aureus B. Strep pneumoniae C. Pseudomonas D. Haemophilus influenzae C. Pseudomonas A mother comes in with her newborn baby. She states that her baby has persistent tear overflow, red eyes and mucus that comes out of the corner of her eyes when touched. which of the following would you recommend for treatment? A. Antibiotic drops B. Topical steroids C. Crigler massage D. Referral for duct probing and catheter insertion to remove mucus C. Crigler massage Hyphema is a ophthalmic emergency, True or False? True What type of eye drops can be used to correct Strabismus? Atropine A patient comes in complaining of loss of peripheral vision. You test their vision and find that their visual acuity has decreased. What is the next thing you would do as far as diagnostics? Use Tonometer to measure IOP What is seen on the funduscopic exam of someone with glaucoma? Cupping of the optic disc Cup to disc ration 0.3 What is the diagnostic tool used to diagnose Glaucoma? Tonometer Corneal inspection Optic nerve inspection Visual field testing Which intrapcular pressure (IOP) is concerning for glaucoma? A. 15 mmHg B. 20 mmHg C. 22 mmHg D. 25 mmHg D. 25 mmHg What's the leading cause of blindness in patients over the age of 60? Macular degeneration A patient describes a blind spot in the center of their field division. What type of macular degeneration is this? Wet Macular Degeneration A patient describes their vision change as unusually fuzzy or distorted. What type of macular degeneration is this? Dry Macular Degeneration What is see on the Fundoscopic Exam if someone with Macular Degeneration? Yellow Drusen Spots What treatment may help slow macular degeneration progression? A. Corticosteroids B. Antihistamines C. Antioxidants and zinc D. Prostaglandins C. Antioxidants and zinc If a patient comes in with issues with their vision, and you perform a pinhole test, if the vision improves with the pinhole, this suggests degeneration, True or False? False, This is suggestive of a refractive error rather than degeneration A child comes into the office with a chief complaint of pain in the right ear. When completing an Otoscopic exam of the ear, what would you expect to see that would be suggestive of otitis media? Bulging and redness of the Tympanic membrane with or without purulent drainage Which the following patient to with Otitis media require immediate antibiotic therapy? A. A patient with moderate otalgia for 24 hours B. A patient that's 7 months of age C. A patient with a temperature of 100.0 °F D. A patient 12 months of age with Bilateral AOM D. A patient 12 months of age with Bilateral AOM What is the first line treatment for Otitis Media? Amoxicillin 80-90 mg/kg/day In two doses 90% of cases where there is Otitis Media with Effusion (OME) you can just OBSERVE, because it will resolve on its own within 3 months, True or False? True You look into a patient's ear after they have come in complaining of right ear pain. You are unable to visualize the tympanic membrane due to edema and a white cottage cheese like substance in the external canal of the ear. Which of the following medications is the best for treating this type of infection? A. Ciprofloxacin + Hydrocortisone Drops B. 1% Clotrimazole C. Gentamycin Drops D. Hydrocortisone + acetic acid Drops B. 1% Clotrimazole A 50 year old women comes in because she experiencing Vertigo. What question could you ask that would help you rule out Benign Paroxysmal Positional Vertigo? A. Do you get dizzy when you roll over in bed B. Have you had a recent upper respiratory infection? C. Do you get nausea and vomiting when your dizzy A. Do you get dizzy when you roll over in bed What is the Gold Standard for diagnosis of Allergic Rhinitis? Allergy Skin Testing A patient comes in complaining of yellow nasal drainage, facial pressure and tooth pain. The patient is allergic to penicillin and when he takes penicillin, it causes a rash. Name the medications that would be good alternatives? (5-6) Cefpodoxime Cefdinir Cefuroxime Levofloxacin Moxfloxacin Doxycycline What findings indicates bacterial sinusitis? A. Symptoms lasting more than 10 days without improvement B. Water discharge for 5 days C. Clear nasal drainage D. Nighttime coughing A. Symptoms lasting more than 10 days without improvement Which is NOT recommended for sinusitis due to resistance? A. Amoxicillin. B. Azithromycin. C. Cefpodoxime. D. Levofloxacin. B. Azithromycin. The most common site for anterior epistaxis? A. Middle turbinate B. Kisselbach's plexus C. Inferior meatus D. Frontal Sinus B. Kisselbach's plexus An eight-year-old patient comes in with a mild fever and white patches on their tonsils. The patient does not report having a cough. What should be the next steps? Perform a rapid strep test Name all things that gain a point in the Centor Criteria? History of fever Present of tonsillar exudates Tender anterior cervical lymphadenopathy 15 years old Name all things that lose a point in the Centor Criteria? 45 years old Cough Centor Criteria: 3-4 points A. Treat empirically B. Unlikely to be strep, no testing needed C. Perform a rapid strep test A. Treat empirically Centor Criteria: 2 points A. Treat empirically B. Unlikely to be strep, no testing needed C. Perform a rapid strep test C. Perform a rapid strep test Centor Criteria: 1 point A. Treat empirically B. Unlikely to be strep, no testing needed C. Perform a rapid strep test B. Unlikely to be strep, no testing needed What is the first line treatment for Group B strep pharyngitis? (3) Penicillin Pen VK Amoxicillin Penicillinbenzathine injection What is the initial management of Epistaxis? Positioning: tilt the head forward to prevent blood from pooling in the throat What is the second step for management of Epistaxis? Compression: apply direct pressure by pinching nostrils at the septal area continuously for about 5-20 minutes Name two vasoconstrictive Agents used for nose bleeds if compression and position done work? Oxymetazoline Phenylephrine What is used for nose bleeds if compression and vasoconstriction agents don't work? Silver Nitrate A child with drooling tripod posture and strider, likely has: A. Allergic rhinitis B. Otitis Externa C. Pharyngitis D. Epiglottis D. Epiglottis A key sign of peritonsillar abscess is: A. Bilateral tonsillar swelling B. Uvular deviation C. Epistaxis D. Otalgia B. Uvular deviation albuterol, levabuterol, terbutaline are considered what category of medication? SABAs Short acting, beta agonist When are SABAs used? -quick relief of acute exacerbations and pre tx for EIB -use at lowest dosage and frequency possible -excessive use indicates poor asthma control Budesonide/Formoterol and Beclomethasone/ Formoterol Are considered what category of medication? LABA Long acting, beta agonist What are LABAs used for? Maintenance therapy bronchodilation Name two SAMAs Short acting, muscarinic antagonist Ipratropium Bromide Oxitropium Bromide Beclomethasone, Budesonide, Fluticasone propionate, and Mometasone are considered what category of medication? Inhaled Corticosteroids What category of medication is most commonly paired with inhaled cortical steroids? LABAs Name three leukotriene modifiers Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo) Pranlukast What is a rare but serious side effect of Montelukast? A. Weight gain B. Hyperglycemia C. Suicidal ideation D. Rash C. Suicidal ideation: behavioral changes and suicidal thoughts Tiotropium and Umeclidinium are in what category of medication? LAMAs Long acting muscarinic antagonists Glycopyrronium is a medication that is paired with what medication combo when asthma is uncontrolled? ICS+LABA Which of the following Biologics are indicated for sever eosinophilic asthma or Eosinophilic Granulomatosis with Polyangiitis (EGPA)? Mepolizumab (Nucala) What lab should be checked before staring Zarfirlukast? Liver function tests What biologic is approved for eosinophilic asthma and atopic dermatitis? A. Reslizumab B. Benralizumab C. Dupilumab D. Fluticasone C. Dupilumab What airflow limitation would confirm asthma in an adult (range)? FEV1/FVC 0.75 - 0.80 What airflow limitation would confirm asthma in a child? FEV1/FVC 0.90 How is Reversibility confirmed when diagnosing asthma? Reversibility is confirmed if FEV1 improves by 12% What diagnostic confirmed asthma reversibility? A. FEV1 increases by 5% B. FEV1 increases by 12% and 200ml after bronchodilator C. FEV1 drops 10% after exercise D. PEF increases by 5% B. FEV1 increases by 12% and 200ml after bronchodilator What test is most appropriate to confirm asthma when bronchodilator response is inconclusive? Methacholine challenge test A 12 year old is diagnosed with asthma, what is the preferred initial treatment for this patient? A. Levalbuterol B. Fluticasone propionate C.Ipratropium bromide D. Formoterol/Tiotropium E. Monestasone/Formoterol E. Monestasone/Formoterol Before prescribing ADDITIONAL asthma therapy, what should be assessed first? A. Vaccination status B. Inhaler technique and medication adherence C. Allergy testing D. Serum eosinophils B. Inhaler technique and medication adherence When stepping down asthma therapy, how should ICS be adjusted? A. Stop ICS immediately B. Reduce by 10% every 6 months C. Reduce by 20-50% every 2-3 months D. Taper only after 1 year of control C. Reduce by 20-50% every 2-3 months What is the maximum daily dose of Formoterol with budesonide? A. 32 mcg B. 72 mcg C. 100 mcg D. 120 mcg B. 72 mcg Asthma in 12 years and older: Step 1 As needed low dose ICS + Formoterol Asthma in 12 years and older: Step 2 As needed low dose ICS + Formoterol for symptoms twice or more LESS than daily Asthma in 12 years and older: Step 3 DAILY low dose ICS + Formoterol as maintenance therapy Asthma in 12 years and older: Step 4 Medium dose ICS + Formoterol for maintenance Asthma in 12 years and older: Step 5 Add on LAMA Therapy Asthma in 6-11 years old : Step 1 SABA as reliever (First line) Alternative: Low dose ICS taken whenever SABA is used Asthma in 6-11 years old : Step 2 Daily low dose ICS as maintenance therapy Alternative: Daily Leukotriene Receptor Antagonist (LTRA) Low dose ICS taken whenever SABA is used Asthma in 6-11 years old : Step 3 Daily low dose ICS + LABA as maintenance therapy Alternative: lows dose ICS + LTRA with SABA as reliever Asthma in 6-11 years old : Step 4 Medium Dose ICS + LABA Alternative: High dose ICS + LABA or add on LAMA Asthma in 6-11 years old : Step 5 Refer for phenotype assessment Consider monoclonal antibodies An 8 year old is uncontrolled on low dose Budesonide/formoterol. What is the next step? Increase to medium dose Budesonide/formoterol and refer to specialist When asthma is well controlled reduce ICS dose by ___ to ___ % every 2-3 months to minimize the risk of relapse? 20 to 50 % What is the appropriate treatment dose and duration of Prednisone for an adult with an asthma exacerbation? A. 20mg for 3-5 days B. 40mg for 5-7 days C. 60mg for 8-10 day D. 80mg for 7-10 days B. 40 - 50mg for 5-7 days What are the indications for Azithromycin as Add-On Therapy? (2) 1. Patient taking high dose ICS + LABA 2. Patient with eosinophilic or non eosinophilic asthma What is the most common cause of CAP in smokers? A. Step Pneumoniae B. Haemophilus Influenzae C. Mycoplasma Pneumoniae D. Leigionella Pneumophila B. Haemophilus Influenzae What is the most common cause of CAP in young adults? A. Step Pneumoniae B. Haemophilus Influenzae C. Mycoplasma Pneumoniae D. Leigionella Pneumophila C. Mycoplasma Pneumoniae A 20 year old male has been diagnosed with community acquired Pneumonia (CAP). What is the Causative organism? Mycoplasma Pneumoniae A 20 year old male has been diagnosed with community acquired Pneumonia (CAP). What is the first line treatment for a patient with a Macrolide allergy? SATA A. Amoxicillin 1g TID B. Azithromycin 500mg day 1, then 250 mg daily for 4 daily C. Clarithromycin 1g daily D. Doxycycline 100mg BID A. Amoxicillin 1g TID D. Doxycycline 100mg BID What 20 year old with no fever and 1 week cough, allergic to macrolides, what is the best treatment? A. Levofloxacin B. Symptomatic treatment only C. Doxycycline D. Amoxicillin-clavulanate B. Symptomatic treatment only A 60 year old with COPD, mMRC = 1, no exacerbations. What is the best therapy? A. Salmeterol B. Fluticasone/Salmeterol C. Budesonside D. Azithromycin E. Olodaterol/Tiotropium A. Salmeterol Patient would need a Bronchodilator Which would be a SABA or a LABA A 60 year old with COPD, mMRC = 2, 1 exacerbations and no hospitalization . What is the best therapy? A. Salmeterol B. Fluticasone/Salmeterol C. Budesonside D. Azithromycin E. Olodaterol/Tiotropium E. Olodaterol/Tiotropium Patient is considered Group B, they would require a LABA + LAMA Patient has mMRC = 2 and one hospitalization. Eosinophil count is 400, what is the best regimen? A. Tiotropium B. Salmeterol C. Fluticasone/Umecidinium/vilanterol D. Fluticasone/Formoterol/vilanterol E. Roflumilast C. Fluticasone/Umecidinium/vilanterol Patient is considered Group E, if the eosinophils are greater than or equal to 300, the patient will need a LABA + LAMA + ICS 60 year old diagnosed with moderately severe (Stage II) COPD. Smoking cessation is needed and he is willing to try something to help him quit. Which of the following medications is the most effective relent for smoking cessation? A. Varencine B. Bupropion C. Nicotine Inhaler D. Nicotine Gum A. Varencine What CURB-65 score indicates hospitalization? 2 If a patient has both COPD and Asthma you must treat the patient as though they have COPD, True or False? False Treat the patient like they have ASTHMA What is the most common agent of Croup? Parainfluenza Virus What is the first line pharmacological treatment for moderate to severe croup? A. Azithromycin B. Oral Dexamethasone C. Oseltamivir D. Albuterol E. Diphenhydramine B. Oral Dexamethasone What antibiotics will be taken for the Intensive phase of Drug-Susceptible Tuberculosis? (RIPE) Rifampin Isoniazid Pyrazinamide Ethambutol How long is the treatment for the Intensive phase of TB? 8 weeks What antibiotics will be taken for the continuation phase of Drug-Susceptible Tuberculosis? Isoniazid Rifampin What is the treatment for Isoniazid-Resistant TB? For how long? Rifampin Ethambutol Pyrazinamide 6 months What is the treatment for Rifampin -Resistant TB? For how long? Isoniazid Ethambutol Pyrazinamide 18-24 months How long is the treatment for MDR-TB AND XDR-TB? ≥ 24 months Which two antibiotics can patients with HIV never take due to drug interactions? Rifampin Rifabutin How many consecutive negative TB bacteriologic sputum test do you need to get in order to be negative? Two After getting two negative Sputum test, what diagnostic do you have to do next to monitor TB? Chest radiographs How often do you have to do a Chest Radiograph when assessing for TB? Every 2 months Name three TB medications that require baseline and MONTHLY Liver function tests? Rifampin Isoniazid Pyrazinamide Which TB medication requires regular vision testing? Ethambutol Patient with HIV that has induration of 6mm after PPD test. Low, Moderate, or High Risk? High Risk Patient with HIV are high risk when having a positive PPD test due to immunosuppression A patient who is healthy with no risk factors that has an induration of 15 mm after a PPD test. Low, Moderate, or High Risk? Low risk A 3 year old with an induration of 10mm after a PPD test. Low, Moderate, or High Risk? Moderate risk A patient who came in contact with someone who is positive for TB, this patient has annunciation induration of 12mm. Low, Moderate, or High Risk? Moderate risk What supplement should you take while on Isoniazid to avoid peripheral neuropathy? Pyridoxine (Vitamin 6) A 7 year old is brought into the office with a erythemayous macular rash all over both cheeks of the face. What condition could this most likely be? Fifth Disease What is the causative agent for Erythema Infectiosum? Parvovirus B19 A child with Fifth disease has a rash that appears only in the sunlight when it's extremely hot outside. What phase of Fifth disease is the rash in? Third Rash Phase (Transient Rash) Rash in face follows by lacy reticular rash is characteristic of Fifth disease, true or false? True Which two immunoglobulins are tested if a patient is suspected of Fifth disease? IgM and IgG Children with Fifth disease are only contagious when the rash goes away, True or False? False, children with Fifth disease are no longer contagious once the rash APPEARS. Which of the following patients conditions is contraindicated for the flu vaccine? A. A Pregnant woman B. A patient with HIV C. A patient who gets a rash when they eat eggs D. A patient with Guillain Barre Syndrome D. A patient with Guillain Barre Syndrome Which of the following patients are candidates for Antiviral therapy for the flu? A. A Pregnant woman B. A 67 year old adult at a long term care facility C. A black man with hypertension and hyperlipidemia D. A 3 year old E. A dialysis patient F. A patient with HIV G. A 13 year old girl with anemia H. A white man with a BMI of 41 A. A Pregnant woman B. A 67 year old adult at a long term care facility E. A dialysis patient F. A patient with HIV G. A 13 year old girl with anemia H. A white man with a BMI of 41 Nancy comes into the office, she has fever, sore throat, and headache. She is positive for influenza. She is also pregnant. Which is the following medications would be best for Nancy? A. Baloxavir B. Oseltamivir C. Peramivir D. Zanamirvir B. Oseltamivir Claire a 3 year old child is brought in by her mother. Claire has a sore throat, nausea, vomiting, and a non productive cough. Which one of the following would be best for Claire? A. Baloxavir B. Oseltamivir C. Peramivir D. Zanamirvir C. Peramivir - medication is IV and is approved for children greater than or equal to 2 years old Which of the following flu medications is contraindicated for people with asthma and COPD? A. Baloxavir B. Oseltamivir C. Peramivir D. Zanamirvir D. Zanamirvir A 13 year old with a rapid strep test in the office is negative. Patient's flu test is positive. What is the best next step in management? A. Baloxavir B. Oseltamivir C. Peramivir D. Zanamirvir A. Baloxavir 4 year old is brought in by her mother. She had generalized rash, and her mother doesn't understand where it came from. The patient that's had a fever for 5 days. She has a bright red tongue with dry cracked lips, swollen lymph nodes in the neck. Which od the following medications should be given to this patient? A. IV gamma globulin B. Penicillin C. Ibuprofen D. Flu vaccine A. IV gamma globulin What is the causative agent of Lyme Disease? Borrelia burgdorferi (spirochete) What will you see upon physical exam for Lyme Disease? Erythema Migrans (Target Rash) At least one of the following: Neuro: lymphocytic meningitis, cranial neuritis, encephalomyelitis CV: high grade AV block (2nd or 3rd degree) MSK: joint swelling What test can confirm Lyme disease? Western blot Positive EIA or IFA What three medications can be given to a patient with Lyme Disease? CAD Doxycycline Amoxicillin Cefuroxime A 6 year old patient comes in to the office. The mother of the patient said that she has to removed a tick a few days after they got home from a trip. Which of the following would you do to treat the patient? (55lbs) A. Azithromycin 100mg BID divided into two doses for 14 days B. Doxycycline 100mg BID divided into two doses for 14 days C. Amoxicillin 600mg TID for 14 days D. Cefuroxine 1000mg BID for 14 days B. Doxycycline 100mg BID divided into two doses for 14 days What's the Gold Standard Diagnostic test for Rocky Mountain Spotted Fever? Indirect Florescent Antibody Test (IFA) What is the first line treatment for Rocky Mountain Spotted Fever for all age groups? A. Amoxicillin B. Doxycycline C. Ceftriaxone D. Azithromycin B. Doxycycline What type of Rash in seen on patients with RMSF? A. Maculopapular that spares palms B. Urticarial C. Petechial D. Vesicular C. Petechial, staring on wrists ankles and spreading A rash appears on all patients with RMSF, True or False? False, No rash in 10-20% of people A 18 year old patient presents with a sore throat, fever and fatigue. On examination she has educative pharyngitis, bilateral cervical lymphadenopathy and enlargement spleen, you give the patient Penicillin for treatment and a rash appears days later. which of the following conditions could this be? A. Strep throat B. Meningitis C. Rubella D. Influenza E. Mononucleosis E. Mononucleosis A 18 year old patient presents with a sore throat, fever and fatigue. On examination she has educative pharyngitis, bilateral cervical lymphadenopathy and enlargement spleen, which of the following conditions could this be? A. Strep throat B. Meningitis C. Rubella D. Influenza E. Mononucleosis E. Mononucleosis What test is most likely to be positive in Mononucleosis? A. Heterphile antibody test B. Rapid strep test C. EBV DNA PCR D. ANA A. Heterphile antibody test Antivirals such as acyclovir will greatly reduce symptoms of Mononucleosis, True or False? False, There is no clinical benefit to taking acyclovir and it is not routinely recommended for mononucleosis If a patient is positive for Strep and Mononucleosis which of the following medications are best to use? A. Levofloxacin B. Penicillin C. Azithromycin D. Ampicillin C. Azithromycin Pen and Amp both will cause a rash if the patient also has mono. 4 year old patient is brought in by his mother who complains that her son has pink eye and needs medication for the condition. The patient has a fever of 101, is coughing. And has a runny nose. Upon examination of the Boy's oral cavity the NP notices some white spots on a red base of the buccal mucosa. Which of the following conditions could this be? A. Rubeola B. Rubella C. Scarlet fever D. Mononucleosis E. Rocky Mountain Spotted Fever A. Rubeola What is a hallmark of measles rash progression? A. Lady and reticular B. Starts in the face and speeds to trunk and extremities C. Petechiae D. Begins in lower extremities B. Starts in the face and speeds to trunk and extremities Diagnostics test for Measles are not needed, True or False? True A patient with Measles need to get antibiotics within the first 48 hours of rash presentation, True or False? False, Supportive care only What age is the earliest patients can get their MMR vaccine? First and second dose? 1st dose: 12-15 months 2nd dose: 4-6 years old All cases of Measles needs to be reported to the health department, True or False? True What is the causative agent of Roseola? Human herpesvirus 6 (HHV-6) What is the most common age for Roseola acquisition? (Range) 6 to 24 months When a patient has Roseola reassure that child can return to school and daycare once afebrile, True or False? True A 6 year old exposed to rubella yesterday and unvaccinated, what is the next best step? A. Administer MMR vaccine B. Give IVIG C. Isolate and observe D. Start antivirals A. Administer MMR vaccine MMR can be given to pregnant individuals when exposed to Rubella for protection, True or False? False, MMR is a live vaccine and cannot be given to pregnant individuals Rubella is most dangerous when contracted during: A. Adolescence B. The first trimester of pregnancy C. Late childhood D. Infancy B. The first trimester of pregnancy A 5 year old is brought into your office by his mother because of a rash that began on the scalp, neck and upper trunk. The kids at school have been diagnosed either chickenpox. What is the most likely diagnosis? A. Measles B. Rubella C. Varicella D. Impetigo C. Varicella When is chicken pox no longer contagious? A. 24 hours after fever subsides B. When all lesions have crusted over C. After 5 days of rash D. After two weeks B. When all lesions have crusted over When is post-exposure prophylaxis for Varicella? Given within 4 days of exposure Which of the following antiviral therapy is preferred for children and pregnant women? A. Acyclovir B. Famciclovir C. Valacyclovir D. Baloxavir A. Acyclovir Which of the following patients should receive antiviral therapy for chickenpox? A. A 3 year old child B. A 12 year old child C. A 20 year old with asthma on prednisone D. A patient with diabetes C. A 20 year old with asthma on prednisone Children 1 year old Individuals greater than or equal to 13 years old Pullman disease Long term salicylate (aspirin) Patient in steroids (inhaled or oral) Which of the following is considered dangerous in the clinical presentation of Shingles? A. Localized burning, tingling or pain before a rash appears B. Malaise C. Crusted lesions D. Vision loss D. Vision loss Could indicate ophthalmic branch involvement A 20 year old patient comes in with chicken pox, what diagnostic should you consider performing? HIV testing Which pathogen is the most common cause of adult bacterial meningitis? Streptococcus pneumoniae What are two hallmarks of tests to assess if someone has meningitis? Brudzinski sign Kernig sign Which of the following pathogens is associated with meningitis in neonates and the elderly due to contaminated food? A. Strep Pneumoniae B. Neisseria meningitis C. Tuberculosis D. Listeria monocytogenes D. Listeria monocytogenes What cerebral spinal fluid findings are expected in bacterial meningitis? A. Low WBC, high glucose B. High protein, high WBC, low glucose C. High protein, low WBC, low glucose D. Normal protein, and low glucose B. High protein, high WBC, low glucose What is the most appropriate FIRST step in suspected bacterial meningitis with Neurologic Deficits? A. CT scan before lumbar puncture B. Immediate lumbar puncture C. Start antivirals D. Order EEG E. Ziehl-Nelson stain A. CT scan before lumbar puncture What is the empiric antibiotic regimen for adults with bacterial meningitis? A. Azithromycin and ampicillin B. Doxycycline and Ceftriaxone C. Ceftriaxone and vanomycin and ampicillin D. Cefazolin and gentamicin and ampicillin C. Ceftriaxone and vanomycin and ampicillin A 4 year old presents to the office with a runny nose, fever, and rapid coughs followed by a "whoop" sound, which of the following antibiotic is the best treatment of choice? A. Azithromycin B. Doxycycline C. Amoxicillin D. Penicillin E. Levofloxacin A. Azithromycin When should pregnant women receive their Tdap vaccination? Between 27-36 weeks What is the Tdap vaccination trying to prevent? Pertussis (whooping cough) What medication can be giving To a child with Whooping cough if they have an allergy to Macrolides? Trimethoprim/sulfamethoxazole Patient diagnosed with pertussis has only a mild cough that has lasted for about a week at this point in their illness. What stage are they most likely in? A. Catarrhal B. Paroxysmal C. Convalescent D. Prodromal C. Convalescent Patient diagnosed with pertussis has an inspiratory "whoop" , some vomiting and erythematous face when cough at this point in their illness. What stage are they most likely in? A. Catarrhal B. Paroxysmal C. Convalescent D. Prodromal B. Paroxysmal A 5 year old male presents with a UTI. What's the correct management consideration? A. No testing needed B. Repeat urine dipstick C. Urological evaluation needed D. Treat with antibiotics and discharge C. Urological evaluation needed What is the most common UTI pathogen? Escherichia coli (E. coli) Which of the following antibiotics is the safest for treating asymptomatic bacteriuria in a pregnant patient? A. Nitrofurantoin B. TMP-SMX C. Cephalexin D. Ciprofloxacin C. Cephalexin You can use amoxicillin, cephalosporins, or fosfomycin What finding is diagnostic of pyelonephritis on urinalysis? A. Hematuria B. Nitrites C. WBC casts D. Proteinuria C. WBC casts Which of the following antibiotics is the first line treatment for UTI only when there is local resistance? A. Nitrofurantoin B. TMP-SMX C. Cephalexin D. Ciprofloxacin B. TMP-SMX (Bactrim) What is the hallmark symptoms that differentiates pyelonephritis from cystitis? SATA A. Dysuria B. Flank pain C. Urinary urgency D. Fever E. Hematuria Flank pain and fever When should you refer a pyelonephritis patient to Urology? A. Fever for 24 hrs B. GFR of 80 C. No improvement after 48 hrs D. Microscopic hematuria C. No improvement after 48 hrs Refer Pregnant patients, MALE patients , fever 72 hrs, no improvement in 48 hrs , actually ill presentation, recurrent infections What is the recommended management for pregnant women with pyelonephritis? A. Hospitalization and IV antibiotics B. Oral TMP-SMX C. Wait for culture prior to treating D. Use Nitrofurantoin A. Hospitalization and IV antibiotics For for acute pyelonephritis, you want to start empirical treatment immediately pregnant patients must be hospitalized and are to avoid Nitrofurantoin and Fosfomycin (they don't reach therapeutic renal levels) What is the appropriate follow up after resulting if acute pyelonephritis? A. Repeats dipstick in 1 week B. Repeat urine culture in 3-4 weeks C. Repeat renal biopsy D. No follow up needed B. Repeat urine culture in 3-4 weeks After symptom resolution. Repeat urine culture, if it's still positive continue antibiotics for 6 weeks A 55 year old nail technician has painless hematuria, which of the following is the concern? A. Bladder cancer B. Kidney stone C. Glomerulonephritis D. Pyelonephritis A. Bladder cancer - this is due to age and occupational exposure. Adults over age 50 who have hematuria need to be assessed for malignancy Which of the following can cause pseudo hematuria l? A. E. Coli B. Cancer C. Beets D. NSAIDS C. Beets What is the hallmark urine appearance in post strep Glomerulonephritis? A. Cola or tea colored B. Cloudy yellow C. Bright red D. Pink D. Four smelling A. Cola or tea colored What is the next best step for the management of post strep Glomerulonephritis? A. Prescribe steroid B. Start antibiotics C. Repeat throat culture D. Refer to nephrologist D. Refer to nephrologist What are the 4 signs of an Overactive Bladder? FUUN Frequency Urge incontinence Urgency Nocturia Maribelle a 60 year of woman has the urge to urinate often. One day she was jumping rope and accidentally leaked urine. What type of incontinence is this? A. Urge B. Stress C. Overflow D. Functional E. Mixed E. Mixed Ashley has to wear an adult diaper on a daily basis because she has ongoing leakage of urine. She often has feeling of fullness in the bladder even after urinating. What type of incontinence is this? A. Urge B. Stress C. Overflow D. Functional E. Mixed C. Overflow Frankie takes Lorazepam (Ativan) to fall alseep during the day since she does the night shift. Sometime she wakes up and realizes that she wet the bed. What type of incontinence is this? A. Urge B. Stress C. Overflow D. Functional E. Mixed D. Functional Urinary leakage due to a cognitive or physical disability. What type of incontinence is this? A. Urge B. Stress C. Overflow D. Functional E. Mixed D. Functional A 52 year old woman reports leaking urine when she sneezes. What type of incontinence is this? A. Urge B. Stress C. Overflow D. Functional E. Mixed B. Stress What is the MOA of Mirabegron? Relaxes the detrusor muscle and increases bladder capacity by activating beta-3 receptors Which overactive bladder medication works via Beta-3 agonist. Activity and has fever anticholinergic effects? A. Oxybutynin B. Tolterodine C. Mirabegron D. Vibegron E. Tamsulosin C. Mirabegron Which of the following medication is an M3 antagonist with a high anticholinergic burden. A. Oxybutynin B. Tolterodine C. Mirabegron D. Vibegron E. Tamsulosin A. Oxybutynin What is the Gold Standard for diagnosis of a Kidney Stone? Non contrast Helical CT scan of the abdomen or pelvis A 50 year old man has flank pain radiating to the ground and hematuria. The patient is diabetic and has a family history of kidney stones. What should the NP do next? A. Give analgesics and observe B. Urine culture and CT of kidneys C. Start antibiotics D. Refer immediately for surgery B. Urine culture and CT of kidneys What is the first line treatment for bedwetting in a child greater than or equal to 5 years old? A. Imipramine B. Desmopressin C. Enuresis alarm therapy D. Oxybutynin C. Enuresis alarm therapy What is the cause of Primary VUR? Congenital short ureter or faulty valve What is the cause of secondary VUR? Increase bladder pressure and incomplete sore of the retrial junction What diagnostic test is completed to assess for Vesicoureteral Reflux? Fluroscopic Voiding Cystourethrogram (VCUG) What is the most classic presenting symptom of Wilms Tumor? A. Painless abdominal mass B. Jaundice C. Severe back pain D. Hemoptysis A. Painless abdominal mass To where does a Wilm's Tumor metastasize? "The Three Ls": regional lymph nodes, lungs, and the liver. Which of the following diagnostics would you get for a patient with Wilms tumor? A. VCUG B. Bladder ultrasound C. Urine culture D. Chest X-ray D. Chest x-Ray The lung is the most common site of metastasis What is the number 1 cause of kidney failure? diabetes What is the range of GFR for a patient stage G3a? 45-59 What is the range of GFR for a patient stage G3b? 30-45 What CKD Stage would you refer to Nephrology? Stage G3 or higher (GFR 60) A patient has type 2 diabetes, hypertension, and a GFR of 75. What is the next best step? A. Refer to nephrology B. Order renal biopsy C. Check urine for albumin D. Start dialysis C. Check urine for albumin What is the most common cause of anemia in CKD? A. Iron deficiency B. Decreased ethropoietin production C. Hemorrhage D. Folate deficiency B. Decreased ethropoietin production Which medications requires caution in CKD due to lactic acidosis risk? A. Glipizide B. Metformin C. Sitgiptin D. Pioglitazone B. Metformin TSH should be checked yearly in all women over age ___. 40 What is Step 1 of Thyroid check? Check TSH level Of TSH is normal what is the next step? No further testing If TSH is elevated what is the next step? Check Free T4 Step 2 Lab interpretation Inc TSH + Dec Free T4 Hypothyroidism Or Subclinical Hyperthyroidism Hypothyroidism Step 2 Lab interpretation Inc TSH + Normal Free T4 Hypothyroidism Or Subclinical Hyperthyroidism Subclinical Hyperthyroidism A 45 year old has a high TSH and Normal T4, what is the net step? A. Refer to endocrinology B. Start Levothyroxine C. Repeat TSH in 6 months D. Order thyroid ultrasound C. Repeat TSH in 6 months Step 2 Lab interpretation Inc TSH + LOW Free T4 What do we test next? TPO (thyroid peroxidase antibodies) The presence of TPO (thyroid peroxidase antibodies) indicated what endocrine condition? A. Hypothyroidism B: Hyperthyroidism C. Subclinical hypothyroidism D. Hashimoto Thyroiditis E. Idiopathic hypothyroidism D. Hashimoto Thyroiditis What is the most serious complication of untreated congenital hypothyroidism? A. Obesity B. Goiter C. Intellectual disability D. Anemia C. Intellectual disability Levothyroxine dose needs to be increase by 50% starting at weeks ___ to ___ . 4-8 weeks How long should a child be treated for congenital hypothyroidism before attempting a trial off therapy? A. 1 year B. 3 years C. 6 months D. Indefinitely B. 3 years After congenital hypothyroidism treatment for 3 years how long should the patient stop treatment? 4 weeks Which of the following medications are safe to use for hyperthyroidism in pregnancy? A. Atenolol B. Methimazole C. Propranolol D. Propylthiouracil D. Propylthiouracil Shorter half life, risk of liver failure, blocks peripheral T4 to T3 conversion. Preferred medication for 1st trimester of pregnancy What is the first line test for diagnosing hyperthyroidism? TSH What Lab pattern suggests Hyperthyroidism? A. High TSH, High T4 B. Low TSH, High T4 C. Normal TSH, Low T4 D. High TSH, Normal T4 B. Low TSH, High T4 Which of the following medications is used to treat symptoms while awaiting endocrinology consult for hyperthyroidism? A. Atenolol B. Methimazole C. Propranolol D. Propylthiouracil C. Propranolol Which findings suggests Graves' disease? A. Thyroid nodule B. Positive thyroid stimulating immunoglobulin C. Low radioactive iodine D. Low TSH, low T4 B. Positive thyroid stimulating immunoglobulin Which of the following is a contradiction for Radioactive Iodine Therapy? A. Pregnancy B. Type two diabetes C. Hypertension D. Graves' disease E. Thyroid cancer F. Goiter A. Pregnancy Lugol's Solution is a short term pre-op thyroidectomy for thyroid suppression in pregnant patients, True or False? True Mike is a 50 year old immigrant from Canada. He comes in for fatigue, weight miss and muscle pain, he has hypotension, diffuse skin and hyperpigmentation in the oral mucosa, palmar creases and knuckles. Which is the filling conditions could this be? A. Hyperthyroidism B. Hypothyroidism C. Vitiligo D. Cushing's disease E. Addison's disease E. Addison's disease What hormone is deficient is Addison's disease? Cortisol What test confirms adrenal insufficiency? SATA A. Serum potassium B. Morning serum cortisol C. ACTH stimulation test D. 24 hour urine sodium E. FSH and LSH levels B and C Which of the following are electrolyte abnormalities seen in Addision's? SATA A. Hyponatremia B. Hyperthermia C. Hypokalemia D. Hyperkalemia E. Hypocalcemia F. Hypercalcemia G. Hypochloremia H. Hyperchloremia A. Hyponatremia D. Hyperkalemia G. Hypochloremia What does a 24 hour urine cortisol detect? Cortisol overproduction What 24 hour urine cortisol lab level indicates Cushings Disease? 100 mcg Classic triad for Pheochromocytoma includes: A. Headaches, diaphoresis, tachycardia B. Palpitations, nausea, vomiting C. Anxiety, tremor, insomnia D. Cold intolerance, fatigue, weight gain A. Headaches, diaphoresis, tachycardia What lab abnormality confirms hyperparathyroidism? A. High PTH, Low Calcium B. High Calcium, High Phosphorus C. High PTH, High Calcium, Low Phosphorus D. High PTH, High Calcium, High Phosphorus E. High Vitamin D C. High PTH, High Calcium, Low Phosphorus What is the only curative treatment for hyperparathyroidism? Parathyroidectomy What lab abnormality confirms hypoparathyroidism? A. High PTH, Low Calcium B. High Calcium, High Phosphorus C. Low PTH, Low Calcium, Low Phosphorus D. Low PTH, Low Calcium, High Phosphorus E. Low PTH, High Calcium, High Phosphorus F. High Vitamin D D. Low PTH, Low Calcium, High Phosphorus Which of the following can be used at treatment for Hypoparathyroidism? A. Sodium Bicarbonate B. Calcium Carbonate C. Vitamin C D. Vitamin D E. Corticosteroids F. ACTH injections G. Natpara (PTH analog) C, D, G