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A 42-year-old female recalls a brief episode of chest tightness with no radiation or chest
wall injury during her new taekwondo martial arts class. This pain subsided during "the
cool down period" of her class. Which of the following is most likely given her
presentation?
-Pericarditis
-Acute myocardial infarction
-Hiatal hernia
-Angina pectoris - ANSWERS-Angina pectoris
Chest pain with activity and relieved at rest in a middle-aged adult should prompt
concern for myocardial ischemia. Although acute myocardial infarction is a possibility, it
is less likely given the scenario mentioned above.
Gloria is a 68-year-old female with a chronic history of severe anxiety disorder presents
with mild shortness of breath, fine crackles in the right lower lobe with auscultation and
a nonproductive cough. She recently "ran out of pills". Which medication omission most
likely lead to her current presenting symptoms?
-Metoprolol
-Lorazepam
-Furosemide
,-Metformin - ANSWERS-Furosemide
Furosemide or Lasix is a diuretic utilized in the management of heart failure. Although
anxiety can produce shortness of breath, one would not expect fine crackles on exam
unless additional comorbidity exists.
The S2 heart sound is a result of what?
-Closure of the semilunar valves
-Opening of the semilunar valves
-Closure of the atrioventricular valves
-Opening of the atrioventricular valves - ANSWERS-Closure of the semilunar valves
The closure of the semilunar valves results in the second heart sound. The semilunar
valves are the aortic and pulmonary valves.
A systematic inquiry that elaborates on the chief complaint while eliciting pertinent
positive and pertinent negative factors from the history is known as:
-Diagnostic formulation
-The mental status exam
-Physical exam
-Review of systems - ANSWERS-Review of systems
A 21-year-old man had his first drink at his birthday party with friends last night. He
presented the following morning to the emergency department with psychomotor
agitation, cognitive impairment, depressed mood, flat affect, and anhedonia. His heart
rate is 110, his blood pressure is 90/60, and he complains of abdominal pain. He
received 2 L of normal saline IV and is referred to psychiatry for evaluation of mood
disorder. Which of the following tests should the consulting PMHNP order given these
symptoms?
, -Urinalysis
-Acetaminophen level
-Urinary porphobilinogen
-Blood alcohol level - ANSWERS-Urinary porphobilinogen
A 35-year-old man diagnosed with bipolar disorder mentions to his PMHNP that he had
felt a lump on his left testicle. He is concerned he has not had a physical exam in 10
years. What is the best action by the PMHNP?
-Perform a urogenital exam and order an ultrasound
-Refer him to his primary care provider
-Refer him to urology
-Explore the reason for not having had a physical in so long - ANSWERS-Explore the
reason for not having had a physical in so long
An 81-year-old female is found in acute respiratory distress after chocking on a hotdog
during lunch. On exam, which of the following lungs sounds are you most likely to hear?
-Bronchophony
-Egophony
-Crackles
-Stridor - ANSWERS-Stridor
Stridor is the result of an upper airway obstruction, such as when there is a sudden
acute aspiration of an object.
A PMHNP employed within a small telehealth practice routinely "curb side consults" a
collaborative psychiatrist within the same state through email. The email includes the
client's name in the subject line and the email body includes a general question about
Risperdal management. Is this considered a HIPAA violation?