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A 26-year-old female presents to urgent care with complaints of extreme fatigue, muscle aches,
abdominal pain, numbness and tingling in her extremities, and bloating. She explains that she
has been experiencing gastrointestinal upset after meals and has not had a bowel movement for
the past four days. She denies having any chronic diseases. The abdomen is distended and firm.
Bowel sounds are present in all four quadrants. The patient has a steady gait, though verbally
complains of feeling weak and off balance upon ambulation. Following antibody testing, Celiac
disease is suspected. Which follow-up tissue test, the gold standard for this suspected diagnosis,
should be ordered?
A. Endoscopy with stomach biopsy
B. Colonoscopy with large intestine biopsy
C. Endoscopy with small intestine biopsy
D. Colonoscopy with rectal biopsy
C
A 44-year-old woman has recently been diagnosed with advanced metastatic non–small-cell
lung cancer. Genetic testing is ordered to determine if the patient's tumor has any genomic
alterations and to guide treatment decisions. A few weeks later, the patient's test results come
back positive for a genetic mutation. The APN starts osimertinib (Tagrisso). Based on this
information, what types of genetic mutation does this patient have? Choose 2 answers.
A. ALK mutation
B. EGFR mutation
C. BRCA mutation
D. MET amplification mutation
A, B
,A 20-year-old male meets with an advanced professional nurse (APN) to discuss symptoms that
have been slowly progressing over the past several years. He is mainly concerned because he
has been falling frequently. Since childhood, his gait has consisted of walking on his toes. During
middle school, he was able to participate in sports but was unable to participate in high school
sports due to difficulty with running and jumping. Lately, he has noticed it takes longer and is
more difficult to change positions from sitting to standing than it used to in the past. He has also
been waking up with muscle and joint stiffness. The APRN notes that his family history is not
significant for any chronic or genetic diseases. Which condition is likely to be the cause of these
symptoms?
A. Becker muscular dystrophy
B. Myotonic dystrophy
C. Facioscapulohumeral muscular dystrophy (FSHD)
D. Limb-girdle muscular dystrophy
A
A patient with systemic lupus erythematosus (SLE) is diagnosed with idiopathic
thrombocytopenic purpura (ITP). Which statement should the provider give the patient
regarding the pathophysiology of SLE and its relation to thrombocytopenia?
A. SLE disrupts immune homeostasis and promotes development of self-reactive antibodies.
B. SLE causes a cross-reaction of antibodies with normal platelet antigens.
C. SLE causes a defect in the number and function of regulatory B cells.
D. SLE increases megakaryocyte maturation.
A
A female patient presents to an office to establish care. Her previous primary care provider told
her to follow up regarding an elevated ferritin level. She has no previous medical history and is
currently asymptomatic. She is concerned about the elevated ferritin and would like to know if
she should be worried. What should the provider do next for this patient?
A. Order a liver function test
, B. Order a renal ultrasound
C. Refer her for a bone marrow biopsy
D. Order a thyroid panel
A
A 75-year-old female presents to the emergency department with an irregular heart rate of 130.
What can be ascertained about this patient's findings given the limited information?
A. She has a normal sinus rhythm and needs her heart rate controlled with metoprolol
(Lopressor).
B. She is diagnosed with atrial fibrillation and needs her heart rate controlled with metoprolol
(Lopressor).
C. She is diagnosed with ventricular tachycardia and needs her heart rhythm controlled with
metoprolol (Lopressor).
D. She is diagnosed with torsades de pointes and needs her heart rate controlled with
magnesium.
B
A 75-year-old male presents with a history of transient ischemic attack, acute myocardial
infarction, angina, and atrial fibrillation. The patient's echocardiogram shows low cardiac output
and loss of contractility. Which condition from this patient's medical history is contributing to
the loss of contractility?
A. Atrial fibrillation
B. Acute myocardial infarction
C. Angina
D. Transient ischemic attack
B