A 34-year-old male presents with choledocholithiasis, which is suspected after an MRCP
shows a potential stone is the cystic duct. Which procedure would provide diagnostic
and intervention potential for this patient?
*EUS
*ERCP
*EGD
*Colonoscopy
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ERCP
Rationale: An ERCP allows for direct visualization with contrast and imagining
of potential stones, it also allows for direct intervention of dilation and removal
of stones.
,An adult female presents with a 1-week history of left lower quadrant abdominal pain.
T=101.2 degrees F. (38.4 degrees C) and an elevated WBC count. This is the patient's first
episode of severe abdominal pain. The nurse practitioner suspects diverticulitis. Which of
the following diagnostic tests would confirm the diagnosis?
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CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide
evidence of the pathophysiology. Evidence of diverticula will be present on a
flat plate KUB x-ray, but there is not enough specificity to show that it is
inflamed as with a CT scan.
Erysipelas typically presents on the face with:
*Scattered ruborous macules across the cheeks
*A papular erythematous malar rash
*Painful progressive arrythmia and edema
*Vesicles on an erythematous base following a dermatome
Give this one a go later!
, Painful progressive arrythmia and edema
Rationale: Erysipelas is a bacterial skin infection that typically presents with
distinctive symptoms and tends to affect the face more commonly than other
parts of the body.
Symptoms: The infection usually starts suddenly and can cause symptoms
such as:
Red, swollen, and shiny skin
Well-defined borders between affected and unaffected skin
Pain and tenderness
Fever and chills
Blisters or sores filled with fluid (bullae) in severe cases
An elderly patient diagnosed with end-stage lung cancer has been refusing meals,
opting instead for ice cream only. The family is concerned about the patient not getting
enough nutrition. The NP:
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explains loss of appetite is common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully.
Factual re-orientation to the terminal state of a patient's condition may be
appropriate when unrealistic expectations for their longevity have been
voiced. The reasonable choice in this case is to describe the normalcy of what
the patient is experiencing with their loss of appetite and their terminal state.
Testing the patient for depression has really no clinical bearing on this
particular time nor does prescribing methylphenidate. Ordering a UA and CBC
would suggest a concern of a urinary tract infection, and that is not a likely
scenario to describe the patient's existing condition. Support the patient as his
advocate by helping the man enjoy the ice cream he requested.
, A 64-year-old female with a past medical history significant for hepatitis C and Cirrhosis
presents to your office with abdominal pain and distention. Exam reveals tense ascites.
Which is indicated for treatment?
*Midodrine 10mg PO TID
*Labetalol 200mg PO BID
*Transfer to the hospital for large Volume paracentesis
*Furosemide 40mg PO BID
Give this one a go later!
Transfer to the hospital for large Volume paracentesis
Rationale: Large Volume Paracentesis will provide immediate relief for the
patient, it will also allow for testing of fluid for spontaneous bacterial
peritonitis.
A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause?
*Increased bile secretion
*Decreased bowel muscle tone
*Increased absorption of calcium
*Decreased pancreatic secretions
Give this one a go later!
shows a potential stone is the cystic duct. Which procedure would provide diagnostic
and intervention potential for this patient?
*EUS
*ERCP
*EGD
*Colonoscopy
Give this one a go later!
ERCP
Rationale: An ERCP allows for direct visualization with contrast and imagining
of potential stones, it also allows for direct intervention of dilation and removal
of stones.
,An adult female presents with a 1-week history of left lower quadrant abdominal pain.
T=101.2 degrees F. (38.4 degrees C) and an elevated WBC count. This is the patient's first
episode of severe abdominal pain. The nurse practitioner suspects diverticulitis. Which of
the following diagnostic tests would confirm the diagnosis?
Give this one a go later!
CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide
evidence of the pathophysiology. Evidence of diverticula will be present on a
flat plate KUB x-ray, but there is not enough specificity to show that it is
inflamed as with a CT scan.
Erysipelas typically presents on the face with:
*Scattered ruborous macules across the cheeks
*A papular erythematous malar rash
*Painful progressive arrythmia and edema
*Vesicles on an erythematous base following a dermatome
Give this one a go later!
, Painful progressive arrythmia and edema
Rationale: Erysipelas is a bacterial skin infection that typically presents with
distinctive symptoms and tends to affect the face more commonly than other
parts of the body.
Symptoms: The infection usually starts suddenly and can cause symptoms
such as:
Red, swollen, and shiny skin
Well-defined borders between affected and unaffected skin
Pain and tenderness
Fever and chills
Blisters or sores filled with fluid (bullae) in severe cases
An elderly patient diagnosed with end-stage lung cancer has been refusing meals,
opting instead for ice cream only. The family is concerned about the patient not getting
enough nutrition. The NP:
Give this one a go later!
explains loss of appetite is common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully.
Factual re-orientation to the terminal state of a patient's condition may be
appropriate when unrealistic expectations for their longevity have been
voiced. The reasonable choice in this case is to describe the normalcy of what
the patient is experiencing with their loss of appetite and their terminal state.
Testing the patient for depression has really no clinical bearing on this
particular time nor does prescribing methylphenidate. Ordering a UA and CBC
would suggest a concern of a urinary tract infection, and that is not a likely
scenario to describe the patient's existing condition. Support the patient as his
advocate by helping the man enjoy the ice cream he requested.
, A 64-year-old female with a past medical history significant for hepatitis C and Cirrhosis
presents to your office with abdominal pain and distention. Exam reveals tense ascites.
Which is indicated for treatment?
*Midodrine 10mg PO TID
*Labetalol 200mg PO BID
*Transfer to the hospital for large Volume paracentesis
*Furosemide 40mg PO BID
Give this one a go later!
Transfer to the hospital for large Volume paracentesis
Rationale: Large Volume Paracentesis will provide immediate relief for the
patient, it will also allow for testing of fluid for spontaneous bacterial
peritonitis.
A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause?
*Increased bile secretion
*Decreased bowel muscle tone
*Increased absorption of calcium
*Decreased pancreatic secretions
Give this one a go later!
