An 18-month-old child presents with a bulging, immobile tympanic membrane; T = 103°F
(39.4°C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border.
After initiation of treatment for otitis media, the most appropriate intervention is to:
Give this one a go later!
reevaluate the patient in 10 days.
Rationale: Heart murmurs in toddlers are relatively common and can be either
innocent (benign) or pathological (indicative of underlying heart conditions).
Proper evaluation and monitoring are essential to determine the nature of the
murmur and to ensure the child's health and development are not adversely
affected. Re-evaluating in 10 days is an appropriate next course of action.
A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for
management of pain due to pelvic fracture after motor vehicle collision. Admission labs
,show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection.
What is the most appropriate level of intervention for his patient?
Give this one a go later!
Observation until patient becomes symptomatic
Rationale: Treatment of neutropenia in asymptomatic patients is observation.
Your patient has presented with an acute GI bleed. In working up potential causes, which
of the following scenarios is most probable as a reason for the bleed?
Give this one a go later!
Four days of high dose of naproxen sodium for joint pain after a long hike
Rationale: Acute high dose use of NSAID is a risk of developing a stomach
ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with
systemic absorption over 1-2% and accordingly does not carry the
prostaglandin inhibition risks to the gut lining. Use of prednisone does not
predispose to bleeding, nor does acetaminophen use.
A pregnant woman with known HIV infection can reduce the risk of perinatal transmission
through zidovudine (Retrovir) therapy. Based on current research, optimal therapy is to
start daily dosing:
*if maternal viral loads are greater than 10,000.
*after 14 weeks of gestation.
*if premature rupture of membranes occurs.
*post amniocentesis.
Give this one a go later!
, after 14 weeks of gestation.
Rationale: Retrovir (Zidovudine) is an antiretroviral medication used to prevent
mother-to-child transmission of HIV during pregnancy, labor, and delivery. The
timing of initiating Retrovir in a pregnant woman is crucial for maximizing its
effectiveness in reducing the risk of vertical transmission of HIV. Early initiation
(around 14 weeks) helps to reduce viral load and improve maternal health, but
it can be started later if needed.
A patient who has active herpes zoster is at risk of shedding which contagious virus?
Give this one a go later!
Varicella zoster
Rationale: Patients with herpes zoster (shingles) are at risk of transmitting
varicella zoster (chicken pox) to those who have not yet had varicella or been
vaccinated.
Inability to reach the bathroom before urinating is a feature consistent with which of the
following diagnoses?
Give this one a go later!
urge-type incontinence
Rationale: Urge-type incontinence, also known as overactive bladder (OAB) or
urgency incontinence, is a condition characterized by a sudden and strong
need to urinate, often followed by involuntary leakage of urine. This type of
incontinence occurs when the bladder muscle (detrusor) contracts
involuntarily, leading to urgency and sometimes an inability to reach the toilet
in time.
, An older adult female reports nasal congestion, clear nasal secretions, and a post-nasal
drip since going through menopause. After a thorough examination reveals no significant
abnormalities, the nurse practitioner diagnoses the patient with:
Give this one a go later!
Vasomotor rhinitis
Rationale: Hormones can affect how the body reacts to environmental
changes, like humidity and temperature. Menopause can trigger vasomotor
rhinitis (VMR), also known as non-allergic rhinitis.
Your 24-year-old male patient has been admitted post-motor vehicle collision at a high
rate of speed. A CT head is performed revealing a pyramidal fracture involving the lateral
walls of the maxillary sinuses and inferior orbital rim. Which classification of fracture is
this?
Give this one a go later!
Le Fort II
Rationale: Le Fort II fracture lines pass through the posterior alveolar ridge,
lateral walls of maxillary sinuses, inferior orbital rim, and nasal bones
Le Fort type I, the plane of injury is horizontal and typically results in a
separation of the teeth from the upper face. The horizontal fracture line
generally passes through the alveolar ridge which is the bony socket that
holds the teeth, the lateral nose, and the inferior part of the maxillary sinus,
one of the four nasal sinuses that resides near the nose.
Le Fort type II presents with a pyramidal-shaped fracture. The upper teeth
make up the base and the nasofrontal suture— a band of tissue connecting the
frontal bone and the nasal bones—makes up the point or apex of the
pyramidal fracture. The pyramidal plane of fracture can again occur through
the alveolar ridge (an extension of the upper jaw) and maxillary sinuses, but
typically also extends through the orbital rim (eye socket) and nasal bones.
(39.4°C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border.
After initiation of treatment for otitis media, the most appropriate intervention is to:
Give this one a go later!
reevaluate the patient in 10 days.
Rationale: Heart murmurs in toddlers are relatively common and can be either
innocent (benign) or pathological (indicative of underlying heart conditions).
Proper evaluation and monitoring are essential to determine the nature of the
murmur and to ensure the child's health and development are not adversely
affected. Re-evaluating in 10 days is an appropriate next course of action.
A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for
management of pain due to pelvic fracture after motor vehicle collision. Admission labs
,show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection.
What is the most appropriate level of intervention for his patient?
Give this one a go later!
Observation until patient becomes symptomatic
Rationale: Treatment of neutropenia in asymptomatic patients is observation.
Your patient has presented with an acute GI bleed. In working up potential causes, which
of the following scenarios is most probable as a reason for the bleed?
Give this one a go later!
Four days of high dose of naproxen sodium for joint pain after a long hike
Rationale: Acute high dose use of NSAID is a risk of developing a stomach
ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with
systemic absorption over 1-2% and accordingly does not carry the
prostaglandin inhibition risks to the gut lining. Use of prednisone does not
predispose to bleeding, nor does acetaminophen use.
A pregnant woman with known HIV infection can reduce the risk of perinatal transmission
through zidovudine (Retrovir) therapy. Based on current research, optimal therapy is to
start daily dosing:
*if maternal viral loads are greater than 10,000.
*after 14 weeks of gestation.
*if premature rupture of membranes occurs.
*post amniocentesis.
Give this one a go later!
, after 14 weeks of gestation.
Rationale: Retrovir (Zidovudine) is an antiretroviral medication used to prevent
mother-to-child transmission of HIV during pregnancy, labor, and delivery. The
timing of initiating Retrovir in a pregnant woman is crucial for maximizing its
effectiveness in reducing the risk of vertical transmission of HIV. Early initiation
(around 14 weeks) helps to reduce viral load and improve maternal health, but
it can be started later if needed.
A patient who has active herpes zoster is at risk of shedding which contagious virus?
Give this one a go later!
Varicella zoster
Rationale: Patients with herpes zoster (shingles) are at risk of transmitting
varicella zoster (chicken pox) to those who have not yet had varicella or been
vaccinated.
Inability to reach the bathroom before urinating is a feature consistent with which of the
following diagnoses?
Give this one a go later!
urge-type incontinence
Rationale: Urge-type incontinence, also known as overactive bladder (OAB) or
urgency incontinence, is a condition characterized by a sudden and strong
need to urinate, often followed by involuntary leakage of urine. This type of
incontinence occurs when the bladder muscle (detrusor) contracts
involuntarily, leading to urgency and sometimes an inability to reach the toilet
in time.
, An older adult female reports nasal congestion, clear nasal secretions, and a post-nasal
drip since going through menopause. After a thorough examination reveals no significant
abnormalities, the nurse practitioner diagnoses the patient with:
Give this one a go later!
Vasomotor rhinitis
Rationale: Hormones can affect how the body reacts to environmental
changes, like humidity and temperature. Menopause can trigger vasomotor
rhinitis (VMR), also known as non-allergic rhinitis.
Your 24-year-old male patient has been admitted post-motor vehicle collision at a high
rate of speed. A CT head is performed revealing a pyramidal fracture involving the lateral
walls of the maxillary sinuses and inferior orbital rim. Which classification of fracture is
this?
Give this one a go later!
Le Fort II
Rationale: Le Fort II fracture lines pass through the posterior alveolar ridge,
lateral walls of maxillary sinuses, inferior orbital rim, and nasal bones
Le Fort type I, the plane of injury is horizontal and typically results in a
separation of the teeth from the upper face. The horizontal fracture line
generally passes through the alveolar ridge which is the bony socket that
holds the teeth, the lateral nose, and the inferior part of the maxillary sinus,
one of the four nasal sinuses that resides near the nose.
Le Fort type II presents with a pyramidal-shaped fracture. The upper teeth
make up the base and the nasofrontal suture— a band of tissue connecting the
frontal bone and the nasal bones—makes up the point or apex of the
pyramidal fracture. The pyramidal plane of fracture can again occur through
the alveolar ridge (an extension of the upper jaw) and maxillary sinuses, but
typically also extends through the orbital rim (eye socket) and nasal bones.
