FNP654 | FNP654 Family Primary Care II Exam 2
v2 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 55-year-old patient with Type 2 Diabetes has an estimated GFR of 28
mL/min/1.73m2. Which of the following is the most appropriate action regarding their
Metformin therapy?
A. Decrease the dose by 50%
B. Continue the current dose and monitor monthly
C. Switch the patient to a sulfonylurea
D. Discontinue the medication immediately
Correct Answer: D
Expert Explanation: Metformin is contraindicated in patients with an eGFR below
30 mL/min/1.73m2 due to the increased risk of lactic acidosis. Lactic acidosis is a
rare but life-threatening complication associated with biguanide therapy in the
setting of renal insufficiency. The provider should evaluate other glucose-lowering
therapies that are safer for advanced chronic kidney disease.
2. Which of the following physical exam findings is most characteristic of Psoriasis?
A. Targetoid lesions on the palms and soles
B. Honey-colored crusting on the face
,C. Silvery scales on an erythematous base
D. Pearly papules with telangiectasia
Correct Answer: C
Expert Explanation: Psoriasis typically presents as well-demarcated erythematous
plaques with overlying silvery scales, often on extensor surfaces. The Auspitz sign,
which is pinpoint bleeding after removal of a scale, is also a classic finding. This
chronic inflammatory condition requires long-term management with topical
steroids or systemic agents.
3. A patient presents with symptoms of productive cough, fever, and pleuritic chest
pain. Chest X-ray reveals a right lower lobe infiltrate. What is the first-line treatment
for this healthy adult with no comorbidities and no recent antibiotic use?
A. Ciprofloxacin 500mg BID
B. Levofloxacin 750mg daily
C. Amoxicillin 1g TID
D. Vancomycin IV
Correct Answer: C
Expert Explanation: For community-acquired pneumonia in a healthy outpatient,
high-dose Amoxicillin or Doxycycline are now preferred first-line options according
,to current guidelines. Monotherapy with a respiratory fluoroquinolone like
Levofloxacin is typically reserved for patients with significant comorbidities or
recent antibiotic use. Ciprofloxacin is not used for pneumonia because it does not
provide adequate coverage for Streptococcus pneumoniae.
4. Which screening test is recommended for a 65-year-old male who has a 35 pack-
year smoking history and quit 10 years ago?
A. Chest X-ray every 2 years
B. Peak flow monitoring
C. Sputum cytology every 6 months
D. Annual low-dose CT scan of the chest
Correct Answer: D
Expert Explanation: The USPSTF recommends annual screening for lung cancer
with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who
have a 20 pack-year smoking history and currently smoke or have quit within the
past 15 years. This screening aims to detect lung cancer at an earlier, more treatable
stage. Screening should be discontinued once a person has not smoked for 15 years
or develops a health problem that substantially limits life expectancy.
, 5. A 24-year-old female presents with a ‘herald patch’ followed by a ‘Christmas tree’
distribution of smaller maculopapular lesions on her back. What is the most likely
diagnosis?
A. Pityriasis Rosea
B. Secondary Syphilis
C. Tinea Corporis
D. Atopic Dermatitis
Correct Answer: A
Expert Explanation: Pityriasis Rosea is a self-limiting skin rash that typically
begins with a single, large herald patch followed by smaller lesions along skin
cleavage lines. It is often described as having a Christmas tree distribution on the
torso. Treatment is usually supportive, as the rash resolves spontaneously within 6
to 8 weeks.
6. Which laboratory value is most sensitive for diagnosing early iron deficiency
anemia?
A. Hemoglobin
B. Mean Corpuscular Volume (MCV)
C. Serum Ferritin
v2 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 55-year-old patient with Type 2 Diabetes has an estimated GFR of 28
mL/min/1.73m2. Which of the following is the most appropriate action regarding their
Metformin therapy?
A. Decrease the dose by 50%
B. Continue the current dose and monitor monthly
C. Switch the patient to a sulfonylurea
D. Discontinue the medication immediately
Correct Answer: D
Expert Explanation: Metformin is contraindicated in patients with an eGFR below
30 mL/min/1.73m2 due to the increased risk of lactic acidosis. Lactic acidosis is a
rare but life-threatening complication associated with biguanide therapy in the
setting of renal insufficiency. The provider should evaluate other glucose-lowering
therapies that are safer for advanced chronic kidney disease.
2. Which of the following physical exam findings is most characteristic of Psoriasis?
A. Targetoid lesions on the palms and soles
B. Honey-colored crusting on the face
,C. Silvery scales on an erythematous base
D. Pearly papules with telangiectasia
Correct Answer: C
Expert Explanation: Psoriasis typically presents as well-demarcated erythematous
plaques with overlying silvery scales, often on extensor surfaces. The Auspitz sign,
which is pinpoint bleeding after removal of a scale, is also a classic finding. This
chronic inflammatory condition requires long-term management with topical
steroids or systemic agents.
3. A patient presents with symptoms of productive cough, fever, and pleuritic chest
pain. Chest X-ray reveals a right lower lobe infiltrate. What is the first-line treatment
for this healthy adult with no comorbidities and no recent antibiotic use?
A. Ciprofloxacin 500mg BID
B. Levofloxacin 750mg daily
C. Amoxicillin 1g TID
D. Vancomycin IV
Correct Answer: C
Expert Explanation: For community-acquired pneumonia in a healthy outpatient,
high-dose Amoxicillin or Doxycycline are now preferred first-line options according
,to current guidelines. Monotherapy with a respiratory fluoroquinolone like
Levofloxacin is typically reserved for patients with significant comorbidities or
recent antibiotic use. Ciprofloxacin is not used for pneumonia because it does not
provide adequate coverage for Streptococcus pneumoniae.
4. Which screening test is recommended for a 65-year-old male who has a 35 pack-
year smoking history and quit 10 years ago?
A. Chest X-ray every 2 years
B. Peak flow monitoring
C. Sputum cytology every 6 months
D. Annual low-dose CT scan of the chest
Correct Answer: D
Expert Explanation: The USPSTF recommends annual screening for lung cancer
with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who
have a 20 pack-year smoking history and currently smoke or have quit within the
past 15 years. This screening aims to detect lung cancer at an earlier, more treatable
stage. Screening should be discontinued once a person has not smoked for 15 years
or develops a health problem that substantially limits life expectancy.
, 5. A 24-year-old female presents with a ‘herald patch’ followed by a ‘Christmas tree’
distribution of smaller maculopapular lesions on her back. What is the most likely
diagnosis?
A. Pityriasis Rosea
B. Secondary Syphilis
C. Tinea Corporis
D. Atopic Dermatitis
Correct Answer: A
Expert Explanation: Pityriasis Rosea is a self-limiting skin rash that typically
begins with a single, large herald patch followed by smaller lesions along skin
cleavage lines. It is often described as having a Christmas tree distribution on the
torso. Treatment is usually supportive, as the rash resolves spontaneously within 6
to 8 weeks.
6. Which laboratory value is most sensitive for diagnosing early iron deficiency
anemia?
A. Hemoglobin
B. Mean Corpuscular Volume (MCV)
C. Serum Ferritin
