lOMoARcPSD|25701531
1. A 39-year-old male with type 1 DM is seen in the urgent care after a recent
hospitalization for DKA. Treated with IV fluids, IV insulin, and potassium
correction, His BS decreases to 120 mg/dL and is transitioned from IV insulin to
Sub Q. After 6 hours he begins vomiting and ABG is done: pH 7.19, CO2 13, K+
5.5, glucose 180. Which of the following is the most likely reason for persistent
acidosis?
a. Failure to correct hyperkalemia
b. Lack of absorption of Sub Q insulin
c. Failure to give bicarbonate
d. Premature discontinuation of insulin drip
2. Classic findings in a patient with a pheochromocytoma include which of the
following?
a. Postural hypotension
b. Paroxysmal symptoms
c. Generalized anxiety
d. Depression
3. Pheochromocytoma is best diagnosed by which of the following tests:
a. Plasma metanephrines with blood pressure values
b. Adrenal CT/MRI
c. 24-hour urine for catecholamines/metanephrines and plasma
metanephrines
d. Blood pressure values and adrenal CT/MRI
4. Which of the following is produced in the pancreas and counteracts
hypoglycemia?
a. Pancreas
b. Growth hormone
c. Insulin
d. Glucagon
5. A patient is having increased thirst and urination. You have ruled out diabetes
mellitus. After a compete history and physical you suspect diabetes insipidus.
Your initial lab tests should include?
6. Group of answer choices
a. Renal US and 24-hour urine for volume
b. Plasma sodium and renal US
c. Recording Intake and output
d. Plasma sodium, 24-hour urine osmolality and volume
7. A 60-year-old man presents with recurrent kidney stones, abdominal pain, and
bone pain. Laboratory results show elevated serum calcium and low phosphate
levels. What is the most likely diagnosis?
a. Hypoparathyroidism
b. Osteoporosis
c. Hyperparathyroidism
d. Hypercalcemia of malignancy
8. An adult male who has managed type 2 diabetes mellitus well for many years
presents for a 6-month follow up. His Hgb A1c has risen from 7% to 9% over the
, lOMoARcPSD|25701531
interval. All other laboratory values are normal and his BMI is still 25. His
psychiatrist recently added olanzapine (Zypreza) to the medical regimen. The
nurse practitioner will most likely:
a. Begin to increase the patient’s diabetes medications incrementally
b. Encourage the patient to start walking for 30 min every other day
c. Encourage the patient to cut back on dietary intake
d. Discontinue the olanzapine until the patient’s psychiatrist has been
consulted
22. A 92-year-old presents with a decline in personal care and increasing
forgetfulness. They had a CVA a three years ago with mild cognitive changes then
which has slowly progressed. The more likely diagnosis in this case is?
a. Alzheimer’s dementia
b. Lewy-body dementia
c. Progressive vascular dementia
d. Mini-strokes
23. A 90-year-old female is brought to the clinic by her neighbor. She states that
everything is fine, but the nurse practitioner notes that she has poor hygiene and
bruises on her trunk. The neighbor is concerned that the patient often has no
money to buy food, despite income from social security and a coal miner’s
pension. The nurse practitioner suspects abuse. Which of the following is the
nurse practitioner obligated to do next?
a. Tell the neighbor to check on the woman daily and report back.
b. Call the patient’s family and inquire about the concerns.
c. Document the data and report the information to risk management.
d. Report the case to the proper authorities.
24. The management of COPD in the elderly is best guided by:
a. spirometry.
b. radiologic imaging.
c. arterial blood gases.
d. symptomatology.
25. Which of the following gastrointestinal changes is associated with normal aging?
a. Increased salivation
b. Decreased production of gastric acid
c. Decreased incidence of gallstones
d. Increased esophageal emptying
26. An elderly patient is being admitted to the skilled nursing facility and is being
screened for the risk of falling. Which of the following information would trigger a
complete falls assessment?
a. A history of two or more falls in the prior year
b. Osteoarthritis in the hips and knees
c. Medication regimen including acetaminophen for pain and a calcium
channel blocker
d. Living alone and having mild dementia
27. A 36-year-old female presents to your service with RUQ pain, fever, nausea and
vomiting, and loss of appetite. Imagining shows stones present in the gallbladder,
, lOMoARcPSD|25701531
no dilation in the biliary duct, US shows edema and wall thickening. What is the
patients most likely diagnosis?
a. Choledocholithiasis
b. Acute pancreatitis
c. Cholangiocarcinoma
d. Acute cholecystitis
28. An adult patient presents with left lower quadrant abdominal tenderness and a
history of diverticular disease. The patient denies any fever or vomiting, and the
last episode was over 10 years ago. Suspecting this is a mild and uncomplicated
episode the best treatment plan is:
a. CT scan
b. increase whole grain and water intake
c. CBC and metabolic panel
d. ciprofloxacin
29. During the past 24 hours, a 62-year-old has experienced abdominal pain that
radiates to the back. The patient also reports several episodes of nausea and
vomiting, a low-grade temperature, and a history of excessive drinking. Physical
examination reveals a distended abdomen. Laboratory serum values indicate
elevated alkaline phosphatase, amylase, and serum lipase. The most likely
diagnosis is:
a. A alcoholic liver disease.
b. acute pancreatitis.
c. viral hepatitis.
d. acute mesenteric ischemia.
30. A 43-year-old male with past medical history significant for GERD, smoking, and
obesity presents to your clinic for worsening GERD symptoms, he has been taking
Protonix 40mg daily with no improvement. He had an EGD done with biopsy.
Which findings would diagnose the patient with Barret's esophagus?
a. Intestinal metaplasia with goblet cells
b. Smooth muscularis mucosae
c. Intestinal dysplasia with goblet cells
d. Erosion of esophagus, and inflammatory findings on biopsy
31. Where can Crohn’s disease be located within the GI tract and how does it present
(continuous or patchy)?
a. Patchy inflammation throughout the small bowel and colon
b. In the esophagus and stomach only
c. In the colon only and patchy
d. In the colon continuous throughout
32. A 29-year-old male presents with severe abdominal pain, he has a history of
alcohol abuse, and recurrent pancreatitis. Patients Lipase is elevated, and he has
nausea and vomiting as well. Abdominal CT shows inflammatory changes around
the pancreas. What is the most important intervention to consider in the acute
phase?
a. Further imagining and diagnosis with EUS and aspiration for development
of necrosis
1. A 39-year-old male with type 1 DM is seen in the urgent care after a recent
hospitalization for DKA. Treated with IV fluids, IV insulin, and potassium
correction, His BS decreases to 120 mg/dL and is transitioned from IV insulin to
Sub Q. After 6 hours he begins vomiting and ABG is done: pH 7.19, CO2 13, K+
5.5, glucose 180. Which of the following is the most likely reason for persistent
acidosis?
a. Failure to correct hyperkalemia
b. Lack of absorption of Sub Q insulin
c. Failure to give bicarbonate
d. Premature discontinuation of insulin drip
2. Classic findings in a patient with a pheochromocytoma include which of the
following?
a. Postural hypotension
b. Paroxysmal symptoms
c. Generalized anxiety
d. Depression
3. Pheochromocytoma is best diagnosed by which of the following tests:
a. Plasma metanephrines with blood pressure values
b. Adrenal CT/MRI
c. 24-hour urine for catecholamines/metanephrines and plasma
metanephrines
d. Blood pressure values and adrenal CT/MRI
4. Which of the following is produced in the pancreas and counteracts
hypoglycemia?
a. Pancreas
b. Growth hormone
c. Insulin
d. Glucagon
5. A patient is having increased thirst and urination. You have ruled out diabetes
mellitus. After a compete history and physical you suspect diabetes insipidus.
Your initial lab tests should include?
6. Group of answer choices
a. Renal US and 24-hour urine for volume
b. Plasma sodium and renal US
c. Recording Intake and output
d. Plasma sodium, 24-hour urine osmolality and volume
7. A 60-year-old man presents with recurrent kidney stones, abdominal pain, and
bone pain. Laboratory results show elevated serum calcium and low phosphate
levels. What is the most likely diagnosis?
a. Hypoparathyroidism
b. Osteoporosis
c. Hyperparathyroidism
d. Hypercalcemia of malignancy
8. An adult male who has managed type 2 diabetes mellitus well for many years
presents for a 6-month follow up. His Hgb A1c has risen from 7% to 9% over the
, lOMoARcPSD|25701531
interval. All other laboratory values are normal and his BMI is still 25. His
psychiatrist recently added olanzapine (Zypreza) to the medical regimen. The
nurse practitioner will most likely:
a. Begin to increase the patient’s diabetes medications incrementally
b. Encourage the patient to start walking for 30 min every other day
c. Encourage the patient to cut back on dietary intake
d. Discontinue the olanzapine until the patient’s psychiatrist has been
consulted
22. A 92-year-old presents with a decline in personal care and increasing
forgetfulness. They had a CVA a three years ago with mild cognitive changes then
which has slowly progressed. The more likely diagnosis in this case is?
a. Alzheimer’s dementia
b. Lewy-body dementia
c. Progressive vascular dementia
d. Mini-strokes
23. A 90-year-old female is brought to the clinic by her neighbor. She states that
everything is fine, but the nurse practitioner notes that she has poor hygiene and
bruises on her trunk. The neighbor is concerned that the patient often has no
money to buy food, despite income from social security and a coal miner’s
pension. The nurse practitioner suspects abuse. Which of the following is the
nurse practitioner obligated to do next?
a. Tell the neighbor to check on the woman daily and report back.
b. Call the patient’s family and inquire about the concerns.
c. Document the data and report the information to risk management.
d. Report the case to the proper authorities.
24. The management of COPD in the elderly is best guided by:
a. spirometry.
b. radiologic imaging.
c. arterial blood gases.
d. symptomatology.
25. Which of the following gastrointestinal changes is associated with normal aging?
a. Increased salivation
b. Decreased production of gastric acid
c. Decreased incidence of gallstones
d. Increased esophageal emptying
26. An elderly patient is being admitted to the skilled nursing facility and is being
screened for the risk of falling. Which of the following information would trigger a
complete falls assessment?
a. A history of two or more falls in the prior year
b. Osteoarthritis in the hips and knees
c. Medication regimen including acetaminophen for pain and a calcium
channel blocker
d. Living alone and having mild dementia
27. A 36-year-old female presents to your service with RUQ pain, fever, nausea and
vomiting, and loss of appetite. Imagining shows stones present in the gallbladder,
, lOMoARcPSD|25701531
no dilation in the biliary duct, US shows edema and wall thickening. What is the
patients most likely diagnosis?
a. Choledocholithiasis
b. Acute pancreatitis
c. Cholangiocarcinoma
d. Acute cholecystitis
28. An adult patient presents with left lower quadrant abdominal tenderness and a
history of diverticular disease. The patient denies any fever or vomiting, and the
last episode was over 10 years ago. Suspecting this is a mild and uncomplicated
episode the best treatment plan is:
a. CT scan
b. increase whole grain and water intake
c. CBC and metabolic panel
d. ciprofloxacin
29. During the past 24 hours, a 62-year-old has experienced abdominal pain that
radiates to the back. The patient also reports several episodes of nausea and
vomiting, a low-grade temperature, and a history of excessive drinking. Physical
examination reveals a distended abdomen. Laboratory serum values indicate
elevated alkaline phosphatase, amylase, and serum lipase. The most likely
diagnosis is:
a. A alcoholic liver disease.
b. acute pancreatitis.
c. viral hepatitis.
d. acute mesenteric ischemia.
30. A 43-year-old male with past medical history significant for GERD, smoking, and
obesity presents to your clinic for worsening GERD symptoms, he has been taking
Protonix 40mg daily with no improvement. He had an EGD done with biopsy.
Which findings would diagnose the patient with Barret's esophagus?
a. Intestinal metaplasia with goblet cells
b. Smooth muscularis mucosae
c. Intestinal dysplasia with goblet cells
d. Erosion of esophagus, and inflammatory findings on biopsy
31. Where can Crohn’s disease be located within the GI tract and how does it present
(continuous or patchy)?
a. Patchy inflammation throughout the small bowel and colon
b. In the esophagus and stomach only
c. In the colon only and patchy
d. In the colon continuous throughout
32. A 29-year-old male presents with severe abdominal pain, he has a history of
alcohol abuse, and recurrent pancreatitis. Patients Lipase is elevated, and he has
nausea and vomiting as well. Abdominal CT shows inflammatory changes around
the pancreas. What is the most important intervention to consider in the acute
phase?
a. Further imagining and diagnosis with EUS and aspiration for development
of necrosis
