i
1. Which of the following statements best describes a differential diagnosis list?
A. It is a list of planned interventions for the problems assessed during the visit.
B.It is the list of concerns brought to the appointment by the patient.
C.It is a list of different diagnoses experienced by the patient in the past.
D.It is a list of potential/plausible diagnoses that may be causing the patient’s signs and symptoms.
E.It is a list of diagnoses that have already been ruled out as causes for the chief complaint.
Pg 83
It is also important to ask about the presence or absence of additional symptoms or other relevant
information—such as risk factors for coronary artery disease in patients with chest pain, or current medications in
patients with syncope—that may help you generate a list of possible causes (differential diagnosis) to explain the
patient’s problem or condition. This list will include the most likely and, at times, the most serious causes, even if
less likely. When clinicians obtain a history, they are continually generating possible explanations in their minds,
allowing the patient’s answers to direct the logical use of additional probing questions. This process of probing with
questions is similar to testing a hypothesis. With each question, the list of probable diagnoses (or hypotheses) is
pared down until a few likely choices are left from a formerly longer list of diagnostic possibilities.
2. A 66-year-old female presents to the primary care office with complaints of jaw pain, fatigue, and nausea for
the last 48 hours. What course of action is appropriate in the treatment of this patient?
A. Refer the patient to an otolaryngologist to evaluate for jaw pain.
B. Prescribe the medication for the jaw pain and nausea and reevaluate in 2-3 days.
C. Order x-rays of the jaw and abdomen to further evaluate.
D. Recognize these could be atypical symptoms of acute coronary syndrome and proceed accordingly.
E. Order screening blood work to evaluate for thyroid disease.
Pg 503
Upper back pain, neck or gaw pain, SOB; paroxysmal nocturnal dyspnea; N&V = careful history taking is especially
important
Atypical symptoms are particularly seen in woman esp if over the age of 65
3. In an adult over the age of 40, an S3 assessment finding on cardiac auscultation may be indicative of what?
Select all that apply.
A. anemia
B. myocardial infarction
C. heart failure pg 551
D. normal for athletes - pg 522
E. ventricular volume overload from aortic or mitral regurgitation - pg 551
Pg 551
Pathologic S3 or ventricular gallop sounds like a physiological S3 - in adult over 40 is usually pathologic, arising
from high left ventricular filling pressures and abrupt deceleration of inflow across the mitral valve at the end of the
rapid filling phase of diastole. Causes include decreased myocardial contractility, heart failure, and ventricular
volume overload from aortic or mitral regurgitation and left to right shunts
Pg 548 MI can cause soft S1; pg 495 MI causes pathological ventricular stiffness which marks an S4 heart sound
right before the S1 (also heard in HTN)
Pg 1049
Chronic Anemia and following exercise can cause pulmonary flow murmurs - in the presence of volume overload
,4. A 72-year-old male is admitted to intensive care from the Emergency Room for the initial complaint of chest
pain. After the history and physical examination, the NP documents the following cardiovascular findings:
JVP is 5 cm above the sternal angle with the head of the bed elevated to 50°. Carotid upstrokes are
brisk; a bruit is heard over the left carotid artery. The PMI is diffuse, 3 cm in diameter, palpated at the
anterior axillary line in the fifth and sixth intercostal spaces. S1 and S2 are soft. S3 is present at the
apex. High-pitched harsh 2/6 holosystolic murmur best heard at the apex, radiating to the axilla.
Which of the following possible diagnoses is based on the accurate interpretation of the assessment
findings?
A. These findings suggest heart failure.
B. These findings suggest previous myocardial infarction.
C. These findings suggest right carotid occlusion.
D. These findings suggest mitral stenosis.
E. These findings suggest aortic aneurysm.
This scenario is word for word on pg 530 answer in red = these findings suggest heart failure with volume overload
with possible left carotid occlusion and mitral regurgitation
5. A 76-year-old male presents to the office for a routine physical examination. The NP documents the
following skin findings:
Decreased elasticity with multiple lentiginous macules on habitually sun-exposed skin. Multiple,
discrete, brown, stuck-on, non-indurated, verrucous plaques on the back and abdomen varying from
1-2 centimeters.
Which of the following is the most accurate interpretation of these findings?
A. These findings suggest seborrheic keratoses.
B. These findings suggest actinic keratoses.
C. These findings suggest malignant melanoma.
D. These findings suggest lichen planus.
E. These findings suggest psoriasis.
This exact scenario is described on pg 286 = seborrheic keratosis
Description elements = number, color, shape, texture, primary lesion, location and configuration
Seborrheic keratoses Pg 286 5 mm - 2 cm tan to brown, oval, stuck on, flat topped verrucous (cauliflower like)
plaques on the back and abd, following skin tension lines
Actinic keratoses Pg 313 Superficial keratotic papules come and go on sun-damaged skin - keratotic scales
can evolve and SCC (squamous cell carcinoma) is formed by keratin and can result in
cutaneous horn - (scalp, lip, ears)
Malignant melanoma Pg 286 Melanoma with all the classic features from the ABCD method: Asymmetry,
Border irregularity, Color variation, and Diameter >6mm.
When screening moles for melanomas, ABCD-EFG method. Asymmetry, boarder
irregularity - ragged, notched, or blurred; color variation (more than 2 colors, esp
blu-black, white or red); diameter >6 mm; evolving or changing rapidly in size, symptoms
or morphology; elevation; firmness to palpation and proggressive Growing over several
weeks….
Lichen planus 290 freq on wrist, forearms, genitals and lower legs.
Psoriasis Pg 290 freq affects the scalp, extensor surfaces of the elbows and knees, umbilicus and
the gluteal cleft.- 288 psoriasis commonly form plaques
,6. A 14-year-old male presents to the clinic with his grandmother for a complaint of a sore throat. The patient
is afebrile and denies cough. After completing the history and physical examination, the NP documented the
following partial assessment findings:
Throat—Oral mucosa pink, dental caries in lower molars, tongue midline, uvula, and pharynx
erythematous, bilateral tonsils enlarged, no exudates.
Neck—Trachea midline. Neck supple; thyroid isthmus midline, lobes palpable but not enlarged.
Lymph Nodes—Submandibular and anterior cervical lymph nodes tender, 1 cm × 1 cm, rubbery and
mobile; no posterior cervical, epitrochlear, axillary, or inguinal lymphadenopathy.
Which of the following is the most accurate interpretation of the findings?
A. These findings suggest pharyngitis.
B. These findings suggest tonsillar abscess.
C. These findings suggest lymphoma.
D. These findings suggest mononucleosis.
E. These findings suggest upper respiratory illness.
Pg 427 this scenario is detailed with - these findings suggest pharyngitis or mild tonsillitis
Pg 1018 Tonsillar abscess - a peritonsillar abscess is suggested by erythema and asymmetric protrusion of one
tonsil, pain, difficulty opening mouth (trismus), and lateral displacement of the uvula.
Pg 427 Asymmetry tonsils particularly when associated with other symptoms, may signify and underlying pathology
such as lymphoma
Pg 432 - infectious mononucleosis - enlarged posterior cervical lymph nodes (or general lymphadenopathy pg 345);
fatigue pg 212; pg 1047 an adolescent with persistent fever, sore throat, swollen tonsils and cervical
lympadenopathy may have streptococcal pharyngitis or infectious mononucleosis
Pg 402 - Upper respiratory infection - Is nasal or sinus congestion preceded by a viral upper respiratory tract
infection? Is there purulent nasal discharge, loss of smell, tooth pain, facial pain made worse by bending forward,
ear pressure, cough or fever? - Acute bacterial sinusitis (rhinosinusitis) is unlikely until viral URI symptoms persist
more than 7 days; both purulent drainage and facial pain should be present for diagnosis (sensitivity and specificity
are above 50%) if nasal congestion only on one side - consider nasal septum, nasal polyp, foreign body,
granulomatous disease or CA
7. The NP is assuming care for a 56-year-old female resident of a long-term assisted living facility. The woman
is seated in a wheelchair next to a window in her private room. After completing the history and physical
examination, the NP documented the following mental status findings:
The patient appears sad and fatigued; clothes are wrinkled. Speech is slow and words are mumbled.
Thought processes are coherent, but insight into current life reverses is limited. The patient is oriented
to person, place, and time. Digit span, serial 7s, and calculations accurate, but responses delayed.
Clock drawing is good.
Which of the following is the most accurate interpretation of the findings?
A. These findings suggest depression.
B. These findings suggest anxiety.
C. These findings suggest mood disorder.
D. These findings suggest a neurocognitive disorder.
E. These findings suggest intellectual disability.
This scenario is detailed on page 262 - these findings suggest depression
Pg 245 - Anxiety - common risk factors in patient with anxiety and related disorders include family history of anxiety
, personal history of anxiety or mood disorder, childhood stressful life events or trauma, being female, chronic medical
illness and behavioral inhibition.
Pg 247 Anxiety is often comorbid with substance use and mood disorders
Pg 250 Sudden-onset memory problems are concerning for major vascular neurocognitive disorders, wherein
vascular occlusion damages structures important for memory. Rapid-onset memory problems after a head injury
should raise suspicion for a major neurocognitive disorder due to TBI. delirium and dementia fall under
neurocognitive disorders pg 249; mini mental is best known screening for dementia pg 264
Intellectual disability - poor scoring in constructional ability (daw these simple shapes) pg 261; poor abstract thinking
- ask what a proverb means (don’t count your chickens before they hatch) pg 261; impaired recent memory pg 260;
poor performance in serial 7s pg 259; digit span - poor performance at - repeat # back pg 259; poor judgment pg
258;
8. The NP conducted a physical assessment on a 74-year-old male with a complaint of shortness of breath.
His history is significant for a 20 pack-year history of smoking. He uses 2 inhalers daily (medication unknown)
but did not bring them with him to his appointment. The documentation for the respiratory findings is as
follows:
Which of the following is the most accurate interpretation of the findings?
A. These findings suggest COPD. - total guess (2 inhalers - smoker? - makes me think emphysema not list)
B. These findings suggest pneumonia.
C. These findings suggest asthma.
D. These findings suggest chronic bronchitis.
E. These findings suggest left-sided heart failure.
COPD - unable to speak more than two or three words at a time due to shortness of breath. He has intercostal
muscle retraction when breathing and sits upright in bed. He is thin, with diffuse muscle wasting. Height is 6 ft 2 in;
weight, 175 lb; BP, 160/95, right arm; HR, 108 and irregular; RR, 32 and labored; temperature, 101.2°F.”
Pneumonia - pg 87 fever and cough - hx of smoking - rhinorrhea, asymmetric chest wall excursion and dullness to
chest w/ percussion p 145; exudates seen on c ray; pleuritic pain with deep inspiration pg 448; sputum often green
with bacterial pneumonia pg 450
Asthma - pg 483 WH pg 455 retraction occurs in severe asthma
Chronic bronchitis - pg 477 - chronic cough; sputum mucoid to purulent, may be blood-streaked or even bloody -
often recurrent WH and dyspnea and prolonged hx of tobacco
Left-side HF - rales or crackles ( pg 462); orthopnea and PND pg 504; increase JVP (508)
9. A 28-year-old female presents to the office for an annual physical examination. The NP is evaluating the
cranial nerves (CNs) while assessing the eyes. The findings are represented in this image. Damage or
inflammation of which of the following cranial nerve(s) is demonstrated in this image?
ADA Description: Eyes looking right and looking left.
A. CN II
B. CN III somewhat of a guess
C. CN IV
D. CN V
E. CN VI
1. Which of the following statements best describes a differential diagnosis list?
A. It is a list of planned interventions for the problems assessed during the visit.
B.It is the list of concerns brought to the appointment by the patient.
C.It is a list of different diagnoses experienced by the patient in the past.
D.It is a list of potential/plausible diagnoses that may be causing the patient’s signs and symptoms.
E.It is a list of diagnoses that have already been ruled out as causes for the chief complaint.
Pg 83
It is also important to ask about the presence or absence of additional symptoms or other relevant
information—such as risk factors for coronary artery disease in patients with chest pain, or current medications in
patients with syncope—that may help you generate a list of possible causes (differential diagnosis) to explain the
patient’s problem or condition. This list will include the most likely and, at times, the most serious causes, even if
less likely. When clinicians obtain a history, they are continually generating possible explanations in their minds,
allowing the patient’s answers to direct the logical use of additional probing questions. This process of probing with
questions is similar to testing a hypothesis. With each question, the list of probable diagnoses (or hypotheses) is
pared down until a few likely choices are left from a formerly longer list of diagnostic possibilities.
2. A 66-year-old female presents to the primary care office with complaints of jaw pain, fatigue, and nausea for
the last 48 hours. What course of action is appropriate in the treatment of this patient?
A. Refer the patient to an otolaryngologist to evaluate for jaw pain.
B. Prescribe the medication for the jaw pain and nausea and reevaluate in 2-3 days.
C. Order x-rays of the jaw and abdomen to further evaluate.
D. Recognize these could be atypical symptoms of acute coronary syndrome and proceed accordingly.
E. Order screening blood work to evaluate for thyroid disease.
Pg 503
Upper back pain, neck or gaw pain, SOB; paroxysmal nocturnal dyspnea; N&V = careful history taking is especially
important
Atypical symptoms are particularly seen in woman esp if over the age of 65
3. In an adult over the age of 40, an S3 assessment finding on cardiac auscultation may be indicative of what?
Select all that apply.
A. anemia
B. myocardial infarction
C. heart failure pg 551
D. normal for athletes - pg 522
E. ventricular volume overload from aortic or mitral regurgitation - pg 551
Pg 551
Pathologic S3 or ventricular gallop sounds like a physiological S3 - in adult over 40 is usually pathologic, arising
from high left ventricular filling pressures and abrupt deceleration of inflow across the mitral valve at the end of the
rapid filling phase of diastole. Causes include decreased myocardial contractility, heart failure, and ventricular
volume overload from aortic or mitral regurgitation and left to right shunts
Pg 548 MI can cause soft S1; pg 495 MI causes pathological ventricular stiffness which marks an S4 heart sound
right before the S1 (also heard in HTN)
Pg 1049
Chronic Anemia and following exercise can cause pulmonary flow murmurs - in the presence of volume overload
,4. A 72-year-old male is admitted to intensive care from the Emergency Room for the initial complaint of chest
pain. After the history and physical examination, the NP documents the following cardiovascular findings:
JVP is 5 cm above the sternal angle with the head of the bed elevated to 50°. Carotid upstrokes are
brisk; a bruit is heard over the left carotid artery. The PMI is diffuse, 3 cm in diameter, palpated at the
anterior axillary line in the fifth and sixth intercostal spaces. S1 and S2 are soft. S3 is present at the
apex. High-pitched harsh 2/6 holosystolic murmur best heard at the apex, radiating to the axilla.
Which of the following possible diagnoses is based on the accurate interpretation of the assessment
findings?
A. These findings suggest heart failure.
B. These findings suggest previous myocardial infarction.
C. These findings suggest right carotid occlusion.
D. These findings suggest mitral stenosis.
E. These findings suggest aortic aneurysm.
This scenario is word for word on pg 530 answer in red = these findings suggest heart failure with volume overload
with possible left carotid occlusion and mitral regurgitation
5. A 76-year-old male presents to the office for a routine physical examination. The NP documents the
following skin findings:
Decreased elasticity with multiple lentiginous macules on habitually sun-exposed skin. Multiple,
discrete, brown, stuck-on, non-indurated, verrucous plaques on the back and abdomen varying from
1-2 centimeters.
Which of the following is the most accurate interpretation of these findings?
A. These findings suggest seborrheic keratoses.
B. These findings suggest actinic keratoses.
C. These findings suggest malignant melanoma.
D. These findings suggest lichen planus.
E. These findings suggest psoriasis.
This exact scenario is described on pg 286 = seborrheic keratosis
Description elements = number, color, shape, texture, primary lesion, location and configuration
Seborrheic keratoses Pg 286 5 mm - 2 cm tan to brown, oval, stuck on, flat topped verrucous (cauliflower like)
plaques on the back and abd, following skin tension lines
Actinic keratoses Pg 313 Superficial keratotic papules come and go on sun-damaged skin - keratotic scales
can evolve and SCC (squamous cell carcinoma) is formed by keratin and can result in
cutaneous horn - (scalp, lip, ears)
Malignant melanoma Pg 286 Melanoma with all the classic features from the ABCD method: Asymmetry,
Border irregularity, Color variation, and Diameter >6mm.
When screening moles for melanomas, ABCD-EFG method. Asymmetry, boarder
irregularity - ragged, notched, or blurred; color variation (more than 2 colors, esp
blu-black, white or red); diameter >6 mm; evolving or changing rapidly in size, symptoms
or morphology; elevation; firmness to palpation and proggressive Growing over several
weeks….
Lichen planus 290 freq on wrist, forearms, genitals and lower legs.
Psoriasis Pg 290 freq affects the scalp, extensor surfaces of the elbows and knees, umbilicus and
the gluteal cleft.- 288 psoriasis commonly form plaques
,6. A 14-year-old male presents to the clinic with his grandmother for a complaint of a sore throat. The patient
is afebrile and denies cough. After completing the history and physical examination, the NP documented the
following partial assessment findings:
Throat—Oral mucosa pink, dental caries in lower molars, tongue midline, uvula, and pharynx
erythematous, bilateral tonsils enlarged, no exudates.
Neck—Trachea midline. Neck supple; thyroid isthmus midline, lobes palpable but not enlarged.
Lymph Nodes—Submandibular and anterior cervical lymph nodes tender, 1 cm × 1 cm, rubbery and
mobile; no posterior cervical, epitrochlear, axillary, or inguinal lymphadenopathy.
Which of the following is the most accurate interpretation of the findings?
A. These findings suggest pharyngitis.
B. These findings suggest tonsillar abscess.
C. These findings suggest lymphoma.
D. These findings suggest mononucleosis.
E. These findings suggest upper respiratory illness.
Pg 427 this scenario is detailed with - these findings suggest pharyngitis or mild tonsillitis
Pg 1018 Tonsillar abscess - a peritonsillar abscess is suggested by erythema and asymmetric protrusion of one
tonsil, pain, difficulty opening mouth (trismus), and lateral displacement of the uvula.
Pg 427 Asymmetry tonsils particularly when associated with other symptoms, may signify and underlying pathology
such as lymphoma
Pg 432 - infectious mononucleosis - enlarged posterior cervical lymph nodes (or general lymphadenopathy pg 345);
fatigue pg 212; pg 1047 an adolescent with persistent fever, sore throat, swollen tonsils and cervical
lympadenopathy may have streptococcal pharyngitis or infectious mononucleosis
Pg 402 - Upper respiratory infection - Is nasal or sinus congestion preceded by a viral upper respiratory tract
infection? Is there purulent nasal discharge, loss of smell, tooth pain, facial pain made worse by bending forward,
ear pressure, cough or fever? - Acute bacterial sinusitis (rhinosinusitis) is unlikely until viral URI symptoms persist
more than 7 days; both purulent drainage and facial pain should be present for diagnosis (sensitivity and specificity
are above 50%) if nasal congestion only on one side - consider nasal septum, nasal polyp, foreign body,
granulomatous disease or CA
7. The NP is assuming care for a 56-year-old female resident of a long-term assisted living facility. The woman
is seated in a wheelchair next to a window in her private room. After completing the history and physical
examination, the NP documented the following mental status findings:
The patient appears sad and fatigued; clothes are wrinkled. Speech is slow and words are mumbled.
Thought processes are coherent, but insight into current life reverses is limited. The patient is oriented
to person, place, and time. Digit span, serial 7s, and calculations accurate, but responses delayed.
Clock drawing is good.
Which of the following is the most accurate interpretation of the findings?
A. These findings suggest depression.
B. These findings suggest anxiety.
C. These findings suggest mood disorder.
D. These findings suggest a neurocognitive disorder.
E. These findings suggest intellectual disability.
This scenario is detailed on page 262 - these findings suggest depression
Pg 245 - Anxiety - common risk factors in patient with anxiety and related disorders include family history of anxiety
, personal history of anxiety or mood disorder, childhood stressful life events or trauma, being female, chronic medical
illness and behavioral inhibition.
Pg 247 Anxiety is often comorbid with substance use and mood disorders
Pg 250 Sudden-onset memory problems are concerning for major vascular neurocognitive disorders, wherein
vascular occlusion damages structures important for memory. Rapid-onset memory problems after a head injury
should raise suspicion for a major neurocognitive disorder due to TBI. delirium and dementia fall under
neurocognitive disorders pg 249; mini mental is best known screening for dementia pg 264
Intellectual disability - poor scoring in constructional ability (daw these simple shapes) pg 261; poor abstract thinking
- ask what a proverb means (don’t count your chickens before they hatch) pg 261; impaired recent memory pg 260;
poor performance in serial 7s pg 259; digit span - poor performance at - repeat # back pg 259; poor judgment pg
258;
8. The NP conducted a physical assessment on a 74-year-old male with a complaint of shortness of breath.
His history is significant for a 20 pack-year history of smoking. He uses 2 inhalers daily (medication unknown)
but did not bring them with him to his appointment. The documentation for the respiratory findings is as
follows:
Which of the following is the most accurate interpretation of the findings?
A. These findings suggest COPD. - total guess (2 inhalers - smoker? - makes me think emphysema not list)
B. These findings suggest pneumonia.
C. These findings suggest asthma.
D. These findings suggest chronic bronchitis.
E. These findings suggest left-sided heart failure.
COPD - unable to speak more than two or three words at a time due to shortness of breath. He has intercostal
muscle retraction when breathing and sits upright in bed. He is thin, with diffuse muscle wasting. Height is 6 ft 2 in;
weight, 175 lb; BP, 160/95, right arm; HR, 108 and irregular; RR, 32 and labored; temperature, 101.2°F.”
Pneumonia - pg 87 fever and cough - hx of smoking - rhinorrhea, asymmetric chest wall excursion and dullness to
chest w/ percussion p 145; exudates seen on c ray; pleuritic pain with deep inspiration pg 448; sputum often green
with bacterial pneumonia pg 450
Asthma - pg 483 WH pg 455 retraction occurs in severe asthma
Chronic bronchitis - pg 477 - chronic cough; sputum mucoid to purulent, may be blood-streaked or even bloody -
often recurrent WH and dyspnea and prolonged hx of tobacco
Left-side HF - rales or crackles ( pg 462); orthopnea and PND pg 504; increase JVP (508)
9. A 28-year-old female presents to the office for an annual physical examination. The NP is evaluating the
cranial nerves (CNs) while assessing the eyes. The findings are represented in this image. Damage or
inflammation of which of the following cranial nerve(s) is demonstrated in this image?
ADA Description: Eyes looking right and looking left.
A. CN II
B. CN III somewhat of a guess
C. CN IV
D. CN V
E. CN VI
