NSG 554 EXAM 4 V3 - NURSE
PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND ANSWERS
1. A 58-year-old male with a history of Type 2 Diabetes presents for follow-up. His A1C is 8.2%
despite taking Metformin 1000mg BID. He has a history of Heart Failure with reduced ejection
fraction (HFrEF). Which medication class is the most appropriate next step for glucose
management and cardiovascular benefit?
A. DPP-4 inhibitors
B. Sulfonylureas
C. SGLT2 inhibitors
D. TZDs (Thiazolidinediones)
Answer: C
Conceptual Explanation: SGLT2 inhibitors (e.g., Empagliflozin) are recommended in
patients with Type 2 Diabetes and HFrEF as they reduce the risk of heart failure
hospitalization and provide cardiovascular benefits. TZDs are contraindicated in heart
failure.
,2. A patient presents with symptoms of hyperthyroidism. Labs show a suppressed TSH and
elevated Free T4. A radioactive iodine uptake (RAIU) scan shows high, diffuse uptake
throughout the thyroid gland. What is the most likely diagnosis?
A. Subacute thyroiditis
B. Thyroiditis post-partum
C. Toxic multinodular goiter
D. Graves’ disease
Answer: D
Conceptual Explanation: High, diffuse uptake on an RAIU scan is characteristic of Graves’
disease. Low uptake would suggest thyroiditis, and patchy uptake would suggest toxic
multinodular goiter.
3. When evaluating a 65-year-old male for Benign Prostatic Hyperplasia (BPH), which
symptom is considered an ‘obstructive’ symptom rather than an ‘irritative’ one?
A. Hesitancy
B. Nocturia
C. Urgency
D. Frequency
Answer: A
, Conceptual Explanation: Obstructive symptoms include hesitancy, decreased force of
stream, and post-void dribbling. Irritative symptoms include frequency, urgency, and
nocturia.
4. A 24-year-old female presents with a painless, indurated ulcer on her labia. She also has
bilateral inguinal lymphadenopathy. Which diagnostic test is the initial step for the suspected
diagnosis?
A. Tzanck smear
B. RPR or VDRL
C. Viral culture for HSV
D. NAAT for Chlamydia
Answer: B
Conceptual Explanation: A painless indurated ulcer (chancre) is the hallmark of primary
syphilis. Initial screening is done with non-treponemal tests like RPR or VDRL.
5. Which laboratory marker is most specific for the diagnosis of Rheumatoid Arthritis (RA)?
A. Antinuclear antibody (ANA)
B. Erythrocyte sedimentation rate (ESR)
C. Anti-cyclic citrullinated peptide (Anti-CCP)
D. Rheumatoid factor (RF)
Answer: C
PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND ANSWERS
1. A 58-year-old male with a history of Type 2 Diabetes presents for follow-up. His A1C is 8.2%
despite taking Metformin 1000mg BID. He has a history of Heart Failure with reduced ejection
fraction (HFrEF). Which medication class is the most appropriate next step for glucose
management and cardiovascular benefit?
A. DPP-4 inhibitors
B. Sulfonylureas
C. SGLT2 inhibitors
D. TZDs (Thiazolidinediones)
Answer: C
Conceptual Explanation: SGLT2 inhibitors (e.g., Empagliflozin) are recommended in
patients with Type 2 Diabetes and HFrEF as they reduce the risk of heart failure
hospitalization and provide cardiovascular benefits. TZDs are contraindicated in heart
failure.
,2. A patient presents with symptoms of hyperthyroidism. Labs show a suppressed TSH and
elevated Free T4. A radioactive iodine uptake (RAIU) scan shows high, diffuse uptake
throughout the thyroid gland. What is the most likely diagnosis?
A. Subacute thyroiditis
B. Thyroiditis post-partum
C. Toxic multinodular goiter
D. Graves’ disease
Answer: D
Conceptual Explanation: High, diffuse uptake on an RAIU scan is characteristic of Graves’
disease. Low uptake would suggest thyroiditis, and patchy uptake would suggest toxic
multinodular goiter.
3. When evaluating a 65-year-old male for Benign Prostatic Hyperplasia (BPH), which
symptom is considered an ‘obstructive’ symptom rather than an ‘irritative’ one?
A. Hesitancy
B. Nocturia
C. Urgency
D. Frequency
Answer: A
, Conceptual Explanation: Obstructive symptoms include hesitancy, decreased force of
stream, and post-void dribbling. Irritative symptoms include frequency, urgency, and
nocturia.
4. A 24-year-old female presents with a painless, indurated ulcer on her labia. She also has
bilateral inguinal lymphadenopathy. Which diagnostic test is the initial step for the suspected
diagnosis?
A. Tzanck smear
B. RPR or VDRL
C. Viral culture for HSV
D. NAAT for Chlamydia
Answer: B
Conceptual Explanation: A painless indurated ulcer (chancre) is the hallmark of primary
syphilis. Initial screening is done with non-treponemal tests like RPR or VDRL.
5. Which laboratory marker is most specific for the diagnosis of Rheumatoid Arthritis (RA)?
A. Antinuclear antibody (ANA)
B. Erythrocyte sedimentation rate (ESR)
C. Anti-cyclic citrullinated peptide (Anti-CCP)
D. Rheumatoid factor (RF)
Answer: C
