Apea predictor
A 15 years old high school student with a mild sore throat and low-grade fever that has
persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite.
The NP suspects mononucleosis. Which of the following is the LEAST appropriate
intervention?
Palpate the lymph nodes and spleen
Examine the posterior oropharynx for petechiae Obtain a CBC, throat culture, and
heterophil antibody test.
Obtain an urinalyses and serum for LFTs and amylase - answerObtain an urinalyses
and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus.
Common is people 15-24 years of age. Common signs and symptoms following
incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar
exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be
present. A maculopapular or occasionally a petechial rash occurs in less than 15% of
patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and
lymphocytosis are usually detected in the CBC
A 32 years old male patient complaint of urinary frequency and burning on urination for
3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of
urinary tract infections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose - answer. trimethoprim-sulfamethoxazole
(Bactrim, Sulfatrim) for 7-10 day
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication
to treat urinary tract infections in most patients. In the case of community resistance to
TMPS >20%^, another medication should be substituted. In men, the appropriate length
of time is 7 10 days. Women may be treated for 3 days for uncomplicated UTI
Which agent is most effective for the treatment of nodulocystic acne?
Benzoyl peroxide (Benzac)
, Retinoic acid (Retin A)
Topical tetracycline
Isotretinoin - answerIsotretinoin
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with
severe inflammatory acne. Guidelines for its use must be clearly understood by the
patient. A woman of childbearing age must use an effective method of contraception
because isotretinoin is 1 There are many restrictions in prescribing this medication
because of the teratogenic effects is given during pregnancy. Therefore, it is a
pregnancy category X.
An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy
a. Throughout the week of placebo pills
If prescribed topiramate (Topamax) for the treatment of migraines.
If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
if she forgets to take a single dose of the contraceptive - answerIf prescribed topiramate
(Topamax) for the treatment of migraines.
Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol),
primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the
effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or
levonorgestrel-releasing intrauterine devices would be a better method of contraceptive
for patients taking anticonvulsants. Most commonly used antibiotics have not been
proven to reduce the effectiveness of contraceptives. Rifampin is an exception, and
additional .... Be used by women taking this drug and using oral contraceptives,
transdermal, or vaginal ring preparations. Additional backup contraception should be
used if taking antifungal agents. No additional protection is needed thought the week of
placebo pills. Missing one single dose of contraceptive does not require additional
protection, missing more than one doses does.
A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl (6.5
mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and
triglycerides= 344 mg/dL (8.94 mmol/L). What agent have the greatest effect on
improving her lipid profile and reducing morbidity and mortality associates with
dyslipidemia?
Atorvastatin
Niacin (Niaspan)
Omega 3 fatty acids
Fenofibrates - answerAtorvastatin
A 15 years old high school student with a mild sore throat and low-grade fever that has
persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite.
The NP suspects mononucleosis. Which of the following is the LEAST appropriate
intervention?
Palpate the lymph nodes and spleen
Examine the posterior oropharynx for petechiae Obtain a CBC, throat culture, and
heterophil antibody test.
Obtain an urinalyses and serum for LFTs and amylase - answerObtain an urinalyses
and serum for LFTs and amylase
Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus.
Common is people 15-24 years of age. Common signs and symptoms following
incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar
exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be
present. A maculopapular or occasionally a petechial rash occurs in less than 15% of
patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and
lymphocytosis are usually detected in the CBC
A 32 years old male patient complaint of urinary frequency and burning on urination for
3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of
urinary tract infections. The initial treatment should be:
a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day
b. ciprofloxacin (Cipro) for 3-5 days
c. Trimethoprim-Sulfamethoxazole for 3 days
d. 750 mg ciprofloxacin as a one-time dose - answer. trimethoprim-sulfamethoxazole
(Bactrim, Sulfatrim) for 7-10 day
Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication
to treat urinary tract infections in most patients. In the case of community resistance to
TMPS >20%^, another medication should be substituted. In men, the appropriate length
of time is 7 10 days. Women may be treated for 3 days for uncomplicated UTI
Which agent is most effective for the treatment of nodulocystic acne?
Benzoyl peroxide (Benzac)
, Retinoic acid (Retin A)
Topical tetracycline
Isotretinoin - answerIsotretinoin
Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with
severe inflammatory acne. Guidelines for its use must be clearly understood by the
patient. A woman of childbearing age must use an effective method of contraception
because isotretinoin is 1 There are many restrictions in prescribing this medication
because of the teratogenic effects is given during pregnancy. Therefore, it is a
pregnancy category X.
An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy
a. Throughout the week of placebo pills
If prescribed topiramate (Topamax) for the treatment of migraines.
If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
if she forgets to take a single dose of the contraceptive - answerIf prescribed topiramate
(Topamax) for the treatment of migraines.
Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol),
primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the
effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or
levonorgestrel-releasing intrauterine devices would be a better method of contraceptive
for patients taking anticonvulsants. Most commonly used antibiotics have not been
proven to reduce the effectiveness of contraceptives. Rifampin is an exception, and
additional .... Be used by women taking this drug and using oral contraceptives,
transdermal, or vaginal ring preparations. Additional backup contraception should be
used if taking antifungal agents. No additional protection is needed thought the week of
placebo pills. Missing one single dose of contraceptive does not require additional
protection, missing more than one doses does.
A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl (6.5
mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and
triglycerides= 344 mg/dL (8.94 mmol/L). What agent have the greatest effect on
improving her lipid profile and reducing morbidity and mortality associates with
dyslipidemia?
Atorvastatin
Niacin (Niaspan)
Omega 3 fatty acids
Fenofibrates - answerAtorvastatin
