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1. Which of the following findings is assoc. with thyroid hypofunction?
A. Graves Disease
B. Eye Disorder
C. Thyroid storm
D. Myxedema
Answer: D. Myxedema
Myxedema or myxedema coma is seen in patients with severe hypothyroidism. It refers to the skin changes (thickened
skin) seen in chronic severe hypothyroidism. It is a medcial emergency with mortality rates exceeding 20%. It is tx
with very high doses of thyroid hormone.
A thyroid storm occurs when there is the extreme elevation of thyroid hormone. Thyroid storm is life-threatening; if left
untreated, the mortality rate is about 90%. Call 911 if suspected.
Graves Disease is associated with thyroid hyperfunction
,2. A 14 y/o boy is brought in by his mother, who reports that her son has
been complaining for several months of recurrent bloating, stomach upset
and occasional loose stools. She reports that he has difficulty gaining wt. and
is short for his age. She has noticed that his symptoms worsen after eating
large amounts of crackers, cookies, and bread. She denies seeing blood in the
boy's stool. Which of the following conditions is most likely?
A. Amebiasis
B. Malabsorption
C. Chron's
D. Celiac Disease
Answer: D. Celiac Disease
Celiac Disease is also known as celiac sprue Patients should avoid gluten, which causes malabsorption (diarrhea, gas,
bloating, and abd pain). Foods to avoid are wheat, rye, and barley. Oats do not damage mucosa in celiac disease.
Antifiadins IgA and IgG are elevated in almost all patients (90%)
3. A 67 y/o female patient presents with a 3 day old cat bite that has become
swollen, reddened and painful to touch. The NP notes there is purulent drng
at the site of the bite. Which medication will the nurse practitioner prescribe?
A. Gentamycin
B Tetanus toxoid
,C. Rabies prophylaxis
D. Amoxicillin -Clavulante(Augmentin)
Answer: D. Amoxicillin -Clavulante(Augmentin)
The patient present with symptoms associated with Pasteurella multocida, which is an anerobic gram-negative
coccobacillus found in the oropharynx of healthy cats, dogs, and other animals. The dx of the bacteria can be made
with a gram stain culture; however, a broad spectrum antibiotic that targets Pasteurella, as well as other
gram-positive and gram neg bacteria, is preferred for prescribed prophylaxis. Amox-Clav is a recommended antibiotic for
prophylactic tx. Aminoglycosides such as gentamycin have demonstrated poor activity against P. multocida. Tetanus toxoids
is necessary only if the patient has received their last tetanus vaccine greater than 5 years prior. Rabies is unnecessary
unless there is a possibility of exposure after a risk assessment.
4. A 14 year old girl with short stature, swollen hands and feet, and a webbed
neck presents to the clinic. Upon assessment she is found to be at Tanner
stage I. Which test will the NP order to confirm diagnosis?
A. CT scan
B. Karotype
C. Prolactin level
D. Xray of the hand
Answer: B. Karotype
, 5. A 67 y/o woman with a 30 pack a year hx of smoking presents for a routine
annual physical examination. She c/o being easily short of breath and is
frequently fatigued. Physical examination reveals diminished breath sound,
hyprresonance, and hypertrophied respiratory accessory muscles. Her CBC
reveals elevated HCT and her PFT results show increased total lung capacity.
Which dx is most correct?
A. Bronchogenic carcinoma
B. COPD
C. Chronic bronchitis
D. CHF
Answer: B. COPD
COPD is a progressive lung disease that includes emphysema and chronic bronchitis. The most common risk factor is
long-term cigarette smoke (80-90%). Another cause is alpha-1 trypsin deficiency and chronic fume exposure. The three
cardinal symptoms of COPD are dyspnea, chronic cough, and sputum production. The lungs are hyperinflated which
changes the shape of the chest and diaphragm, making the mechanics of breathing more diflcult Excess mucus and
obstructed airflow from progressive thickening and stittening of the airways finish breath sound. COPD creates a high
hematocrit percentage because of chronic hypoxemia.
6. An elderly male presents to the clinic for a routine physical examination. The
NP notes multiple rough, scaly patches on the patients forearms and face and