APEA Predictor Test Bank - Questions with Correct Answers & Complete Solutions - Psychiatric Mental Health & Neuro - Graded
A+
APEA Predictor Exam | Advanced Practice Education Associates | NP Certification Review | Graded A+
TABLE OF CONTENTS
1. I. Adult Health - Chronic Disease Management, Hypertension, Diabetes, COPD, Heart Failure, Asthma Classification
2. II. Cardiology - Atrial Fibrillation Warfarin INR Management, Chest Pain Unstable Angina NSTEMI ST Depression Aspirin Heparin Troponin
TIMI Risk, Heart Failure HFrEF EF 30% ACE Beta Blocker Diuretic Aldosterone Antagonist ARNI SGLT2
3. III. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Asthma
Mild Intermittent vs Mild Persistent vs Moderate Persistent FEV1
4. IV. Endocrine - Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine Empty Stomach,
Hyperthyroidism Graves Low TSH High Free T4 Palpitations Weight Loss Heat Intolerance Tremor Exophthalmos Methimazole PTU Beta Blocker
Propranolol
5. V. Pharmacology - Warfarin INR 4.5 No Bleeding Hold Low Dose Vitamin K, Lithium Level 0.6-1.2 TSH Creatinine Toxicity Tremor Confusion
Ataxia Hydration, SSRI Black Box Suicidal Ideation Safety Plan
6. VI. Women's Health & OB - Preeclampsia BP 140/90 After 20 Weeks Proteinuria 300 mg Severe BP 160/110 Headache Visual Platelets LFTs
Magnesium Sulfate Delivery, Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer
7. VII. Infectious Disease - Acute Cystitis Dysuria Frequency Suprapubic Pain Leuk Esterase Nitrites E. coli Nitrofurantoin 100 BID 5 Days
TMP-SMX 3 Days Fosfomycin, Strep Throat Centor Criteria Sore Throat Fever Exudates Anterior Cervical No Cough Rapid Strep Penicillin
Amoxicillin
8. VIII. Pediatrics - Croup Barky Cough Inspiratory Stridor Night Parainfluenza Cool Mist Dexamethasone 0.6 mg/kg Racemic Epi, Epiglottitis Hib
Drooling Tripod Muffled Voice Stridor Emergency Do Not Examine Throat Secure Airway Ceftriaxone, Physiologic Jaundice After 24 Hours
Bilirubin <12-15 vs Pathologic <24 Hours >15
9. IX. Neurology - Normal Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP
Shunt
10. X. Psychiatry - Major Depressive Disorder SSRI Sertraline Agitation Insomnia Suicidal Ideation Black Box Warning Young Adults Safety
Monitoring
11. XI. Musculoskeletal - OA Knee Pain Worse Activity Morning Stiffness <30 min Crepitus No Systemic Weight Loss PT Acetaminophen Topical
NSAIDs Oral NSAIDs Intra-articular Steroids vs RA >30 min Systemic Symmetric Small Joints
12. XII. GI - Duodenal Ulcer Pain Worse Night Relieved Food NSAID H. pylori Epigastric Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline
13. XIII. Practice Questions - Each Asked Like Real APEA Predictor Exam - Original Questions
14. XIV. Answer Key with Correct Answers & Complete Solutions - Graded A+
,APEA PREDICTOR TEST BANK - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on APEA Predictor Blueprint - Adult, Women's Health, Pediatrics, Pharmacology, Cardiology, Endocrine, Psych, Infectious Disease. High Yield.
1. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Alzheimer
B. Parkinson
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. No disease
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
2. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Parkinson
B. Alzheimer
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. No disease
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
3. A 2-year-old child with barky cough, inspiratory stridor, low grade fever, worse at night. What is diagnosis and treatment?
A. Epiglottitis intubate
B. No treatment
C. Croup laryngotracheobronchitis parainfluenza most common - cool mist, dexamethasone 0.6 mg/kg, nebulized racemic epinephrine if moderate-severe,
humidified air
D. Asthma albuterol only
Answer: C
Rationale: Croup barky cough inspiratory stridor night low grade fever parainfluenza most common cool mist dexamethasone 0.6 mg/kg racemic epi if
moderate-severe.
4. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. No monitoring
B. Lithium monitoring - lithium level 0.6-1.2, TSH baseline 6 months, creatinine BUN, electrolytes, pregnancy test, signs toxicity tremor confusion ataxia - narrow
therapeutic index, hydration
C. Only lithium level
D. No TSH
Answer: B
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
5. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Only reassurance
B. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
C. Give antacid
D. Discharge home
Answer: B
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
6. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. What is treatment?
A. No bronchodilators
B. COPD exacerbation - short-acting bronchodilators albuterol ipratropium, systemic steroids prednisone 40 mg 5 days, antibiotics if purulent sputum increased
dyspnea increased volume - amoxicillin or doxycycline or azithromycin, oxygen target 88-92%
C. No steroids
D. Only oxygen
Answer: B
Rationale: COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume
oxygen target 88-92% avoid excess oxygen.
7. A patient with asthma uses albuterol daily, nighttime symptoms 2x/week, FEV1 75%. Classification and treatment?
A. Severe
B. No asthma
C. Mild intermittent
D. Mild persistent - symptoms >2 days/week but <daily, nighttime 3-4/month, FEV1 >=80%? Actually mild persistent symptoms >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80 - this case moderate persistent daily albuterol nighttime 2/week FEV1 75%
moderate persistent - add low dose ICS
Answer: D
Rationale: Asthma classification mild intermittent symptoms <=2 days/week nighttime <=2/month FEV1 >=80, mild persistent >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80, severe continuous nighttime frequent FEV1 <60 - treatment ICS stepwise.
8. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
,A. Inevitable abortion - os open bleeding cramping tissue - complete vs incomplete depends tissue passed, threatened os closed, inevitable os open
B. No abortion
C. Threatened abortion
D. Ectopic
Answer: A
Rationale: Abortion definitions: threatened os closed bleeding cramping, inevitable os open bleeding cramping, incomplete some tissue passed os open,
complete all tissue passed os closed, missed no bleeding fetal demise.
9. A 40-year-old male with epigastric pain worse at night, relieved by food, NSAID use, H. pylori positive. Diagnosis?
A. Gastric ulcer pain worse after food
B. No ulcer
C. GERD only
D. Duodenal ulcer - pain worse at night relieved by food, H. pylori NSAID risk, epigastric pain - treat triple therapy clarithromycin amoxicillin PPI or quadruple
bismuth metronidazole tetracycline PPI, stop NSAID
Answer: D
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID epigastric pain triple therapy clarithromycin amoxicillin PPI or quadruple bismuth
metronidazole tetracycline PPI stop NSAID.
10. A 30-year-old pregnant female at 28 weeks presents with headache, visual changes, BP 160/100, proteinuria 2+, edema. What is diagnosis?
A. No disease
B. Gestational HTN only
C. Preeclampsia - BP >=140/90 after 20 weeks plus proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs twice normal pulmonary edema - severe preeclampsia if BP >=160/110 headache visual
D. Chronic HTN
Answer: C
Rationale: Preeclampsia BP >=140/90 after 20 weeks proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs 2x normal pulmonary edema. Severe if BP >=160/110 headache visual etc. Manage magnesium sulfate delivery.
11. A 40-year-old male with epigastric pain worse at night, relieved by food, NSAID use, H. pylori positive. Diagnosis?
A. Duodenal ulcer - pain worse at night relieved by food, H. pylori NSAID risk, epigastric pain - treat triple therapy clarithromycin amoxicillin PPI or quadruple
bismuth metronidazole tetracycline PPI, stop NSAID
B. Gastric ulcer pain worse after food
C. No ulcer
D. GERD only
Answer: A
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID epigastric pain triple therapy clarithromycin amoxicillin PPI or quadruple bismuth
metronidazole tetracycline PPI stop NSAID.
12. A 60-year-old with osteoarthritis knee pain worse with activity, morning stiffness <30 min, crepitus, no systemic symptoms. Treatment?
A. OA knee - nonpharmacologic weight loss PT exercise, pharmacologic acetaminophen topical NSAIDs oral NSAIDs if no contraindications, intra-articular
steroids, no systemic inflammation - vs RA morning stiffness >30 min systemic symmetric small joints
B. Only opioids
C. Only surgery
D. No treatment
Answer: A
Rationale: OA knee pain worse activity morning stiffness <30 min crepitus no systemic weight loss PT acetaminophen topical NSAIDs oral NSAIDs
intra-articular steroids vs RA >30 min systemic symmetric small joints.
13. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. No disease
B. Parkinson
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. Alzheimer
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
14. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
B. No action
C. Give FFP immediately
D. Increase warfarin
Answer: A
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
15. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. No biopsy
B. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
C. Reassure
D. Only repeat ultrasound
, Answer: B
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
16. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Increase warfarin
B. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
C. No action
D. Give FFP immediately
Answer: B
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
17. A 50-year-old with major depressive disorder started sertraline 2 weeks ago reports worsening agitation, insomnia, suicidal ideation. What is
action?
A. No concern
B. Stop abruptly
C. Black box warning SSRI increased suicidal ideation young adults initial weeks - assess safety, close monitoring, consider dose adjustment or switch, safety
plan, involve psychiatry, do not abruptly stop but evaluate
D. Continue same dose
Answer: C
Rationale: SSRI black box warning increased suicidal ideation initial weeks young adults assess safety close monitoring safety plan psychiatry.
18. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. Lithium monitoring - lithium level 0.6-1.2, TSH baseline 6 months, creatinine BUN, electrolytes, pregnancy test, signs toxicity tremor confusion ataxia - narrow
therapeutic index, hydration
B. No TSH
C. No monitoring
D. Only lithium level
Answer: A
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
19. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Give antacid
B. Only reassurance
C. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
D. Discharge home
Answer: C
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
20. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. Add NSAID
B. Stop ACE
C. No additional
D. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
Answer: D
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
21. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Give antacid
B. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
C. Only reassurance
D. Discharge home
Answer: B
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
22. A 25-year-old female with dysuria, frequency, suprapubic pain, no fever or flank pain. Urinalysis shows positive leukocyte esterase nitrites. What
is diagnosis and treatment?
A. Acute uncomplicated cystitis - E. coli most common - treat nitrofurantoin 100 mg BID 5 days or TMP-SMX 3 days or fosfomycin single dose, increase fluids
B. No treatment
C. Pyelonephritis ciprofloxacin
D. No infection
Answer: A
A+
APEA Predictor Exam | Advanced Practice Education Associates | NP Certification Review | Graded A+
TABLE OF CONTENTS
1. I. Adult Health - Chronic Disease Management, Hypertension, Diabetes, COPD, Heart Failure, Asthma Classification
2. II. Cardiology - Atrial Fibrillation Warfarin INR Management, Chest Pain Unstable Angina NSTEMI ST Depression Aspirin Heparin Troponin
TIMI Risk, Heart Failure HFrEF EF 30% ACE Beta Blocker Diuretic Aldosterone Antagonist ARNI SGLT2
3. III. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Asthma
Mild Intermittent vs Mild Persistent vs Moderate Persistent FEV1
4. IV. Endocrine - Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine Empty Stomach,
Hyperthyroidism Graves Low TSH High Free T4 Palpitations Weight Loss Heat Intolerance Tremor Exophthalmos Methimazole PTU Beta Blocker
Propranolol
5. V. Pharmacology - Warfarin INR 4.5 No Bleeding Hold Low Dose Vitamin K, Lithium Level 0.6-1.2 TSH Creatinine Toxicity Tremor Confusion
Ataxia Hydration, SSRI Black Box Suicidal Ideation Safety Plan
6. VI. Women's Health & OB - Preeclampsia BP 140/90 After 20 Weeks Proteinuria 300 mg Severe BP 160/110 Headache Visual Platelets LFTs
Magnesium Sulfate Delivery, Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer
7. VII. Infectious Disease - Acute Cystitis Dysuria Frequency Suprapubic Pain Leuk Esterase Nitrites E. coli Nitrofurantoin 100 BID 5 Days
TMP-SMX 3 Days Fosfomycin, Strep Throat Centor Criteria Sore Throat Fever Exudates Anterior Cervical No Cough Rapid Strep Penicillin
Amoxicillin
8. VIII. Pediatrics - Croup Barky Cough Inspiratory Stridor Night Parainfluenza Cool Mist Dexamethasone 0.6 mg/kg Racemic Epi, Epiglottitis Hib
Drooling Tripod Muffled Voice Stridor Emergency Do Not Examine Throat Secure Airway Ceftriaxone, Physiologic Jaundice After 24 Hours
Bilirubin <12-15 vs Pathologic <24 Hours >15
9. IX. Neurology - Normal Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP
Shunt
10. X. Psychiatry - Major Depressive Disorder SSRI Sertraline Agitation Insomnia Suicidal Ideation Black Box Warning Young Adults Safety
Monitoring
11. XI. Musculoskeletal - OA Knee Pain Worse Activity Morning Stiffness <30 min Crepitus No Systemic Weight Loss PT Acetaminophen Topical
NSAIDs Oral NSAIDs Intra-articular Steroids vs RA >30 min Systemic Symmetric Small Joints
12. XII. GI - Duodenal Ulcer Pain Worse Night Relieved Food NSAID H. pylori Epigastric Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline
13. XIII. Practice Questions - Each Asked Like Real APEA Predictor Exam - Original Questions
14. XIV. Answer Key with Correct Answers & Complete Solutions - Graded A+
,APEA PREDICTOR TEST BANK - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on APEA Predictor Blueprint - Adult, Women's Health, Pediatrics, Pharmacology, Cardiology, Endocrine, Psych, Infectious Disease. High Yield.
1. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Alzheimer
B. Parkinson
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. No disease
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
2. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Parkinson
B. Alzheimer
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. No disease
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
3. A 2-year-old child with barky cough, inspiratory stridor, low grade fever, worse at night. What is diagnosis and treatment?
A. Epiglottitis intubate
B. No treatment
C. Croup laryngotracheobronchitis parainfluenza most common - cool mist, dexamethasone 0.6 mg/kg, nebulized racemic epinephrine if moderate-severe,
humidified air
D. Asthma albuterol only
Answer: C
Rationale: Croup barky cough inspiratory stridor night low grade fever parainfluenza most common cool mist dexamethasone 0.6 mg/kg racemic epi if
moderate-severe.
4. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. No monitoring
B. Lithium monitoring - lithium level 0.6-1.2, TSH baseline 6 months, creatinine BUN, electrolytes, pregnancy test, signs toxicity tremor confusion ataxia - narrow
therapeutic index, hydration
C. Only lithium level
D. No TSH
Answer: B
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
5. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Only reassurance
B. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
C. Give antacid
D. Discharge home
Answer: B
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
6. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. What is treatment?
A. No bronchodilators
B. COPD exacerbation - short-acting bronchodilators albuterol ipratropium, systemic steroids prednisone 40 mg 5 days, antibiotics if purulent sputum increased
dyspnea increased volume - amoxicillin or doxycycline or azithromycin, oxygen target 88-92%
C. No steroids
D. Only oxygen
Answer: B
Rationale: COPD exacerbation albuterol ipratropium systemic steroids prednisone 40 mg 5 days antibiotics if purulent increased dyspnea increased volume
oxygen target 88-92% avoid excess oxygen.
7. A patient with asthma uses albuterol daily, nighttime symptoms 2x/week, FEV1 75%. Classification and treatment?
A. Severe
B. No asthma
C. Mild intermittent
D. Mild persistent - symptoms >2 days/week but <daily, nighttime 3-4/month, FEV1 >=80%? Actually mild persistent symptoms >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80 - this case moderate persistent daily albuterol nighttime 2/week FEV1 75%
moderate persistent - add low dose ICS
Answer: D
Rationale: Asthma classification mild intermittent symptoms <=2 days/week nighttime <=2/month FEV1 >=80, mild persistent >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80, severe continuous nighttime frequent FEV1 <60 - treatment ICS stepwise.
8. A 28-year-old female with 6 weeks amenorrhea, vaginal bleeding, cramping, cervical os open, tissue passing. Diagnosis?
,A. Inevitable abortion - os open bleeding cramping tissue - complete vs incomplete depends tissue passed, threatened os closed, inevitable os open
B. No abortion
C. Threatened abortion
D. Ectopic
Answer: A
Rationale: Abortion definitions: threatened os closed bleeding cramping, inevitable os open bleeding cramping, incomplete some tissue passed os open,
complete all tissue passed os closed, missed no bleeding fetal demise.
9. A 40-year-old male with epigastric pain worse at night, relieved by food, NSAID use, H. pylori positive. Diagnosis?
A. Gastric ulcer pain worse after food
B. No ulcer
C. GERD only
D. Duodenal ulcer - pain worse at night relieved by food, H. pylori NSAID risk, epigastric pain - treat triple therapy clarithromycin amoxicillin PPI or quadruple
bismuth metronidazole tetracycline PPI, stop NSAID
Answer: D
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID epigastric pain triple therapy clarithromycin amoxicillin PPI or quadruple bismuth
metronidazole tetracycline PPI stop NSAID.
10. A 30-year-old pregnant female at 28 weeks presents with headache, visual changes, BP 160/100, proteinuria 2+, edema. What is diagnosis?
A. No disease
B. Gestational HTN only
C. Preeclampsia - BP >=140/90 after 20 weeks plus proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs twice normal pulmonary edema - severe preeclampsia if BP >=160/110 headache visual
D. Chronic HTN
Answer: C
Rationale: Preeclampsia BP >=140/90 after 20 weeks proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs 2x normal pulmonary edema. Severe if BP >=160/110 headache visual etc. Manage magnesium sulfate delivery.
11. A 40-year-old male with epigastric pain worse at night, relieved by food, NSAID use, H. pylori positive. Diagnosis?
A. Duodenal ulcer - pain worse at night relieved by food, H. pylori NSAID risk, epigastric pain - treat triple therapy clarithromycin amoxicillin PPI or quadruple
bismuth metronidazole tetracycline PPI, stop NSAID
B. Gastric ulcer pain worse after food
C. No ulcer
D. GERD only
Answer: A
Rationale: Duodenal ulcer pain worse night relieved food H. pylori NSAID epigastric pain triple therapy clarithromycin amoxicillin PPI or quadruple bismuth
metronidazole tetracycline PPI stop NSAID.
12. A 60-year-old with osteoarthritis knee pain worse with activity, morning stiffness <30 min, crepitus, no systemic symptoms. Treatment?
A. OA knee - nonpharmacologic weight loss PT exercise, pharmacologic acetaminophen topical NSAIDs oral NSAIDs if no contraindications, intra-articular
steroids, no systemic inflammation - vs RA morning stiffness >30 min systemic symmetric small joints
B. Only opioids
C. Only surgery
D. No treatment
Answer: A
Rationale: OA knee pain worse activity morning stiffness <30 min crepitus no systemic weight loss PT acetaminophen topical NSAIDs oral NSAIDs
intra-articular steroids vs RA >30 min systemic symmetric small joints.
13. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. No disease
B. Parkinson
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. Alzheimer
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
14. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
B. No action
C. Give FFP immediately
D. Increase warfarin
Answer: A
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
15. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. No biopsy
B. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
C. Reassure
D. Only repeat ultrasound
, Answer: B
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
16. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Increase warfarin
B. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
C. No action
D. Give FFP immediately
Answer: B
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
17. A 50-year-old with major depressive disorder started sertraline 2 weeks ago reports worsening agitation, insomnia, suicidal ideation. What is
action?
A. No concern
B. Stop abruptly
C. Black box warning SSRI increased suicidal ideation young adults initial weeks - assess safety, close monitoring, consider dose adjustment or switch, safety
plan, involve psychiatry, do not abruptly stop but evaluate
D. Continue same dose
Answer: C
Rationale: SSRI black box warning increased suicidal ideation initial weeks young adults assess safety close monitoring safety plan psychiatry.
18. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. Lithium monitoring - lithium level 0.6-1.2, TSH baseline 6 months, creatinine BUN, electrolytes, pregnancy test, signs toxicity tremor confusion ataxia - narrow
therapeutic index, hydration
B. No TSH
C. No monitoring
D. Only lithium level
Answer: A
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
19. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Give antacid
B. Only reassurance
C. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
D. Discharge home
Answer: C
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
20. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. Add NSAID
B. Stop ACE
C. No additional
D. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
Answer: D
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
21. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Give antacid
B. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
C. Only reassurance
D. Discharge home
Answer: B
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
22. A 25-year-old female with dysuria, frequency, suprapubic pain, no fever or flank pain. Urinalysis shows positive leukocyte esterase nitrites. What
is diagnosis and treatment?
A. Acute uncomplicated cystitis - E. coli most common - treat nitrofurantoin 100 mg BID 5 days or TMP-SMX 3 days or fosfomycin single dose, increase fluids
B. No treatment
C. Pyelonephritis ciprofloxacin
D. No infection
Answer: A
