APEA Predictor Test Bank - Questions with Correct Answers & Complete Solutions - Women's Health & OB Mastery - 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 COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. What is treatment?
A. Only oxygen
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. No bronchodilators
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.
2. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. No TSH
B. No monitoring
C. 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
D. Only lithium level
Answer: C
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
3. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, TSH low free T4 high. Diagnosis?
A. Hypothyroidism
B. Hypothyroidism treat levothyroxine
C. Graves disease hyperthyroidism - autoimmune TSH low free T4 high symptoms palpitations weight loss heat intolerance tremor exophthalmos - treat
methimazole PTU first trimester pregnancy, beta blocker propranolol symptom control, RAI definitive
D. No thyroid disease
Answer: C
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune treat methimazole PTU
first trimester beta blocker propranolol RAI definitive.
4. A 30-year-old pregnant female at 28 weeks presents with headache, visual changes, BP 160/100, proteinuria 2+, edema. What is diagnosis?
A. Chronic HTN
B. 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
C. No disease
D. Gestational HTN only
Answer: B
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.
5. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. TSH is elevated, free T4 low. What
is diagnosis and treatment?
A. Hyperthyroidism methimazole
B. Hypothyroidism - elevated TSH low free T4 - treat levothyroxine start low go slow, check TSH 4-6 weeks, take empty stomach 30-60 min before breakfast,
avoid calcium iron 4 hours
C. No treatment
D. Euthyroid sick
Answer: B
Rationale: Hypothyroidism elevated TSH low free T4 symptoms fatigue weight gain cold intolerance constipation dry skin hair loss. Treatment levothyroxine
start low go slow especially elderly cardiac, empty stomach 30-60 min before breakfast avoid calcium iron 4 hours, recheck TSH 4-6 weeks.
6. A 18-month-old with fever, drooling, tripod position, muffled voice, stridor. Diagnosis?
A. Asthma
B. No emergency
C. Epiglottitis - Hib, medical emergency, drooling tripod muffled voice stridor fever - do not examine throat, secure airway ENT anesthesia, ceftriaxone
D. Croup
Answer: C
Rationale: Epiglottitis Hib emergency drooling tripod muffled voice stridor fever do not examine throat secure airway ceftriaxone.
7. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. Only lithium level
B. No monitoring
C. No TSH
D. 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
Answer: D
,Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
8. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, TSH low free T4 high. Diagnosis?
A. No thyroid disease
B. Hypothyroidism treat levothyroxine
C. Hypothyroidism
D. Graves disease hyperthyroidism - autoimmune TSH low free T4 high symptoms palpitations weight loss heat intolerance tremor exophthalmos - treat
methimazole PTU first trimester pregnancy, beta blocker propranolol symptom control, RAI definitive
Answer: D
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune treat methimazole PTU
first trimester beta blocker propranolol RAI definitive.
9. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type of jaundice?
A. No jaundice
B. Physiologic jaundice - appears after 24 hours, bilirubin <12-15, no hemolysis, normal exam - pathologic if <24 hours bilirubin >15 rapid rise hemolysis
C. Always pathologic
D. Pathologic
Answer: B
Rationale: Physiologic jaundice appears after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
10. 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. No treatment
B. No infection
C. Pyelonephritis ciprofloxacin
D. 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
Answer: D
Rationale: Acute uncomplicated cystitis E. coli most common dysuria frequency suprapubic pain positive leuk esterase nitrites. Treat nitrofurantoin 100 BID 5
days or TMP-SMX 3 days or fosfomycin single dose.
11. A 18-month-old with fever, drooling, tripod position, muffled voice, stridor. Diagnosis?
A. Asthma
B. Epiglottitis - Hib, medical emergency, drooling tripod muffled voice stridor fever - do not examine throat, secure airway ENT anesthesia, ceftriaxone
C. No emergency
D. Croup
Answer: B
Rationale: Epiglottitis Hib emergency drooling tripod muffled voice stridor fever do not examine throat secure airway ceftriaxone.
12. A 2-year-old child with barky cough, inspiratory stridor, low grade fever, worse at night. What is diagnosis and treatment?
A. Croup laryngotracheobronchitis parainfluenza most common - cool mist, dexamethasone 0.6 mg/kg, nebulized racemic epinephrine if moderate-severe,
humidified air
B. Asthma albuterol only
C. Epiglottitis intubate
D. No treatment
Answer: A
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.
13. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. TSH is elevated, free T4 low. What
is diagnosis and treatment?
A. Euthyroid sick
B. No treatment
C. Hypothyroidism - elevated TSH low free T4 - treat levothyroxine start low go slow, check TSH 4-6 weeks, take empty stomach 30-60 min before breakfast,
avoid calcium iron 4 hours
D. Hyperthyroidism methimazole
Answer: C
Rationale: Hypothyroidism elevated TSH low free T4 symptoms fatigue weight gain cold intolerance constipation dry skin hair loss. Treatment levothyroxine
start low go slow especially elderly cardiac, empty stomach 30-60 min before breakfast avoid calcium iron 4 hours, recheck TSH 4-6 weeks.
14. A 50-year-old with major depressive disorder started sertraline 2 weeks ago reports worsening agitation, insomnia, suicidal ideation. What is
action?
A. Continue same dose
B. No concern
C. Stop abruptly
D. 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
Answer: D
Rationale: SSRI black box warning increased suicidal ideation initial weeks young adults assess safety close monitoring safety plan psychiatry.
15. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Alzheimer
, B. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
C. Parkinson
D. No disease
Answer: B
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
16. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. TSH is elevated, free T4 low. What
is diagnosis and treatment?
A. Hyperthyroidism methimazole
B. No treatment
C. Hypothyroidism - elevated TSH low free T4 - treat levothyroxine start low go slow, check TSH 4-6 weeks, take empty stomach 30-60 min before breakfast,
avoid calcium iron 4 hours
D. Euthyroid sick
Answer: C
Rationale: Hypothyroidism elevated TSH low free T4 symptoms fatigue weight gain cold intolerance constipation dry skin hair loss. Treatment levothyroxine
start low go slow especially elderly cardiac, empty stomach 30-60 min before breakfast avoid calcium iron 4 hours, recheck TSH 4-6 weeks.
17. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. Reassure
B. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
C. Only repeat ultrasound
D. No biopsy
Answer: B
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
18. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. No biopsy
B. Reassure
C. Only repeat ultrasound
D. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
Answer: D
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
19. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. No monitoring
B. Only lithium level
C. No TSH
D. 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
Answer: D
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
20. A 2-year-old child with barky cough, inspiratory stridor, low grade fever, worse at night. What is diagnosis and treatment?
A. No treatment
B. Asthma albuterol only
C. Epiglottitis intubate
D. Croup laryngotracheobronchitis parainfluenza most common - cool mist, dexamethasone 0.6 mg/kg, nebulized racemic epinephrine if moderate-severe,
humidified air
Answer: D
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.
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. Discharge home
D. Only reassurance
Answer: B
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
22. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. What is treatment?
A. 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%
B. Only oxygen
C. No bronchodilators
D. No steroids
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 COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. What is treatment?
A. Only oxygen
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. No bronchodilators
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.
2. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. No TSH
B. No monitoring
C. 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
D. Only lithium level
Answer: C
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
3. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, TSH low free T4 high. Diagnosis?
A. Hypothyroidism
B. Hypothyroidism treat levothyroxine
C. Graves disease hyperthyroidism - autoimmune TSH low free T4 high symptoms palpitations weight loss heat intolerance tremor exophthalmos - treat
methimazole PTU first trimester pregnancy, beta blocker propranolol symptom control, RAI definitive
D. No thyroid disease
Answer: C
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune treat methimazole PTU
first trimester beta blocker propranolol RAI definitive.
4. A 30-year-old pregnant female at 28 weeks presents with headache, visual changes, BP 160/100, proteinuria 2+, edema. What is diagnosis?
A. Chronic HTN
B. 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
C. No disease
D. Gestational HTN only
Answer: B
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.
5. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. TSH is elevated, free T4 low. What
is diagnosis and treatment?
A. Hyperthyroidism methimazole
B. Hypothyroidism - elevated TSH low free T4 - treat levothyroxine start low go slow, check TSH 4-6 weeks, take empty stomach 30-60 min before breakfast,
avoid calcium iron 4 hours
C. No treatment
D. Euthyroid sick
Answer: B
Rationale: Hypothyroidism elevated TSH low free T4 symptoms fatigue weight gain cold intolerance constipation dry skin hair loss. Treatment levothyroxine
start low go slow especially elderly cardiac, empty stomach 30-60 min before breakfast avoid calcium iron 4 hours, recheck TSH 4-6 weeks.
6. A 18-month-old with fever, drooling, tripod position, muffled voice, stridor. Diagnosis?
A. Asthma
B. No emergency
C. Epiglottitis - Hib, medical emergency, drooling tripod muffled voice stridor fever - do not examine throat, secure airway ENT anesthesia, ceftriaxone
D. Croup
Answer: C
Rationale: Epiglottitis Hib emergency drooling tripod muffled voice stridor fever do not examine throat secure airway ceftriaxone.
7. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. Only lithium level
B. No monitoring
C. No TSH
D. 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
Answer: D
,Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
8. A 35-year-old female with palpitations, weight loss, heat intolerance, tremor, exophthalmos, TSH low free T4 high. Diagnosis?
A. No thyroid disease
B. Hypothyroidism treat levothyroxine
C. Hypothyroidism
D. Graves disease hyperthyroidism - autoimmune TSH low free T4 high symptoms palpitations weight loss heat intolerance tremor exophthalmos - treat
methimazole PTU first trimester pregnancy, beta blocker propranolol symptom control, RAI definitive
Answer: D
Rationale: Graves hyperthyroidism low TSH high free T4 palpitations weight loss heat intolerance tremor exophthalmos autoimmune treat methimazole PTU
first trimester beta blocker propranolol RAI definitive.
9. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type of jaundice?
A. No jaundice
B. Physiologic jaundice - appears after 24 hours, bilirubin <12-15, no hemolysis, normal exam - pathologic if <24 hours bilirubin >15 rapid rise hemolysis
C. Always pathologic
D. Pathologic
Answer: B
Rationale: Physiologic jaundice appears after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
10. 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. No treatment
B. No infection
C. Pyelonephritis ciprofloxacin
D. 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
Answer: D
Rationale: Acute uncomplicated cystitis E. coli most common dysuria frequency suprapubic pain positive leuk esterase nitrites. Treat nitrofurantoin 100 BID 5
days or TMP-SMX 3 days or fosfomycin single dose.
11. A 18-month-old with fever, drooling, tripod position, muffled voice, stridor. Diagnosis?
A. Asthma
B. Epiglottitis - Hib, medical emergency, drooling tripod muffled voice stridor fever - do not examine throat, secure airway ENT anesthesia, ceftriaxone
C. No emergency
D. Croup
Answer: B
Rationale: Epiglottitis Hib emergency drooling tripod muffled voice stridor fever do not examine throat secure airway ceftriaxone.
12. A 2-year-old child with barky cough, inspiratory stridor, low grade fever, worse at night. What is diagnosis and treatment?
A. Croup laryngotracheobronchitis parainfluenza most common - cool mist, dexamethasone 0.6 mg/kg, nebulized racemic epinephrine if moderate-severe,
humidified air
B. Asthma albuterol only
C. Epiglottitis intubate
D. No treatment
Answer: A
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.
13. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. TSH is elevated, free T4 low. What
is diagnosis and treatment?
A. Euthyroid sick
B. No treatment
C. Hypothyroidism - elevated TSH low free T4 - treat levothyroxine start low go slow, check TSH 4-6 weeks, take empty stomach 30-60 min before breakfast,
avoid calcium iron 4 hours
D. Hyperthyroidism methimazole
Answer: C
Rationale: Hypothyroidism elevated TSH low free T4 symptoms fatigue weight gain cold intolerance constipation dry skin hair loss. Treatment levothyroxine
start low go slow especially elderly cardiac, empty stomach 30-60 min before breakfast avoid calcium iron 4 hours, recheck TSH 4-6 weeks.
14. A 50-year-old with major depressive disorder started sertraline 2 weeks ago reports worsening agitation, insomnia, suicidal ideation. What is
action?
A. Continue same dose
B. No concern
C. Stop abruptly
D. 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
Answer: D
Rationale: SSRI black box warning increased suicidal ideation initial weeks young adults assess safety close monitoring safety plan psychiatry.
15. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Alzheimer
, B. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
C. Parkinson
D. No disease
Answer: B
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
16. A 45-year-old female presents with fatigue, weight gain, cold intolerance, constipation, dry skin, and hair loss. TSH is elevated, free T4 low. What
is diagnosis and treatment?
A. Hyperthyroidism methimazole
B. No treatment
C. Hypothyroidism - elevated TSH low free T4 - treat levothyroxine start low go slow, check TSH 4-6 weeks, take empty stomach 30-60 min before breakfast,
avoid calcium iron 4 hours
D. Euthyroid sick
Answer: C
Rationale: Hypothyroidism elevated TSH low free T4 symptoms fatigue weight gain cold intolerance constipation dry skin hair loss. Treatment levothyroxine
start low go slow especially elderly cardiac, empty stomach 30-60 min before breakfast avoid calcium iron 4 hours, recheck TSH 4-6 weeks.
17. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. Reassure
B. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
C. Only repeat ultrasound
D. No biopsy
Answer: B
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
18. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. No biopsy
B. Reassure
C. Only repeat ultrasound
D. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
Answer: D
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
19. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. No monitoring
B. Only lithium level
C. No TSH
D. 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
Answer: D
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
20. A 2-year-old child with barky cough, inspiratory stridor, low grade fever, worse at night. What is diagnosis and treatment?
A. No treatment
B. Asthma albuterol only
C. Epiglottitis intubate
D. Croup laryngotracheobronchitis parainfluenza most common - cool mist, dexamethasone 0.6 mg/kg, nebulized racemic epinephrine if moderate-severe,
humidified air
Answer: D
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.
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. Discharge home
D. Only reassurance
Answer: B
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
22. A 70-year-old with COPD exacerbation increased dyspnea, wheezing, increased sputum purulent. What is treatment?
A. 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%
B. Only oxygen
C. No bronchodilators
D. No steroids
