LEIK FNP PAPER LATEST ANSWERS AND QUESTIONS
SET A+
✔✔A patient comes to the clinic following discharge from the ED due to colliding with a
teammate during soccer practice. The ED work-up was unimpressive and the patient
was discharged without incident and told to follow-up with their PCP in the next 3 days.
Today the patient reports feeling a bit tired and has begun to have a runny nose. He
also complains of tenderness behind his ear where his teammate hit him. On
examination the NP notices that the patient has bruising behind his ear and periorbital
eccymosis. What does the NP order/test for to rule out basilar skull fracture?
a. Dix-Hallpike test
b. CT scan
c. X-ray
d. Urine dipstick of nasal discharge - ✔✔d
Testing the nasal discharge with a urine dipstick is a quick method that can be used to
assess for glucose. CSF slowly leaks through a basilar skull fracture, which may leak
out the nose or ear. The fluid may be clear or golden in color. If it is positive for glucose,
a leak should be suspected and the patient should be sent to the ED for further
evaluation. A CT scan is appropriate to order but not for quick assessment. Dix-hallpike
is to test for vertigo.
✔✔Which of the following signs and symptoms are expected in a patient with a
peritonsillar-abscess except?
a. "hot potato" voice
b. Odynophagia
c. Trismus
d. Bilateral swelling - ✔✔d
It is not expected that an abscess would cause bilateral swelling. Unilateral swelling of
the peritonsillar area and soft palate is typical. A patient may have difficulty opening the
mouth (trsimus) and may complain of pain on swallowing (odynophagia). Uvula is
displaced away from mass. ED referal.
✔✔The nurse practitioner suspects diphtheria based on the following sign or symptom:
,a. Yellow-colored pseudomembrane
b. Markedly red uvula
c. Bulging mass behind uvula
d. White spotted coating on pharynx - ✔✔a
Diphtheria is marked with sore throat, fever, and markedly swollen neck ("bull neck").
Fever, hoarseness and dysphagia are common. Yellow-colored pseudomembrane
covers pharynx, tonsils, uvula, and soft palate. VERY CONTAGIOUS. Contact
prophylaxis required. ED referral.
✔✔A nurse practitioner used a tynpanogram to measure for fluid inside the middle ear.
In a patient with otitis media and serious otitis, the NP will note a:
a. Straight line
b. Peaked shape
c. Cone shape
d. Bell-like curve - ✔✔a
In acute otitis media and serious otitis media will show a straight line on testing.
Tympanogram is the most objective measure to test for presence of lfuid inside middle
ear. An intact tympanic membrane appears as translucent off-white to gray color with
the "cone of light".
✔✔At what age are sphenoid sinuses typically present?
a. Birth
b. One-year old
c. 5 years old
d. 12 years old - ✔✔d
Sphenoid sinuses are typically present at 12 years of age. Ethmoid and maxillary
sinuses are both present at birth. Frontal at age 5.
✔✔A patient presents to the clinic today with leukoplakia. What must the nurse
practitioner rule out given this finding?
a. Esophageal cancer
b. Oral cancer
c. Aphthous ulcers
d. Oral thrush - ✔✔b
Oral cancer must be ruled out with leukoplakia (white to light-gray patches that appear
on tongue, floor of mouth, or inside cheek). Smoking/chewing tobacco and alcohol
abuse are risk factors for oral cancer.
✔✔A patient comes to the clinic with complaints of painful mouth ulcers. The nurse
practitioners diagnoses the patient with aphthous stomatitis. How should this be
treated?
,a. No treatment needed
b. Magic mouthwash
c. Salt water swish
d. Lozenges - ✔✔b
"Magic mouthwash" is a combination of liquid diphendydramine, viscous lidocaine, and
glucocorticosteroid. Swish, hold, and spit every 4 hours as needed. Canker sore will
resolve in 7-10 days.
✔✔A patient with torus palatinus will have:
a. Tongue surface with a map-like appearance
b. Split uvula
c. Painless bony protuberance on the hard palate
d. Tight lingual frenulum - ✔✔c
Torus palatinus is a painless protuberance midline on the hard palate. May be
assymetrical; skin normal. Benign. Map-like surface of tongue is Geographic Tongue.
Tight lingual fenulum causes "tongue-tie" (ankyloglossia).
✔✔Arteriouvenous nicking is common in:
a. Hypertensive retinopathy
b. Diabetic retinopathy
c. Macular degeneration
d. Retinal detachment - ✔✔a
AV nicking is when the arteriosclerotic arteriole crosses retinal vein, it indents the vein.
Retinal hemorrhages are also common in hypertensive retinopathy. Diabetic retinopathy
is more known for microaneurysms caused by neovascularization and cotton wool
spots.
✔✔A 16 year old male patient comes to the clinic today with visible small-sized red
papules with white centers inside the buccal mucosa by the lower molars. What is this
indicative of?
a. Koplik's spots
b. Leukoplastia
c. Oral thrush
d. Cheilosis - ✔✔a
Pathognomonic for measles.
✔✔A 78 year old male patient comes to the clinic to see the nurse practitioner for pain
in the corners of his mouth. He wears dentures, smokes, and has diabetes. The nurse
practitioner notices that he has skin fisures and maceration at the corners of his mouth.
What does she note in his chart?
a. Keukoplakia
, b. Cheilosis
c. Cobblestoning
d. Oral dermatitis - ✔✔b
Cheilosis is painful skin fissures and maceration at the corners of the mouth due to
excessive moisture. Common in elderly who wear dentures.
✔✔A patient complaints of dry, cracked corners of their mouth. The nurse practitioner
diagnoses the patient with angular cheilitis. What labs should the nurse practitioner
order to determine if the cause of angular cheilitis is due to pernicious anemia?
a. Potassium
b. Iron
c. Vitamin D
d. Vitamin B12 - ✔✔d
Check B12 levels to rule out pernicious anemia with cheliosis.
✔✔A patient comes to the clinic with complaints of oversalvation and creamy, white
lesions on her tongue. The nurse practitioner suspects a yeast infection and confirms
the diagnosis with KOH. What should the treatment plan include?
a. Miconazole
b. Prednisolone
c. Terconazole
d. Tolsura - ✔✔a
Miconazole is a topical zole ointment and should be prescribed if a patient has oral
yeast infection. Prednisolone is not apporopriate. Terconazole is typically used for
vaginal infections.
✔✔If a patient's distance vision is intact, but near vision is blurry, they would be
considered to have:
a. Hyperopia
b. Myopia
c. Nearsightedness
d. Refractive error - ✔✔a
Hyperopia is "farsigtedness"; distance vision is intact, but near vision is blurry. Myopia
"nearsightedness"; near vision is intact but distance vision is blurry. Refractive error is
blurred vision.
✔✔A 10 year old female patient comes for their well visit and she has been stating that
she does not see certain colors. Which of the following tests would the nurse
practitioner use to determine if the child is colorblind?
a. Snellen test
b. Tumbling E chart
SET A+
✔✔A patient comes to the clinic following discharge from the ED due to colliding with a
teammate during soccer practice. The ED work-up was unimpressive and the patient
was discharged without incident and told to follow-up with their PCP in the next 3 days.
Today the patient reports feeling a bit tired and has begun to have a runny nose. He
also complains of tenderness behind his ear where his teammate hit him. On
examination the NP notices that the patient has bruising behind his ear and periorbital
eccymosis. What does the NP order/test for to rule out basilar skull fracture?
a. Dix-Hallpike test
b. CT scan
c. X-ray
d. Urine dipstick of nasal discharge - ✔✔d
Testing the nasal discharge with a urine dipstick is a quick method that can be used to
assess for glucose. CSF slowly leaks through a basilar skull fracture, which may leak
out the nose or ear. The fluid may be clear or golden in color. If it is positive for glucose,
a leak should be suspected and the patient should be sent to the ED for further
evaluation. A CT scan is appropriate to order but not for quick assessment. Dix-hallpike
is to test for vertigo.
✔✔Which of the following signs and symptoms are expected in a patient with a
peritonsillar-abscess except?
a. "hot potato" voice
b. Odynophagia
c. Trismus
d. Bilateral swelling - ✔✔d
It is not expected that an abscess would cause bilateral swelling. Unilateral swelling of
the peritonsillar area and soft palate is typical. A patient may have difficulty opening the
mouth (trsimus) and may complain of pain on swallowing (odynophagia). Uvula is
displaced away from mass. ED referal.
✔✔The nurse practitioner suspects diphtheria based on the following sign or symptom:
,a. Yellow-colored pseudomembrane
b. Markedly red uvula
c. Bulging mass behind uvula
d. White spotted coating on pharynx - ✔✔a
Diphtheria is marked with sore throat, fever, and markedly swollen neck ("bull neck").
Fever, hoarseness and dysphagia are common. Yellow-colored pseudomembrane
covers pharynx, tonsils, uvula, and soft palate. VERY CONTAGIOUS. Contact
prophylaxis required. ED referral.
✔✔A nurse practitioner used a tynpanogram to measure for fluid inside the middle ear.
In a patient with otitis media and serious otitis, the NP will note a:
a. Straight line
b. Peaked shape
c. Cone shape
d. Bell-like curve - ✔✔a
In acute otitis media and serious otitis media will show a straight line on testing.
Tympanogram is the most objective measure to test for presence of lfuid inside middle
ear. An intact tympanic membrane appears as translucent off-white to gray color with
the "cone of light".
✔✔At what age are sphenoid sinuses typically present?
a. Birth
b. One-year old
c. 5 years old
d. 12 years old - ✔✔d
Sphenoid sinuses are typically present at 12 years of age. Ethmoid and maxillary
sinuses are both present at birth. Frontal at age 5.
✔✔A patient presents to the clinic today with leukoplakia. What must the nurse
practitioner rule out given this finding?
a. Esophageal cancer
b. Oral cancer
c. Aphthous ulcers
d. Oral thrush - ✔✔b
Oral cancer must be ruled out with leukoplakia (white to light-gray patches that appear
on tongue, floor of mouth, or inside cheek). Smoking/chewing tobacco and alcohol
abuse are risk factors for oral cancer.
✔✔A patient comes to the clinic with complaints of painful mouth ulcers. The nurse
practitioners diagnoses the patient with aphthous stomatitis. How should this be
treated?
,a. No treatment needed
b. Magic mouthwash
c. Salt water swish
d. Lozenges - ✔✔b
"Magic mouthwash" is a combination of liquid diphendydramine, viscous lidocaine, and
glucocorticosteroid. Swish, hold, and spit every 4 hours as needed. Canker sore will
resolve in 7-10 days.
✔✔A patient with torus palatinus will have:
a. Tongue surface with a map-like appearance
b. Split uvula
c. Painless bony protuberance on the hard palate
d. Tight lingual frenulum - ✔✔c
Torus palatinus is a painless protuberance midline on the hard palate. May be
assymetrical; skin normal. Benign. Map-like surface of tongue is Geographic Tongue.
Tight lingual fenulum causes "tongue-tie" (ankyloglossia).
✔✔Arteriouvenous nicking is common in:
a. Hypertensive retinopathy
b. Diabetic retinopathy
c. Macular degeneration
d. Retinal detachment - ✔✔a
AV nicking is when the arteriosclerotic arteriole crosses retinal vein, it indents the vein.
Retinal hemorrhages are also common in hypertensive retinopathy. Diabetic retinopathy
is more known for microaneurysms caused by neovascularization and cotton wool
spots.
✔✔A 16 year old male patient comes to the clinic today with visible small-sized red
papules with white centers inside the buccal mucosa by the lower molars. What is this
indicative of?
a. Koplik's spots
b. Leukoplastia
c. Oral thrush
d. Cheilosis - ✔✔a
Pathognomonic for measles.
✔✔A 78 year old male patient comes to the clinic to see the nurse practitioner for pain
in the corners of his mouth. He wears dentures, smokes, and has diabetes. The nurse
practitioner notices that he has skin fisures and maceration at the corners of his mouth.
What does she note in his chart?
a. Keukoplakia
, b. Cheilosis
c. Cobblestoning
d. Oral dermatitis - ✔✔b
Cheilosis is painful skin fissures and maceration at the corners of the mouth due to
excessive moisture. Common in elderly who wear dentures.
✔✔A patient complaints of dry, cracked corners of their mouth. The nurse practitioner
diagnoses the patient with angular cheilitis. What labs should the nurse practitioner
order to determine if the cause of angular cheilitis is due to pernicious anemia?
a. Potassium
b. Iron
c. Vitamin D
d. Vitamin B12 - ✔✔d
Check B12 levels to rule out pernicious anemia with cheliosis.
✔✔A patient comes to the clinic with complaints of oversalvation and creamy, white
lesions on her tongue. The nurse practitioner suspects a yeast infection and confirms
the diagnosis with KOH. What should the treatment plan include?
a. Miconazole
b. Prednisolone
c. Terconazole
d. Tolsura - ✔✔a
Miconazole is a topical zole ointment and should be prescribed if a patient has oral
yeast infection. Prednisolone is not apporopriate. Terconazole is typically used for
vaginal infections.
✔✔If a patient's distance vision is intact, but near vision is blurry, they would be
considered to have:
a. Hyperopia
b. Myopia
c. Nearsightedness
d. Refractive error - ✔✔a
Hyperopia is "farsigtedness"; distance vision is intact, but near vision is blurry. Myopia
"nearsightedness"; near vision is intact but distance vision is blurry. Refractive error is
blurred vision.
✔✔A 10 year old female patient comes for their well visit and she has been stating that
she does not see certain colors. Which of the following tests would the nurse
practitioner use to determine if the child is colorblind?
a. Snellen test
b. Tumbling E chart
