A 17 yo male presents for follow up on a “fainting” episode that occurred during football practice at the end of a running exercise. He states, “I do not know what happened. We finished a set of running sprints and next thing I knew, I was on the ground.” He denies injury from the event and history of prior episodes. His physical examination reveals a crescendo-decrescendo systolic murmur heart best at the apex, increasing in intensity with position change from supine to standing position. &n...
A 40 year-old accountant presents for advice on measles prevention. He reports disembarking from an airplane approximately 40 hours ago, and now being notified that one of the passengers on the plane has been diagnosed with measles today. He denies any chronic health problems, states he received “all the shots I should have” when he was a child. However, he is unable to produce documentation of childhood vaccinations. Which of the following represents the most appropriate action? ...
A nurse practitioner receives a message from a neighbor, a 35-year-old woman who is asking for a prescription to treat a “urine infection”. The neighbor states she's had this condition occur in the past and does quite well if she gets on an antimicrobial quickly. The neighbor also mentions that she's going out of town on a business trip the next day and is unable to contact her personal healthcare provider nor get to urgent care. The NP considers the following in prescribing a medicatio...
Which of the following best describes a disease that should be reported to the local or regional public health department? A. Diseases where public health intervention is needed to help prevent spread to the region or community. B. Diseases with significant rates of mortality and morbidity. C. Diseases that are most often noted among individuals with significant immunocompromise. D. Diseases where intervention in early life helps lead to improved health in adulthood...
A 6-year-old presents with his parents, with a chief complaint of a 3 day history of sore throat, intermittent frontal headache and fever with a 1 day history of a non pruritic fine, raised rash, without N, V, D or C. He is able to take fluids without difficulty but has diminished appetite. The parents report that other children in their son’s kindergarten class have been sick with similar signs and symptoms. A rapid strep screen is positive. Clinical evaluation is consistent with scarlet fev...
A 50 yo woman presents with a 6-month history of intermittent RUQ abdominal pain, bloating and nausea, particularly after eating fatty food, describing the discomfort as sharp, occasionally radiating to the right shoulder, usually lasting around 45 mins, and accompanied by eructation. She is currently without distress, stating that, “I cut back on food that I know bothers my stomach. Physical exam reveals, BMI=35, no jaundice, mild RUQ abdominal tenderness and negative Murph...
An 18-month-old toddler presents for a sick visit with a chief complaint of recent onset of fever and skin lesions. Which of the following is most consistent with the presentation of measles (rubeola)? A. A 3-day history of anterior cervical lymphadenopathy, significant sore throat, fever with a 1-day history of a fine erythematous skin eruption. B. A 3-day history of fever, mild nasal congestion, and crankiness followed by resolution of elevated temperature and erupt...
A 28 year old assigned male at birth presents with the chief complaint of a "new problem in my private parts” He states he feels well otherwise. Which of the following would be most consistent with the clinical presentation of primary syphilis? A. A three day history of purulent penile discharge with dysuria. B. A one week history of a painless genital ulcer on the penile shaft. C. A 5 day history of painful vesicular lesions over the penile glands, with some lesions now crusting over. D. A o...
A 52-year-old man presents for an initial primary care visit at the nurse practitioners practice period he has not seen any health care providers since age 38, stating that he has been in good health. Social history, drinking approximately 2 beers per night over the weekend, two nights per week, has a 5 pack year cigarette smoking history, having taken up smoking when he was in college, and quit at age 22. He reports feeling well and without chief complaint or chronic health problems. H...
A 10-year-old of Middle Eastern ancestry , assigned female at birth, is seen for routine well child care. She is generally healthy and plays soccer, reporting excellent exercise tolerance, stating, “I’m the fastest midfield on the team.” Physical examination is within normal limits with Tanner stage 2. Height and weight are at 40% tile, consistent with previous measures. Laboratory evaluation reveals a mild microcytic hypochromic anemia with a NL RDW. This likely represents which of the...
A 70 year old man with a 35 year history of hypertension, dyslipidemia, and a 20 year history of type 2 diabetes presents. He was recently diagnosed with systolic heart failure, presenting with dyspnea on exertion and orthopnea. Prior clinical assessment revealed the murmur of mitral regurgitation. Which of the following would the NP anticipate finding on today’s physical exam? A. A mid to late systolic murmur that follows a mid systolic click. B. In early to mid systolic murmur ...
Which of the two following findings would be anticipated in the normal funduscopic exam of a healthy 40-year-old woman who is normotensive, generally in good health and without ocular complaint? A. Arteriovenous nicking B. Optic cup to disc ratio < .0.5 C. Retinal arteries are brighter and narrower than veins D. Slight bulging of the optic disk --- YouTube: https://www.youtube.com/watch?v=VchTtrKTmfw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=112 Visit fhea.com to ...
Which of the following is most consistent with the clinical presentation of a person with folate-deficiency anemia? A. A 45-year-old woman with uterine fibroids, menorrhagia and a microcytic, hypochromic anemia with elevated RDW B. A 35-year-old woman with newly diagnosed systemic lupus and a normocytic, normochromic anemia with NL RDW C. A 40-year-old woman with alcohol use disorder who drinks 5-6 glasses of wine per day and a macrocytic normocytic anemia with an elevated R...
A 70 year old man with a history of BPH, HTN and dyslipidemia presents with a 3-day history of perineal pain, intermittent fever, dysuria, and difficulty initiating urine stream. He denies GI upset and is taking fluids without difficulty. He denies sexual activity with others for the past three years. He is alert, oriented and appears slightly uncomfortable while seated. Abdominal and scrotal exam are WNL, there is no penile discharge and digital rectal exam reveals a tender, enlarged prostat...
Which of the following clinical scenarios is most consistent with an older adult presenting with acute bacterial prostatitis? A. A 65 year old male who presents with a 6 month history of urinary frequency, occasional difficulty initiating urine stream, without dysuria or fever. GU exam within normal limits with the exception of prostate enlargement. B. A 50-year-old male with a 4 day history of increased urinary frequency, end-void dysuria, and intermittent fever. GU exam ...
The NP sees a 74-year-old woman with a BMI=30 kg/m2 who has a 30-year history of type 2 diabetes, HTN, and dyslipidemia. Pertinent social history includes the following: a retired elementary school teacher who lives in a 1-story home with her spouse and adult child, nonsmoker, drinks approximately 2, 5 oz glasses of wine per month, and walks approximately 2 miles per day. Her current medications include telmisartan, HCTZ, rosuvastatin, metformin, semaglutide and canagliflozin at optimized dos...
Mrs. Mahem is a 68-year-old patient with a 25-year history of type 2 diabetes mellitus. In the past year, her A1c remains at around 8.5% with the use of the following medications: metformin, sitagliptin, and canagliflozin, at optimized doses and with adherence. She states, “ I haven’t changed the way I eat and I walk about ½ h a day, just like I have for years”. Additional health issues include HTN and dyslipidemia, treated with medications and at therapeutic goal, and obesity with a BM...
A patient presents with a chief complaint of a gradual onset vision change, present for the past 6 months, while denying eye pain, redness or trauma. The funduscopic exam, extraocular movements and pupillary reactions are within normal limits. When considering a diagnosis of presbyopia, which of the following best describes patient presentation? A. A 50-year-old who states, "I need to hold what I'm reading really far away in order to see it clearly". B. A 75-year-old who states,"W...
A 27-year-old woman presents as a new patient to your practice. She is without chief complaint. She asks to, “get a refill on my birth control pills” , having used combined oral contraceptives for the past 12 years without adverse effects. Social history reveals she is a nonsmoker, without recreational drug use, drinks approximately 1-2 mixed drinks per week, and runs 2-3 miles 5 days a week with reported excellent activity tolerance. Her health history is generally unremarkable, ...
A 29-year-old who is 8 weeks pregnant presents with a chief complaint of nausea and vomiting. She states, “I’ve been like this for three weeks. I don’t know why this is called morning sickness since I feel sick to my stomach almost all the time”, reporting that she vomits 2-3 times nearly every day, stating, “I was worse 2-3 weeks ago, when I was throwing up 4-5 times a day. I figured out what food really bothers my stomach and cut those out.” A 24-h dietary recall reveals frequent low-fat me...