Sample Exam Questions
A 15 year old high school athlete complains of a painful area below both knees. He tells you they feel bone-like and are tender to palpation. He denies any hot joints, fever, rash, or difficulties with weight-bearing. Which of the following conditions is most likely:

a) osteomyelitis
b) internal tibial torsion
c) Osgood-Schlatter Disease
d) Calve-Perthe's Disease

Tip: A good clue is the patient's age ( a teen) and the presentation. The correct answer is c. 

Sue D., a 30 year old bank teller, tells the nurse practitioner during a routine physical that she forgot to take her birth control pills for 2 consecutive days (or 2 days in a row).  The NP would recommend which of the following: 

a) Take two pills now, then two pills the next day and use condoms as back-up until the next pill cycle.
b) Throw away the current package and start a new pill cycle.
c) Use condoms and throw away the two forgotten pills, then start a new pill cycle
d) Take two pills today, then one pill daily until the next pill cycle

Tip: The correct answer is a

Which cranial nerve is the nurse practitioner assessing with the Rinne test:

a) CN 7
b) CN 8
c) CN 9
d) CN 3, 4, and 6

Tip: The correct answer is b. CN 8 is the acoustic nerve.Other methods to test hearing is the whisper test and the Weber.

Which of the following drugs is contraindicated in pregnant women:

a) nitrofurantoin macrocrystals (Macrobid)
b) cephalexin (Keflex)
c) isotretinoin (Accutane)
d) acetaminophen (Tylenol)

Tip: The answer is c. Accutane is a category X drug and any reproductive-aged female on this drug should always be on two forms of reliable birth control. Accutane causes massive birth defects of the CNS, face, eyes, heart, glandular system, etc.
A 13 year old female patient who is allergic to erythromycin and sulfa drugs has a positive strep culture. Which of the following pharmacologic agents would you recommend:

a) clarithromycin (Biaxin) 500mg po BID x 10 days
b) penicillin 250mg po QID x 10 days
c) levofloxacin (Levaquin) 500mg po daily x 7days
d) trimothoprim-sulfamethazole (Bactrim DS) one tablet BID x 10 days

Tip: Remember, flouroquinolones (or quinolones) are contraindicated in patients younger than 18 years of age due to ...(we will tell you what in the review course). The correct answer is b.

A 35 year old woman has a history of mitral valve prolapse (MVP) and is scheduled for a root canal the next day. She tells the NP that she needs an antibiotic before undergoing the procedure.
Which of the following is the best option for the NP to follow: 

a) Write a script for amoxicillin 2 g before and 1.5 g after the procedure.
b) Write a script for amoxicillin 2 g one hour before the procedure
c) Advise the patient that according to the American Heart Association's latest guidelines, there is no need for prophylaxis before dental procedures if the patient does not have a prrosthetic valve
d) Tell the patient that prophylaxis before certain procedures is still recommended.for patients with her diagnosis

Tip: The correct answer is c. 

Balanitis is caused by which of the following organisms:

a) staphylococcus aureas
b) stroptococcus pyogenes
c) candida albicans
d) tinea fungi

Tip. The correct answer is c. Balanitis is more likely to be seen in uncirmcumcised males especially diabetic males and those who are immunocompromised (ie: HIV/AIDs). 

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Websites (to help you study)

University of California's (San Diego) "A Practical Guide to Clinical Medicine". 


Cardiac System 

PMI (Point of Maximal Impulse)
The PMI is caused by contraction of the left ventricle. It should be about the size of a penny. 
It is usually found at the 4th -5th intercostal space by the MCL (midclavicular line). Patients with enlarged hearts and LVH will have their PMI displaced laterally.
Source: http://meded.ucsd.edu/clinicalmed/heart.htm 

Sample Questions

Which of the following heart sounds is found in the majority of patients diagnosed with acute heart failure:
1. S1, S2
2. S1, S2, S3
3. S1, S2, S4
4. S1, S2, S3, S4

The bell of the stethoscope is best used for auscultation of which of the following heart sounds:
1) S3 and S4 and low-pitched tones
2) S3 and S4 only
3) S1 and S2 and high-pitched tones
4) S1 and S2 only

What is the most common cause of gynecological cancer DEATHS among women in the U.S.?
1. breast cancer
2. ovarian cancer
3. endometrial cancer (cancer of the uterus)
4. endocervical cancer

​Which type of cancer has the highest mortality in males and females:

1. Colon cancer
2. Lung cancer
3. Liver cancer
4. Skin cancer

​Lung cancer has the highest mortality. 
A male with HIV infection has a CD4 count of less than200 cells/mm3. Which of the following is an appropriate action:

1. Start patient on Bactrim DS daily
2. Schedule pentamidine nebulizer treatments
3. Recheck CD4 count 
4. Recommend vaccination against Herpes zoster.

Tip: CD4 count of 200 or less, start prophylaxis against "PCP" pneumonia (new name organism is P. jirovicii).
​Zoster vaccine (Zostrix) is contraindicated in immune-compromised patients.


What type of immunity is less active in the elderly:

1. Cell-mediated immunity
2. Humoral immunity
3. Total immunity
4. Passive immunity

A 70 year old ex-smoker has a diagnosis of COPD, hypertension, and DJD. The color of the patient's phlegm has changed to a green color the past few days. The patient is not febrile, but has been lethargic for the past few days. Which of the following can treat the source of the patient's new symptoms: 

1. Oxygen at 2/L by nasal cannula
2. Start patient on an antibiotic
3. Albuterol: saline nebulizer treatments
4. Increase fluid intake because many elderly patients become dehydrated when ill.

Patients with community-acquired pneumonia (CAP) or  who have a history of smoking or have COPD are are at higher risk for CAP that is caused by: 

1. Strep pneumoniae
2. Mycoplasma pneumoniae
3. Pseudomonas aeroginosa
4. Hemophilus influenzae