NP Certification Q&A

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Differential Diagnosis Skin Condition in Infant Mar 11, 2024

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The nurse practitioner sees a six week old with her parents for an urgent care visit. The family is of southeast Asian ancestry. They voiced concern about “dark spots” over her lower back and buttocks that have developed over the past three weeks. The child was born after a full term pregnancy, went home with parents in 24 hours, has had an appropriate weight gain, and is meeting developmental milestones. On physical exam, the infant appears in no acute distress, and has blue to blue gray spots over the back, and the buttocks. The areas are flat with irregular shape and unclear edges and are noted in the areas that the parents report. The areas of discoloration are 8 to 20 centimeters in diameter. Palpating the areas does not appear to elicit any discomfort in the child and the color does not blanch with pressure. The skin texture is within normal limits, and The physical exam is otherwise within normal limits. These findings are most consistent with:
A. Cafe au lait spots
B. Congenital dermal melanocytosis
C. Port wine stain
D. Capillary Hemangioma
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YouTube: https://www.youtube.com/watch?v=CJnbvuB_iO0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=59

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Infant labs Feb 19, 2024

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A 12-month-old is seen for well child care. He has been walking solo since age 11 months, and now waves “bye-bye”, searches for an item under a blanket as well as using “mama” and “dada” specifically. His physical examination is within normal limits. Laboratory evaluation reveals a mild microcytic hypochromic anemia with an elevated RDW. The NP considers which of the following two are the most likely contributing causes of this anemia.
A. Vitamin B 12 deficiency
B. Plumbism
C. Iron deficiency
D. Beta thalassemia minor
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YouTube: https://www.youtube.com/watch?v=650oKqmbEgk&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=56

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Infant Milestones Feb 12, 2024

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Ariel is a 7 month old infant, born at 40 weeks gestation, with Apgar scores of 9 and 10. The baby is up-to-date for well child care and immunizations and has had 2 minor episodic illnesses at aged 4 and 6 months with full recovery. Ariel rolled tummy to back, started to purposely bring hands together, and babble at around age 4 months, and has had a social smile since age 2 months. Ariel is the youngest of three children, and today, parents mention that they are concerned that, “She’s not sitting up by herself yet. Our older kids were all sitting by now. She tries but then falls over.” Physical exam reveals a highly interactive healthy appearing infant with excellent muscle tone, who age appropriately resists exam. The NP considers which of the following?
A. Refer the infant to an early intervention program for additional evaluation.
B. Discuss a referral for genetic counseling with the child’s parents.
C. Advise that the child’s clinical presentation is consistent with normal parameters for an infant of this age.
D. Order testing for plumbism and iron-deficiency anemia.
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https://www.youtube.com/watch?v=650oKqmbEgk&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=56

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GYN Findings Feb 05, 2024

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A 22-year-old woman presents with a chief complaint of a 4-day history of mild dysuria, described as, “It burns a bit when I urinate.” She denies fever, GI upset, urinary urgency and frequency. About 1 month ago, she entered a relationship with a male partner who is currently without symptoms. Clinical assessment reveals a friable cervix covered by a thick yellow discharge. Suprapubic, CVA and cervical motion tenderness are absent. UA is positive for leukocytes and negative for nitrites, and microscopic examination of vaginal discharge reveals a large number of white blood cells (WBCs). She is in no acute distress. Thie presentation is most consistent with:
A. Pelvic inflammatory disease
B. Lower urinary tract infection
C. Genital herpes
D. Chlamydia trachomatis cervicitis.
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Youtube: https://www.youtube.com/watch?v=7X1T771b9ac&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=54

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Clinical Testing Considerations Jan 29, 2024

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Which of the following applies when considering issues in clinical testing in a target disease?
A. A false negative result identifies a person with the target disease
B. A true positive result identifies a person with the target disease.
C. A true negative result allows for the patient and clinician to discuss treatment
options for the target disease.
D. A false positive result supports a patient and clinician to discussion on the impact of the target disease on the patient’s overall health.
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Youtube: https://www.youtube.com/watch?v=85m02XdQeXE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=53

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Older Adult UTI Jan 22, 2024

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A 68-year-old woman presents for follow-up at her primary care provider with a chief complaint of “another urine infection”, stating she was seen 4 days ago at urgent care with new onset dysuria and urinary frequency. A review of her clinical record reveals that she has had 3 symptomatic, culture-confirmed UTIs in the past 8 months. She is currently on day 4 of 5 of the antimicrobial prescribed and is without symptoms. Her concomitant health issues include HTN and dyslipidemia, both at treatment goals with lifestyle modification and medication. When discussing with the patient efforts to prevent future UTIs, the NP considers which of the following will be appropriate?
A. Adding cranberry juice supplements to her diet daily.
B. Avoiding tub baths.
C. Initiating long-term antimicrobial prophylaxis
D. Regular use of a vaginal estrogen.
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YouTube: https://www.youtube.com/watch?v=LxjF5uUuSHg&t=4s

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Adult GU Complaint Jan 15, 2024

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A 28 year-old woman presents with a 2-day history of urinary frequency, urgency and dysuria, stating, “This feels like when I had a urine infection 4 years ago.” She denies fever or GI upset and otherwise feels well. In consideration of the diagnosis of lower UTI/cystitis, a urinalysis is ordered. Which of the following is the most sensitive and specific finding for UTI caused by a Gram-negative organism?
A. Positive leukocyte esterase
B. Presence of bacteriuria
C. Proteinuria
D. Positive nitrite
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YouTube: https://www.youtube.com/watch?v=LxjF5uUuSHg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=51

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Medical Malpractice Jan 08, 2024

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Which of the following examples represents a potential medical malpractice scenario?
A. A 25-year-old who is being treated for acute otitis media, reports penicillin allergy to the healthcare provider. An amoxicillin prescription is advised. The patient takes prescribed amoxicillin without adverse reaction.
B. A 40-year-old patient with acute bacterial sinusitis reports to his healthcare provider that his symptoms have not improved after 2 days of a dose-appropriate prescription for amox with clavulanate.
C. Before taking a medication, a 28-year-old patient realizes the wrong drug was dispensed at the pharmacy. She returned the prescription and the correct medication was dispensed.
D. A 50-year-old patient has an abnormal mammogram and was not advised by her healthcare providers about appropriate follow-up. A mammogram 1 year later confirmed the prior findings, the HCP shared the findings and the patient was referred for further evaluation and breast biopsy.
---YouTube: https://www.youtube.com/watch?v=41Ee5brI-N0

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Heart Failure Patient Jan 01, 2024

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A 67-year-old man with a five-year history of heart failure with reduced ejection fraction presented to the ER approximately 7 days ago with worsening shortness of breath, and new onset orthopnea. He was hospitalized for two days, with medications adjusted, and states at that time his symptoms were significantly improved. The nurse practitioner now sees him in follow up. The patient states today that, “For the past day, I feel just like I did the day I was admitted to the hospital. I might even feel worse.” The patient reports a 5 lb weight gain since arriving home from the hospital. He denies dietary indiscretion with high sodium foods and states he is taking all medications prescribed at hospital discharge as advised On physical exam, he is sitting upright, slightly labored breathing, BP=165/92, his resting heart rate=110 with S3 heart sound present, respiratory rate 26, neck veins to 8 cm, and bilateral crackles through the lung fields. The most appropriate next step in his care is to:
A. Perform medication reconciliation.
B. Obtain a detailed 48-hour dietary and fluid intake history.
C. Advise on the need for evaluation and treatment in the emergency department.
D. Ensure he has a cardiology follow-up within the next week.
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YouTube: https://www.youtube.com/watch?v=bFdd4tB96hQ

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Well Child Care - Toddler Foot Dec 18, 2023

Show notes

A 14-month-old is brought into the clinic for a well-child visit. Born at 39.5 weeks gestation, he has been healthy and is up-to-date with immunizations. The child started to walk at age 12 months and the parents note that “his feet look a little crooked when he stands and sometimes he will trip when he is trying to run because they curve in.” The NP notes a mild inward curvature of the front half of the foot bilaterally, with an intoeing positioning when he stands. The feet are flexible and the child walks with ease without evidence of discomfort during ambulation or on exam. There is no joint redness, heat, or swelling. This most likely represents:

Pes planus.
Club foot.
Metatarsus adductus.
Idiopathic juvenile arthritis.

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YouTube: https://www.youtube.com/watch?v=NvjewWxJpUE

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