NP Certification Q&A

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 eruption of a fine pink rash C. A 3-day history of cough, conjunctivitis with clear eye discharge, mild sore throat without exudate, diffuse lymphadenopathy and fever, followed by a new onset diffuse maculopapular rash D. A 2-day history of fever, mild sore throat, posterior cervical lymphadenopathy, and maculopapular skin lesions.  ---YouTube: https://www.youtube.com/watch?v=IWRqAkns1MQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=117Visit fhea.com to learn more!

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 one week history of N void dysuria without penile discharge.---YouTube: https://www.youtube.com/watch?v=Jp-dk0BZ37o&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=116Visit fhea.com to learn more!

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.  He asks about what kind of cancer screening he should have. The NP advisors which of the following?A. Colonoscopy B. Prostate specific antigen (PSA) C. Low dose chest CTD. Given his history, no routine cancer screening is advised. ---YouTube: https://www.youtube.com/watch?v=qnKPe2EHgl4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=115Visit fhea.com to learn more!

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 following?A. Vitamin B 12 deficiencyB. G6PD deficiencyC. Iron deficiencyD. Beta thalassemia minor---YouTube: https://www.youtube.com/watch?v=ch5dbCqkPTM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=114Visit fhea.com to learn more!

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 harsh in quality, that radiates to the neck. C. A holosystolic murmur that radiates to the axilla.D. A localized mid to late diastolic murmur.---YouTube: https://www.youtube.com/watch?v=jN29-on3tn8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=113Visit fhea.com to learn more!

Which of the two following findings would be anticipated in the normal fundoscopic exam of a healthy 40-year-old woman who is normotensive, generally in good health and without ocular complaint?  A. Arteriovenous nickingB. Optic cup to disc ratio < .0.5C. Retinal arteries are brighter and narrower than veins  D. Slight bulging of the optic diskVisit fhea.com to learn more!

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 RDW D. A 65 yo woman with a 20 year-history of hypothyroidism presenting with a 6-month history of stocking-glove neuropathy and a macrocytic, normochromic anemia with an elevated RDW.  ---YouTube: https://www.youtube.com/watch?v=VsxbJMBLd4U&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=111Visit fhea.com to learn more!

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 prostate. UA reveals positive leukocyte esterase and > 10 WBCs per HPF. With a working diagnosis of acute bacterial prostatitis, which of the following is the most appropriate antimicrobial option in this clinical scenario?  A. Ciprofloxacin PO x 10 days B. IM Ceftriaxone as a one-time dose with doxycycline PO BID X 10 days C. IV piperacillin with tazobactam for 5 days D. Nitrofurantoin PO BID x 5 days.  Visit fhea.com to learn more!

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 reveals suprapubic tenderness,  without  prostatic enlargement or scrotal abnormalities.  C. A 70 year old man with a 3-day history of perineal pain, intermittent fever, dysuria, and difficulty initiating urine stream. Scrotal exam WNL and digital rectal exam reveals a tender, enlarged prostate.  D. A 78 year old man with a 3 month history of intermittent gross hematuria and urinary frequency without dysuria. GU exam is WNL with the exam of a nontender enlarged prostate with multiple nodular lesions.  Visit fhea.com to learn more!

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 doses, and current A1c=9.2%. Her current A1c= 9.2% and is at HTN and lipid goal. Prior mediations have included sitagliptin, with patient stating, “That medication did not help my sugar at all.” She states she is adherent to her medications and dietary advice. Her eGFR is within acceptable parameters and she is feeling well. Physical exams are unremarkable. Which of the following is the most appropriate next step? A. Advise that her A1c is at an age-acceptable level.  B. Add post-meal sliding scale rapid acting insulin C. Prescribe basal and pre meal insulin. D. Add oral glipizide.  Visit fhea.com to learn more!

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 BMI= 33. Her eGFR is 65. Which of the following is the most appropriate next step in the pharmacologic management of her diabetes?  A. Add glyburide to enhance glycemic control.B. Consider discontinuing metformin due to age and renal function.C. Advise that her glycemic control is adequate for an older adult. D. Prescribe semaglutide to help her achieve A1c goal.  Visit fhea.com to learn more!

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,"When I look at a bright light, I see a colored halo around it".C. An 80-year-old who states, "I have a blurry spot in the middle of my eyesight". D. A 17-year-old who states, "I went to get my driver's license, but failed the distance vision exam".Visit fhea.com to learn more!

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, but with patient report of a “mild heart murmur that was picked up when I was a teenager during a physical I needed so I could run track. I was told not to worry about it.” Physical exam is unremarkable with the exception of a mid-systolic click followed by a grade II mid to late systolic murmur without radiation. The remainder of the cardiac exam is within normal limits.  These findings most likely represent which type of murmur? A. PhysiologicB. Aortic stenosis C. Mitral regurgitation D. Mitral valve prolapse---YouTube: https://www.youtube.com/watch?v=wmGI7v_DPMY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=105Visit fhea.com to learn more!

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 meals and consistent sipping of liquids. She denies thirst or infrequent urination, and reports, “I'm just tired of feeling this way. I've missed so much work and can hardly keep up with my 3-year-old.”  Physical exam reveals the following; Alert, appears fatigued, with moist mucous membranes,  a 1 lb. weight loss since last visit 4 weeks ago, and minimal epigastric tenderness without rebound.   The NP considers advising on the following: A.  Initiate therapy with an oral  5HT-3 antagonist such as ondansetron (Zofran®).B.  Referral to high-risk for advise on further management.  C.  Advise on the use of daily dose of oral  vitamin B6  with doxylamine.  D. Increase fluid and fiber intake. Visit fhea.com to learn more!

The NP sees  a 44-year-old male of African ancestry with a BMI=34 kg/m2 and recently diagnosed  type 2 diabetes mellitus. He works on a rotating shift in healthcare and reports eating irregularly. He was started on metformin therapy 4 months ago, is at maximum recommended dose, and states he is tolerating the medication well. His initial A1c was 9.8%, with today's A1c=8.7%. eGFR is within acceptable parameters and he is feeling well, stating, “I was so thirsty and needed to urinate all the time before I started that pill”. Physical exam reveals extensive acanthosis nigricans.  He mentions that his health insurance. “Does not pay for all that much. I'm OK with paying for the pill I am taking now, but really cannot afford expensive medicines. “ Which of the following is the most appropriate next step? A. Prescribe weekly injectable semaglutide.  B. Adding post-meal sliding scale rapid acting insulin.C. Add a daily dose of pioglitazone.D. Add glipizide on days when his eating schedule is predictable.  ---YouTube: https://www.youtube.com/watch?v=xyh0ld2l9_M&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=103Visit fhea.com to learn more!

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!In evaluating a 66-year-old man with dilated cardiomyopathy and heart failure, the NP notes a grade 3/6 medium-pitched blowing systolic murmur that radiates to the axillae. What do these findings most likely represent?A.Innocent murmurB. Mitral stenosisC. Aortic regurgitationD. Mitral regurgitation---YouTube: https://www.youtube.com/watch?v=jhrYmC-kq6Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=102Visit fhea.com to learn more!

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!A 72-year-old woman with severe COPD, who uses an inhaled LAMA/ LAMA daily on a set schedule and SABA via MDI as needed for symptom relief, presents with a 4-day history of URI symptoms, starting with sore throat and clear nasal discharge, without fever. She denies N, V, or other GI upset. She now reports a 2-day history of increasing shortness of breath and production of clear to white sputum. SaO2= 97% and she is no acute distress. In considering the diagnosis of COPD exacerbation, which of the following best describes the role of imaging in the evaluation of COPD exacerbation?A. A chest x-ray should be ordered in COPD exacerbation in the patient with fever and/or low SaO2 to help rule out concomitant pneumonia.B.  A chest x-ray should be ordered routinely in the evaluation of a person with COPD exacerbation.C. Given the frequency of COPD exacerbations that typically occur in a person with COPD, chest x-ray use should be limited due to radiation exposure risk.D. A thoracic ultrasound is the preferred imaging study to order in a COPD exacerbation.Visit fhea.com to learn more!

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!A  45-year-old woman with no chronic health problems presents a 6-month history increasing fatigue despite adequate opportunity for rest , worsening dry skin and increased menstrual flow volume. In analyzing the laboratory data below, which is most consistent with the diagnosis of hypothyroidism? A. TSH

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!Saundra is a 72-year-old with hypertension who is on an appropriate dose of an ACE inhibitor with adherence. Today's BP= 152/96 and is without HTN-related complaint.  Physical exam is unremarkable.She has a history of well-controlled asthma and is using ICS/LABA therapy.  Due to osteoarthritis, she reports, “I get up slowly. Sometimes I do not get the bathroom on time and I lose my urine control.” Which of the following represents the next best step in Saundra's HTN therapy? A.Advise that her BP is in an acceptable rangeB. Thiazide diuretic therapy should be initiatedC. Add a CCB to her current therapyD. A beta blocker represents the optimal additional therapy---YouTube: https://www.youtube.com/watch?v=JRjErXhuqpY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=99Visit fhea.com to learn more!

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!Josh is a well 16-year-old male who presents with a reporting a 4-day history of moderate left-sided otalgia with intermittent fever.  Clinical assessment is consistent with acute otitis media (AOM).  No drug allergy or recent (within the past month) antimicrobial use is reported.  Which of the following represents the most appropriate first-line antimicrobial therapy?A. Oral moxifloxacinB. Oral amoxicillin C. Oral trimethoprim-sulfamethoxazoleD. Oral azithromycinVisit fhea.com to learn more!

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!A 35-year-old w presents complaining of a 15+ year history of recurrent cramping abdominal pain that is often relieved with defecation that occurs intermittently. Symptom onset is often accompanied by bloating and a change in stool frequency and form, particularly when “I eat certain foods.” She denies bloody or tarry stools, nausea, vomiting or fever. The NP notes the patient's weight is stable, and there is no evidence of anemia. The most likely diagnosis is?A. Irritable bowel syndromeB. Paralytic ileusC. Peptic ulcer diseaseD. Ulcerative colitis---YouTube: https://www.youtube.com/watch?v=2exovTbGVvI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=97Visit fhea.com to learn more!

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!The NP sees a 34-year-old woman with a chief complaint of 6-month history of increasing fatigue despite adequate opportunity to sleep and rest. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW. You expect to find which of the following upon review of the patient's health history?A. Report that she has been eaten a plant-based diet since age 18B. History of prolonged menses with the need for =8 pads per dayC. Report of drinking 5 or more 5 oz glasses of wine dailyD. A prior diagnosis of rheumatoid arthritis---YouTube: https://www.youtube.com/watch?v=bXell7YIQKE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=96Visit fhea.com to learn more!

Which of the following is most accurate about nurse practitioner's scope of practice?A. The organization that grants NP certification dictates a profession scope of practice.B. The employer is able to require the NP to provide services that are beyond what regulatory bodies outline.C. The law of the state where the NP practices provides regulatory guidance on scope of practice.D. Federal law advises on NP scope of practice.Visit fhea.com to learn more!

A four-week-old infant born at 39 weeks' gestation, exclusively breast fed and has been healthy was brought in for an evaluation following a 2 day history of projectile vomiting that occurs after each feeding without with increased fussiness. The child's father mentioned that the baby appears to be without distress after vomiting and wants to feed immediately afterwards. Parents deny the infant has had fever, diarrhea or skin lesion; in addition, has not had exposure to individuals with similar symptoms. His last BM was about 18 hours ago, described as small and firm. Physical exam reveals an alert, active infant with a small palpable mask that is appreciated in the right upper quadrant of the abdomen. The most likely diagnosis is:A. Viral gastroenteritisB. Pyloric stenosisC. IntussusceptionD. Gastroesophageal refluxVisit fhea.com to learn more!

A 25-year-old woman gravida 2, para 1 is 24 weeks pregnant and is being seen for an urgent care visit. She reports a constant headache over the past two days along with ankle swelling. Her BP today is 162/86 in, which is a significant elevation from her pre pregnancy blood pressure of 122/68.Laboratory results indicate 2 plus proteinuria as well as elevated ALT and AST. Platelets and LDH are within normal limits, as is fundoscopic and neurological exams. The most likely diagnosis is: A. Health syndromeB. Gestational hypertensionC. PreeclampsiaD. Hypertensive emergencyVisit fhea.com to learn more!

A 77-year-old man is in for a routine follow up visit. He has its twenty-year history of type 2 diabetes and hypertension as well as a 5-year history of stage 3B chronic kidney disease, or CKB. At this visit, his A1C is 8.4% and his estimated GFR is 42 mL per minute. His BP is 128/76. He states he's feeling well and denies headache, visual changes, dizziness and hypoglycemic episodes. His medications include metformin, amlodipine, lisinopril and rosuvastatin. In reviewing his current medication, the NP considers which of the following options?A. Prescribe glipizideB. Add pioglitazone C. Continue on his current medication without adjustment D. Initiate therapy with Canagliflozin---YouTube: https://www.youtube.com/watch?v=rOuR7ATNdMQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=92Visit fhea.com to learn more!

A 72-year-old woman with a 20-year history of hypertension and dyslipidemia-- both at EBP goals with appropriate drug therapy, as well as a remote history of peptic ulcer disease-- presents for follow up. She is a nonsmoker, drinks about 1- 2 glasses of wine per week and denies the use of other substances. Her daily routine includes a 2- 3 mile walk and she denies history of acute coronary syndrome or other ASCVD related conditions. She mentions that one of her friends takes an aspirin a day to “prevent a heart attack or a stroke”, and further states, “I live alone, and I need to maintain my independence.” According to the latest recommendations from US Preventative Services Task Force, which of the following is the most appropriate advice regarding low dose aspirin use in this patient?A. Start low dose aspirin therapy 81 mg daily as the vascular benefits outweigh the risk.B. Best evidence for primary prevention of ASCBT event is with higher dose aspirin at 325 mg a day.C. The risks associated with aspirin therapy in this patient outweigh the potential benefits.D. Start aspirin therapy only if the patient has a family history of heart disease and 1st degree relatives.---YouTube: https://www.youtube.com/watch?v=9uK3CINTFOg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=91Visit fhea.com to learn more!

A 57-year-old man presents for a routine physical exam during history taking. He reports that he drinks approximately 7-to-8 12-ounce beers nightly and denies other substance use, including tobacco. His physical examination is unremarkable except for mild pharyngeal erythema without exudate. In consideration of his health history, which of the following lab results would be anticipated?A. Elevated plateletsB. MacrocytosisC. LymphocytosisD. Elevated sed rate Visit fhea.com to learn more!

Which of the following are the most common features of skin changes noted in areas of the feet affected by tinea pedis?A. Widely distributed with consistently raised with areas of hyperpigmentation.B. Localized to the dorsal aspect with central clearing and a raised borderC. Involving plantar crusting and interdigital fissuresD. Remains stable in size over time with lateral lichenification.---YouTube: https://www.youtube.com/watch?v=D70UTIMym6w&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=89Visit fhea.com to learn more!

Mrs. Martinez is a 64-year-old woman with 10 year-history of type 2 diabetes mellitus, HTN, and dyslipidemia. Her current medications include metformin, an SGLT-2 inhibitor, statin, ARB and thiazide diuretic. She is at EBP-advised goals including recent A1c=6.9%. Today, she reports she is feeling well. Her history and physical examination are unremarkable. She mentions that, for the past year, in addition to her prescribed medications, she drinks a special tea blend that her sister makes, taking this each day to help “draw out the sugar” in her blood. She states, “I feel much better when I take it.” Your most appropriate response is:A. “I don't believe the tea is helpful in controlling your blood sugar.”B. "Please stop using the tea until I can look into its contents."C. "Homemade teas might interact with your medicines”D. “Tell me more about how the tea draws out the sugar.”Visit fhea.com to learn more!

A 76-year-old woman with presbycusis presents for a follow-up visit on HTN and dyslipidemia, treated with an ARB, thiazide diuretic and a statin, and at treatment goal. Which of the following is she likely to report?A. Occasional difficulty with speech discriminationB. Need to use her prescription eyeglasses to readC. Altered sense of smellD. Diminished sense of touchVisit fhea.com to learn more!

A 24-year-old adult, assigned female at birth, presents to your practice chief complaint of bilateral lower abdominal pain for the past three days, worsening over this time frame. She describes the pain as a heavy pressure like feeling, accompanied by intermittent fever , mild dysuria, yellow vaginal discharge, as well as nausea without vomiting nausea without vomiting. She is tolerating fluids well and has a markedly decreased appetite. Additional history of present illness includes recent LMP, ending about three days ago with normal timing and normal flow, she is sexually active with two male partners, and describes that the last episode of coitus six days ago was painful for deep pelvic discomfort. The physical exam reveals a temp of 100.4 Fahrenheit, rest of vital signs within normal limits, mild lower abdominal discomfort to light and deep palpation without rebound, yellow vaginal discharge and cervical motion tenderness without palpable pelvic mass. This clinical presentation is most consistent with:A. Acute AppendicitisB. Pelvic Inflammatory DiseaseC. Ovarian CystD. Ectopic Pregnancy---YouTube: https://www.youtube.com/watch?v=hS0zWLA9b_A&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=86Visit fhea.com to learn more!

A 14 yo presents with a 4 h history of sudden onset LLQ abdominal and scrotal pain, described as a pulling, burning sensation. He denies vomiting, diarrhea or constipation, and reports mild nausea and is taking fluids without difficulty. HPI is negative for recent trauma to the region, dysuria, penile discharge, genital lesions or fever. He reports milder, similar episodes during the past 3 months, “that just went away.” Physical exam reveals loss of the cremasteric reflex, negative Blumberg sign and a high riding left testicle.A. Testicular NeoplasiaB. Acute EpididymitisC. Incarcerated Inguinal HerniaD. Testicular TorsionVisit fhea.com to learn more!

A 24-year-old woman presents to your practice with a diagnosis of pelvic inflammatory disease, suitable for outpatient treatment. Which of the following is recommended? Chose two that apply.A. A single dose of IM ceftriaxoneB. A two-week course of oral doxycycline and oral metronidazoleC. A five-day course of oral azithromycin with a one-week course of oral ciprofloxacinD. A single dose of IM penicillinVisit fhea.com to learn more!

A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one-day history of fever, projective cough with yellow sputum and increasing shortness of breath. He denies GI distress but states his appetite is not what it usually is. He has a history of hypertension, type 2 diabetes, and dyslipidemia at guideline-based goals. He is a former smoker, quitting about 10 years ago with approximately a 35-pack-year history and was diagnosed 5 years ago with COPD.  Clinical assessment confirms the diagnosis of community-acquired pneumonia, suitable for outpatient treatment.  Which of the following represents the most appropriate antimicrobial option? A. Oral levofloxacinB. Injectable ceftriaxoneC. Oral azithromycinD. Oral amoxicillin---YouTube: https://www.youtube.com/watch?v=Sh1cpNy59A0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=84Visit fhea.com to learn more!

A 9-year-old female presents for well child care with her parent. She is in the 4th grade, doing well academically, plays soccer on a local team, and reports, “I have 3 best friends”. Health history per parent and child reveals no concerns. On physical exam the clinician's notes the child is at about 40th percentile height and weight for age, and has breast budding and downy, straight, slightly pigmented pubic hair long the labia majora.These physical findings are consistent with:A. Precocious pubertyB. Early onset normative pubertyC. Age-appropriate pubertal findingsD. Concern for a GNrH producing lesionVisit fhea.com to learn more!

A 40-year-old computer programmer presents for a sick visit with the chief complaint of a two-day history of low back pain. He reports the pain started after many hour stretch of doing yard work. The pain is described as a dull constant ache, worse with activity, better with rest, across the lower back, without radiation to the legs. He denies leg weakness, tingling, or numbness, and states he had similar pain in the past after doing extensive lifting. In considering the diagnosis of lumbar sacral strain, which of the following would most likely be noted on clinical assessment in this patient?A. Diminished to absent lower extremity DTRsB. Patient report of new-onset difficulty with voiding. C. Paraspinal muscle tendernessD. Positive straight leg raise testVisit fhea.com to learn more!

A 22-year-old woman who is 20-weeks pregnant was treated for C. trachomatis 4 weeks ago with an appropriate antimicrobial. She presents today for a follow-up visit and reports she is currently without symptoms, that her partner was also treated,  “And we both took the medicine just as we were advised.” Which of the following represents next steps in this patient's care?Choose two that apply. A. Testing for C. trachomatis should be obtained at today's visit.B. A repeat of C. trachomatis testing should be conducted at 1 month postpartum.C. Given she is without symptoms and her partner was also treated, no further C. trachomatis testing is advised. D. In the absence of new clinical findings, follow-up test is advised at around 28-32 weeks gestation. Visit fhea.com to learn more!

A 55-year-old man with a BMI of 40%, with the chief complaint of low back pain for the past two weeks. He describes the pain as originating in the lumbar sacral region, with radiation across the left buttock associated with numbness and tingling sensation in his left leg. The pain is worse with sitting and somewhat better with standing. He denies lower extremity weakness or a change in bowel or bladder function. He states, “I've tried ice, heat and ibuprofen and these just take the edge off. I've had back pain like this in the past. Usually just lasts a couple of days and it's not that bad. I'm going to try that again and it's not this bad.” This history of present illness is most consistent with: A. Lumbar RadiculopathyB. Spinal StenosisC. Vertebral FractureD. Lumbar Sacral Strain---YouTube:https://www.youtube.com/watch?v=RayHhiD23iU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=79Visit fhea.com to learn more!

A 45-year-old adult presents for a sick visit, with the chief complaint of three-day history of low back pain. Clinical assessment is consistent with lumbar sacral strain. Which of the following represents the most appropriate next step in this person's care? A. Advised three days of bed rest on a firm surface. B. Apply ice or heat to the affected area based on clinical response.C. Refer to neurology for further advice. D. Order a lumbar sacral x ray to help confirm the diagnosis.---YouTube: https://www.youtube.com/watch?v=bNQp-Vq4jds&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=78Visit fhea.com to learn more!

You see a 44-year-old woman with a 6-month history of increasing fatigue despite adequate opportunity for sleep and rest.  Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW as well as TSH within normal limits. You expect to find which of the following upon review of the patient's health history?A. Report that she has been consuming a plant-based diet since age 18 B. Report of menorrhagia C. A history of alcohol use disorderD. A diagnosis of rheumatoid arthritisVisit fhea.com to learn more!

A 48-year-old woman presents for follow up on T2DM and HTN. As part of today's visit, routine labs are ordered. Which of the following is an appropriate form of electronic communication for sharing these  results  with the patient?A. Private message through Facebook® or similar social media website with patient permissionB. Electronic fax or scan uploaded to the patient's personal account for a third-party file sharing service (e.g., DropBox®) C. Using encrypted email  or other messaging service that is part of the patient's electronic medical record (EMR) system  D. Text message using the patient's personal mobile phone number---YouTube: https://www.youtube.com/watch?v=MH2-1Wi0NWQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=76Visit fhea.com to learn more!

A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one day history of fever, productive cough with yellow sputum and increasing shortness of breath. His vital signs are as follows, temp 99.8 °F (37.6 °C) , BP 140/85, heart rate 98 beats per minute, and respiratory rate 22 at rest period O2 saturation is 94% on room air. He has a history hypertension and type 2 diabetes, at guideline-based goals. He is a former smoker, quitting about 35 years ago with approximately a 25-pack year history. On physical exam, he has crackles in his right lower lung fields, no wheezing, and can speak in complete sentences. He answers questions appropriately, has moist mucous membranes, and reports voiding approximately 1 hour ago. He denies GI distress but states his appetite's not what it usually is. He lives in a single-story home with his spouse and adult child, both of whom are with him for today's visit. His laboratory results include a mild leukocytosis and renal function is within normal limits. There is no evidence of anemia, and chest X-ray confirms a right lower lobe infiltrate consisted with pneumonia. Which of the following is the most appropriate treatment location for this patient?  A. Intensive care unitB. At home with careful follow upC. Inpatient medical wardD. Long-term care facility ---YouTube: https://www.youtube.com/watch?v=4tM6zLePTkM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=75Visit fhea.com to learn more!

A 49-year-old woman with type 2 diabetes mellitus was started on a standard dose of an ARB daily 6 weeks ago for the management of hypertension. Today her blood pressure is 128/78 mm Hg, stating she is taking the medication without difficulty and is feeling well. The appropriate action at this time would be to:A. Order a white blood cell count to assess for neutropenia.B. Continue her current medication regimen.  C. Add HCTZ to enhance HTN control.D. Obtain a 12-lead ECGVisit fhea.com to learn more!

Esteban is an 18-month-old child who presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations and has no drug allergies, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago.  For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6 °F (39.2 °C), with father stating, “This is how he acted a few months ago when he had an ear infection.” Physical exam confirms the diagnosis of bilateral AOM. When prescribing an antimicrobial for this child, which of the following represents the first-line treatment option?A. Oral azithromycinB. Oral cefpodoximeC. IM ceftriaxoneD. Oral amoxicillin---YouTube: https://www.youtube.com/watch?v=PRQHo531djY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=73Visit fhea.com to learn more!

An 18-month-old toddler, Estaban, presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago.  For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6°F   (39.2°C), with the father stating, “This is how he acted a few months ago when he had an ear infection.”  Which of the two following findings are most suggestive in the diagnosis of acute otitis media in a toddler? A. Bulging tympanic membraneB. CoughC. Evidence of ear discomfortD. Bilateral cervical lymphadenopathy Visit fhea.com to learn more!

 A 60 year old man presents with a chief complaint of a 6 month history of increasing fatigue despite adequate rest and sleep. He denies chest pain or difficulty breathing, and reports he is a non smoker. Concurrent history includes a 25 year history of alcohol used disorder, with daily intake of 5-7, occasionally more, 1.5 oz shots of whiskey, and chronic poor nutrition, reporting, “I eat chips and crackers a lot, I do not have the time to make a meal and I cannot afford to eat out. He is currently employed as a warehouse working, and states, “I get to work every day. The booze is really not  problem.”  On physical exam, mild pharyngeal redness without exudate, conjunctival pallor, and epigastric tenderness are present. The following lab results are noted.Hgb = 9 g/dL (normal 14 to 16 g/dL)Hct = 28.5% (normal 42% to 48%)RBC = 3.4 million mm3 (normal 4.7 to 6.1 million mm3)MCV = 108 fL (normal 81 to 96 fL)MCHC = 33.2 g/dL (normal 31 to 37 g/dL)RDW = 18.4% (normal 11-15%) These findings are most likely caused by:A. iron deficiency anemiaB. Vitamin B12 deficiency anemiaC. Folic acid deficiency anemiaD. Anemia of chronic disease.Visit fhea.com to learn more!

A 45 year old woman with a 10 year history of hypothyroidism presents for follow up care. She's been taking levothyroxine 100 micrograms per day with excellent adherence. Stating "I take the medicine every morning on an empty stomach with a big glass of water.” She states she's generally feeling well, but notices increased fatigue over the past four months, which she attributes to the stress of starting her graduate studies while working full time. The results of today's laboratory testing include the following:TSH is 2.3, the norm being .4 to 4, pre T4 15 with norm being 10 to 27.The next step in her care is to:A. continue on the same levothyroxine dose and obtain a repeat TSH in one year.B. increase the levothyroxine dose by 25 micrograms per day and repeated TSH in one month.C. increase the levothyroxine dose by 25 micrograms per day and repeated TSH in two months.D. Repeat the TSH and free T4 today and provide counseling about taking the medication with breakfast.Visit fhea.com to learn more!

A 28-year-old woman presents with new onset worsening fatigue, present for approximately the last month. She is 28 weeks pregnant with her second child, has a 1.5-year-old healthy child at home, says she remembers being tired towards the end of her pregnancy with her first child, but states, “This is worse than with my last pregnancy”. She denies vaginal bleeding or discharge, abdominal pain, or other concerning issues, is sleeping about 7 hours per night, and has adequate access to nutritious food. She is not taking a prenatal vitamin, reporting, “I kept throwing up every time I took one.” During early pregnancy. PHQ-9 screening tool results are without concern.Labs results are as follows.Hemoglobin 9.2g per dl (NL=12-14)Hct=27% (NL=36-42%)Total RBC= 2.9 million (3.9 to 5.2 million cells per microliter (million/µL)MCV 75 FL (NL=80-98)MCH 22 PG (NL=27-33)RDW 18% (NL=11.5-15%)These results are most consistent with:A. Pregnancy related hemodilution.B. Folic acid deficiency anemiaC. Iron deficiency anemia.D. Beta thalassemia minor.Visit fhea.com to learn more!

A 35 year old presents with chief complaint of “my sinus infection is not getting better”, with continued nasal and sinus congestion, yellow to white nasal discharge, and a feeling of sinus pressure particularly when he bends over. He denies sore throat headache, and GI symptoms, and previously reported fever prior to treatment is now resolved. The EMR documentation notes a prescription for dose-appropriate amoxicillin with clavulanate written 2 1/2 days ago when seen for a sick visit. Patient states he has taken the antibiotic as advised, staring the medicine on the day of his sick visit, and has not missed any doses. Physical exam reveals a no acute distress, mild tenderness to sinus palpation, and no fever. The next most appropriate step in this patient's treatment plan is to:A. Advise the patient to continue his current course of therapy.B. Switch his antimicrobial to moxifloxacin.C. Order a CT of the sinuses.D. Perform a posterior pharyngeal culture and sensitivity.Visit fhea.com to learn more!

Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick visit, stating, “My stomach has not been right for about 4  days. The illness began with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I'm not sure how many times I threw up or had diarrhea.” He last vomited about 24 h ago, last stool was around 4 h ago, reported as yellow-brown in color, small volume and without blood.  He has been tolerating  clear liquids for the past 24  h and voided a small amount around 2 h ago.  He feels “a little bit hungry but I am afraid to eat or I might throw up again. I still feel a little bit sick to my stomach.”  Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits  and denies dizziness with position change from supine to sit or stand. His mucous membranes are slightly dry, with intact skin turgor, and  mild diffuse abdominal tenderness without rebound.  With a working diagnosis of viral gastroenteritis, which of the two following clinical actions should be taken?A. Obtain stool for culture and sensitivity. B. Order a chem panel. C. Provide information about a slowly progressive diet as tolerated. D. Prescribe an antiemetic. Visit fhea.com to learn more!