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 fever. The child has no drug allergies.

Which of the following is the most appropriate intervention?

A. IM penicillin

B. Oralamoxicillin

C. Topical triamcinolone

D. No specific therapy is needed.

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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 Murphy’s sign.

Which of the following is the next step in her care?

A. Provide a 1-month trial of proton pump inhibitor (PPI) therapy.

B. Refer to surgery for further evaluation.

C. Order a RUQ ab for abdominal ultrasound and hepatic enzymes.

D. Obtain serum H. pylori testing.

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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.

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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.

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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 CT

D. Given his history, no routine cancer screening is advised.

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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 deficiency

B. G6PD deficiency

C. Iron deficiency

D. Beta thalassemia minor

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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.

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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

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