Which of the following is consistent with the clinical presentation of placental abruption? 

a. A 38 year-old with primary HTN, who is now 28 weeks pregnant with her 6th child, presents with a 1-h history of sudden onset abdominal pain as well as dark red vaginal bleeding,dizziness,  tachycardia and BP= 88/ 55

b. A 32 year old who's pregnant with her eighth child, now 32 weeks pregnant presenting with A2 hour history of bright red vaginal bleeding stating she does not have abdominal pain.

c. 28 year old who states she had a positive home pregnancy test three days ago with last menstrual period six weeks ago. Normal timing and flow with an 8 hour history of intermittent bright red vaginal spot spotting with mild cramping.

d. A 26 year old with a past medical history of pelvic inflammatory disease who's now 8 weeks pregnant by LMP with A2 hour History of sudden onset. Severe left sided abdominal pain radiating to the shoulder, Small amount of bright red bleeding per vagina. Feeling lightheaded. Vital signs reveal tachycardia in ABP of 80 / 45.

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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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A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of  breath, chest pain or visual changes.  He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.”  His physical examination shows no acute distress, grade 1 HTN retinopathy, and S4 heart sound, neck veins WNL, chest is clear, no peripheral edema with resting HR= 73, RR=16. 12-lead ECG is WNL. BMI= 33. Which of the following is the next best step in this patient’s care?

A.  Administer in-office oral clonidine and reassess blood pressure in 1 hour.
B.  Activate EMS with prompt transfer to emergency department
C.  Restart prior blood pressure medications with follow-up within the next month
D.  Advise restricting dietary sodium and weight loss to help with BP control.

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A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of  breath, chest pain or visual changes.  He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.”  His physical examination is normal with the exception of which of the following?

A. S4 heart sound
B. Grade 3 HTN retinopathy
C. Neck vein distension
D. Murmur of aortic regurgitation

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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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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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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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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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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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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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