NP Family Nurse Practitioner 3 — Questions and Answers
Question 1: A 16-year-old female presents with primary amenorrhea, absent breast development, and elevated FSH and LH. The most likely diagnosis is:
- Polycystic ovary syndrome
- Turner syndrome (Correct answer)
- Hypothalamic amenorrhea
- Prolactinoma
Correct answer: Turner syndrome
Elevated gonadotropins with absent secondary sex characteristics in a phenotypic female suggests hypergonadotropic hypogonadism, most commonly Turner syndrome (45,X).
Question 2: Which of the following is the most appropriate screening tool for depression in a primary care setting for adults?
- Beck Depression Inventory (BDI-21)
- Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
- Hamilton Rating Scale for Depression (HAM-D)
- Columbia Suicide Severity Rating Scale (C-SSRS)
Correct answer: Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 is the validated, USPSTF-recommended screening tool for depression in primary care adults due to its brevity and accuracy.
Question 3: A 55-year-old male smoker presents with hemoptysis, weight loss, and a persistent cough. Chest X-ray shows a hilar mass. The next best diagnostic step is:
- Sputum cytology x3
- CT scan of the chest with contrast (Correct answer)
- Bronchoscopy immediately
- PET scan
Correct answer: CT scan of the chest with contrast
CT chest with contrast is the appropriate next step to characterize the mass, assess lymphadenopathy, and guide further biopsy planning.
Question 4: A 3-year-old child is brought in with a limp. X-ray shows a lucent area in the femoral head with flattening. The most likely diagnosis is:
- Septic arthritis
- Legg-Calvé-Perthes disease (Correct answer)
- Slipped capital femoral epiphysis
- Developmental dysplasia of the hip
Correct answer: Legg-Calvé-Perthes disease
Legg-Calvé-Perthes disease (avascular necrosis of the femoral head) presents in children 4–8 years with limp and characteristic X-ray findings of femoral head flattening.
Question 5: A patient with CKD stage 3b has a potassium level of 5.8 mEq/L. Which medication in their current regimen is most likely contributing?
- Amlodipine
- Lisinopril (Correct answer)
- Atorvastatin
- Metformin
Correct answer: Lisinopril
ACE inhibitors like lisinopril block aldosterone production, reducing renal potassium excretion and causing hyperkalemia, especially in CKD.
Question 6: Which vaccine is recommended for all adults aged 50 and older regardless of prior varicella-zoster infection history?
- Varivax (live attenuated varicella vaccine)
- Zostavax (live zoster vaccine)
- Shingrix (recombinant zoster vaccine) (Correct answer)
- No vaccine is needed if no prior shingles history
Correct answer: Shingrix (recombinant zoster vaccine)
Shingrix (RZV) is recommended for all adults ≥50 years, offering >90% efficacy against herpes zoster, and is preferred over the older Zostavax.
Question 7: A 28-year-old male presents with painful oral ulcers, genital ulcers, and uveitis. This triad is most characteristic of:
- Reactive arthritis (Reiter syndrome)
- Behçet disease (Correct answer)
- Stevens-Johnson syndrome
- Herpes simplex virus infection
Correct answer: Behçet disease
Behçet disease is characterized by the triad of recurrent oral aphthous ulcers, genital ulcers, and uveitis, often affecting young adults.
NP Family Nurse Practitioner 3
A 16-year-old female presents with primary amenorrhea, absent breast development, and elevated FSH and LH.
The most likely diagnosis is: