Typed Pre-Predictor

1)          A 15 years old high school student with a mild sore throat and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucleosis. Which of the following is the LEAST appropriate intervention?

a.            Palpate the lymph nodes and spleen

b.          Examine the posterior oropharynx for petechiae

c.           Obtain a CBC, throat culture, and heterophil antibody test. d.       Obtain an urinalyses and serum for LFTs and amylase

Explanation: mononucleosis is a symptomatic infection caused by the Epstein-Bar virus. Common is people 15-24 years of age. Common signs and symptoms following incubation period (1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates and lymphadenopathy or posterior cervical region. Splenomegaly can be present. A maculopapular or occasionally a petechial rash occurs in less than 15% of patients. A diagnosis is usually made using the Monospot. In addition, neutropenia and lymphocytosis are usually detected in the CBC.

2)          A 32 years old male patient complaint of urinary frequency and burning on urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be:

a.  trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day

b.          ciprofloxacin (Cipro) for 3-5 days

c.            Trimethoprim-Sulfamethoxazole for 3 days

d.          750 mg ciprofloxacin as a one-time dose

Explanation: trimethoprim-sulfamethoxazole (TMPS) is usually n appropriate medication to treat urinary tract infections in most patients. In the case of community resistance to TMPS

>20%^, another medication should be substituted. In men, the appropriate length of time is 7-10 days. Women may be treated for 3 days for uncomplicated UTI

3)          Which agent is most effective for the treatment of nodulocystic acne?

a.            Benzoyl peroxide (Benzac)

b.          Retinoic acid (Retin A)

c.           Topical tetracycline d.         Isotretinoin)

Explanation: Isotretinoin (Accutane) is a systemic agent indicated for treatment with severe inflammatory acne. Guidelines for its use must be clearly understood by the patient. A woman of childbearing age must use an effective method of contraception because isotretinoin is teratogenic. There are many restrictions in prescribing this medication because of the teratogenic effects is given during pregnancy. Therefore, it is a pregnancy category X.

4)          An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the prevention of pregnancy

a.            Throughout the week of placebo pills

b.          If prescribed topiramate (Topamax) for the treatment of migraines.

c.            If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection

d.  if she forgets to take a single dose of the contraceptive

Explanation: Anticonvulsant including phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), topiramate (Topamax) and oxcarbazepine (Trileptal) reduce the effectiveness of contraceptives. Depo-medroxyprogesterone acetate injections or levonorgestrel- releasing intrauterine devices would be a better method of contraceptive for patients taking anticonvulsants. Most commonly used antibiotics have not been proven to reduce the effectiveness of contraceptives. Rifampin is an exception, and additional …. Be used by women taking this drug and using oral contraceptives, transdermal, or vaginal ring preparations.

Additional backup contraception should be used if taking anti