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תוכן מסופק על ידי Fitzgerald Health Education Associates. כל תוכן הפודקאסטים כולל פרקים, גרפיקה ותיאורי פודקאסטים מועלים ומסופקים ישירות על ידי Fitzgerald Health Education Associates או שותף פלטפורמת הפודקאסט שלהם. אם אתה מאמין שמישהו משתמש ביצירה שלך המוגנת בזכויות יוצרים ללא רשותך, אתה יכול לעקוב אחר התהליך המתואר כאן https://he.player.fm/legal.
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Murmur Evaluation

12:49
 
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Manage episode 463389608 series 3456065
תוכן מסופק על ידי Fitzgerald Health Education Associates. כל תוכן הפודקאסטים כולל פרקים, גרפיקה ותיאורי פודקאסטים מועלים ומסופקים ישירות על ידי Fitzgerald Health Education Associates או שותף פלטפורמת הפודקאסט שלהם. אם אתה מאמין שמישהו משתמש ביצירה שלך המוגנת בזכויות יוצרים ללא רשותך, אתה יכול לעקוב אחר התהליך המתואר כאן https://he.player.fm/legal.

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. Physiologic
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral valve prolapse
---
YouTube: https://www.youtube.com/watch?v=wmGI7v_DPMY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=105

Visit fhea.com to learn more!

  continue reading

119 פרקים

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Murmur Evaluation

NP Certification Q&A

published

iconשתפו
 
Manage episode 463389608 series 3456065
תוכן מסופק על ידי Fitzgerald Health Education Associates. כל תוכן הפודקאסטים כולל פרקים, גרפיקה ותיאורי פודקאסטים מועלים ומסופקים ישירות על ידי Fitzgerald Health Education Associates או שותף פלטפורמת הפודקאסט שלהם. אם אתה מאמין שמישהו משתמש ביצירה שלך המוגנת בזכויות יוצרים ללא רשותך, אתה יכול לעקוב אחר התהליך המתואר כאן https://he.player.fm/legal.

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. Physiologic
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral valve prolapse
---
YouTube: https://www.youtube.com/watch?v=wmGI7v_DPMY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=105

Visit fhea.com to learn more!

  continue reading

119 פרקים

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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. --- YouTube: https://www.youtube.com/watch?v=udyt2WeaoJo&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=119 Visit fhea.com to learn more!…
 
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. --- YouTube: https://www.youtube.com/watch?v=qZSVLmpbTEA&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=118 Visit fhea.com to learn more!…
 
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=117 Visit 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=116 Visit 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 CT D. Given his history, no routine cancer screening is advised. --- YouTube: https://www.youtube.com/watch?v=qnKPe2EHgl4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=115 Visit 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 deficiency B. G6PD deficiency C. Iron deficiency D. Beta thalassemia minor --- YouTube: https://www.youtube.com/watch?v=ch5dbCqkPTM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=114 Visit 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=113 Visit fhea.com to learn more!…
 
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 --- YouTube: https://www.youtube.com/watch?v=VchTtrKTmfw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=112 Visit 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=111 Visit 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. --- YouTube: https://www.youtube.com/watch?v=gS2EITYZ1ps&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=110 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. --- YouTube: https://www.youtube.com/watch?v=tHiLger_l68&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=109 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. --- YouTube: https://www.youtube.com/watch?v=uZqb0nZpa8k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=108 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. --- YouTube: https://www.youtube.com/watch?v=CBH6MbYUIBQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=107 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". --- YouTube: https://www.youtube.com/watch?v=KYfi3O-ZMEc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=106 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. Physiologic B. Aortic stenosis C. Mitral regurgitation D. Mitral valve prolapse --- YouTube: https://www.youtube.com/watch?v=wmGI7v_DPMY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=105 Visit fhea.com to learn more!…
 
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