Hormonal Havoc
In a 42-year-old female presenting with fatigue you would send these three diagnostic tests
- TSH
- B12
- Ferritin
In clinical practice, various screening tools are used to assess depression. Name three commonly used screening tools that help identify symptoms of depression in patients.
- PHQ-9
- Beck Depression Inventory
- HAM-D
A 72-year-old man is brought in by his family due to noticeable changes in his behaviour over the past few days. He has been confused about the time of day, forgetting appointments, and repeating questions during conversations. His mood has been low, and he seems less engaged with activities he once enjoyed. He also appears disoriented at times. Medical history is significant for HTN and family history of Alzheimer's List three differentials with rationale
- Delirium: acute onset, confusion
- Depression: low mood, less engaged, forgetfulness
- Dementia: noticeable behaviour changes, confusion, disorientation, family history of AD (less likely due to acute onset.
A 36-year-old female comes for her routine prenatal visit. She has a history of one vaginal delivery at 39 weeks, twins born at 36 weeks and one miscarriage at 15 weeks. As her NP, you know that her GTPAL status is...
G4 T1 P1 A1 L3
Robert (37M) brings his son Brad for his newborn assessment. List five things you would look for during physical assessment of a newborn male infant.
1. Fontanelles
2. Red light reflex
3. Feel palate
4. Look for tongue tie
5. Listen for heart murmurs
6. Barlow/Ortolani for hips
7. Check for distended testes
8. Spinal dimple
9. Primitive reflexes
A 45-year-old male comes for an annual diabetes follow-up. List three tests/exam components that are used to screen for microvascular complications.
- Eye exam
- Monofilament test
- Urine ACR/eGFR
A 45-year-old patient presents with chronic pain, a history of alcohol use, and increasing anxiety. To comprehensively assess their mental health, substance use, and opioid misuse risk, you could use these three screening tools.
- PHQ-9
- GAD-7
- CAGE
- Opioid Risk Tool
An 86-year-old female is brought into the clinic by her family for memory concerns. As part of the comprehensive assessment, a MOCA is completed. The NP knows that a score of ____ indicates cognitive impairment.
< 26
A 36-year-old Indigenous woman presents for her prenatal visit at 24 weeks of gestation. This is her first pregnancy. She has a BMI of 30, a personal history of anxiety, and a family history of T2DM. She is currently asymptomatic, with no history of polyuria or polydipsia. List three risk factors for GDM within this scenario.
- Indigenous heritage
- BMI 30
- Family hx of T2DM
A 4-year-old presents with a 2-day history of fever followed by a bright red rash on the cheeks, which spread to the arms and torso. The child is otherwise well and has no past medical history. The parents report mild cold-like symptoms a few days before the fever started. List three differentials
1. Fifth's Disease
2. Measles
3. Rubella
4. Allergy
A 55-year-old postmenopausal female with a family history of hip fracture presents to the clinic for follow-up after a BMD showing osteopenia. She admits to a vegan diet, a sedentary lifestyle, and drinking 3 glasses of wine daily. What are three modifiable risk factors for osteoporosis in this scenario?
- Vegan diet (low in calcium)
- Sedentary lifestyle
- Alcohol consumption
A 40-year-old TG male presents with excessive worry and fear that has been ongoing for several months. He frequently feels restless, has difficulty concentrating, and experiences physical symptoms such as muscle tension and difficulty sleeping. He finds himself worrying about everyday situations, which interferes with work. His GAD-7 score is 12. As his NP, you interpret this score as...
Moderate anxiety (GAD-7 score of 10-14)
GAD-7 Scores
Minimal: 0-4
Mild: 5-9
Moderate: 10-14
Severe: 15-21
A 65-year-old female presents with a 3-day history of dizziness with nausea. She describes feeling lightheaded, particularly when standing up quickly, and sometimes experiences a sensation of the room spinning. She has a history of hypertension and osteoarthritis but is otherwise healthy. There are no signs of chest pain, palpitations, or hearing loss, though she does state she hears ringing in her left ear at times. Her symptoms are worse in the morning and improve with sitting or lying down. List three differentials with rationale.
- Orthostatic hypotension: light-headed when standing up. Hx of hypertension.
- BPPV: Room spinning. Worse with position changes.
- Vestibular neuritis: Room is spinning. 3-day history. Nausea.
- Meniere's Disease: Dizziness with ringing in her ear
A 30-year-old woman presents for her postpartum check-up at 6 weeks following a c-section. She is breastfeeding and reports mild discomfort while nursing but no significant pain. She mentions feeling fatigued, experiencing occasional mood swings, and has some difficulty sleeping. List three components of a postpartum assessment you would include in this scenario.
1. Breasts
2. Belly (incision)
3. Blues (mood)
Also: Bowels, bladder, bleeding, bottom
List three risk factors for neonatal hyperbilirubinemia
1. Exclusive breastfeeding
2. Preterm birth
3. ABO incompatibility with mother
4. Low birth weight
5. Cephalohematoma
6. G6PD Deficiency
A 21-year-old female presents with unintentional weight loss, a racing heart, tremors, and increased anxiety. She reports pain in her chest, reduced appetite, and frequent nervousness, especially in social situations. Family history is significant for bulimia nervosa on her mother's side. A physical exam reveals an elevated heart rate, mild fatigue, and an enlarged thyroid. List three differentials with rationale
- Hyperthyroidism: Racing heart, unintentional weight loss, tremor, enlarged thyroid
- Arrhythmia: Racing heart, elevated heart rate, chest pain
- Anorexia: unintentional weight loss, tremors, family history of eating disorder.
A 28-year-old man presents with a 6-month history of hearing voices that tell him he is being watched. He often talks to people who aren’t there and expresses paranoid beliefs, such as thinking that his coworkers are plotting against him. He has become socially withdrawn, neglecting his personal hygiene and avoiding family interactions. His thoughts and speech seem disorganized, and he has difficulty maintaining a conversation. What are three positive symptoms of schizophrenia in this scenario?
- Auditory hallucinations: Hearing voices
- Delusions: thinking his coworkers are plotting against him.
- Disorganized speech
A 26-year-old patient presents with concerns about new-onset headaches. As the NP, you know the SNOOP4 criteria can be used to assess headaches. Identify all of the SNOOP4 criteria and what they are used for.
Red flags that indicate secondary causes of headache
S: Systemic signs/symptoms
N: Neurological symptoms
O: Onset for first time over age 50
O: Onset reaches maximum intensity within 60s
P: Progression (pattern change)
P: Papilloedema
P: Worse with positioning
P: Precipitated by Valsalva manoeuvre
List five diagnostic investigations you would routinely order for a pregnant patient on their first prenatal visit
- CBC
- ABO/Rh
- Urinalysis and Culture
- Gonorrhoea
- Chlamydia
- Rubella serology
- HIV serology
- Syphilis serology
- Hep B Surface antigen serology
- Dating ultrasound
List three developmental milestones you would expect to see on an 18-month old well-child assessment
1. Identifies pictures in a book
2. Follows directions with the words "on" or "under"
3. Points to at least three different body parts when asked
4. Say 20+ words
5. Makes four different consonant sounds
6. Holds a cup to drink
7. Picks up and eats finger food
8. Walks alone
9. Walks up a few stairs holding your hand
10. Show affection
11. Stacks 3 or more blocks
A 43-year-old female presents with recent weight gain, fatigue and menstrual irregularities. She states she has had difficulty concentrating on things recently and has been feeling "down" over the past few months. List three differentials with rationale
- Hypothyroidism: weight gain, fatigue, menstrual irregularities
- Depression: fatigue, feeling down, difficulty concentrating on things
- Anemia: Fatigue, menstrual irregularities
- Peri-menopause: Menstrual irregularities with difficulty concentrating
- PCOS: Weight gain, fatigue, menstrual irregularities
A 30-year-old woman presents with a history of mood swings. At times she feels energetic and spends money impulsively. Her friends state that she talks loudly and rapidly, frequently changing topics that are difficult to follow. She has difficulty sleeping, believes she is invincible, and takes on multiple projects at once, but often does not finish because she is easily distracted. However, other times, she experiences deep sadness, fatigue, and a lack of interest in things she normally enjoys. These mood shifts have been occurring for several years. List five symptoms of a manic episode within this scenario.
Distractibility: Easily distracted
Impulsivity: spends money impulsively
Grandiosity: Believes she is invincible
Flight of Ideas: Frequently shifting topics in conversation
Activity (goal-directed): Takes on multiple projects at once
Sleep: Difficulty sleeping
Talkativeness: Talks rapidly and loudly
A 54-year-old male comes to your clinic with complaints of a new headache that began early this morning. The patient feels chilled and is wearing sunglasses on presentation. List five components of the physical exam you would include.
- VS
- General Appearance
- Brudzinski's/Kernigs (nuchal rigidity)
- Limb strength
- Cranial nerve assessment
- Gait
- Reflexes
- Inspect eyes
A pregnant patient asks about first-trimester genetic screening at her first prenatal appointment. She wants to know...
1. What does it involve?
2. What does it tell her?
3. When can she have it done?
As her NP, you say...
2. Tells her whether she is high risk or low risk for having an infant with Down's Syndrome and Edwards Syndrome.
3. Can be done between 11 and 13+6 weeks
1. Follow a moving person with their eyes
2. Cooing/vocalization
3. Responds to sounds with noises or movement
4. Laughing and smiling
5. Support self on forearms during tummy time
6. Lifts head
7. Briefly holds an object when placed in their hand
8. Brings both hands to chest and holds them midline when on back