Beth presents with complaints of intermittent palpitations that started last week, with spells of lightheadedness and nausea, and feeling like “my heart beats out of my chest”.  You obtain an EKG and find the following rhythm:  

A 14-year-old was diagnosed and treated for left acute otitis media 3 weeks ago. She reports resolution of pain but persistent fullness feeling of her ear at today’s follow-up visit. You perform tympanometry and the results for the left ear are abnormal showing shallow peak/low compliance. What do you suspect is the cause?

The nurse practitioner suspects Meniere’s disease on a patient with episodes of vertigo & hearing loss, so she performs the Weber and Rinne tests. What are the expected findings:

You are examining a patient who presents to your clinic with report of ear pain and foreign body in the ear. You are aware that you should refer to ENT for the foreign body removal & NOT attempt it in your clinic if: 

A high school wrestler presents to clinic reporting an ear injury during his last match 10 days ago and complaining of pain, swelling and redness. You note an auricular hematoma on examination of his ear.  True or False: You can perform aspiration to evacuate the hematoma during his appointment today to relieve his symptoms. 

In what patient population seen frequently in the FNP’s office for a wellness visit is an elevated Alk Phos a normal finding?

Use the following case for the next 2 questions: Bill, a 33 year old male patient presents to your office with severe abdominal pain, nausea and vomiting. Sam has been your patient for the past 3 years. He tells you he has not been able to keep fluids down for the past 24 hours. Your physical assessment reveals tenderness in the epigastric region, LUQ and RUQ.  CBC – wnl,except WBC 13.8Na 138K 4.0Ca 9.6Cl 102CO2 21Glu 112BUN 17Cr .9Total protein 7.5Albumin 4.6Total bili 1.4AST 433ALT 343Alk Phos 273   Differential Diagnosis for Bill include:

Margaret presents to clinic today with a 4cm x 5cm edematous area on her right thigh with surrounding tissue erythema, warmth and an intact tender, soft center with purulent appearance.  She denies any history of prior abscesses or MRSA infections.  The most appropriate treatment plan for Margaret today is:             

During a yearly physical you find the following 1 cm lesion on David’s back.  You would:  

Identify the lesion.  14 year old male patient represents with lesions along the lower abdomen.  He reports “some of them have white stuff that will come out”.