A 19 year old female presents to the emergency department with complaints from her best friend of “she isn’t acting her normal self”. The patient is lethargic though awakens to voice, tachypneic, diaphoretic, with poor skin turgor. Her best friend reports she hasn’t felt good for two days, but has progressively worsened. The patient denies any medical problems, smoking, or drug use. She reports she is not currently sexually active.  She complains of extreme thirst and fatigue.  Labs: WBC 20K, H&H 17.5 & 45, Plt 450K. Na+ 129, K+ 5.6, anion gap 25, Cr 1.8, BUN 40, Ca+ 8.5, glucose 448. Serum acetone moderate.  ABG: pH 7.12, CO2 22, O2 80, HCO3 8.  Vitals: Temp 97.8F, Pulse 122, BP 104/54, RR 34, O2 96% on room air.  What is the patient’s primary diagnosis? 

51-year-old female presented to urgent care with intermittent headaches, progressive fatigue, sparse axillary hair, arthralgia, and unexplained weight loss. Vital signs are significant for mild hypotension. Denies fever or night sweats. Clinical examination reveals hyperpigmentation in buccal mucosa and skin folds. What endocrine disorder does the AG-ACNP suspect? 

A 55 year old male presents to the emergency department with complaints of abdominal pain x 2 days. He describes the pain sharp to his right upper quadrant and burning to the center of his chest. He states the pain was initially intermittent, but now it is constant. He has a history of hypertension, which he states lisinopril 10mg daily. When asked about social habits he reports he drinks beer daily. His wife is present and reports he actually drinks “a 30 pack in two days”. He also smokes 1 ppd.  ECG: Sinus tachycardia, rate 105, no ST changes, normal QTC, normal axis.  Vitals: Temp 99.2F, Pulse 110, BP 105/54, RR 22, O2 94% on room air. Labs: WBC 18K, H&H 16.1&42.3, Plt 356K. Na+ 145, K+ 5.0, anion gap 8, BUN 41, Cr 1.9, glucose 128, Ca+ 10.2. AST 50. ALT 78. Amylase 1984. Lipase 4768. Lactic 2.3.  A abdominal pelvis CT scan is ordered with suspicion for which condition? 

As the hospitalist nurse practitioner, you are called by the emergency department provider to admit a patient who has confirmed acute diverticulitis per abdominal/pelvis CT scan. Which of the following will be included in your admission orders? Select all that apply: 

What is the gold standard diagnostic test for esophageal varices?

Which of the following can lead to hypoglycemia. Select all the apply. 

Match the cause of renal injury with its associated category. 

 Which of the following is the preferred treatment for an acute gastric ulcer? 

A 22 year old female presents to the emergency department with complaints of abdominal pain that started yesterday. She reports that pain started in the center of her abdomen and has now moved to her right lower quadrant. Last bowel movement yesterday. Reports she is sexually active with one partner. Denies smoking or drug use.  Vitals: Temp 100.2F, Pulse 104, BP 110/68, RR 22, O2 98% on room air. Labs: WBC 14K, RBC 4.58K, H&H 13.1 & 39.2, Plt 224K. Na+ 145, K+ 3.6, BUN 15, Cr 0.6, Ca+ 9.2, glucose 97. On exam you note tenderness at McBurney’s point and a positive Psoas sign.  You order an abdominal/pelvis CT with contrast, because you are concerned for which condition? 

Both final and midterm exams are worth 200 points each.