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Aligned with the American Association of Nurse Practitioner and American Nurses Credentialing Center format. Authored & peer-reviewed by Adult-Gerontology Primary Care NPs.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
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A 50-year-old man presents to the clinic with dizziness. He has a history of hypertension, hyperlipidemia, and diabetes mellitus. He states that, in the last week, he has had increased dizziness, noticed floaters in his vision, and occasionally loses vision in one eye for brief moments. Which of the following components of the physical assessment will most likely assist in identifying the suspected diagnosis?

A Assessment of cranial nerves III, IV, and VI
B Assessment of dorsalis pedis pulses
C Auscultation of the carotid arteries
D Palpation of the abdomen for an aortic aneurysm

Carotid artery disease precipitates approximately 20% of ischemic strokes. The bifurcation of the common carotid artery in the bulb region is typically where atherosclerotic carotid stenosis originates. Conditions near the bulb that increase contact time between lipids and the vessel wall include flow separation, low shear stress, and nonlaminar flow. As the plaque gradually enlarges, cerebral perfusion can be interrupted or reduced due to narrowing or occlusion of the internal carotid artery. Additionally, turbulent blood flow of the atherosclerotic carotid arteries can cause damage to the plaque, resulting in ulceration or loss of intimal continuity. Thrombosis results from platelet and fibrin aggregation on the roughened intimal surface. Interruptions in cerebral blood flow result in clinical manifestations such as dizziness, vision floaters, fleeting attacks of monocular blindness, numbness of the contralateral extremity, dysarthria, and aphasia. Risk factors of carotid artery disease include hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, chronic kidney disease, heavy alcohol consumption, and sleep apnea. The risk of carotid artery disease increases significantly after the age of 50. Physical examination should include a complete neurologic and cardiovascular assessment. Auscultation of the carotid arteries for bruits is a marker for generalized atherosclerosis and should be assessed in patients with and without clinical manifestations of carotid stenosis. Carotid bruits have low sensitivity for the detection of carotid stenosis, which is why symptomatic patients should undergo diagnostic studies. Duplex ultrasound of the carotid arteries is the chief diagnostic tool for carotid stenosis. Asymptomatic patients with carotid bruits should also receive a carotid ultrasound. Patients with carotid stenosis should be referred to a surgeon for a possible carotid angioplasty with stenting or a carotid endarterectomy.

Assessment of cranial nerves III, IV, and VI (A) should be included in this patient’s physical assessment, but carotid auscultation is more likely to reveal carotid stenosis. Assessment of dorsalis pedis pulses (B) should be included in the physical assessment due to the patient’s medical history but is not likely to reveal carotid stenosis. Palpation of the abdomen for an aortic aneurysm (D) is recommended in the periodic health examination of men over age 65 years. Patients with an abdominal aortic aneurysm typically present with abdominal or flank pain with a pulsatile abdominal mass.


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Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

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carotid artery stenosis

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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

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Q: What pharmacologic therapy significantly increases the risk of stroke in postmenopausal women?


A: Hormonal treatment with combination estrogen and progestin.

Transient Ischemic Attack

  • Transient episode of neurological dysfunction without acute infarction
  • 10% of TIA patients will have a stroke within 90 days
  • Low-risk TIA (ABCD2 score < 4) or moderate to major ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) > 3): Treatment with aspirin alone
  • High-risk TIA (ABCD2 score ≥ 4) or minor ischemic stroke (NIHSS score ≤ 3): Begin with dual antiplatelet therapy (DAPT) for 21 days using aspirin plus clopidogrel
  • ABCD2 score: predicts likelihood of subsequent stroke within 2 days

Rapid Review

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These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

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I’ve been a nurse for 10 years and used Rosh Review for my NP exam and loved it. The content is in-depth and did a great job to help me learn what I needed for the exam.


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