Online Course for NAPLEX / Clinical portion of CPJE

Our online course provides you with 12 months of access to a library of board prep video-lectures (65 hours), accompanying Course Book following the lectures slide by slide, a 2500+ Online Question Bank with two concluding practice exams, along with progress tracking for your convenience. For further details, please click on the tabs below. 

2000+ QUESTION BANK - Each Video lesson is followed by practice questions with explanation to solidify what you have learned. The format of questions include "Patient Profiles", "Select ALL that apply", "Fill in the blank" calculations, "Multiple Choice" and "K-type" questions. The 2000+ question bank concludes with two comprehensive "Practice TESTS" at the end.

Case:
SJ is a 39-year-old male patient with a history significant for penetrating head trauma two weeks ago. Today, he presented to the local hospital ED with a chief complaint of lethargy, severe headache, fever, chills, nausea for one day.

Upon hearing SJ's complaints, the triage nurse placed him in an isolation room for further workup.

Past Medical History:
Penetrating head trauma with a knife during a bar fight two weeks ago

Home Medications: 
None

Allergies: Vancomycin: anaphylactic reaction seven years ago

Physical Exam:
Weight: 70 kg    Height: 185 cm
Vitals: BP: 166/85 mmHg,   Pulse: 114   Resp Rate: 20   Temp 103.1C     O2Sat: 98%
Appearance: Moderate distress; alert and oriented to time, place, and person
Exam significant for nuchal rigidity, and positive Babinski sign

ER course: Lumbar puncture was performed

CSF Preliminary Report:
Gram-positive cocci in clusters 
Coagulase positive

CSF culture and sensitivity: pending

Hospital course:
The attending physician orders IV ceftriaxone and IV Bactrim for empiric treatment.

Question:
Based on the cerebrospinal fluid preliminary report after the lumbar puncture, which of the following bacteria is the most likely cause of SJ's infection?
Answer:
Case:
TA is a 62-year-old female diagnosed with endometrial cancer currently undergoing chemotherapy. 

LABS:

CBC w/ Diff

Normal Range

Day 1

Day 8

Day 15

Day 22

WBC

(4.5 - 10) x 103 per µL 

9.9 

8.9

9.6

9.8

Hemoglobin

12.0 - 15.5 g/dL female

13.5 - 16.5 g/dL male

14.5 

11.9

9.2

8.0

Hematocrit

35.0 - 50.0 %

42.7

33.4

27.8

24.1

MCV

80.0 - 100.0 fL

85.2

88.2

91.4

89.5

Platelet

150 - 450 thou/µL

278 

287 

265

278

Neutrophil

50 - 75 %

58

51

58

55

Lymphocytes

20 - 44 %

32

29

30

33

Monocytes

0 - 10 %

3

6

5

3

Eosinophils

1 - 7 %

2

6

4

3

Basophils

1 - 5 %

2

4

2

4

Bands

0 - 5 %

3

4

1

2

 

Question:

Which of the following medications are used to treat the chemotherapy-induced complication TA is experiencing? Select ALL that apply.

Answer:
Case:
KG is a 58-year-old male patient admitted to the hospital yesterday for acute pancreatitis secondary to alcohol use. 

Past Medical History:
Alcohol use disorder

Allergies:
Sulfa

Labs:

CMP

Normal Range

Day 1

Sodium

135 - 145 mEq/L

139

Potassium

3.5 - 5.2 mEq/L

4.5 

Chloride

97 - 108 mEq/L

105

Bicarb

23 - 29 mEq/L

25

BUN

6 - 20 mg/dL

18 

Cr

0.6 - 1.3 mg/dL

1.0

Glucose

70 - 100 mg/dL

89

eGFR

90 - 120 mL/min/1.73

95

ALT

< 35  U/L

14

AST

< 35  U/L

12

Bilirubin

0.3 - 1.9 mg/dL

1.1

Albumin

3.4 - 5.4 g/dL

4.7


CBC w/ Diff

Normal Range

Day 1

WBC

(4.5 - 10) x 103 per µL 

9.9 

Hemoglobin

12.0 - 15.5 g/dL female

13.5 - 16.5 g/dL male

14.5 

Hematocrit

35.0 - 50.0 %

42.7

MCV

80.0 - 100.0 fL

85.2

Platelet

150 - 450 thou/µL

278 

Neutrophil

50 - 75 %

55

Lymphocytes

20 - 44 %

32

Monocytes

0 - 10 %

3

Eosinophils

1 - 7 %

2

Basophils

1 - 5 %

2

Bands

0 - 5 %

3



 

Normal range

Day 1

Lipase

60 - 140 U/L

660

Amylase

30 - 110 to U/L

528


Hospital Orders:
NPO
D5 1/2 NS IV fluid at 75 mL/hour


Hospital Course:
Day 1: Non-eventful; patient stable
Day 2: 08:21 AM: The patient was unresponsive, turning blue in color, and not breathing. Code blue was called, and the cause for the respiratory paralysis was found to be the accidental administration of vecuronium by the nurse.

Question:
Which of the following measures could have been of help prior to the event in preventing the sentinel event that occurred on Day 2 of KG's hospital stay? Select ALL that apply.
Answer:
Case:
RC is a 29-year-old female patient with HIV. She has been on a HAART medication regimen for the last year. Her HIV specialist has been following her CBC, CD4 count, and HIV RNA count for the last year. Here are the results:

CBC w/ Diff

Normal Range

Jan 12

Apr 20

Jul 8

Dec 12

WBC

(4.5 - 10) x 103 per µL 

6.9

5.6

3.6

3.2

Hemoglobin

12.0 - 15.5 g/dL female

13.5 - 16.5 g/dL male

12.5

10.9

8.2

7.0

Hematocrit

35.0 - 50.0 %

36.7

33.4

24.8

22.1

MCV

80.0 - 100.0 fL

85.2

91.2

98.4

109.5

Platelet

150 - 450 thou/µL

278 

266

222

194

PMN

500 - 1500

1250

1120

980

870

Lymphocytes

20 - 44 %

32

29

30

33

CD4 count

500 - 1500 cells/mm3

870

820

788

768

HIV RNA count

0

8,500

7,200

6,400

5,200


Question:

Which of the following medications is the most likely cause of bone marrow suppression (anemia, neutropenia) in this patient?

Answer:
Case:

RN, a 56-year-old male patient, presents to the ER with progressively worsening shortness of breath when walking more than 20 feet, fatigue, and bilateral pitting edema of his legs for the last few months.

Past Medical History:
DM type 2
Long-standing hypertension

Current Medications:
Metformin 1000 mg PO BID
Pioglitazone 30 mg PO once daily
Hydrochlorothiazide 25 mg PO once daily
Lisinopril 40 mg PO once daily
Amlodipine 10 mg PO once daily

Vitals:  BP: 110/63 mmHg    P: 110,    Resp Rate: 22    Temp: 97.8

Labs:
BUN  ................................   19 mg/dL (6-20)
Serum Creatinine .............    1.1 mg/dL (0.6-1.2)
Potassium .......................     3.1 mEq/L (3.5-5.2)
BNP ................................     960 (10-300)
Troponins .......................     Negative

Imaging Studies:
Chest x-ray:
 Enlarged cardiac silhouette, mild pulmonary edema
Echocardiogram: Ejection Fraction: 30%


Question:

Which of his medications may be worsening his pulmonary edema and leg edema symptoms? Select ALL that apply.

Answer:
Case:

UM, a 58-year-old female presents to the ER complaining of heart palpitations, fatigue, and slight lightheadedness.
On exam, she was found to have an irregular pulse, and her 12-lead ECG showed atrial fibrillation (AF).

Past Medical History: 
HTN,
DM type 2
Obesity

Family History: Father had CAD

Allergy: Shellfish allergy

Medications:
HCTZ 25 mg PO once daily
Fortamet  2500 mg PO once daily
Glyburide 5 mg PO once daily

Physical Exam:
Vitals: BP: 167/91 mmHg    P: 122     RR: 18     T: 98.4     O2Sat: 97%

Labs:
Troponin I  ..................  Negative
Glucose  .....................  230 mg/dL
BUN ............................  30 mg/dL
Creatinine  ..................  1.0 mg/dL

12-lead ECG: Atrial fibrillation with a ventricular rate of 122 bpm


Question:

Based on her CHA2DS2-VAS score, which of the following medications would be the MOST appropriate for her treatment?

Answer:
Case:

MK is a 49-year-old male with history of liver cirrhosis. He is brought to ER by family members with a chief complaint of confusion and altered mental status for the last 24 hours.

On exam, MK is difficult to arouse; he is not oriented to time, person or place.

Vitals:   BP: 110/67 mmHg       P: 80          RR: 14       Temp 98.6

Labs:

Comprehensive Metabolic Panel:

 

Normal Range

Results

Sodium

135 – 145 mEq/L

138

Potassium

3.5 5.2 mEq/L

4.2

Chloride

97 – 108 mEq/L

100

HCO3

23 – 29 mEq/L 

25

Calcium

8.5 – 10.2 mg/dL

9.2

BUN

6 – 20 mg/dL

15

Creatinine

0.6 – 1.3 mg/dL

1.0

Glucose

70 – 100 mg/dL

85

ALT

< 35 U/L            

52

AST

< 35 U/L

55

Albumin

3.4 – 5.4 g/dL

2.0

Bilirubin

0.3 – 1.9 mg/dL

4.0

Ammonia

15 45 mcg/dL

110


INR ………………….   2.1

Urine analysis & Lumbar puncture results are normal.

Question:

Which of the following treatment measures do you recommend? Select ALL that apply.

Answer:
Question:

DB is a 67-year-old male with ESRD on dialysis who has been on Epogen 3000 units SC three times a week for anemia of chronic renal failure. His recent labs are as follows:

Hgb …………………. 12.6 g/dL (13.5 – 16.5 g/dL for males)
Hct …………………… 38.6 % (40% – 52%)
MCV …………………. 86 fL
WBC ………………… 4.0 thous/microL
Platelets …………….. 185 thous/microL

With regards to his Epogen dosing, what would be the most appropriate course of action?

Answer:
Case:

JB a 59-year-old female patient with newly diagnosed pyelonephritis has been unable to hold PO fluids and oral antibiotics due to severe vomiting. As a result, she has been admitted to the hospital for IV fluids and antibiotic therapy. She is otherwise healthy, and her CrCl was calculated to be 85 mL/hour. Her IV fluids and medication orders during the first 3 days of her hospital stay are as follows:

October 17 (Day of admission):
Normal Saline  1/2 liter + 20 mEq KCl for the first 5 hours, then change to IV maintenance with D5 1/2 NS at 100 mL/hour.
Levofloxacin 500 mg IV daily
Heparin 5000 units SC twice daily
Famotidine 20 mg IV twice daily
Zofran 4 mg IV Q 8 hours PRN nausea/vomit

October 18 (Day 2):
D5 1/2 NS at a 100 mL/hour
Levofloxacin 500 mg IV daily
Heparin 5000 units SC twice daily
Famotidine 20 mg IV twice daily
Zofran 4 mg IV Q 8 hours PRN nausea/vomit

October 19 (Day 3):
D/C  IV fluid D5 1/2 NS from 10/18
Lactated Ringers at a 100 mL/hour
Levofloxacin 500 mg IV daily
Heparin 5000 units SC twice daily
Famotidine 20 mg IV twice daily
Zofran 4 mg IV Q 8 hours PRN nausea/vomit

On the first day of admission, the patient received 1/2 liter NS with 20 mEq KCl for the first 5 hours and then changed to IV maintenance with D5 1/2 NS at a rate of 100 mL/hour for the remaining 10 hours of the day. 


Question:

How many mEq of Na+ has the patient received in total from her IV fluids on 10/17? 


Round off your final answer to ONE decimal point.

Answer:
  mEq
Calculator
Case:
A 54-year-old male presents to the ER with a seizure. His wife was awakened at 5:30 A.M by her husband making an odd gurgling noise with his head deviating to the left, and his left arm tonically stiffened. This was followed by generalized body jerking. In the ER, his wife states that he has returned to baseline.

PMH: Type 2 DM

Vitals and physical exam: essentially normal

Current Medications:
Metformin
Hydrochlorothiazide
Contrave
Suprenza

Labs

Na+

138 mEq/L (135-145)

 

WBC

10.2 thou/µL (3.5-10.5)

K+

4.2 mEq/L (3.5-5.2)

Hemoglobin

14.4 g/dL (12.0-15.5)

BUN

22 mg/dL

Platelets

167 thou/µL (150-450)

Serum Creatinine

1.1 mg/dL

   

Glucose

87 mg/dL

   

ALT

21 U/L

   

Question:
Which of the following medications could have been the culprit for his seizure? Select ALL that apply.
Answer:

Your score:

You correctly answered out of questions.



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2500+ Board-type questions with answers, & detailed explanations.  Progress Tracking allows you to follow and manage your question bank results, track the video-lectures watched and evaluate your progress on your user dashboard. You can watch the video lectures and take the quizzes as many times as needed until you feel comfortable and confident with all of the topics. At the end of your study, we have two comprehensive practice tests to conclude the material that has been covered. 

  • 12 months of online access to 65 hours of online lessons for NAPLEX® and the clinical portion of CPJE with accompanying course book that follows the lessons slide by slide. The videos can be watched from anywhere, on your own time, and as many times as needed to mater the topic. Same lectures, speakers, and course book as the live course with emphasis on details essential to NAPLEX® and the clinical pharmacy portion of CPJE. Access to the online video-lectures is immediate, and viewing of the lectures is compatible with most mobile devices/tablets such as iPhone, iPad, Android.  Note: There are NO law lectures with this course (the law portion of CPJE is covered via CA LAW online course that can be added to cart separately.)                   
  • Course book:  730 pages, FOCUSED & TO THE POINT, following the lectures slide by slide. The instructions with the accompanying course book/chart book are comprehensive, and no other review material will be needed; Our students rely on our course as their sole source of study, and they do very well. The course book/chart book set will be mailed after registration and received within 7 business days (Note: Due to Covid-19 shipment delays, this might take a little longer for some locations.)                                                                                                                              
  • Question Bank: 2500+ online questions bank with comprehensive answers to assess your knowledge and solidify your understanding of the material (See demo).                                                                                                                                                                                                  
  • Dr. Yavari and Dr. Miremadi's support and assistance via email with your NAPLEX® and CPJE questions throughout your preparation.                                                                                                                                                                                                                                             
  • There are No Law lectures with this course (CPJE Law portion is covered in our CA LAW Online Course).

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