6501 moodle quiz questions exam 3

Mr Knight presents to the clinic with left ankle injury he sustained while playing basketball earlier today with a group of friends. He describes the pain as spasms of pain localized to the left ankle. The area is swollen, with ecchymosis, painful with movement. According to Ottawa ankle rules, the nurse practitioner can predict ankle radiography is needed when: Select one: a. There is pain in the malleolar zone, there is no bone tenderness, he was unable to weight bear immediately after the injury, but since applying ice and taking ibuprofen 400mg he is able to minimally weight bear b. There is pain the malleolar zone that has decreased a little in intensity since applying ice and taking ibuprofen 400mg, there is bone tenderness at posterior edge of tip of lateral malleolus, and he has been unable to weight bear since the injury. c. There is pain in the malleolar zone, there is no bone tenderness over the medial malleolus, and he is able to minimally weight bear since applying ice and taking ibuprofen 400mg. d. All of the statements would require x-ray of the foot and ankle.

b. There is pain the malleolar zone that has decreased a little in intensity since applying ice and taking ibuprofen 400mg, there is bone tenderness at posterior edge of tip of lateral malleolus, and he has been unable to weight bear since the injury. Correct

Joey, a 17 year old soccer player, injured his left ankle during a game. The injury resulted in an incomplete tear of the ligament and functional impairment. This type of injury would be classified as: Select one: a. Grade I sprain. b. Grade II sprain c. Grade III sprain d. Stress fracture

b. grade II

A patient presents with complaints of intermittent wrist pain and numbness and tingling radiating form the palm to the thumb, index finger, and middle finger. What would be the most appropriate initial diagnostic technique for this patient? Select one: a. Xray b. Phalen's maneuver c. Finkelstein test d. Electromyography

b. phalen

You are evaluating a 36-year-old man in your office with the chief complaint of abdominal pain. Which of the following characteristics of the pain, if present, would lead you toward an emergent evaluation? Select one: a. The pain is located in the right lower quadrant b. The pain began suddenly c. The pain is described as a "gnawing" sensation d. The pain is worse after eating e. The pain is associated with emesis

b. the pain begins suddenly

choice that penetrate the prostatic capsule/tunica include _________ for _____ weeks. Select one: a. Penicillins or cephalosporins for 12 weeks b. Trimethoprim-sulfamethoxazole or fluoroquinolones for 2-6 weeks c. Macrolides for 6 months d. Doxycycline for 1 week

b. trimethoprim sulfamethozozole

Alarm features that warrant prompt gastroenterology referral include the following: Select one or more: a. Bleeding or anemia b. Epigastric pain c. Early satiety d. Unexplained weight loss e. Progressive dysphagia or odynophagia f. Recurrent vomiting g. Family or personal history of GI cancer

bleeding, anemia, early satiety, weightloss, , recurrent vomiting

An 82 year old female with history of gout presents with red, swollen right ankle that is warm to touch. Patient notes constant pain in the area that is interfering with her daily activities. Which of the following diagnostics would be most useful to rule IN your differential diagnosis of septic arthritis? Select one: a. X-ray of the reddened and swollen joint b. Three-phase technetium bone scan of the area surrounding the joint c. Athrocentesis for culture and evaluation of joint fluid d. CT scan of the joint and surrounding soft tissue structures

c. athrocentesis for culture

A 42-year-old woman presents to your office complaining of abdominal pain. She describes upper abdominal pain that radiates to her scapula. For which of the following is this description classic? Select one: a. Acute appendicitis b. Pancreatitis c. Gallbladder disease d. Esophageal spasm e. Gastroesophageal reflux disease

c. gallbladder dz

Questions 10-11 refer to the following case study: Mr. Linstad, an obese 45 year old male, presents to you after hiking and camping the last two weeks in the desert. He has colicky pain in his abdomen and groin, nausea, vomiting, hematuria and severe flank pain. He is very restless and can't sit still. You suspect he has: Select one: a. Pyelonephritis b. Acute bacterial prostatitis c. Renal calculi d. Sepsis

c. renal calculi

While performing an abdominal examination on a 42-year-old woman in your office, she suddenly stops inspiratory effort during deep palpation of the right upper quadrant. Which of the following problems is this most suggestive of? Select one: a. Hepatitis b. Gallstones c. Cholecystitis d. Pancreatitis e. Right-sided renal calculi

cholecystitis

24 year old male presents with complaints of severe right arm pain, he denies any trauma. HPI: Patient explains he recently started lifting weights with the guys at work and believes he may have pulled a muscle when he dropped a free weight onto his arm. He immediately applied ice to the area and has taken ibuprofen, but the symptoms seem to be worsening. This morning he woke with numbness and tingling in the fingers of the affected arm. The plan of care includes all the following EXCEPT: Select one: a. Compartment pressure monitoring b. Prep for OR c. Serial serum CKs d. Apply compression dressings to affected limb and keep elevated

d. compression and elevation

Compartment syndrome is suspected in your 45 year old patient with the fractured tibial plateau. The physical exam findings include all the following EXCEPT: Select one: a. Parasthesia b. Pulselessness c. Poikilothermia d. Pachyonychia

d. pachyoncyia

Low back pain (LBP) refers to spinal and paraspinal symptoms in the lumbosacral region. Who is likely to encounter and to do the initial care and treatment of a patient presenting with LBP symptoms? Select one: a. General practitioners, family practitioners, orthopedic surgeons b. Family practitioners, orthopedic specialists, massage therapists, chiropractors c. Neurologists, rheumatologists, osteopathic physicians, family practitioners d. a and b e. all of the abov

e. all of the above

The peak age for the occurance of acute appendicitis is ages 20-40. Select one: True False

false

You have diagnosed a patient with acute pancreatitis. What is the most common cause of this condition? Select one: a. Gallstones b. Alcohol abuse c. Iatrogenic d. Idiopathic e. Hyperlipidemia

gall stones

In addition to a CBC, lipid profile, HgbA1c and BMP, testing for proteinuria should include testing for Bence Jones proteins which if present suggest: Select one: a. Diabetes b. Hypertension c. Polycystic kidney disease d. Multiple myeloma

multiple myloma

You encourage supportive measures for Mr. Rock which include: Select one: a. Exercise such as running or bicycle riding b. Sitz baths 3 times daily c. Avoiding analgesics such as NSAIDS or Aspirin to avoid increased bleeding d. Prostatic massage or ejaculation daily

sitz baths 3 time daily

The most superficial section, or outer/barrier layer of the skin is the: Select one: a. vascularized dermis b. stratum corneum c. hypodermis d. epidermis

stratum corneum

What does NOT apply to a duodenal ulcer? Select one: a. tenderness at the epigastrum b. gnawing pain 2-3 hours after eating c. middle of the night waking d. vomiting e. relief with food or antacids f. H. pylori

vomiting

Causes of transient proteinuria include (check all that apply): Select one or more: a. Diabetes or hypertension b. Dehydration, fever or exercise c. Congestive heart failure exacerbation d. Hypothyroidism

B and C

Common risk factors for stone formation include (check all that apply): Select one or more: a. Excess dietary protein b. Urinary tract infections c. Reduced urinary flow or dehydration d. Primary hyperparathyroidism

C and D reduced urinary flow or dyhydration, primary hyperparathryodisim

The key imaging or laboratory test to confirm your suspicion is: Select one: a. Kidneys/ureters/bladder (KUB) x-ray b. Intravenous pyelogram (IVP) c. Urinalysis and urine culture (UA/UC) d. Helical (spiral) CT scan

CT

You are evaluating a 64-year-old man with abdominal pain. Your differential diagnosis includes diverticulitis, perforated diverticuli, and appendicitis. What imaging study would be most helpful to establish the diagnosis? Select one: a. Abdominal radiograph b. Ultrasound of the abdomen and pelvis c. Computed tomography (CT) scan of the abdomen and pelvis d. Magnetic resonance imaging (MRI) of the abdomen and pelvis e. Colonoscopy

CT

A 44-year-old woman is admitted to the hospital for acute right upper quadrant pain for 4 hours consistent with biliary colic, fever, and a positive Murphy's sign. She has a history of asymptomatic gallstones, identified incidentally several years ago. Her laboratory evaluation is as follows: WBC: 17.5 K/uL (H) with a left shift Aspartate aminotransferase AST: 88 U/L (H) Alanine aminotransferase (ALT): 110 U/L (H) Alkaline Phosphatase: 330 U/L (H) Bilirubin (total):3.2 mg/dL (H) What would the next test of choice be? What would the next test of choice be? Select one: a. Ultrasound of the abdomen b. CT scan of the abdomen c. MRI of the abdomen d. Endoscopic retrograde cholangiopancreatography (ERCP) e. Cholescintigraphy (HIDA or PISIDA)

ERCP

The most common etiologic agents in nosocomial urinary tract infections not associated with catheter use are: Select one: a. Staphylococcus aureus and Serratia b. Escherichia coli and Klebsiella pneumoniae c. Escherichia coli and Proteus mirabilis d. Pseudomonas aeruginosa

Escherichia and Klebsiella

Some health promotion ideas for someone with ___________ include avoidance of heartburn-inducing foods, no eating two hours before bedtime, and not wearing tight clothing. Select one: a. Constipation b. GERD c. Hemorrhoids d. IBS e. PUD

GERD

Amoxicillin and clarithromycin is the preferred regimen for H. pylori infection. Select one: True False

True

If radiologic findings are negative for fracture or dislocation, most acute orthopedic injuries will respond to rest, ice, compression, elevation (RICE) and immobilization. Of course, this assumes there has been a thorough assessment of the neurovascular function distal to the injury. Select one: True False

True

It is important to differentiate between ankle and foot pain. Once that has been properly evaluated, according to the Ottowa rules, radiography is necessary if there is an inability to bear weight for four steps immediately after the injury in the ED or provider's office. Select one: True False

True

Stool H. pylori antigen testing is more sensitive than serologic antigen testing. Select one: True False

True

Warm tub soaks, decaf fluids, and fiber in the diet are management strategies for hemorrhoids. Select one: True False

True

You are seeing a 53-year-old man who was hospitalized for pancreatitis. His admission laboratory studies include a white blood cell count of 18,000/mm 3 , glucose of 153 mg/dL, lactate dehydrogenase of 254 IU/L, and AST of 165 U/L. According to Ranson's criteria, which of these factors suggest a poor prognosis in this patient? Select one: a. Age b. White blood cell count c. Glucose d. LDH e. AST

WBC

When taking a patient's history who presents with pain in a joint, be suspicious of a septic joint/arthritis if: Select one: a. the joint is painful only when weight bearing b. the joint is painful when at rest, in motion, and when weight bearing c. the joint is painful when in motion, when weight bearing, but not when at rest

When taking a patient's historyb. the joint is painful when at rest, in motion, and when weight bearing Correct

A 26-year-old man presents with 3 months of heartburn. He also complains of regurgitation, belching, and occasional dry cough. His symptoms are worse when he is lying down. He denies melena, weight loss, or dysphagia. What is the appropriate next step, if you suspect gastroesophageal reflux disease (GERD) in this patient? Select one: a. Treat with H2 receptor antagonists, a proton pump inhibitor or a prokinetic agent and evaluate the response b. Obtain a barium swallow c. Obtain a CT scan of the abdomen with oral and IV contrast d. Obtain an ultrasound of the abdomen e. Perform an esophagogastroduodenoscopy (EGD)

a. Treat with H2 receptor antagonists, a proton pump inhibitor or a prokinetic agent and evaluate the response

In a male, hematuria at the beginning or end of micturition suggests: Select one: a. A prostatic source of bleeding b. Goodpasture syndrome c. Post-infection glomerulonephritis d. A ureteral source of bleeding

a. a prostatic source of bleeding

Mr. Rock, a 67 year old male, comes to visit you for a primary care visit after a negative prostate biopsy several weeks ago. He is complaining of acute onset of fever, chills and malaise starting 2 days ago. He also tells you his "back is killing him, his balls hurt and he feels like he has to pee all the time but he doesn't feel empty." You suspect: Select one: a. Acute bacterial prostatitis b. Chronic bacterial prostatitis c. Non-bacterial prostatitis d. Prostatodynia

a. acute bacterial prostatitis

A papule is: Select one: a. Raised/elevated , solid lesion, greater than one cm b. Flat, no elevation, greater than one cm c. Elevated, sharply defined, containing serous fluid d. Irregularly shaped, elevated, progressively enlarges with excessive collagen

a. raised.elevated, sold lesion, greater than one cm

Which risk factor(s) are similiar for GERD and PUD? Select one or more: a. Alcohol intake b. Caffeine ingestion c. Cigarette smoking d. Family history

alcohol intake and family hx

Microproteinuria is defined as the excretion of 30-150 mg of protein per day and is a sign of early renal disease particularly in diabetics. Other causes may include (check all that apply): Select one or more: a. Drugs such as lithium or NSAIDS b. Collagen vascular disorders such as lupus or vasculitis c. Tuberculosis d. Sickle cell disease

all, a,b,c,d

An 80-year-old man presents with mild, crampy, bilateral lower quadrant pain, decreased appetite, and low-grade fever for about 48 hours. Which of the following is most likely? Select one: a. Small bowel obstruction b. Appendicitis c. Constipation d. Irritable bowel syndrome

appendicitis

Characteristics of the type of bacterial prostatitis Mr. Rock has include (check all that apply): Select one or more: a. Patients will generally have had a life-long history of voiding difficulty b. Patients will generally complain of hesitancy, frequency, urgency, nocturia and dysuria c. Patients may have markedly elevated PSA levels d. The provider should do a digital rectal exam (DRE) to obtain a culture to determine the proper antibiotic to use

b and C hestiancy, frequency, urgency, nocturia, dysuria and may have elevated PSA