Practice Questions for Exam 3 - Primary Care 639

A nurse practitioner is trying to distinguish between an articular and a nonarticular musculoskeletal complaint in a 26-year-old patient complaining of pain in the elbow area. Which of the following would characterize nonarticular bursitis? 1.Deep or diffuse pain 2.Limited range of motion (ROM) on active and passive movement 3.Point or focal tenderness 4.Swelling and instability

3.Point or focal tenderness (Articular disorders are characterized by deep or diffuse pain, limited ROM on both active and passive movement, swelling, crepitation, instability, and deformity. Nonarticular disorders are characterized by painful active but not passive movement and point or focal tenderness in regions far from articular surfaces)

The nurse practitioner (NP) is seeing a patient with cervical spondylosis in follow-up. The patient has been vigilant about following the plan of care for his neck pain including traction, physical therapy and NSAID use. He continues to have pain and radiculopathy. What is the appropriate approach at this point? 1.Trial a course of oral steroids 2.Referral to pain management 3.Surgical evaluation by a spine specialist 4.Epidural steroid injections

3.Surgical evaluation by a spine specialist

A dark-field microscopic examination is used to diagnose which of the following? 1.Scabies 2.Leprosy 3.Syphilis 4.Candida infections

3.Syphilis

In assessing a patient, you place the tips of your first 2 fingers in front of each ear and ask the patient to open and close his mouth. Then you drop your fingers into the depressed area over the joint and assess for smooth motion of the mandible. With this action, what are you checking? 1.Maxillomandibular integrity 2.Well-positioned permanent teeth or well-fitting dentures 3.Temporomandibular joint (TMJ) syndrome 4.Mastoid inflammation

3.Temporomandibular joint (TMJ) syndrome

Linda is the 26-year-old mother of Alysia, a 2-year-old girl of African descent. Linda is concerned that Alysia has a large area on her sternum that is much paler that the rest of her skin. What is the appropriate response Linda? 1.When the infant reaches her adult height, this can be surgically removed. 2.She should take the infant immediately to a plastic surgeon because this is a rare cancerous lesion. 3.This is a normal finding in up to 70% of black children and may resolve with age. 4.She should always keep the spot covered because sunlight will aggravate it.

3.This is a normal finding in up to 70% of black children and may resolve with age.

Ms. Anderson is a 59-year-old female who has been experiencing low back pain, and she is reading the report of her radiograph. She sees that the interpretation includes the presence of spondylosis and asks what that means. What does the nurse practitioner (NP) reply? 1.This suggest a herniated nucleus propulsus. 2.This is consistent with a congenital narrowing of the intervertebral space. 3.This is the term used to describe degenerative osteoarthritic changes. 4.This is consistent with a history of pathologic fracture of the spine.

3.This is the term used to describe degenerative osteoarthritic changes.

Jennifer, age 32, is pregnant and has genital warts (condylomata) and would like to have them treated. What should you order? 1.Benzoyl peroxide 2.Podophyllin (Podocon-25) 3.Trichloroacetic acid 4.Corticosteroids

3.Trichloroacetic acid

Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. What is the nurse practitioner's next step? 1.Refer her to a hand surgeon. 2.Take a more complete history. 3.Try neutral position wrist splinting and order an oral NSAID. 4.Order nerve conduction studies and electromyography (EMG).

3.Try neutral position wrist splinting and order an oral NSAID.

Karen, who is postmenopausal, is taking 1200 mg of calcium daily but does not understand why she also needs to take vitamin D. What do you tell her? 1.A deficiency of vitamin D results in inadequate mineralization of bone matrix. 2.All vitamins need to be supplemented. 3.Vitamin D increases intestinal absorption and renal reabsorption of dietary calcium and mobilizes calcium from the bone. 4.Vitamin D binds with calcium to allow active transport into the cells.

3.Vitamin D increases intestinal absorption and renal reabsorption of dietary calcium and mobilizes calcium from the bone.

Risk factors for overuse injuries include all of the following except which? 1.Obesity 2.Vibration 3.Cardiovascular disease 4.Heat

4. Heat

You are teaching Mitch, age 18, about his tinea pedis. You know he does not understand your directions when he tells you which of the following? 1."I should dry between my toes every day." 2."I should wash my socks with bleach." 3."I should use an antifungal powder twice a day." 4."I should wear rubber shoes in the shower to prevent transmission to others."

4."I should wear rubber shoes in the shower to prevent transmission to others." (Rubber shoes can harbor the fungus and therefore should not be worn. The shower should be washed with bleach to kill the fungi).

The nurse practitioner (NP) is assessing Maya, a 69-year-old Asian woman, for the first time. When trying to differentiate between scoliosis and kyphosis, the NP recalls that kyphosis involves what? 1.Asymmetry of the shoulders, scapulae, and waist creases 2.A lateral curvature and vertebral rotation on posteroanterior x-rays 3.One leg appearing shorter than the other 4.A posterior rounding at the thoracic level

4.A posterior rounding at the thoracic level

Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further? 1.Scoliosis 2.Osteoarthritis 3.Spinal stenosis 4.Herniated nucleus pulposus

4.Herniated nucleus pulposus -A plain x-ray will not show a herniated nucleus pulposus or a muscle strain. It will show spondylolisthesis, scoliosis, osteoarthritis, and spinal stenosis. Note that x-rays of the spine are not indicated in low back pain unless the cause of the pain is thought to be bony in origin or traumatic in nature or there is a need to rule out systemic disease.

Mr. Wrightson is a 41-year-old male patient who is seen in clinic for medical management of androgenic alopecia. After a discussion of all medical options, he is started on minoxidil. The nurse practitioner (NP) recognizes that Mr. Wrightson understands his treatment regimen when he says what? 1.If I stop treatment, my hair may start to fall out in a few months. 2.I will use this every day for 3 months. 3.My wife and I should be careful not to conceive while I am using this medication. 4.I should be watchful for skin irritation or dermatitis

4.I should be watchful for skin irritation or dermatitis

Which treatment is considered the gold standard in tissue-conserving skin cancer removal? 1.Cryosurgery 2.Simple excision 3.Photodynamic therapy 4.Mohs micrographic surgery (MMS)

4.Mohs micrographic surgery (MMS)

Which of the following has not been linked to the use of isotretinoin? 1.Elevated liver transaminases 2.Depression, psychosis, and suicidality 3.Benign intracranial hypertension 4.Pancreatitis

4.Pancreatitis

Candidiasis may occur in many parts of the body. James, age 29, has it in the glans of his penis. What is your diagnosis? 1.Balanitis 2.Thrush 3.Candidal paronychia 4.Subungual Candida

1. Balanitis Candidiasis of the glans of the penis is balanitis. Thrush is oral candidiasis. Candidal paronychia involves the tissue surrounding the nail. Subungual Candida is candidiasis under the nail

Mr. Jorgenson is a 52-year-old male who has been suffering with hand pain and swelling on and off for years. He finally decides to have it evaluated and, upon physical examination, he is found to have erythematous, edematous hands and proximal interphalangeal joints. When the nurse practitioner (NP) squeezes his metacarpals, Mr. Jorgenson almost screens. The NP recognizes that treatment should being with what? 1.Methotrexate 2.NSAIDs 3.An immunomodulator 4.Nonpharmacologic therapies such as splinting and heat

1. Methotrexate (The American College of Rheumatology advises that methotrexate or another non-biologic disease modifying antirheumatic drug should be tried first.)

Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? 1.Musculoskeletal pain 2.Difficulty sleeping 3.Depression 4.Fatigue

1. Musculoskeletal pain

A 25-year-old male presents to your urgent care clinic complaining of genital pruritus. On physical exam, the patient has small, erythematous, excoriated papules in his pubic hair. No mites are identified. There is no penile discharge, and the patient has no constitutional symptoms. He is sexually active but wears condoms during all sexual experiences. What is the most likely diagnosis? 1.Pediculosis 2.Scabies 3.Gonorrhea 4.Chlamydia

1. Pediculosis (genital lice) - scabies not typical in genital region - gonorrhea = testicular pain and penile discharge - chlamydia - penile discharge

J.R. is a 41-year-old male patient who presents with a complaint of low back pain. He says that is has been present for a few years, and in the past he has tried conservative treatments such as physical therapy, NSAIDs, and muscle relaxants. Which of the following findings on physical examination leads the nurse practitioner (NP) to suspect a nonorganic etiology? 1.Waddell's signs 2.A negative straight leg raise 3.Normal gait 4.Spurling's sign

1. Waddell's signs - Waddell et al. grouped a series of physical exam findings into five types that suggest a nonorganic cause of back pain. These five types, or categories of signs, are tenderness, simulation, distraction, regional disturbances, and overreaction

Which of the following should be used with all acne medications? 1.Sunscreen 2.Oily makeup 3.Plain soap 4.A light alcohol wipe once a week

1. sunscreen

Louis, age 52, presents with pruritus with no rash present. He has hypertension, diabetes, and end-stage renal disease (ESRD). Which of the following would be included in the differential diagnosis? 1.Uremia from chronic renal disease 2.Contact dermatitis 3.Lichen planus 4.Psoriasis

1. uremia from chronic renal disease

John, age 16, works as a stock boy at the local supermarket. He is in the office for a routine visit. You notice that he had an episode of low back pain 6 months ago after lifting heavy boxes improperly. In discussing with him proper body mechanics to prevent future injuries, what do you tell him? 1."Bend your knees and face the object straight on." 2."Hold boxes away from your body at arm's length." 3."Bend and twist simultaneously as you lift." 4."Keep your feet firmly together."

1."Bend your knees and face the object straight on."

Which of the following patients would not be at risk for Candida infection? 1.A patient with a history of coronary artery disease 2.A diabetic patient 3.A patient requiring home antibiotics while recovering from an operation for an infected hernia 4.A patient using a steroid regimen for asthma control

1.A patient with a history of coronary artery disease

Jill, age 49, has recently begun a rigorous weightlifting regimen. She presents to the primary care office with a shoulder dislocation. Which of the following clinical manifestations leads the nurse practitioner to suspect an anterior shoulder dislocation over a posterior dislocation? 1.Arm held slightly abducted. 2.Absence of pain 3.Inability to rotate the shoulder externally 4.Shortening of the arm

1.Arm held slightly abducted.

Which condition is not among the atopic triad? 1.Aspirin sensitivity 2.Asthma 3.Allergic rhinitis 4.Eczema

1.Aspirin sensitivity

The ABCDEs of melanoma identification include which of the following? 1.Asymmetry: one half does not match the other half 2.Border: the borders are regular; they are not ragged, notched, or blurred 3.Color: pigmentation is uniform 4.Diameter: the diameter is 5 mm

1.Asymmetry: one half does not match the other half

A 16-year-old male presents to your office. He was sent by an orthopedist. He has recently had surgical fixation of a humerus fracture. The patient has been going to physical therapy and has been developing a rash on his arm after therapy that disappears shortly after returning home. He does not have the rash prior to therapy. The patient denies fevers and chills, and his incision is well healed, with no signs of infection. Of note, the patient has been experiencing more hand edema than the average patient and has had edema wraps used at the end of therapy to help with his swelling. The wraps are made of a synthetic plastic material. The rash the patient gets is erythematous and blotchy, not raised; it is on the operative upper extremity. What is the most likely diagnosis? 1.Contact dermatitis 2.Atopic dermatitis 3.Seborrheic dermatitis 4.Psoriasis

1.Contact dermatitis (latex or plastic sensitivity caused by the edema wraps used in therapy.)

Which presentation is most concerning for skin cancer? 1.Dark pigmentation of 1 solitary nail that has developed quickly and without trauma 2.A 1 mm blue, round, nonpalpable discoloration of the skin that has been present since birth without change 3.A 5 mm black mole with round, regular boarders 4.A 2 mm brown mole that is raised 1 mm but round and regular

1.Dark pigmentation of 1 solitary nail that has developed quickly and without trauma

Trevor, age 4, has an apparent hypertrophy of the calf muscles, which seem doughy on palpation. His mother is concerned because Trevor is unable to raise himself from the floor without bracing his knees with his hands. What should the nurse practitioner suspect? 1.Duchenne muscular dystrophy 2.Cerebral palsy 3.Legg-Calvé-Perthes disease 4.Multiple sclerosis

1.Duchenne muscular dystrophy

Carrie Sue is a 29-year-old female who presents for evaluation of wrist symptoms. She reports that she often has an aching in her wrist that radiates to the bottom of her thumb. She did not think much of it until she started waking up sometimes at night with pain and numbness in her hand and fingers. Which of the following diagnostic tests would best support the presumed diagnosis? 1.Electromyography/nerve conduction velocity (EMG/NCV) 2.Magnetic resonance imaging (MRI) 3.Radiograph 4.Sharp/dull discrimination testing

1.Electromyography/nerve conduction velocity (EMG/NCV)

Disc herniation can cause significant back pain and radiculopathy. The majority of patients are successfully treated with conservative therapies and report resolution of symptoms within 3 months or sooner. Which of the following is a relative indication for surgical intervention in the patient with herniated disk? 1.Intractable pain after 6 weeks of conservative therapy 2.Progressive neurological deficit 3.Alteration in bladder function 4.Lack of response to oral corticosteroids

1.Intractable pain after 6 weeks of conservative therapy

Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, how do you respond? 1.It develops when loss of bone occurs more rapidly than new bone growth. 2.It is a degenerative joint disease characterized by loss of cartilage in certain joints. 3.It is a chronic inflammatory disorder that affects multiple joints. 4.It is a bone disorder that has to do with inadequate mineralization of the bones.

1.It develops when loss of bone occurs more rapidly than new bone growth.

A 70-year-old patient with herpes zoster has a vesicle on the tip of the nose. This may indicate: 1.Ophthalmic zoster 2.Herpes simplex 3.Kaposi sarcoma 4.Orf and milker's nodules

1.Ophthalmic zoster

A 4-year-old male presents to your pediatric clinic with his mother complaining of an itchy rash, mostly between his fingers. This has been going on for multiple days and has been getting worse. The patient recently started at a new day care. On physical exam, the patient is afebrile and has multiple small (1-2 mm) red papules in sets of three located in the web spaces between his fingers. He also has signs of excoriation. What is the treatment for this problem? 1.Permethrin lotion for the patient and also his family members 2.Cold compresses and hydrocortisone cream 1% twice a day 3.Over-the-counter Benadryl cream 4.Ketoconazole cream

1.Permethrin lotion for the patient and also his family members (scabies treatment)

One week after a camping trip, Jim, age 35, abruptly developed fever, headache, and joint pain. Shortly afterward his wife reports that he developed confusion. Initial imaging is consistent with encephalitis. What do you suspect Jim has? 1.Rocky Mountain spotted fever 2.Sepsis 3.Kawasaki disease 4.Lyme disease

1.Rocky Mountain spotted fever (CNS s/s less likely with lyme disease and takes longer to develop)

Which human papillomavirus serotypes most commonly cause cancer? 1.Serotypes 16 and 18 2.Serotypes 6 and 11 3.Serotypes 3 and 10 4.Serotypes 27 and 29

1.Serotypes 16 and 18

Assessment of musculoskeletal complaints should include a series of specific queries to differentiate emergencies and musculoskeletal manifestation of systemic disease. What is an important component of the assessment of acute injury? 1.Specific recollection of the physical mechanism of injury 2.The presence of absence of systemic symptoms such as rash or fever 3.Immediate treatment measures rendered at site of injury 4.The patient's medical history

1.Specific recollection of the physical mechanism of injury

De Quervain's tenosynovitis is typically best managed with which of the following? 1.Splinting and NSAIDs 2.Steroid injections into the hand 3.Orthopedic referral 4.Only indicated if conservative measures fail

1.Splinting and NSAIDs

A 55-year-old landscaper presents to your primary care office complaining of a small skin lesion on his face. The patient states that the lesion causes no pain or other symptoms. On physical exam, you notice a small (3 mm) papule that is flesh colored and irregular. To palpation, the lesion feels hard and like sandpaper. What type of malignancy is this patient at risk for given the appearance of this lesion? 1.Squamous cell carcinoma 2.Melanoma 3.Basal cell carcinoma 4.Rosacea

1.Squamous cell carcinoma (actinic keratosis, which is a premalignant lesion that can progress to squamous cell carcinoma) - Melanoma is a type of cancer that arises in melanin-forming cells; Basal cell carcinoma typically presents as a papular lesion with telangiectasia.

The nurse practitioner is considering a diagnosis of calcium pyrophosphate deposition disease (CPPD), or pseudogout, in a 72-year-old man who presents with complaints of pain and stiffness in his wrists and knees. What are the most useful diagnostic tests to assist in confirming this diagnosis? 1.Synovial fluid analysis and x-ray 2.Bacterial cultures 3.Bone scan and magnetic resonance imaging (MRI) 4.Anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF)

1.Synovial fluid analysis and x-ray

A 27-year-old female comes to your primary care office complaining of a perioral rash. The patient noticed burning around her lips a couple days ago that quickly went away. She awoke from sleep yesterday and noticed a group of vesicles with erythematous bases where the burning had been before. There is no burning today. She is afebrile and has no difficulty eating or swallowing. What test would confirm her diagnosis? 1.Tzanck smear 2.Potassium hydroxide (KOH) prep 3.Exam under a Wood lamp 4.Sterile culture sent for aerobic and anaerobic bacteria

1.Tzanck smear (giant cells in HPV)

You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to which? 1.Lateral meniscus 2.Cruciate ligament 3.Medial meniscus 4.Collateral ligament

2. Cruciate ligament -Positive anterior and posterior drawer signs indicate injury to the anterior cruciate ligament and posterior cruciate ligament, respectively. The drawer and Lachman tests are used to assess for cruciate ligament injury. To examine for a meniscal tear, perform the McMurray test. The abduction, or valgus, stress test and the adduction, or varus, stress test are used to test the medial collateral ligament (MCL) and lateral collateral ligament (LCL), respectively.

Mike, age 42, a golf pro, has had chronic back pain for many years. His workup reveals that it is not the result of a degenerative disk problem. His back "goes out" about twice per year, and he is out of work for about a week each time. Which of the following should the nurse practitioner advise him to do? 1.Consider changing careers to something less physical. 2.Begin a planned exercise program to strengthen back muscles. 3.Make an appointment with a neurosurgeon for a surgical consultation. 4.Start on a daily low-dose narcotic to take away the pain.

2.Begin a planned exercise program to strengthen back muscles.

The nurse practitioner (NP) is evaluating a patient who presents with acute onset of pain and swelling of the left elbow. Aspirate of the area presents no pathologic findings and radiographic assessment is negative. What are these findings most suggestive of? 1.Pseudogout 2.Bursitis 3.Infection 4.Red blood cells

2.Bursitis

A 55-year-old patient presents with complaints of paresthesias in the lower lateral arm, thumb, and middle finger. The nerve roots most commonly related to these symptoms are C6 and C7. What is the most likely diagnosis? 1.Brachial plexus neuritis 2.Cervical radiculopathy 3.Peripheral polyneuropathy 4.Thoracic outlet syndrome

2.Cervical radiculopathy

Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows it is caused by urate crystals that "get stuck in the joint and cause pain." She is on hydrochlorothiazide (HCTZ) for management of her hypertension. What should the NP suspect as a diagnosis? 1.Septic arthritis 2.Gout 3.Rheumatoid arthritis 4.Charcot neuro-osteoarthropathy

2.Gout

Dan, age 57, has just been given a diagnosis of herpes zoster. He asks you about exposure to others. What do you tell him? 1.Once he has been on the medication for a full 24 hours, he is no longer contagious. 2.He should stay away from children and pregnant women who have not had chickenpox. 3.He should wait until the rash is completely gone before going out in crowds. 4.He should be isolated from all persons except his wife

2.He should stay away from children and pregnant women who have not had chickenpox.

Elizabeth, age 83, presents with a 2-day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules at that site. What do you suspect? 1.Varicella 2.Herpes zoster 3.Syphilis 4.Rubella

2.Herpes zoster

Greg, age 26, runs marathons and frequently complains of painful contractions of his calf muscles after running. What do you attribute this to? 1.Hypercalcemia 2.Hyponatremia 3.Heat exhaustion 4.Dehydration

2.Hyponatremia

When developing a treatment plan for overuse syndromes, the nurse practitioner (NP) recognizes that treatment should not include which of the following? 1.Ice for the first 48 hours 2.Immobilization 3.Active rest 4.Heat after the first 48 hours

2.Immobilization

Upon assessment, the nurse practitioner notes unilateral back pain of acute onset that increases when standing and bending. A straight leg raise test is negative. What is the most likely diagnosis? 1.Herniated nucleus pulposus 2.Muscle strain 3.Osteoarthritis 4.Spondylolisthesis

2.Muscle strain

June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back muscles and spine, without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. What is the most likely diagnosis? 1.Ankylosing spondylitis 2.Musculoskeletal strain 3.Spondylolisthesis 4.Herniated disk

2.Musculoskeletal strain

Sarah is a 54-year-old female who is being seen for an annual health evaluation. Her last menstrual period was two years ago, and while she has not been having any symptoms, she is presumed menopausal. She asks about how she can prevent osteoporosis; her mother had it and suffered pathologic fractures that ultimately led to functional decline and death. She asks about taking estrogen replacement therapy. What does the nurse practitioner (NP) advise? 1.This is an excellent option as long as she has no contraindications. 2.Pharmacotherapy is not indicated for prevention; she requires lifestyle counseling. 3.Estrogen is not appropriate unless a diagnosis of osteoporosis is made. 4.Estrogen has best outcomes when used in conjunction with bisphosphonates.

2.Pharmacotherapy is not indicated for prevention; she requires lifestyle counseling.

When counseling a patient about prevention of osteoporosis, the nurse practitioner (NP) advises that smoking cigarettes is a risk factor because it can do which of the following? 1.Lead to hypoxemia 2.Reduce circulating estrogen 3.Inhibit osteoclastic activity 4.Activate nicotinic receptors and accelerate bone breakdown

2.Reduce circulating estrogen

Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her "anatomical snuffbox." You know this probably indicates which? 1.Ulnar styloid fracture 2.Scaphoid fracture 3.Hamate fracture 4.Radial head fracture

2.Scaphoid fracture (There is tenderness over the "anatomical snuffbox" in a scaphoid (aka navicular) fracture, the most common injury of the carpal bones. Poor blood supply puts the scaphoid bone at risk for avascular necrosis; therefore wrist pain and tenderness in the anatomical snuffbox, even without history of antecedent trauma, warrant a wrist x-ray.)

Christian, age 22, is a carpenter who is right-hand dominant. He comes to the clinic for follow-up from the emergency department, where he was seen for right forearm pain. He states that he was diagnosed with right forearm tendinitis and wants the provider to explain this diagnosis to him. Patient teaching should explain that he has inflammation of one or more tendons. What are tendons? 1.The ropelike bundles of collagen fibrils that connect bone to bone 2.The collagen fibers that connect muscle to bone 3.The pouches of synovial fluid that cushion bone and other joint structures 4.The fibrocartilaginous disks that separate bony surfaces

2.The collagen fibers that connect muscle to bone

Danny, age 18, presents with a pruritic rash on his upper trunk and shoulders. You observe flat to slightly elevated brown papules and plaques that scale when they are rubbed. You also note areas of hypopigmentation. What is your initial diagnosis? 1.Lentigo syndrome 2.Tinea versicolor 3.Localized brown macules 4.Ochronosis

2.Tinea versicolor (If a patient presents with a pruritic rash on his upper trunk and shoulders and you observe areas of hypopigmentation and flat to slightly elevated brown papules and plaques that scale when they are rubbed, suspect tinea versicolor.)

Thomas, age 35, uses a high-potency corticosteroid cream for a dermatosis. He also currently has tinea corporis. What do you tell him regarding the cream? 1."You must use this for an extended period of time for it to be effective." 2."It will work better if you occlude the area." 3."It may exacerbate your concurrent tinea corporis." 4."Be sure to use it daily."

3. "It may exacerbate your concurrent tinea corporis."

Mr. Turner presents to the urgent care complaining of neck pain. He repots that he had a car accident yesterday morning but at the time felt fine. Today he finds that it is more uncomfortable, especially when sitting at his computer screen. Suspecting whiplash, the nurse practitioner (NP) expects that an additional finding will include which of the following? 1.Posterior neck pain with normal posture 2.Pain radiating to the elbow 3.Paraspinal pain in the trapezius region 4.Radiograph demonstrates narrowing of the cervical spine

3.Paraspinal pain in the trapezius region

Sandra, age 69, is complaining of dry skin. What do you advise her to do? 1.Every day, when bathing, vigorously use a washcloth to exfoliate the upper layers of the stratum corneum. 2.Bathe or shower with lukewarm water and use a mild soap or skin cleanser. 3.Use a dehumidifier. 4.Decrease the oral intake of fluids.

2.Bathe or shower with lukewarm water and use a mild soap or skin cleanser.

Mrs. Ramirez is a 59-year-old female who presents with a chief complaint of muscle weakness. She denies any specific injury but reports that in the last several months her muscles appear to become tired so easily and she is not able to sustain normal daily activity for very long without stopping to rest. On physical examination you appreciate both proximal and distal muscle weakness. What would your leading differential diagnoses include? 1.Duchenne muscular dystrophy 2.Sarcoidosis 3.Guillain-Barre syndrome 4.Rheumatoid arthritis

3.Guillain-Barre syndrome

The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests to check the integrity of the ligaments of the knee. Which test would the nurse practitioner choose to assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe knee injury? 1.Valgus stress test 2.Varus stress test 3.Lachman test 4.Thumb sign

3.Lachman test

Helen, age 39, comes to your clinic for generalized joint pain, especially in the knees and hands. She tells you that the pain is moderate, spreading, and symmetrical. She reports having had a sore throat and low-grade fever for a few days and then developing a rash, described as warm erythema of the cheeks, which lasted about 4 days before disappearing. You ask her if the rash on the cheeks included the nasolabial folds or circumoral skin, and she tells you that it did not cover these areas. Two days later, she developed a nonspecific macular eruption that preceded the joint pain. Her rash faded within 2 weeks, but she tells you that it comes and goes if she bathes in hot water or spends time in the sunlight. Your patient's symptoms are most consistent with a diagnosis of what? 1.Rubella 2.Erythema infectiosum 3.Rheumatoid arthritis 4.Scarlet fever

2. Erythema infectiosum (5th disease - is distinguished by its erythematous, warm rash, which gives the appearance of "slapped cheeks," and it does not involve the nasolabial folds or the circumoral region. Women are more likely to have joint pain as a symptom of erythema infectiosum.)

All of the following medications may cause alopecia except which? 1.Warfarin (Coumadin) 2.Minoxidil (Rogaine) 3.Oral contraceptives 4.Acetylsalicylic acid (aspirin)

2. Minoxidil - (Rogaine) is a vasodilator and may stimulate vertex hair growth.

You are caring for a patient who has a history of psoriasis and is now showing signs of joint involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis (PsA). What is the initial treatment choice for management of the patient? 1.Disease-modifying antirheumatic drugs (DMARDs) 2.NSAIDs 3.Tumor necrosis factor-alpha (TNF-a) inhibitors 4.Uricosuric medications

2. NSAIDs - NSAIDs are the first-line treatment for musculoskeletal signs and symptoms with joint involvement.

The nurse practitioner (NP) tells Samantha, age 52, that she has an acrochordon on her neck. What is the NP referring to? 1.A nevus 2.A skin tag 3.A lipoma 4.A wart

2. a skin tag

Justin, an obese 42-year-old, cut his right leg 3 days ago while climbing a ladder. Today his right lower leg is warm, reddened, and painful, without a sharply demarcated border. What do you suspect? 1.Diabetic neuropathy 2.Cellulitis 3.Peripheral vascular disease 4.A beginning stasis ulcer

2. cellulitis

Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change? 1.Lordosis 2.Dorsal kyphosis 3.Scoliosis 4.Kyphoscoliosis

2. dorsal kyphosis

A 55-year-old patient is able to complete range of motion (ROM) against gravity with some resistance. The nurse practitioner would assign which of the following numerical grades to this manual muscle testing description? 1.5 2.4 3.3 4.2

2. score of 4 (5 is normal strength)

Ashley, age 6 months, has a Candida infection in the diaper area. What do you suggest to the parent? 1."Use rubber or plastic pants to contain the infection and prevent it from getting to the thighs." 2."Keep the area as dry as possible." 3."Use baby powder with cornstarch." 4."Keep Ashley away from other babies until the infection is cleared up."

2."Keep the area as dry as possible."

Kate is a 32-year-old female who presents for evaluation of foot pain. She denies any accident or identifiable mechanism of injury. She is actually a very healthy woman and is a captain in the Air Force; she runs several miles a day and works out with weights. She reports that her left foot has become so painful she has had to stop her exercise regimen. On physical examination, there is mild ecchymoses and some point tenderness, but no pain to resistive motion. The nurse practitioner (NP) anticipates which of the following upon diagnostic evaluation? 1.Joint aspirate for uric acid crystals 2.A negative radiograph 3.Magnetic resonance imaging (MRI) consistent with soft tissue swelling 4.Computed tomography (CT) scan demonstrating hairline translucency

2.A negative radiograph - this is a stress fracture, typically negative on initial x-ray, in a few weeks there may be new bone visible

Kevin Sheffield is a 28-year-old male who presents to the urgent care with acute shoulder pain. He said he was horsing around physically with his fiancé, tripped over a rug, and fell right on his shoulder. The shoulder is painful to palpation, and pain is enhanced by abducting the arm 110°F from the body. X-ray of the shoulder is within normal limits (WNL). The nurse practitioner (NP) recognizes that this presentation is consistent with which of the following? 1.Acromioclavicular (AC) sprain 2.AC strain 3.Coroclavicular ligament tear 4.Septic shoulder

2.AC strain (There are more often radiographic changes, e.g., disruption or widening of the AC joint with sprain as opposed to strain. Option 2:The findings are consistent with AC insult, and the normal radiograph suggests strain.)

When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, which is an important point to stress? 1.Carrying the cane in the ipsilateral hand 2.Advancing the cane with the ipsilateral leg 3.Making sure the cane length equals the height of the iliac crest 4.Using the cane to aid in joint protection and safety

2.Advancing the cane with the ipsilateral leg

Jessie, age 49, states she thinks she has rheumatoid arthritis. Before any diagnostic tests are ordered, the nurse practitioner completes a physical examination and makes a diagnosis of osteoarthritis rather than rheumatoid arthritis. Which clinical manifestation ruled out rheumatoid arthritis? 1.Fatigue 2.Affected joints are swollen, cool, and bony hard on palpation 3.Decreased range of motion 4.Joint stiffness

2.Affected joints are swollen, cool, and bony hard on palpation

Jeffrey, age 16, was involved in a motor vehicle accident. He walks into the office with an obvious facial fracture and then collapses. What should be the first action of the nurse practitioner? 1.Calling his parents for permission to treat 2.Assessing for an adequate airway 3.Obtaining a head and maxillofacial computed tomography (CT) 4.Assessing for a septal hematoma

2.Assessing for an adequate airway

Which skin cancer that arises from skin cells characteristically occurs on body areas exposed to the sun, most commonly presents as a pearly nodule with fine telangiectasias over the surface and a border that appears rolled, and is the most common skin cancer? 1.Actinic keratosis 2.Basal cell carcinoma 3.Squamous cell carcinoma 4.Melanoma

2.Basal cell carcinoma (arises from skin cells and is the most common type of nonmelanoma skin cancer >80%.) Melanoma begins in the melanocytes. Actinic keratosis often preceded squamous cell carcinoma.

Mrs. Choate is a 41-year-old female who presents complaining of pain in her hands bilaterally. She reports that it seems to be at its worst when she first gets up in the morning, and that sometimes her hands and even knuckles are red and feel hot. On physical examination today her hands do not appear erythematous or edematous, but when the metacarpals are held firmly and squeezed, Mrs. Choate actually yells out loud from the pain. A CBC, ESR, RF, and ANA are all within normal limits, and radiographic examination of the hands is normal. Which of the following is the most appropriate nest step for this patient? 1.Treat the patient conservatively for osteoarthritis. 2.Advise that no further diagnostic test or treatment are indicated at this time. 3.Begin methotrexate and refer to rheumatology. 4.Counsel the patient to return to clinic if signs and symptoms return to visualize physical findings.

3. Begin methotrexate and refer to rheumatology. (Metacarpal pain to firm grab is a hallmark finding of early RA, present well before laboratory or radiographic findings. The patient should have methotrexate ordered ASAP and referred to rheumatology for further treatment.)

Daniel, age 45, is of Northern European ancestry and has a dysfunctional and disfiguring condition affecting the palmar tissue under the skin of the distal palm and fourth and fifth fingers. What do you suspect? 1.Hallux valgus 2.De Quervain tenosynovitis 3.Dupuytren contracture 4.Hallux rigidus

3. Dupuytren contracture - Dupuytren contracture affects the palmar tissue under the skin of the distal palm and fingers, most often the fourth and fifth fingers, but also the thumb-index finger web space. It is progressive and results in a flexion contracture, though it does not affect the flexor tendons. Occurring most frequently in males between the ages of 40 and 60, it is common among people of Northern European ancestry.

Lee brings her 13-year-old son to your clinic. He has been complaining of a rash on the buttocks, anterior thighs, and posterolateral aspects of his upper arms. He tells you it is mildly pruritic and looks like gooseflesh. On examination, the rash appears as small, pinpoint, follicular papules on a mildly erythematous base. You explain to Lee that the benign condition is likely to resolve by the time her son reaches adulthood. What is it known as? 1.Comedones of acne 2.Molluscum contagiosum 3.Keratosis pilaris 4.Atopic dermatitis

3. Keratosis pillaris (most commonly appears on the cheeks, buttocks, anterior thighs, and posterolateral aspects of the upper arms.)

Anne Marie states that she has a maternal history of rheumatoid disease, but she has never been affected. Today she presents with complaints of dryness of the eyes and mouth. What is the most likely diagnosis? 1.Rheumatoid arthritis (RA) 2.Systemic lupus erythematosus (SLE) 3.Sjögren syndrome 4.Rosacea

3. Sjögren syndrome (affects the salivary and lacrimal glands, causes patients to have dry eyes and mouths. It is an inflammatory disease of the exocrine glands and may be an isolated entity or may be associated with other rheumatic diseases, such as RA or SLE)

Buddy, age 13, presents with annular lesions with scaly borders and central clearing on his trunk. What do you suspect? 1.Psoriasis 2.Erythema multiforme 3.Tinea corporis 4.Syphilis

3. Tinea corporis (Psoriasis, erythema multiforme, tinea corporis, and syphilis all have lesions with annular configurations. Tinea corporis (ringworm) has ring-shaped lesions with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk.)

Jim, age 59, presents with recurrent, sharply circumscribed red papules and plaques with powdery white scale on the extensor aspects of his elbows and knees. What do you suspect? 1.Actinic keratosis 2.Eczema 3.Psoriasis 4.Seborrheic dermatitis

3. psoriasis

Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether he should apply heat or cold. What should the nurse practitioner tell him? 1."Use continuous heat for the first 12 hours and then use heat or cold to your own preference." 2."Use continuous cold for the first 12 hours and then use heat or cold to your own preference." 3."Apply cold for 20 minutes, then remove it for 30 to 45 minutes; repeat this for the first 24 to 48 hours while awake." 4."Alternate between cold and heat for 20 minutes each for the first 24 to 48 hours."

3."Apply cold for 20 minutes, then remove it for 30 to 45 minutes; repeat this for the first 24 to 48 hours while awake."

Sandy asks what she can do for Dolores, her 90-year-old mother, who takes a bath every day and who has extremely dry skin. How do you respond? 1."After bathing every day, use a generous amount of moisturizer." 2."Use a special moisturizing soap every day." 3."Your mother does not need a bath every day." 4."Increase your mother's intake of fluids."

3."Your mother does not need a bath every day."

What is the most important thing a person can do to maintain healthy skin and hopefully reduce wrinkles? 1.Keep well hydrated. 2.Use sunscreen with a sun protection factor (SPF) of at least 45. 3.Avoid smoking. 4.Use mild defatted or glycerin soap.

3.Avoid smoking.

Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders an NSAID and should educate him in which of the following? 1.Maintaining moderate bed rest for 3 to 4 days 2.Calling the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours 3.Beginning lower back strengthening exercises depending on pain tolerance 4.Wearing a Boston brace at night

3.Beginning lower back strengthening exercises depending on pain tolerance

Sam, age 50, presents with Paget disease that has been stable for several years. Recently, his serum alkaline phosphatase level has been steadily rising. The nurse practitioner determines that it is time to start him on pharmacologic management. Which of the following should she initially prescribe? 1.NSAIDs 2.Corticosteroids 3.Bisphosphonates 4.Calcitonin

3.Bisphosphonates

Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment should the nurse practitioner use to check for effusion of the patient's knee? 1.Thomas test 2.Tinel test 3.Bulge test 4.Phalen test

3.Bulge test

Although osteoarthritis (OA) and rheumatoid arthritis (RA) are different diseases, they do share common features. While evaluating a patient with arthritic pain in the hands and fingers, which of the following features distinguishes OA from RA? 1.The presence of swelling 2.The absence of deformity 3.Distal interphalangeal joint involvement 4.Stiffness of the digits

3.Distal interphalangeal joint involvement

Michael, a 25-year-old military reservist, presents to your clinic for a rash that began on his chest and has since developed into smaller lesions that are more concentrated on the lower abdomen and pubic area. In obtaining a history of the present illness, he reports that he had an upper respiratory infection 1 month before the rash developed. He tells you it started with 1 large oval-shaped lesion on his left chest, and 1 to 2 weeks later he developed numerous smaller lesions on the lower abdomen and groin. It has been 2 weeks since the smaller lesions developed, and he tells you he is concerned that the rash is not improving. As you examine the patient, you note that the lesions are salmon-colored and have a thin collarette of scale within them. The original lesion is still present. What do you suspect Michael has? 1.Guttate psoriasis 2.Tinea versicolor 3.Secondary syphilis 4.Pityriasis rosea

4.Pityriasis rosea (Pityriasis rosea is a common, self-limiting, usually asymptomatic eruption with a distinct initial lesion. This "herald patch," which appears suddenly and without symptoms, usually is on the chest or back. Secondary lesions appear 1 to 2 weeks later while the herald patch remains. The collarette scaling is another classic symptom of pityriasis rosea. The lesions usually resolve spontaneously in 4 to 12 weeks without scarring. Outbreaks have been known to occur in close quarters like military barracks and dormitories.)

Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? 1.Ordering physical therapy 2.Ordering a lumbosacral x-ray 3.Ordering extensive lab work 4.Referring to a neurosurgeon

4.Referring to a neurosurgeon

Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? 1.Cancer 2.Cauda equina syndrome 3.Neurologic compromise 4.Spinal fracture

4.Spinal fracture

Roy, age 13, was recently diagnosed with epilepsy and prescribed carbamazepine for control of his seizures. He has developed erythematous papules, dusky appearing vesicles, purpura, and target lesions that have erupted rapidly and are more centrally distributed on the face. He has hemorrhagic crusts on his lips. He tells you his skin feels tender and burns. Additionally, he has developed exudative conjunctivitis. What are these findings indicative of? 1.Urticaria 2.Pemphigus vulgaris 3.Herpetic gingivostomatitis 4.Stevens-Johnson syndrome (SJS)

4.Stevens-Johnson syndrome (SJS) (SJS is a severe blistering mucocutaneous syndrome that involves at least 2 mucous membranes. Drugs frequently implicated in the development of SJS are phenytoin, phenobarbital, carbamazepine, sulfonamides, and aminopenicillins.)

The nurse practitioner (NP) suspects a herniated disk in a 72-year-old patient. The NP elevates the patient's affected leg when she is in the supine position, and it elicits back and sciatic nerve pain, which indicates a positive test. This is known as which test or sign? 1.Femoral stretch test 2.Crossed straight leg raise test 3.Doorbell sign 4.Straight leg raise test

4.Straight leg raise test

Which of the following statements about malignant melanomas is true? 1.They usually occur in older adult males. 2.There will usually be no family history of melanoma. 3.They are common in populations with dark skin. 4.The prognosis is directly related to the thickness of the lesion.

4.The prognosis is directly related to the thickness of the lesion.

Sean, a factory line worker, has osteoarthritis (OA) of the right hand. According to the American College of Rheumatology (ACR), the guidelines for pharmacologic treatment include which of the following? 1.Acetaminophen, tramadol, and intra-articular corticosteroid injections 2.Oral NSAIDs, tramadol, and articular corticosteroid injections 3.Acetaminophen, topical capsaicin, and topical NSAIDs 4.Topical capsaicin, topical NSAIDs, and oral NSAIDs

4.Topical capsaicin, topical NSAIDs, and oral NSAIDs

Marilyn is a 59-year-old female who has experienced neck pain off and on for several years. She has never had an acute injury, but she has been evaluated for this and reports that she really has been compliant with performing the neck exercises that have been prescribed. Her symptoms have gradually progressed, and today upon physical examination the nurse practitioner (NP) suspects spondylotic myelopathy when she finds all of the following on physical examination except which? 1.Unsteady gait 2.Fine motor deficit 3.Diminished dexterity 4.Weakness to adduction

4.Weakness to adduction

Joan, age 76, has been given a diagnosis of osteoporosis, confirmed with a dual-energy x-ray absorptiometry (DXA) scan. The nurse practitioner has educated her about the importance of increasing calcium and vitamin D in her diet and starting a low-impact, weight-bearing exercise program. The nurse practitioner is also going to start the patient on medical management. Joan asks about a medicine that she has heard she can take only once a year. Which of the following pharmacologic therapies for osteoporosis is classified as an annual infusion? 1.Alendronate (Fosamax) 2.Risedronate (Actonel) 3.Calcitonin-salmon 4.Zoledronic acid (Reclast)

4.Zoledronic acid (Reclast) - bisphosphonate medication administered yearly Alendronate and Risedronate are bisphosphonates and can be used for prevention and treatment of osteoporosis