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The most current Eighth Joint National Committee (JNC 8) recommendation for the blood pressure goal in diabetics is: A) <140/90 mmHg B) <130/85 mmHg C) <130/80 mmHg D) <125/75 mmHg

A) <140/90 mmHg The Eighth Joint National Committee (JNC 8) blood pressure goal for adults and older adults 60 years of age or older who have diabetes (with or without chronic kidney disease) is blood pressure less than 140/90. In addition, all patients with hypertension should have lifestyle intervention (i.e., weight loss, smoking cessation, healthy diet), which should be continued throughout treatment.

A positive obturator sign might signify which of the following conditions? A) Acute appendicitis B) Acute pancreatitis C) Acute cholecystitis D) Acute hepatitis

A) Acute appendicitis A positive obturator sign may indicate acute appendicitis. The test is performed with the patient supine. The examiner rotates the hip, using full range of motion. The test is positive if pain is experienced with movement or flexion of the hip.

Cullen's sign is most commonly associated with which of the following? A) Acute pancreatitis B) Myocardial infarction C) Acute pyelonephritis D) Preeclampsia

A) Acute pancreatitis Cullen's sign is commonly seen in acute pancreatitis. It refers to a yellowish-blue skin color change around the umbilicus. It is thought to occur due to the pancreatic enzymes that run along the ligament and subcutaneous tissues around the umbilicus.

Grey-Turner's sign is highly suggestive of which of the following conditions? A) Acute pancreatitis B) Acute appendicitis C) Acute diverticulitis D) Gastric cancer

A) Acute pancreatitis Grey-Turner's sign is the acute onset of bluish discoloration located on the flank area that is caused by bruising. It is usually associated with severe acute pancreatitis, but it can also be found in some cases of ruptured ectopic pregnancy.

107. Rovsing's sign is associated with which of the following? A) An acute abdomen, such as during a ruptured appendix B) Knee instability C) Damage to the meniscus of the knee D) Acute cholelithiasis

A) An acute abdomen, such as during a ruptured appendix Rovsing's sign identifies an acute abdomen, such as occurs in acute appendicitis. With the patient in the supine position, the examiner palpates deep into the left lower quadrant of the abdomen. The maneuver is positive if pain is referred to the right lower quadrant.

Which of the following drugs does the Eighth Joint National Committee (JNC 8) 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults recommend for the initial treatment for White adults with microalbuminuria? A) Angiotensin-converting enzyme (ACE) inhibitors B) Diuretics C) Calcium channel blockers D) Beta-blockers

A) Angiotensin-converting enzyme (ACE) inhibitors According to the Eighth Joint National Committee (JNC 8; 2014), non-Black and Black hypertensive patients with chronic kidney disease (i.e., microalbuminuria) with or without diabetes can be treated with either angiotensin-converting enzyme (ACE) inhibitors or an angiotensin recep- tor blocker (ARB), alone or in combination with another drug class. The blood pres- sure goal for adults and older adults from this risk group is blood pressure less than 140/90 mmHg.

A35-year-old woman is complaining of gradual weight gain, lack of energy, and amenorrhea. The urine pregnancy test is negative. A complete blood count (CBC) shows hemoglobin of 13.5 g/dL and mean corpuscular volume (MCV) of 84 fL. The nurse practitioner suspects that the patient may have hypothyroidism. The thyroid-stimulating hormone (TSH) level is 10 mU/L. Which of the following is the next step in the evaluation? A) Check the thyroid profile B) Check the total T3 level C) Check the FSH level D) Recheck the TSH in 4 to 6 months

A) Check the thyroid profile The upper limit of the serum thyroid-stimulating hor- mone (TSH) level is about 4.0 mU/L. With an elevated TSH of 10, it is important to rule out hypothyroidism. The next step in this patient's evaluation is to order a thyroid profile or thyroid panel test. Serum assays measure bound and unbound (free) forms of thyroxine (T4) and triiodothyronine (T3). Classic findings of hypothyroidism are a low free T4, low T3-resin uptake (THBI), and low free T4 index.

Which of the following is a true statement regarding acute gastritis? A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder B) Chronic lack of dietary fiber is the main cause of the disorder C) The screening test for the disorder is the barium swallow test D) The gold standard to evaluate the disorder is a colonoscopy

A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the disorder Signs and symptoms of gastritis are nausea/vomiting, upset stom- ach, loss of appetite, and burning/aching or gnawing pain located in the epigastric area. Nonselective NSAIDs (aspirin, ibuprofen, naproxen, others) have adverse effects on the gastrointestinal (GI) tract, kidneys, central nervous system, and cardiovascu- lar effects, and decrease platelet aggregation (aspirin). Chronic use of nonselective NSAIDs disrupts the production of prostaglandins, which involves cycloxygenase-1 (COX-1) and COX-2. The GI mucosa uses COX-1 to produce mucosal protective fac- tors. Blocking COX-1 decreases these protective factors and increases risk of gastritis, ulcers, and GI bleeding. Selective NSAIDs, such as celecoxib (Celebrex), do less dam- age to the GI tract because they block only COX-2, which is responsible for pain and inflammation.

Which chronic illness disproportionately affects the Hispanic population? A) Diabetes mellitus B) Hypertension C) Alcohol abuse D) Skin cancer

A) Diabetes mellitus The risk of diabetes mellitus is two to three times higher in Mexican Americans than in non-Hispanic Americans.

All of the following signs and symptoms are associated with irritable bowel syndrome except: A) Diarrhea with blood mixed in the stool B) Diarrhea and/or constipation C) Abdominal pain relief after defecation D) Mucus with stools

A) Diarrhea with blood mixed in the stool Irritable bowel syndrome (IBS) is consid- ered a functional disorder because the colon tissue is normal. There is no inflamma- tion or bleeding in IBS. Patients report chronic abdominal pain, flatulence, bloating, and changes in bowel movements. IBS is more common in women than men. Rectal bleed- ing, blood in stool, anemia, fatigue, and weight loss are associated with inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis.

Which of the following is recommended treatment for erythema migrans or early Lyme disease? A) Doxycycline (Vibramycin) 100 mg PO BID × 21 days B) Ciprofloxacin (Cipro) 250 mg PO BID × 14 days C) Erythromycin (E-mycin) 333 mg PO TID × 10 days D) Dicloxacillin (Dynapen) 500 mg PO BID × 10 days

A) Doxycycline (Vibramycin) 100 mg PO BID × 21 days Erythema migrans is the rash characteristic of Lyme disease and it usually appears 7 to 10 days after a tick bite. Lyme disease is caused by Borrelia burgdorferi, a spirochete. The rash appears either as a single expanding red patch or a central spot surrounded by clear skin that is in turn ringed by an expanded red rash (bull's eye). The choice of antibiotic depends on bacterial sensitiv- ity. Doxycycline 100 mg BID for 14 to 21 days is the recommended treatment of adults.

The mother of an 8-year-old boy reports the presence of a round red rash on the child's left lower leg. It appeared 1 week after the child returned from visiting his grandparents, who live in Massachusetts. During the skin exam, the maculopapular rash is noted to have areas of central clearing making it resemble a round target. Which of the following is best described? A) Erythema migrans B) Rocky Mountain spotted fever C) Meningococcemia D) Larva migrans

A) Erythema migrans Erythema migrans is a symptom of early Lyme disease. It is an annular lesion that slowly enlarges with time (days to weeks) and has central clearing. It is caused by a bite from an infected (Borrelia burgdorferi) blacklegged tick. If untreated, infection will spread to joints, nervous system, and heart. Most cases of Lyme dis- ease occur in the Northeast, mid-Atlantic states, Wisconsin, Minnesota, and northern California.

Which of the following conditions is associated with three stages of rashes? A) Fifth disease B) Erythema infectiosum C) Varicella D) Rocky Mountain spotted fever

A) Fifth disease Fifth disease has three stages. The prodromal stage begins with symp- toms of an upper respiratory infection, such as low-grade fever, headache, chills, and malaise. In the second stage, a red rash appears on the cheeks, known as the "slapped cheek" rash. This usually resolves in 2 to 3 days. In the third stage, the rash moves to the arms and legs and becomes a lacy-appearing rash that is flat and appears purple; this may last for a few weeks.

666. A 42-year-old obese White man presents to the clinic with a history of recurrent heartburn. He is diagnosed by the nurse practitioner with gastroesophageal reflux disease (GERD). Which of the following drug classes is preferred initially to treat symptoms of GERD? A) Histamine-2 receptor antagonist B) Proton-pump inhibitor C) Antibiotic D) Antiviral

A) Histamine-2 receptor antagonist A histamine-2 receptor antagonist (H2 receptor antagonist) is the initial drug considered in treating a patient with GERD whose symp- toms are not responding to lifestyle changes. If a patient's symptoms do not respond to the H2 receptor antagonist, the next step is a trial of a proton-pump inhibitor.

Epidemiological studies show that Hashimoto's disease occurs most commonly in: A) Middle-aged to older women B) Smokers C) Obese individuals D) Older men

A) Middle-aged to older women Hashimoto's disease (Hashimoto's thyroiditis, or chronic lymphocytic thyroiditis) is an autoimmune disease. An enlarged thyroid is most often the first sign of the disease. Hashimoto's disease is about seven times more com- mon in women than in men. It can occur in teens and young women, but is more com- mon in middle age.

An urgent care nurse practitioner is assessing a 45-year-old White woman with a body mass index (BMI) of 32 for a complaint of intermittent right upper quadrant abdominal pain over the past few weeks that is precipitated by eating fried foods and peanut butter. On exam, the patient's heart and lungs are normal. There is no pain over the costover- tebral angle. During abdominal exam, bowel sounds are present in all quadrants. While the nurse is palpating deeply on the right upper quadrant during deep inspiration, the patient complains of severe sharp pain. Which of the following is best described? A) Murphy's sign B) McMurray's sign C) Rovsing's sign D) Obturator sign

A) Murphy's sign Murphy's sign is suggestive of acute cholecystitis and gallbladder disease. It is elicited by palpating the subcostal region on the right upper abdomen; in response, the patient abruptly stops inspiration because of the severe pain.

Which of the following is an accurate description of eliciting Murphy's sign? A) On deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle B) Bend the patient's hips and knees at 90 degrees, then passively rotate the hip externally, and internally C) Ask the patient to squat, then place the stethoscope on the apical area D) Press into the abdomen deeply, then release it suddenly

A) On deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle Murphy's sign is tested during an abdominal examination for biliary disorders. As the patient breathes in, the abdominal contents are pushed downward as the diaphragm moves down and the lungs expand. As the patient stops/hold the breath, the gallbladder comes in contact with the exam- iner's fingers and may elicit pain. To be considered positive, the same maneuver must not elicit pain when performed on the left side. A negative Murphy's test in the elderly is not useful for ruling out cholecystitis if history and other tests suggest the diagnosis.

A 30-year-old woman with type 2 diabetes uses regular and NPH (neutral protein Hagedorn) insulin in the morning and in the evening. She denies changes in her diet or any illness, but recently started attending aerobic classes in the afternoon. Her fasting blood glucose level before breakfast is now elevated. Which of the following is best described? A) Somogyi phenomenon B) Dawn phenomenon C) Raynaud's phenomenon D) Insulin resistance

A) Somogyi phenomenon This is caused by too much insulin (or missing a meal or snack) in the evening, which results in hypoglycemia in the early morning (2 a.m. to 3 a.m.). The body compensates by secreting glucagon (from the liver) and epinephrine, which results in high blood glucose levels in the morning. The Somogyi phenomenon (or Somogyi effect) is also known as the rebound effect.

Erysipelas is an infection of the skin most commonly caused by which of the following class of organisms? A) Streptococci B) Staphylococci C) Gram-negative bacteria D) Fungi

A) Streptococci Erysipelas is a skin infection commonly caused by group A beta- hemolytic streptococci. This infection is usually more superficial than other bacterial infections of the skin, such as cellulitis.

Café-au-lait spots look like tan to light-brown stains that have irregular borders. They can be located anywhere on the body. Which of the following is a correct statement? A) They are associated with neurofibromatosis or von Recklinghausen's disease B) They may be identified as precancerous after a biopsy C) They are more common in children with darker skin D) They are associated with Wilson's disease

A) They are associated with neurofibromatosis or von Recklinghausen's dis- ease Café-au-lait spots are caused by an increase in melanin content, often with the presence of giant melanosomes. They have irregular borders and vary in color from light to dark brown. Neurofibromatosis causes tumors to grow in the nervous system, and these tumors commonly cause skin changes.

A 20-year-old White man is being seen for a physical exam by the nurse practitioner. He complains of pruritic macerated areas in his groin that have been present for the past 2 weeks. Which of the following is the most likely? A) Tinea cruris B) Tinea corporis C) Tinea capitis D) Tinea pedis

A) Tinea cruris Tinea cruris (jock itch) is a common skin infection that is caused by a type of fungus called tinea. The fungus thrives in warm, moist areas of the body and, as a result, infection can affect the genitals, inner thighs, and buttocks. Infections occur more frequently in the summer or in warm, wet climates. Tinea cruris appears as a red, itchy rash that is often ring shaped. Tinea corporis involves the body, tinea capitis involves the head, and tinea pedis involves the feet.

Which of the following drug classes is recommended for the treatment of postherpetic neuralgia? A) Tricyclic antidepressants (TCAs) B) Selective serotonin reuptake inhibitors (SSRIs) C) Atypical antidepressants D) Benzodiazepines

A) Tricyclic antidepressants (TCAs) TCAs and anticonvulsants are recommended for postherpetic neuralgia. These medications may help with the neuropathic pain.

Which of the following groups has been recommended to be screened for thyroid disease? A) Women aged 50 years or older B) Adolescent girls C) Elderly men D) School-aged children

A) Women aged 50 years or older Women have a greater risk of developing thyroid disease than men. Being age 50 or older increases the risk of thyroid disease for both men and women. Screening for thyroid disease is therefore recommended for women 50 years of age and older.

Acanthosis nigricans is associated with all of the following disorders except: A) Obesity B) Diabetes C) Colon cancer D) Tinea versicolor

Acanthosis nigricans is a benign skin condition that is a sign of insulin resistance. It appears as hyperpigmented velvety areas that are usually located on the neck and the axillae. It is rarely associated with some types of adenocarcinoma of 32. ANSWERS WITh RATIONAlES 703 704 VII. PRACTICE QUESTIONS AND ANSWERS the gastrointestinal tract. Tinea versicolor is a superficial infection of the skin (stratum corneum layer) that is caused by dermatophytes (fungi) of the tinea family. Another name for it is sunspots.

A bulla is defined as: A) A solid nodule less than 1 cm in size B) A superficial vesicle filled with serous fluid greater than 1 cm in size C) A maculopapular lesion D) A shallow ulcer

B) A superficial vesicle filled with serous fluid greater than 1 cm in size This is a blister—a circumscribed, fluid-containing, elevated lesion of the skin, usually more than 5 mm in diameter

Which of the following laboratory test results meet the diagnostic criteria for prediabetes? A) Fasting plasma glucose of 79 mg/dL B) A1C of 5.9% C) Random blood glucose of 200 mg/dL with polyuria, polydipsia, and polyphagia D) Random blood glucose of 200 mg/dL

B) A1C of 5.9% Do not confuse the criteria for diabetes with those for prediabetes. For prediabetes, look for an A1C between 5.7% to 6.4%, fasting plasma glucose (FPG) of 100 to 125 mg/dL, and/or 75-g oral glucose tolerance test (OGTT) 2-hour postprandial glucose of 140 to 199 mg/dL. To diagnose diabetes, look for random blood glucose ≥200 mg/dL with polyuria, polydipsia, and polyphagia, or A1C ≥6.5%, FPG of ≥126 mg/dL, or 2-hour OGTT ≥200 mg/dL (American Diabetes Association, 2016).

A positive psoas and obturator sign is highly suggestive of which of the following conditions? A) Ectopic pregnancy B) Acute appendicitis C) Peritonitis D) Abdominal aortic aneurysm

B) Acute appendicitis Both the psoas and obturator signs are associated with acute appendicitis. When the appendix becomes inflamed or ruptured, the blood and pus irri- tate the psoas and/or obturator muscles, which are both located in the retroperitoneal area. Both muscles are hip flexors and assist with hip movement.

The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for: A) Cholecystitis B) Acute appendicitis C) Inguinal hernia D) Gastric ulcer

B) Acute appendicitis Signs and symptoms of an acute abdomen include involuntary guarding, rebound tenderness, boardlike abdomen, and a positive obturator and psoas sign. A positive obturator sign occurs when pain is elicted by internal rotation of the right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on his or her side with knees extended, or when pain occurs with active flexion of the thigh at the hip.

Extreme tenderness and involuntary guarding at McBurney's point is a significant finding for possible: A) Acute cholecystitis B) Acute appendicitis C) Acute gastroenteritis D) Acute diverticulitis

B) Acute appendicitis Symptoms of an acute abdomen, such as appendicitis, include extreme tenderness and involuntary guarding at McBurney's point. McBurney's point is the name given to the point over the right side of the abdomen that is one third of the distance (approximately 2 inches) from the anterior superior iliac spine to the umbilicus. This point roughly corresponds to the most common location of the base of the appen- dix where it is attached to the cecum. (During pregnancy the location of the appendix changes as the uterus grows.)

Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? A) Chancroid B) Chlamydia trachomatis C) Herpes genitalis D) Pelvic inflammatory disease (PID)

B) Chlamydia trachomatis When diagnosed with gonorrhea, the patient should also be treated for Chlamydia trachomatis.

There is a higher risk of balanitis in which of the following conditions? A) Renal insufficiency B) Diabetes mellitus C) Graves' disease D) Asthma

B) Diabetes mellitus Balanitis is a yeast infection of the glans of the penis. Men who are not circumcised and who have diabetes mellitus are at higher risk for developing balanitis.

Whichofthefollowingdrugclassesisindicatedforinitialtreatmentofanuncomplicated case of Helicobacter pylori-negative peptic ulcer disease? A) Proton-pump inhibitors B) H2 receptor antagonists C) Antibiotics D) Antacids

B) H2 receptor antagonists Because the ulcer is not infected with Helicobacter pylori, antibiotics are not recommended. The first-line treatment option are H2 receptor antagonists (also known as H2 blockers) such as ranitidine (Zantac), famotidine (Pepcid), or nizatidine (Axid). Other causes of peptic ulcer disease are nonsteroidal anti-inflam- matory drugs (NSAIDs); the patient should be educated to avoid use of these agents.

A 10-year-old boy has type 1 diabetes. His late afternoon blood sugars over the past 2 weeks have ranged between 210 mg/dL and 230 mg/dL. He currently injects 10 units of regular insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units of NPH insulin in the evening. Which of the following is the best treatment plan for this patient? A) Increase both types of the morning dose B) Increase only the NPH insulin in the morning C) Decrease the afternoon dose of NPH insulin D) Decrease both NPH and regular insulin doses in the morning

B) Increase only the NPH insulin in the morning Regular insulin is rapid/short-act- ing insulin. Depending on the type of regular insulin, the onset is 10 to 15 minutes and peaks within an average of 1.5 hours, with a duration of 3 to 5 hours. NPH insulin is an intermediate-acting insulin. Depending on the type of NPH insulin, the onset is 1.5 to 3 hours. NPH peaks in 4 to 12 hours, and the duration is from 18 to 24 hours. By increasing the morning NPH, the peak will occur in the afternoon, bringing down the blood glucose.

All of the following are false statements about atopic dermatitis except: A) Contact with cold objects may exacerbate the condition B) It does not have a linear distribution C) It is associated with bullae D) The lesions have vesicles that are full of serous exudate

B) It does not have a linear distribution Atopic dermatitis, also known as eczema, is a skin condition in which the lesions occur in a linear fashion. They may have many differ- ent stages, including erythematous papules and vesicles, with weeping, drainage, and/ or crusting. Lesions are commonly pruritic and are found on the scalp, face, forearms, wrists, elbows, and backs of the knees.

A22-year-old man is brought to an urgent care center by his anxious mother. She reports that her son returned from a camping trip 2 days ago with a high fever and bad head- ache. Apparently, he had complained to her of a painful and stiff neck along with nausea shortly after he returned. The mother states that her son started breaking out in a rash the day before, parts of which are now turning a dark-red to purple color. During the physi- cal exam, the nurse practitioner evaluates the patient for Kernig's sign, which is positive. Which of the following conditions is most likely? A) Stevens-Johnson syndrome B) Meningococcemia C) Rocky Mountain spotted fever D) Erythema multiforme

B) Meningococcemia Kernig's maneuver is performed by flexing both hips and legs and having the patient straighten the legs against resistance, testing for meningitis. A positive test indicates meningitis. Other characteristics of meningitis include high fever, headache, stiff neck, and nausea/vomiting.

A 65-year-old Hispanic woman has a history of type 2diabetes. A routine urinalysis reveals a few epithelial cells and is negative for leukocytes, nitrites, and protein. The serum creatinine is 1.5 mg/dL. Which of the following actions would you recommend next? A) Order a urine test for culture and sensitivity (C&S) B) Order a spot urine for microalbumin-to-creatinine ratio C) Because the urinalysis is negative, no further tests are necessary D) Recommend a screening intravenous pyelogram (IVP)

B) Order a spot urine for microalbumin-to-creatinine ratio The American Diabetes Association (ADA) now prefers a spot urine for the microalbumin-to-creatinine ratio (ACR) test instead of a urine albumin test. Use the first morning void sample. The ACR has high predictive value for albuminuria and early kidney disease in patients with pre- diabetes, diabetes, and hypertension (McCulloch & Bakris, 2016). Because the patient has type 2 diabetes, both an annual urinalysis and an annual ACR test are recommended. Regarding the urinalysis result, a few epithelial cells is within normal limits.

A 28-year-old woman with a history of hypothyroidism presents to an urgent care clinic complaining of numbness and tingling in the fingertips of both her hands for several hours. On examination, both radial pulses are at +2 and equal bilaterally. The patient reports that over the past few months she has had identical episodes, each lasting several hours. During these episodes, the skin changes color from blue to white, and then to dark red. Eventually, it returns to normal and the tingling and numbness disappear. Which of the following conditions is best described? A) Hashimoto's disease B) Raynaud's phenomenon C) Peripheral neuropathy D) Vitamin B12 deficiency anemia

B) Raynaud's phenomenon Raynaud's phenomenon involves an interruption in the blood flow to fingers and toes (sometimes nose and ears), due to spasms in the blood ves- sels. During a Raynaud's attack, the affected area typically turns white, and, as oxygen fails to reach the extremities, they can turn blue, tingle, or throb painfully, and the affected area may swell. Symptoms may resolve quickly or last for hours. Raynaud's disease is more com- mon in women, is not curable, and it is associated with increased risk of other autoimmune diseases such as rheumatoid arthritis or lupus, but treatment can decrease symptoms. The preferred drug is a calcium channel blocker such as nifedipine (Norvasc) or amlodipine (Procardia).

A 40-year-old White woman with a body mass index (BMI) of 32 complains of colicky pain in the right upper quadrant of her abdomen that gets worse if she eats fried food. During the physical exam, the nurse practitioner presses deeply on the left lower quad- rant of the abdomen. After she releases her hand, the patient complains of pain on the right side of the lower abdomen. What is the name of this finding? A) Rebound tenderness B) Rovsing's sign C) Murphy's sign D) Psoas test

B) Rovsing's sign The Rovsing sign is right lower quadrant pain intensified by left lower quadrant abdominal pressure (i.e., pain referred to the opposite side of the abdo- men after release of palpation). It is associated with peritoneal irritation and appendicitis.

Metronidazole (Flagyl) produces the disulfiram (Antabuse) effect when combined with alcoholic drinks or medicine. You would educate the patient that: A) She should avoid alcoholic drinks during the time she takes the medicine B) She should avoid alcoholic drinks 1 day before, during therapy, and a few days after therapy C) She should avoid alcoholic drinks after she takes the medicine D) There is no need to avoid any food or drink

B) She should avoid alcoholic drinks 1 day before, during therapy, and a few days after therapy The patient should avoid alcoholic drinks during and for at least 3 days after therapy with metronidazole (Flagyl). Flagyl and alcohol together cause severe nau- sea and vomiting, flushing, fast heartbeat (tachycardia), and shortness of breath. The reaction has been described as being similar to the effects of Antabuse.

A middle-aged patient newly diagnosed with type 2 diabetes wants to start an exercise program. All of the following statements are true except: A) If the patient is unable to eat due to illness, antidiabetic agents can be continued with frequent glucose monitoring B) Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes C) Exercise increases the body's ability to metabolize glucose D) Patients who exercise vigorously in the afternoon may have hypoglycemic episodes in the evening or at night if they do not eat

B) Strenuous exercise is contraindicated for most patients with type 2 diabetes because of a higher risk of hypoglycemic episodes Exercise is recommended because exercise helps to use the glucose stores and reduce blood sugar. When exercising, the patient should monitor blood sugar closely, especially if using insulin, to avoid hypoglycemia

An 18-year-old female patient is being followed up for acne by the nurse practitioner. During the facial exam, papules and pustules are noted mostly on the forehead and the chin areas. The patient has been using prescription topical medications and over- the-counter medicated soap daily for 6 months without much improvement. Which of the following would the nurse practitioner recommend next? A) Isotretinoin (Accutane) B) Tetracycline (Sumycin) C) Clindamycin topical solution (Cleocin T) D) Minoxidil (Rogaine)

B) Tetracycline (Sumycin) First-line treatment for acne vulgaris includes over-the- counter medicated soap and water with topical antibiotic gels. The next step in treat- ment would be the initiation of oral tetracycline.

A 70-year-old woman complains of left lower quadrant abdominal pain and fever for 2 days. Her blood pressure of 130/80 mmHg, pulse is 90 beats/min, respirations are 14 breaths/min, and temperature is 100.5°F. During the abdominal exam, the left lower quadrant of the abdomen is tender to palpation. The nurse practitioner (NP) does not palpate a mass; neither is there guarding or rigidity. Rovsing's sign is negative. Bowel sounds are present in all quadrants. The NP is familiar with the patient, who is alert and is asking appropriate questions about her condition. The nurse practitioner suspects that the patient has acute diverticulitis. Which of the following treatment plans is appropriate for this patient? A) The patient should be referred to the physician as soon as possible B) The patient has a mild case of acute diverticulitis and can be treated with antibiotics in the outpatient setting with close follow-up C) This patient has a moderate to severe case of acute diverticulitis and needs to be admitted to the hospital for IV antibiotics D) The patient should be referred to the emergency department as soon as possible

B) The patient has a mild case of acute diverticulitis and can be treated with antibiot- ics in the outpatient setting with close follow-up The patient has a mild case of acute diverticulitis and can be treated as an outpatient with antibiotics and a clear fluid diet. If outpatient treatment is selected, close follow-up (within 24-48 hours) is very impor- tant. Instruct patients to go to the hospital if symptoms get worse, if fever increases, if unable to tolerate PO treatment, and if pain worsens. Order a complete blood count (to check for leukocytosis, neutrophils, and possible shift to the left), chemistry profile, and urinalysis (to rule out renal causes).

The best screening test for both hyperthyroidism and hypothyroidism is: A) Free T4 (thyroxine) B) Thyroid-stimulating hormone (TSH) C) Thyroid profile D) Palpation of the thyroid gland

B) Thyroid-stimulating hormone (TSH) The best screening test for both hypothyroid- ism and hyperthyroidism is TSH level. A normal TSH rules out primary hypothyroidism in asymptomatic patients. Abnormal TSH should be followed by determination of thy- roid hormone levels. Overt hypothyroidism is defined as a clinical syndrome of hypothy- roidism associated with elevated TSH and decreased serum levels of T4 or T3. Subclinical hypothyroidism is defined as a condition without typical symptoms of hypothyroidism, elevated TSH (>5 μU/mL), and normal circulating thyroid hormone. Overt thyrotoxicosis is defined as the syndrome of hyperthyroidism associated with suppressed TSH and elevated serum levels T4 or T3. Subclinical thyrotoxicosis is devoid of symptoms, but TSH is suppressed, although there are normal circulating levels of thyroid hormone.

Rocky Mountain spotted fever is caused by the bite of a: A) Mosquito B) TickC) LouseD) Flea

B) Tick Rocky Mountain spotted fever is caused by a bite from a tick infected with the parasite Rickettsia rickettsii. The mortality rate is 1% to 7% if left untreated.

You have diagnosed a 30-year-old male patient with contact dermatitis on the left side of the face secondary to poison ivy. You would recommend: A) Washing with antibacterial soap BID to reduce risk of secondary bacterial infection until it is healed B) Zanfel poison ivy wash C) Clotrimazole (Lotrimin) cream BID for 2 weeks D) Halcinonide (Halog) 1% ointment BID for 2 weeks

B) Zanfel poison ivy wash Zanfel is a soap-like product (OTC) that removes uru- shiol oil from poison ivy, poison sumac, and poison oak. It will relieve the itch and pain quickly. A topical steroid can be used to speed up healing. For rashes, hydrocortisone cream 1% BID (OTC) is helpful.

The nurse practitioner is evaluating a middle-aged woman who has experienced gradual weight gain, lack of energy, dry hair, and an irregular period for the past 8 months. Routine annual laboratory testing showed a thyroid-stimulating hormone (TSH) level of 10 mU/L. The nurse practitioner decides to order a thyroid profile. Results show that TSH is 8.50 mU/L and serum free T4 is decreased. During the physical exam, the patient's body mass index (BMI) is 28. The heart and lung exams are both normal. Which of the following is the best treatment plan for this patient? A) Advise the patient that the decreased thyroid-stimulating hormone (TSH) level means her thyroid problem has resolved B) Start the patient on levothyroxine (Synthroid) 0.25 mcg PO daily C) Start the patient on Armour thyroid D) Refer the patient to an endocrinologist

B)Start the patient on levothyroxine(Synthroid) 0.25mcg PO daily The patient is symptomatic (weight gain, lack of energy, and irregular periods) with low free T4. Even though the thyroid-stimulating hormone (TSH) level decreased slightly, the free T4 remains low. An elevated TSH and low free T4 are indicative of hypothyroidism. The next step is to start the patient on levothyroxine (Synthroid) 0.25 mcg daily and recheck the TSH in 6 weeks. The goal is to normalize the TSH (between 1.0 and 3.5) and to ameliorate the patient's symp- toms (increased energy, feels better, etc.). Armour thyroid (desiccated thyroid) is a natural supplement composed of dried (desiccated) pork thyroid glands. It is used in alternative medicine as an alternative to synthetic levothyroxine/T4 (Synthroid).

The following skin findings are considered macules except: A) A freckle B) Petechiae C) Acne D) A flat, 0.5-cm brown birthmark

C) Acne A macule is a flat, nonraised lesion on the skin. Acne lesions are papules because they consist of raised, erythemic lesions on the skin. A freckle, petechiae, and a flat birthmark are all considered macules.

Which of the following is used to confirm a diagnosis of Hashimoto's thyroiditis? A) Serum thyroid-stimulating hormone (TSH) B) Free T4 test C) Anti-thyroid peroxidase and anti-thyroglobulin antibodies D) Thyroid ultrasound

C) Anti-thyroid peroxidase and anti-thyroglobulin antibodies These are the two types of antibodies that are positive in Hashimoto's thyroiditis. Anti-thyroid peroxidase antibody is also known as antimicrosomal antibody. Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States. The serum TSH and free T4 test are tests for hypothyroidism, but they are not specific for Hashimoto's thyroiditis, an autoimmune disease.

A 16-year-old male patient with psoriasis is scratching and rubbing one of the psoriatic plaques located on his right elbow. Fine silvery scales with pinpoint areas of bleeding are noted on the plaque. What is the name of this clinical finding? A) Erosion B) Lichenification C) Auspitz sign D) Koebner phenomenon

C) Auspitz sign Auspitz sign is observed when a psoriatic lesion is scraped or scratched multiple times, resulting in pinpoint areas of bleeding on the psoriatic plaque. Lichenification is thickened skin caused by chronic irritation (itching). It is considered a secondary lesion. Another type of secondary skin lesion is an erosion, which occurs with loss of epidermis (but not the dermis). It can resemble a shallow ulcer. The Koebner phe- nomenon refers to lesions (often linear) that appear on the skin of patients with psoriasis as a result of trauma to the skin (e.g., scratching).

All of the following may help relieve the symptom(s) of gastroesophageal reflux disease (GERD) except: A) Losing weight B) Stopping caffeine intake C) Chewing breath mints D) Stopping alcohol intake

C) Chewing breath mints Gastroesophageal reflux disease (GERD) is a condition in which food comes up the esophagus from the stomach because of a weak sphincter. The reflux is usually worsened by lying down, and can cause a cough and esophageal irritation if not treated. Effective treatment may include weight loss, decreased caffeine intake, and avoidance of alcohol.

A 55-year-old male patient with a body mass index (BMI) of 30 has a history of angina and type 2 diabetes. His lipid profile results are total cholesterol of 280 mg/dL, low-density lipoprotein (LDL) of 195 mg/dL, and high-density lipoprotein (HDL) of 25 mg/dL. The nurse practitioner diagnoses him with hyperlipidemia and wants to start him on statin therapy. What intensity of treatment is recommended for this patient? A) Low-intensity statin B) Moderate-intensity statin C) High-intensity statin D) Very high-intensity statin

C) High-intensity statin This patient fulfills the criteria for high-intensity statin dos- ing criteria from the 2013 American College of Cardiology/American Heart Association (ACC/AHA) blood cholesterol guideline. He already has heart disease (angina), type 2 diabetes, low-density lipoprotein (LDL) of 195 mg/dL, and low high-density lipopro- tein (HDL) of 25 mg/dL. This patient is at very high risk for heart disease and war- rants a high-intensity dose of statin. There are only two choices at this level: atorvastatin (Lipitor) 40 to 80 mg or rosuvastatin (Crestor) 20 to 40 mg.

The Somogyi effect is characterized by which of the following? A) It is a complication of high levels of growth hormone B) It is the physiological spike of serum blood glucose in the early morning that is caused by secretion of growth hormone C) It is characterized by high fasting blood glucose in the morning that is caused by the secretion of glucagon by the liver D) It is a rare phenomenon that only occurs in type 1 diabetic patients

C) It is characterized by high fasting blood glucose in the morning that is caused by the secretion of glucagon by the liver The Somogyi phenomenon or Somogyi effect occurs when nocturnal hypoglycemia (2 a.m.-3 a.m.) stimulates the liver to produce glucagon, which causes the fasting blood glucose to become elevated. It is also known as the "rebound effect."

All of the following are true statements about diverticula except: A) Diverticula are located in the colon B) A low-fiber diet is associated with the condition C) Most diverticula in the colon are infected with gram-negative bacteria D) Supplementing with fiber, such as psyllium (Metamucil), is recommended

C) Most diverticula in the colon are infected with gram-negative bacteria Diverticula in the colon can be infected with both gram-negative and gram-positive bacteria.

All of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except: A) Patients with renal disease B) Patients with hypoxia C) Obese patients D) Patients who are alcoholics

C) Obese patients Metformin is used for initial therapy for type 2 diabetes. In patients who are obese, it can help with weight loss. The starting dose is 500 mg once a day. Maximum dose is 2 g or 2,000 mg/day. Titrate dose slowly to minimize side effects (fla- tus, bloating, and diarrhea). Contraindications to the use of metformin include signifi- cant renal and hepatic disease, alcoholism, conditions associated with hypoxia (cardiac/ pulmonary problems), sepsis, dehydration, and advanced age.

A 13-year-old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with over-the-counter benzoyl peroxide and topical salicylic acid products. Which of the following would be recommended next? A) Isotretinoin (Accutane) B) Tetracycline C) Retin-A 0.25% gel D) Careful face washing with medicated soap at bedtime

C) Retin-A 0.25% gel Topical agents are the first-line treatment for acne vulgaris. Retin-A 0.25% gel would be the next step. Oral preparations (tetracycline) would then be offered, and Accutane would be the final step.

A new patient who recently visited a relative in North Carolina complains of an onset of fever and red rashes that started 2 days ago. The rash first appeared on the wrist and the ankles and included the palms of the hands. The patient reports that it is spreading toward his trunk. The patient's eyes are not injected and no enlarged nodes are palpated on his neck. There is no desquamation of the skin. Which of the following is most likely? A) Kawasaki's disease B) Meningococcemia C) Rocky Mountain spotted fever D) Measles

C) Rocky Mountain spotted fever Given the location in the East, Rocky Mountain spotted fever is most likely the infection causing symptoms of fever and a rash on ankles and wrists, moving to the palms of the hands and the trunk. Rocky Mountain spotted fever is caused by the bacterium Rickettsia rickettsii, which is transmitted by a bite from an infected tick.

Which of the following laboratory tests would you order for an older diabetic man with the following complete blood count (CBC) results: hemoglobin = 11 g/dL, hematocrit = 38%, mean corpuscular volume (MCV) = 105 fL, and normal reticulocyte count? A) Serum ferritin and a peripheral smear B) Hemoglobin electrophoresis C) Serum folate acid and B12 level D) Schilling test

C) Serum folate acid and B12 level The patient has macrocytic anemia (MCV 102). The differential diagnoses are B12 deficiency and folate deficiency anemia. Initial test is the serum folate and B12 level. Other tests for macrocytic/megaloblastic anemias are the peripheral smear, methylmalonic acid, and homocysteine level. If B12 deficiency, order anti-parietal antibodies to check for pernicious anemia.

89. A 73-year-old patient complains of recent episodes of acute-onset left-sided facial asym- metry, slurred speech, weakness, and dizziness, accompanied by weakness of the left arm and left leg. She reports that the episodes occur at random and last from 30 minutes to about 2 hours. Each episode resolved completely. The patient has type 2 diabetes with hyperlipidemia, peripheral arterial disease, hypertension, and osteoporosis. Her symp- toms suggest: A) Benign paroxysmal positional vertigo B) Ménière's disease C) Transient ischemic attack (TIA) D) Cerebrovascular accident (CVA)

C) Transient ischemic attack (TIA) Transient ischemic attack (TIA) is a transient epi- sode of ischemia in the brain, retina, or spinal cord without acute infarction. About 10% to 20% of patients with TIA will have a stroke within 90 days. TIA signs and symptoms are acute onset of facial asymmetry, slurred speech, weakness, monocular visual loss, headache, and hemiplegia that resolves within minutes to several hours. TIA is a neu- rological emergency; should undergo brain imaging (MRI preferred) within 24 hours of onset.

Symptoms suggestive of ulcerative colitis include all of the following except: A) Bloody diarrhea mixed with mucus B) Nausea and vomiting C) Weight gain D) Abdominal pain

C) Weight gain Symptoms of ulcerative colitis include bloody diarrhea mixed with mucus, nausea/vomiting, abdominal pain, and possible weight loss with long-term diarrhea.

All of the following patients should be screened for diabetes mellitus except: A) An obese man of Hispanic descent B) An overweight middle-aged Black woman whose mother has type 2 diabetes C) A woman who delivered an infant weighing 9.5 lbs D) A 30-year-old White man with hypertension

D) A 30-year-old White man with hypertension The 30-year-old White man with hypertension would be the last patient to be screened for diabetes. Not having any infor- mation about him also puts him lower on the list. Obesity, ethnicity (Hispanic/Latino Americans, African Americans, Native Americans, Asian Americans, Pacific Islanders, and Alaska natives), family history of diabetes, and gestational diabetes (mother of the infant weighing 9.5 lbs) are all risk factors. These were present in all of the other selec- tions. Other risk factors for diabetes include impaired glucose tolerance test, sedentary lifestyle, polycystic ovary syndrome (PCOS), and hypertension.

You would associate a positive iliopsoas muscle test result with which of the following conditions? A) Left cerebral vascular accident B) Urinary tract infection C) Heel fractures D) Acute appendicitis

D) Acute appendicitis A positive iliopsoas muscle test may be seen with acute appen- dicitis. The right iliopsoas muscle lies under the appendix, This test is performed by ask- ing the patient to actively flex the thigh at the hip. A "positive psoas sign" is noted when the patient exhibits pain in the right lower quadrant due to the inflamed tissue.

Which of the following laboratory tests is the most sensitive test for evaluating an active Helicobacter pylori infection of the stomach or duodenum: A) Helicobacter pylori titer B) Fasting gastrin level C) Upper GI series D) Urea breath test

D) All of the above The urea breath test is a very sensitive test used to evaluate a patient for an active Helicobacter pylori infection. It can also be used to document treat- ment response after a treatment regimen of antibiotics (14 days) and proton-pump inhib- itor (PPI) therapy.

203. An obese Asian patient with BMI (body mass index) of 33 complains of fatigue, and excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing to con- firm diagnosis can include: A) Fasting plasma glucose level B) Glycated hemoglobin level (A1C) C) Oral glucose tolerance testing D) All of the above

D) All of the above Type 2 diabetes mellitus screening tests include fasting plasma glucose level (>126 mg/dL), random plasma glucose level (>200 mg/dL), and oral glu- cose tolerance testing (2-hour blood glucose level >200 mg/dL) with a 75-g glucose load. Normal A1C levels are less than 6%.

270. When a patient is suspected of having acute pancreatitis ,initial testing should include all of the following except: A) Electrolyte panel B) Serum amylase level C) Serum lipase level D) Barium swallow

D) Barium swallow When a patient has acute abdominal pain, initial labs performed are serum electrolytes, amylase, and lipase. Barium swallow would not be performed initially.

Which of the following regimens is known as "triple therapy" for treating a Helicobacter pylori infection? A) Metronidazole (Flagyl) BID, doxycycline BID, and omeprazole (Prilosec) daily B) Bismuth subsalicylate (Pepto-Bismol) tablets QID, metronidazole (Flagyl) QID, azithromycin (Zithromax), and cimetidine (Tagamet) daily C) Amoxicillin BID, sulfamethoxazole-trimethoprim (Bactrim DS) BID, and ranitidine (Zantac) daily D) Clarithromycin (Biaxin) BID, amoxicillin BID, and omeprazole (Prilosec) daily

D) Clarithromycin (Biaxin) BID, amoxicillin BID, and omeprazole (Prilosec) daily This combination is known as "triple therapy" for the treatment of peptic ulcer disease caused by the bacterium Helicobacter pylori. The original quadruple therapy consists of bismuth subcitrate (Pepto Bismol), metronidazole, and tetracycline with a proton-pump inhibitor (PPI) or H2 blocker. The antibiotics are taken for 14 days with a PPI or an H2 blocker, and then the PPI or H2 blocker is continued for 2 to 4 weeks after. Currently, there are several regimens for treating H. pylori infection. To confirm eradica- tion, order a urea breath test or fecal antigen test.

A common side effect of metformin (Glucophage) therapy is: A) Weight gain B) Lactic acidosis C) Hypoglycemic episodes D) Diarrhea

D) Diarrhea Common side effects of metformin (Glucophage) include diarrhea, stom- ach pain, nausea, and flatulence.

A lipid profile for a newly diagnosed hypertensive patient with a BMI(body mass index) of 27 shows a triglyceride level of 950 mg/dL, total cholesterol of 240 mg/dL, LDL (low density lipoprotein) of 145 mg/dL, and HDL (high-density lipoprotein) of 45 mg/dL. What is the best intervention for this patient? A) Educate the patient about lifestyle changes that will help lower cholesterol levels B) Initiate a prescription of metformin (Glucophage) C) Recommend that the patient exercise at least 30 minutes daily D) Initiate a prescription of fenofibrate (Tricor)

D) Initiate a prescription of fenofibrate (Tricor) A triglyceride level above 800 mg/dL is considered to be "very high"; there is an increased risk of acute pancreatitis, especially if the patient also drinks alcohol. Two fibrate drugs have been approved for use in the United States: fenofibrate (Tricor) and gemfibrozil (Lopid). Another option is nicotinic acid, but fibrates are more potent and better tolerated. In addition, lifestyle changes are important; these include avoiding foods with concentrated sugars, alcohol, weight loss if overweight or obese, and regular, moderate to intense aerobic exercise.

Which of the following findings is associated with thyroid hypofunction? A) Graves' disease B) Eye disorder C) Thyroid storm D) Myxedema

D) Myxedema Myxedema (or myxedema) is seen in patients with severe hypothyroid- ism. It refers to the skin changes (thickened skin) seen in chronic severe hypothyroid- ism. Myxedema coma is a medical emergency with mortality rates exceeding 20%. It is treated with very high doses of thyroid hormone. A thyroid storm occurs when there is extreme elevation of thyroid hormones. Thyroid storm is life-threatening; untreated, the mortality rate is about 90%. Call 911 if suspected.

Which of the following eye findings is seen in patients with diabetic neuropathy? A) Arteriovenous nicking B) Copper wire arterioles C) Flame hemorrhages D) Neovascularization

D) Neovascularization Patients with diabetes often develop ophthalmic complica- tions, such as neovascularization, which is the formation of new fragile blood vessels in the retina. Other signs of diabetic retinopathy are dot and blot hemorrhages, microaneu- ryms, and "cotton wool" spots (soft exudates). In the initial stages of diabetic retinopathy, patients are generally asymptomatic, but in more advanced stages of the disease patients may experience floaters, as well as distortions, blind spots (scotomas) and/or blurred vision. Diabetic retinopathy is the most common cause of blindness in adults. Screening for diabetic retinopathy is recommended for type 2 diabetics at the time of diagnosis. Arteriovenous nicking (AV nicking), copper wire arterioles, and flame hemorrhages are associated with hypertensive retinopathy.

Which of the following symptoms in an older male patient with a history of gastroesophageal reflux disease is most worrisome? A) Chronic heartburn B) Recurrent regurgitation of sour-tasting food C) Hoarseness and sore throat D) Odynophagia and early satiety

D) Odynophagia and early satiety Worrisome symptoms in patients with gastro- esophageal reflux disease (GERD) include odynophagia, early satiety, weight loss, iron-deficiency anemia, gastrointestinal bleeding, and recurrent vomiting. Symptoms of odynophagia and early satiety in a patient with GERD should prompt a workup to rule out esophageal cancer.

A female patient, who has a BMI (body mass index) of 29 has a 20-year history of primary hypertension. She has been taking hydrochlorothiazide 25 mg PO daily with excellent results. On this visit, she complains of feeling thirsty all the time even though she drinks more than 10 glasses of water per day. She reports to the nurse practitioner that she has been having this problem for about 6 months. Upon reading the chart, the nurse practitioner notes that the last two fasting blood glucose levels have been 140 mg/dL and 168 mg/dL. The result of a random blood glucose test is 210 mg/dL. Which of the following is the appropriate action to follow at this visit? A) Order another random blood glucose test in 2 weeks B) Initiate a prescription of metformin (Glucophage) 500 mg PO BID C) Order a 3-hour glucose tolerance test D) Order an A1C level

D) Order an A1C level. The next step is to check the A1C level. The treatment goal is an A1C less than 7%. But if the patient is frail or has frequent hypoglycemic episodes, the American Diabetes Association allows a goal of up to 8%. If the A1C level is 6.5 or higher, the patient has type 2 diabetes.

All of the following medications have drug interactions with levothyroxine (Synthroid) except: A) Antacids B) Tricyclic antidepressants C) Anticoagulants D) Penicillins

D) Penicillins Levothyroxine does not interact with penicillins. But it does have numerous drugs it interacts with such as anticoagulants, tricyclic antidepressants, antac- ids and calcium, iron, multivitamins, proton-pump inhibitors, estrogens, statins, metfor- min, and others. Certain foods interfere with absorption (calcium-fortified foods, dietary fiber, walnuts, soy). Patients should avoid taking them together, and should space these foods and drugs several hours apart. Levothyroxine (Synthroid) is a synthetic form of T4.

Which of the following conditions is associated with a positive Auspitz sign? A) Contact dermatitis B) Seborrheic dermatitis C) Systemic lupus erythematosus D) Psoriasis

D) Psoriasis The Auspitz sign is simply bleeding that occurs after psoriasis scales have been removed. It occurs because the capillaries run very close to the surface of the skin under a psoriasis lesion, and removing the scale essentially pulls the tops off the capillaries, causing bleeding. Auspitz sign is also found in other scaling disorders such as actinic keratoses.

Amalepatienthastype2diabetesmellitusanda"sensitivestomach."Whichmedication is least likely to cause him gastrointestinal distress? A) Naproxen sodium (Anaprox) B) Aspirin (Bayer's aspirin) C) Erythromycin (E-mycin) D) Sucralfate (Carafate)

D) Sucralfate (Carafate) Naproxen sodium, aspirin, and erythromycin all have gas- trointestinal side effects. Sucralfate is used to protect the stomach lining by building a protective layer over the stomach lining; it allows healing to occur.

A 74-year-old man presents with recurrent abdominal cramping and pain associated with diarrhea that occurs from four to five times per day. He reports that currently he is having an exacerbation. The stools are bloody with mucus and pus. The patient reports that he has lost weight and is always fatigued. The patient denies recent travel or outdoor camping. Which of the following conditions is most likely? A) Giardiasis B) Irritable bowel syndrome (IBS) C) Diverticulitis D) Ulcerative colitis

D) Ulcerative colitis The most important clue for ulcerative colitis is bloody stools that are covered with mucus and pus along with the systemic symptoms (fatigue, low-grade fever).

A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with: A) Contact dermatitis B) Impetigo C) Larva migrans D) Scabies

D)Scabies Scabiesisaparasiticdisease(infestation)oftheskincausedbythehumanitch mite Sarcoptes scabiei. The rash is generally characterized as red, raised excoriated papules. The scabies mite is generally transmitted from one person to another by direct contact with the skin of the infested person and can also be acquired by wearing an infested person's clothing (fomites), such as sweaters, coats, or scarves. Following the incubation period, the infested person will complain of pruritus (itching), which intensifies at bedtime under the warmth of the blankets. Common sites of infection are the webs of fingers, wrists, flexors of the arms, the axillae, lower abdomen, genitalia, buttocks, and feet.