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2012-05-09 21:16:32
Primary Care Families II

Final exam cards
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  1. Osteomyelitis can be acute or chronic. All of the following are signs/symptoms of acute disease process except?
    a. Fever is present
    b. Develops over several months
    c. Localized inflammatory process is evident
    d. Leukocytosis is present
  2. Ms. Kilbane presents today with complaint of swelling, redness and warmth in her foot. She denies recent trauma. PMI includes: diabetes, smoking and mild obesity. You suspect a Charcot joint which is:
    a. An acute bone infection
    b. A progressive destructive arthritis
    c. An infection in the joint space
    d. Another term for gouty arthritis
  3. Mr. Jones, 82, is seen today for anticoagulation management following his recent knee surgery. He complains of his surgical knee being painful, swollen, red and warm to touch. PMI includes: OA, HTN, mild obesity. After your examination you
    • a. Explain to Mr. Jones this is a normal part of the healing process and prescribe RICE for 3 days
    • b. Explain to Mr. Jones you are concerned about osteomyelitis and order and MRI.
    • c. Explain to Mr. Jones he has gouty arthritis and prescribe colchicine.
    • d. Explain you are concerned that he may have septic arthritis and you order lab work including a culture of the synovial fluid of the affected knee.
  4. A specific assessment finding associated with Charcot Joint is
    a. Brudzinski’s sign
    b. Babinski’s sign
    c. Boas’ sign
    d. Brodsky
  5. A patient presents to the clinic with low back pain. Which of the following symptoms would require immediate physician consultation?
    a. Back pain associated with neurologic deficit
    b. Decreased or absent pulses
    c. Bowel or bladder dysfunction
    d. All of the above
  6. Which of the following diagnostics in primary care may be considered INITIALLY in a patient with the symptom of lower back pain?

    a. X-ray
    b. MRI
    c. A & B
    d. CT scan
  7. Which of the following is NOT a clue that would suggest underlying
    systemic disease in a patient presenting with back pain?
    a. Age under 50 years
    b. History of cancer
    c. Unexplained weight loss
    d. Duration of pain > 1 month
  8. A patient with Lumbar spinal stenosis presenting with pseudoclaudication would have:
    a. Leg pain during rest
    b. Leg pain during ambulation, improving with rest
    c. No numbness
    d. Pain that does not radiate to the feet
  9. Clinicians often commit one of the 8-D’s when overprescribing. Which of the following is not one of
    the 8-D’s?
    A. Deceived
    B. Distracted
    C. Deliberate
    D. Discomfort
  10. Which of the following has the highest abuse potential?
    A. Buprenorphine
    B. Benzos
    C. Hydrocodone
    D. Oxycodone
  11. Which of the following would be a sign that a patient may have a drug abuse problem?
    A. Working in a healthcare setting
    B. Use of alcohol, tobacco, or marijuana at a young age
    C. Past addiction
    D. All of the above
  12. How can the PsychMental health Provider help you as a provider?
    A. Determine treatment history
    B. Tell you who is caught selling prescription meds
    C. Deter illegitimate use of prescription drugs
    D. Both A & C
  13. A patient with a PE will have which of the following manifestations?
    a. shortness of breath
    b. tachypnea
    c. chest discomfort
    d. All of the above
  14. All of the following would be a cardioselective B1 receptors that you
    may want to prescribe to this patient with angina except?
    a. Atenolol (Tenormin)
    b. Carvediol (Coreg)
    c. Acebutolol (Sectral)
    d. Metoprolol (Lopressor)
  15. What type of angina is often precipitated by exertion, relieved with rest or nitroglycerin, and has a predictable pattern?
    a. Chronic stable angina
    b. Variant angina
    c. Microvascular angina
    d. Unstable Angina
  16. If you sent your patient for an exercise stress test for angina symptoms and the results showed a lateral reversible defect with an EF of less than 40% what medication would you prescribe to this patient based on
    their low EF?
    a. Beta blocker
    b. Calcium channel blocker
    c. ACE inhibitor
    d. ARB
  17. There are several grades of rotator cuff injury. Which of the following grades is caused by chronic degenerative changes and is commonly seen in middle aged adults.
    a. Grade I
    b. Grade II
    c. Grade III
    d. Grade IV
  18. Which of the following conditions is characterized by the inflammation, swelling and tenderness of the tendons?
    a. Bursitis
    b. Tendinitis
    c. Muscle strain.
    d. Rotator cuff syndrome
  19. Which of the following theories is used to explain the mechanism of injury to the rotator cuff?
    a. Degeneration
    b. Impingement
    c. Tension overload
    d. All of the above
  20. Which of the following is NOT a treatment plan for a patient with rotator cuff damage/ tear?
    a. Overhead activities does not need to be avoided.
    b. Once pain has subsided, muscle strengthening activity must be performed 2-3 times daily to maintain function and prevent adhesive capsulitis.
    c. Rest, ice application, activity modification, physical therapy and NSAIDs are necessary for healing.
    d. If conservative therapy fails, corticosteroid injections and surgery can be considered.
  21. The exam to test for meniscal tears is called the:
    a) Murphy’s test
    b) McMurray tes
    tc) McBurney’s test
    d) Murray test
  22. Another test indicative of meniscal tears is:
    a) the squat and duck walk test
    b) the kick and release test
    c) the twist and shout test
    d) the high squat test
  23. The diagnostic test most specific to meniscal pathology is:
    a) The MRI
    b) The CT scan
    c) X-rays
    d) Bone scan
  24. Movements to avoid with a possible meniscal tear in the knee are all BUT:
    a) Squats
    b) Lunges
    c) Planting and twisting
    d) Straight leg raises
  25. What is an uncontrollable risk factor for patient
    who have a CVA?
    A. Race
    B. Tobacco Abuse
    C. Physical Inactivity
    D. Hyperlipidemia
  26. What is the most important diagnostic test for a patient to have done if suspected a CVA?
    A. Chest X-ray
    B. CT or MRI
    C. Ultrasound
    D. KUB
  27. What is a major risk factor of a CVA if left untreated?
    A. Hypertension
    B. Atrial Fibrillation
    C. Hyperlipidemia
    D. All the above are correct
  28. The First symptom the patient complains about
    if they are having an intracranial hemorrhage?
    A. My legs are numb and weak
    B. This is the worst headache of my life
    C. Dyspnea
    D. Nausea and vomiting
  29. The following medications are used for acute flares of gout:
    B. Corticosteroids
    C. triamcinolone injection
    D. All of the above
  30. The following statements about gout are true:
    A. Gout is an inflammatory process due to the deposits of calciumpyrophosphate crystals in the joint
    B. Hyperuricemia by itself causes gout
    C. Risk factors are male gender, age 40-50, obesity and alcohol intake
    D. all of the above
  31. The following food(s) contain purines:
    A. oranges
    B. milk
    C. sweetbreads
    D. corn
  32. Gout often occurs after:
    A. Stress
    B. Surgery
    C. Trauma
    D. All of the above
  33. Approximately 20% of patients with cholecystitis present with jaundice. We know this is a result of:
    a. The gallstones obstructing the bile duct preventing
    bile secretion into the small intestine
    b. The gallstones obstructing the bile duct creating
    more bile secretion into the small intestine
    c. The gallstones causing blockage which cause more
    bile to back up into the duodenum
    d. The gallstones causing blockage which leads to
    acute liver failure
  34. With regards to abdominal pain and the possible diagnoses listed in the power point, what would be the rationale for the findings of: bacteria and WBCs in a urinalysis?
    a. Bacteria in the urine would be a result of long
    term use of PPIs
    b. Bacteria in the urine would suggest a fistula
    c. WBCs in the urine if the inflammatory process is
    adjacent to the bladder or ureter
    d. Both B and C
  35. What are the two common causes of Peptic Ulcer Disease in the United States?
    a. H. pylori and Proton pump inhibitors
    b. H. pylori and Antibiotics
    c. NSAIDS and H. Pylori
    d. NSAIDS and Chemotherapy drugs
  36. When suspecting a perforated peptic ulcer, the practitioner’s FIRST course of action should be to:
    a. Give the patient a prescription for broad spectrum
    b. Order an abdominal x-ray and abdominal ultrasound
    to be completed that day
    c. Prescribe a proton pump inhibitor or H2 blocker
    d. Immediately send them to a hospital and consult
    with a surgeon
  37. All of the following are true concerning Irritable bowel Syndrome patient teaching except:
    a. It is a benign disorder
    b. There is no organic cause therefore symptoms are “in their head”
    c. Treatment aims at normalizing bowel habits
    d. It is important to identify psychological stressors
    leading to flares
  38. Those with coexisting psychiatric disorders and IBS:
    a. Are less likely to have IBS symptoms resolve
    b. May require higher doses of SSRIs than general
    population for IBS treatment
    c. Should be managed by a Psychiatrist for IBS symptoms
    d. Symptoms really are in their head
  39. Those with IBS and no clinical red flags should be evaluated for:
    a. Inflammatory bowel diseases
    b. Autoimmune diseases
    c. Malabsorption disease (Celiac disease)
    d. Infective gastrointestinal diseases
  40. Red flags for IBS include:
    a. A history of foreign travel
    b. Lower abdominal discomfort associated with diarrhea
    and menses
    c. Hemorrhoids and blood on tissue with wiping
    d. Family history of colon cancer and anemia
  41. Which of the following can be presenting symptoms in a patient with an esophageal stricture? Please select all that apply.
    a. Chest pain
    b. Dysphagia
    c. Odynophagia
    d. Heart burn
    a, b, c, & d
  42. In a patient with suspected achalasia, which of the following
    should alert the clinician towards the diagnosis?
    a. Isolated heartburn
    b. Simultaneous dysphagia for solids and
    c. Fatigue
    d. Diarrhea
  43. In your patient with known GERD, how does a hiatal hernia impact this diagnosis, and how might the two be related?
    Please select all that apply.
    a. Not at all
    b. The hernia acts as a trap, allowing longer
    contact time for the acid
    c. The GERD may have contributed to the hiatal
    hernia formation by causing fibrosis
    d. The GERD eroded the diaphragm, allowing
    an opening into the chest cavity
    b & c
  44. For your patient complaining of dysphagia and odynophagia,
    which of the following are appropriate tests? Please select all that apply.
    a. MRI
    b. EGD
    c. Barium swallow
    d. Chest CT
    b & c
  45. What is the most common presenting skin symptom of Lupus?
    a. Rash on skin exposed areas
    b. Malar rash
    c. Dry skin
    d. Mouth sores
    b – Malar rash
  46. In differentiating between a Malar rash and other facial rashes, it’s important to note that:
    a. A malar rash forms the shape of butterfly wings on the face
    b. The rash extends over the nose
    c. The rash is not apparent on nasolabial folds
    d. All of the above
    d – the rash forms the shape of butterfly wings, extends over the nose and is not apparent on nasolabial folds
  47. What symptom signifies worsening (SLE) disease and is a poor prognostication
    of disease outcome?
    a. Pericarditis
    b. Thrombophlebitis
    c. Hypertension
    d. Pleuritis
    c -hypertension is a symptom that signifies renal involvement. Inflammation and tissue scaring as a result of autoimmune destruction signifies progressive disease and is a poor prognosis for the patient.
  48. The gold standard for diagnosis of SLE is:
    A. Review of ANA, CBC, CMP, UA and ESR
    B. Referral to Rheumatology for definitive diagnosis and initial treatment
    C. Presence of symmetrical joint inflammation and pain
    D. Presence of pain with palpation in 11 out of 18 target areas
    B. The gold standard for diagnosis is referral to rheumatology and collaborative care after initiation of treatment.
    (this multiple choice question has been scrambled)
  49. Which of the following is not an associated side effect of medication used to treat bipolar disorder?
    a. Dry mouth
    b. Insomnia
    c. tremors
    d. sialorrhea
    d is incorrect, sialorrhea refers to excessive salivation. Medications used to treat bipolar disorder are more likely to cause dry mouth.
  50. Which of the following behaviors is a concerning behavior in the patient with Bipolar Type I:
    a. Hypersomnia
    b. Impulsive spending
    c. Severe fatigue
    d. Loss of interest in things that use to give pleasure
    b is correct. a, c, d are more likely seen in MDD
  51. Mr. Smith is seeking treatment for depression and has been started on Prozac 40mg po q day. He returns to the clinic 3 weeks after starting treatment and c/o of new onset sexual dysfunction described as an inability to achieve orgasm.
    Which of the following would be an appropriate explanation/course of treatment?
    a. There is no correlation between Prozac and sexual dysfunction continue current regimen
    b. Decrease the dose of Prozac to 20mg po q day
    c. Change to another SSRI
    d. None of these
    • d. none of the above is correct,
    • common reported side effect of SSRIs is sexual dysfunction.
  52. Schizophrenia is a chronic and debilitating mental illness that affects 1% of the population in all cultures. All of the following symptoms are characteristic of schizophrenia except:
    a. Hallucinations and delusions
    b. Social withdrawal
    c. Altered thought processing
    d. Increased energy and talkativeness
  53. DSM-IV-TR criteria for a diagnosis of schizophrenia states that:
    a. 4 or more of the symptoms must be present for at least 1 month but no longer than 6 months.
    b. 2 or more of the symptoms must be present for a significant portion of the time for at least 1 month and last for a duration of at least 6 months.
    c. 5 or more of the symptoms must be present during the same 2 week period and must include either depressed
    mood or loss of interest.
    d. 3 or more of the symptoms must be present during the same 2 week period and last at least 1 month.
  54. Positive symptoms of schizophrenia
    include all the following except:
    a. Hallucinations
    b. Disorganized speech and/or behavior
    c. Blunted affect
    d. Delusions
  55. What medication of last resort is used to treat schizophrenia when all other drugs have been ineffective at controlling symptoms and has 5 black box warnings?
    a. Chlorpromazine
    b. Quetiapine
    c. Clozapine
    d. Paliperidone
  56. When evaluating the presence of COPD, the diagnostic test most accurate is spirometry. This diagnostic test should be performed after the administration of a bronchodilator.
    Which of the following results indicate severe COPD?
    a. FEV1 ≥ 80% predicted
    b. 50% ≤ FEV1, ≥ 80% predicted
    c. 30% ≤ FEV1 < 50% predicted
    d. FEV1 < 30% predicted
    • C”. Spirometry is required to make the diagnosis of COPD. This diagnostic test identifies the presence of airflow restriction. Severe COPD is having 30% ≤ FEV1 < 50% predicted. All of the results are listed below.
    • GOLD 1: Mild à FEV1 ≥ 80% predicted;
    • GOLD 2: Moderate à 50% ≤ FEV1, ≥ 80% predicted
    • Gold 3: Severe à 30% ≤ FEV1 < 50% predicted
    • GOLD 4: Very Severe à FEV1 < 30% predicted
  57. Which of the following prescribed inhalation mediations require the patient to rinse his/her mouth after use?
    a. Fluticasone
    b. Tiotropium Bromide
    c. Combivent
    d. Albuterol
    A”. Fluticasone is a corticosteroid that can cause oral thrush (Candida). Patients should rinse their mouth thoroughly after each administration. Educating the patient to look for signs is important (i.e. white plaque or hoarse voice).
  58. Diagnostic testing is important in evaluating the efficacy of the patient’s COPD regime. Which of the following
    statement is true?
    a. ABG’s should be monitored at every visit to evaluate medication compliance.
    b. Pulmonary function tests should be ordered annually to identify the progression of lung disease.
    c. Peak flows should be monitored daily for COPD patients to evaluate airway restriction.
    d. Sputum specimens should be collected at each visit to identify respiratory infections.
    B”. Diagnostic testing is important in evaluating the efficacy of the patient’s COPD regime. The only statement that is correct is “B” à pulmonary function tests should be ordered annually to identify the progression of lung disease. ABG’s are not monitored at every visit to evaluate medication compliance. This is usually performed in acute exacerbation. Peak flows should be monitored daily for asthma patients, not COPD patients. Sputum specimens are not required unless pneumonia or a respiratory infection is suspected.
  59. Identify common side effects with pharmacotherapy in COPD patients. Select all that apply.
    a. Tachycardia
    b. Sedation
    c. Weight gain
    d. Thrush in oral cavity
    A”, “C” and “D”. Common side effects with medications given for COPD include: tachycardia (β agonist), weight gain (corticosteroids therapy), oral thrush (2ndary to pt. not rinsing mouth after administration of corticosteroid inhaler). Sedation is not a common side effect.
  60. Which of the following patients would be at highest risk for developing a pulmonary embolism?
    A)Jane, a 26 year female that is 32 weeks pregnant
    B)Mike, a 74 year old male with a history of prostate cancer
    C) Beth, a 24 year old college student that drives 5 hours one way to school
    D)Marie, a 63 year of female that is 1 day post-op total left knee replacement
  61. Which of the following symptoms would be suggestive of a pulmonary embolism?
    A) chest pain, dyspnea, cough, anxiety
    B) bilateral lower extremity edema and tenderness
    C) chest pain that radiates into the neck and down the left arm
    D) bradycardia, dizziness, “black spots” in line of vision
  62. All of the following are possible diagnostic test changes that you may see in a patient with a pulmonary embolism except which?
    A) Low arterial PO2(hypoxia)
    B) Arterial PCO2 decreased (alkalosis)
    C) Elevated hemidiaphram
    D) Normal chest X-ray without dyspnea or hypoxemia
  63. A patient with a history of pulmonary embolism is placed on warfarin therapy. They should be educated about avoiding foods that are high in vitamin k. All of the follow are foods high in vitamin k except?
    A) prunes
    B) cheddar cheese
    C) spring onions
    D) herbs
  64. Education on prevention of a DVT is vital to patients who have had a pulmonary embolism. You would encourage your patient to do all of the following except to decrease their risk of developing a DVT?
    A) Use thigh-high or calf-high compression stockings.
    B) Do not resume mobility after a surgery for at least 72 hours.
    C) On long drives stop every couple of hours and walk around.
    D) Do not sit with your legs crossed of extended periods of time.
  65. Which of the following is not a sign of cellulitis?
    a. swelling
    b. erythema
    c. cool to the touch
    d. tenderness
  66. Which of the following does staphylococcus aureus commonly cause?
    a. cellulitis
    b. septic arthritis
    c. osteomyelitis
    d. all of the above
  67. A positive blood culture occurs in what percentage of septic arthritis patients?
    a. 75%
    b. 35%
    c. 10%
    d. 40%
  68. Which of the following treatment options is most effective in methicillin-resistant osteomyelitis?
    a. 2gm oxacillin IV every 4-6 hours for 6 weeks
    b. 1gm cefazolin IV every eight hours for 4 weeks
    c. 1gm Vancomycin IV every 12 hours for 6 weeks
    d. none of the
    above are correct treatment options
  69. Pharyngitis is commonly due to which viral cause?
    A) Epstein-Barr virus
    B) Cytomegalovirus
    C) Adenoviruses
    D) All the above
  70. Tonsillitis symptoms are most commonly all of the following except?
    A) Fever
    B) Headache
    C) Delayed onset sore throat
    D) pain on swallowing
  71. Peritonsillar abcess/cellulitis symptoms commonly are all of the following except?
    A) low grade fever
    B) Drooling
    C) Neck pain
    D) Anorexia
  72. Typical antibiotic treatment for peritonsillar abcess are which of the following?
    A) clindamycin
    B) ceftriaxone
    C) amoxicillin/clavulanic acid
    D) All the above
  73. When evaluating a patient with hip pain, what are the key elements?
    a. Character and location
    b. Gait and balance
    c. Quality and quantity
    d. Aggravating and alleviating symptoms
  74. You suspect a patient has osteoarthritis of the hip.
    Which pain pattern would be most consistent with the diagnosis?
    a. Lateral hip pain aggravated by direct pressure
    b. Lateral hip pain associated with parethesias
    c. Anterior hip or groin pain
    d. Posterior hip and gluteal hip pain
  75. As the patient walk into the exam room, what is the
    first priority of the physical examination of a patient with hip pain?
    a. Palpation of hip joint
    b. Gait evaluation
    c. Range of motion
    d. Test sensation over the thigh
  76. After completing the physical exam, what physical finding would be suggestive of osteoarthritis?
    a. Symmetrical hip pain
    b. Point tenderness over the greater trochanter
    c. Gradual onset of asymmetric hip pain
    d. Localized area of pain and burning
  77. Your patient presents to the office complaining of low back pain. Initially he had difficulty voiding and now has urinary incontinence. What do you do?
    a. Rule out a UTI
    b. Obtain an x-ray
    c. Order an MRI
    d. Send to the ED
  78. When examining a patient with complaints of low back
    pain, but no radiating pain to the legs, you palpate the patient’s back and notice that when you apply pressure to the right low back, the patient nearly jumps off the exam table in pain. No other areas of the patient’s back are noted to be tender. You are most likely to suspect which of the following diagnoses?
    a. Lumbar Strain
    c. Herniated Disc
    d. Compression Fracture
  79. You examine a patient and highly suspect a herniated disc. The patient’s symptoms began 3 days ago. What is your next step?
    A. Order an MRI
    B. Recommend a scheduled regimen of NSAIDs
    C. Refer to physical therapy
    D. Prescribe the patient a narcotic analgesic and muscle relaxer
  80. You attempt 4 weeks of conservative therapy with the
    patient who you thought had a herniated disc. He has no improvement. You determine that imaging needs to be completed. You order which of the following tests?
    a. X-ray
    b. CT
    c. CT myelogram
    d. MRI
  81. All of the following are treatments for arrhythmia except?
    A. Lisinopril
    B. Atenolol
    C. Sotalol
    D. Diltiazem
    Answer A. ACE inhibitor used S/P MI. Best treatment for arrhythmias are with B-Blockers, CCB, and antidysrhythmics.
  82. A NP can assume with a negative ECG that there are no risk of immediate cardiac ischemia or damage?
    A. True
    B. False
    Answer B= If ACS is suspected biomarkers are needed to evaluate risk and repeating level 8-12 hours after onset and ECG 15-30 minutes after onset of symptoms.
  83. A-Fibrillation increases the risk of stroke. Many patients are placed on Warfarin. What food below should be monitored in the diet?
    A. Spinach
    B. Apples
    C. Wheat
    D. Rye
    • A- potassium rich foods decrease the effectiveness
    • of Warfarin. The patient should avoid large quanities.
  84. What range level should INR be maintained with Warfarin therapy for A-Fib patient?
    a. 1-2
    b. 2-3
    c. 3-4
    d. 0-1