COMMON PROBS/CULTURE/RISK

Question 1

Your 24M patient has been out hiking on vacation. He shows you the following rash, (circle red rash) and thinks he has Rocky Mountain Spotted Fever. What is his diagnosis?

Answer 1

Lyme Disease (Erythema Migrans/Bullseye rash)
(both are treated with Doxycycline)

Question 2

Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to?

Answer 2

A sign of respect

Question 3

Your patient speaks only Spanish and you need to evaluate his pain. What do you do?

Answer 3

Use a visual pain scale (less $$ than interpreter)

Question where the patient spoke a foreign language and you wanted to get consent from him. The options were to give him the consent form in his own language, use the hospital’s telephone interpreter service, have a family member translate, and then an obviously wrong option.

Question 4

58yo Japanese M with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the ED warrant admission?

Answer 4

Ethnicity (underestimates pain, taught to be stoic. Pain is probably much more severe)

Question 5

A 77M patient’s wife cares for him at home. Which statement by the wife indicates a need for a SNF?

Answer 5

My husband needs more help with his ADLs

Question 6

Which psychiatric disorder is most commonly diagnosed, yet least commonly treated?

Answer 6

Depression

Question 7

Your pt w/PNA is noted to have a heavy drinking habit. 2 days p admit he becomes combative/agitated. What is Tx?

Answer 7

po Librium

Question 8

Your patient has developed a fever of unknown origin. What is the next step?

Answer 8

Do nothing until diagnosis is confirmed

Question 9

How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed?

Answer 9

2 days

Question 10

The patient has been in a bar fight and has a human bite on his hand. What should you do next?

Answer 10

Order PO abx

Question 11

Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication?

Answer 11

Osteomyelitis

Question 12

What is the strongest predictor of functional impairment prior to discharge of the elderly pt?

Answer 12

Cognitive impairment

Question 13

Your pt has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.92), what should you do next:

Answer 13

Give IVF (flush it out. This is neuroleptic malignant syndrome)

Question 14

You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention?

Answer 14

Stop the TPN, Remove the line, and place a new line for TPN

Question 15

Your patient has a fever 3 days post op, WBC are 15,000, Blood Cx (-), and Eos 9%. What is the dx?

Answer 15

Drug fever (eos – allergic rxn. Normal is 1-4%)

Question 16

What are protein supplements best used for?

Answer 16

Aid in post-op healing

Question 17

Which macronutrient of TPN significantly increases the osmolality of the solution?

Answer 17

Dextrose

Question 18

Which electrolyte are you most concerned about monitoring in a cachexic patient?

Answer 18

K (refeeding syndrome. hypokalemia. also hypophosphatemia)

Question 19

Which lab do you monitor daily in a patient on nutritional supplements?

Answer 19

BMP (And monitor LFTs weekly) The answer had some other things in it, but it was the only one with BMP.

Question 20

What alternative therapy can you order to relax the pt prior to a procedure?

Answer 20

Music

There was a question about what to do for the patient to help/distract their pain during a procedure, and the answer was guided imagery.

Question 21

Which helps a Parkinson’s pt. with coordination

Answer 21

Tai Chi (also helps prevent falls in elderly)

Question 22

Which 2 headaches can be treated with triptans?

Answer 22

Migraines and cluster.

Question 23

What kind of dressing do you use on a decubitus ulcer with necrotic tissue?

Answer 23

Hydrocolloid

Question 24

45 yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site.

Answer 24

Neuropathic pain

Question 25

Pt has a post-op fever. what do you do

Answer 25

give fluids

Question 26

pain medication for breakthrough cancer pain

Answer 26

fentanyl patch

Question 27

Best pain indicator

Answer 27

pt self report

Question 28

Best alternative therapy to decrease pain in clavicle fracture

Answer 28

therapeutic touch/reiki

(Reiki: hand or palm-healing that transfers ‘universal energy’, has been used for cancer, emotional, or physical healing)

Question 29

Picture of Gunshot wound to the R lung area: you purpose of dressing.

Answer 29

The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration. Another answer was to let air blow out during inhalation.

Question 30

Cocaine induced psychosis

Answer 30

s/s: paranoia, delusions, hallucinations ‘cocaine bugs’ under skin, mydriasis

Question 31

Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms w/dilated pupils

Answer 31

Sympathomimetic (which is cocaine or meth)

Question 32

Antidepressant OD signs and symptoms and treatment

Answer 32

s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension, (can’t see, can’t pee, can’t spit, can’t shit), TX: ICU if CNS or cardio toxic, activated charcoal, NaHCO3 for dysrhythmias and maintain PH, Benzos (valium) for Sz (if serotonin syndrome: dantrium/dantrolene sodium)

Question 33

ASA overdose signs and symptoms and treatment

Answer 33

s/s: n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis. Tx: activated charcoal, NaHCO3 for severe acidosis of <7.1. MONITOR ABGs

Question 34

How do you treat group A strep on skin:

Answer 34

TMP/SMX or Doxy/Mino + beta lactam (1st gen ceph, PCN or Amoxil)

Question 35

Pt has cellulitis of lower extremity with a wound, what do you treat with?

Answer 35

Based on the hospital sensitivity

Question 36

Mallampati grades for visualization of oral cavity:

Answer 36

(I complete soft palate, II complete uvula, III uvula base only, IV none)

Question 37

Osteomalacia

Answer 37

softening of bones, rickets

Question 38

Osteomalacia most common cause

Answer 38

Deficient VitD (also Phos, Ca, UV-B light)

Question 39

Hospice vs palliative care:

Answer 39

Palliative are still receiving Tx. Hospice is no curative treatment, has death dx, and ≤6mos to live

Question 40

Venous stasis ulcer

Answer 40

use compression stocking

Question 41

The patient has had a dog bite and 3 doses of Tetanus in the past. The NP knows the recommendation for tetanus is that the:

Answer 41

patient gets a booster if they have a dirty wound and haven’t had a tetanus shot in five years.

Question 42

Tdap vaccine is an example of what type of immunity?

Answer 42

Active immunity

Question 43

How often should a woman between the ages of 20-39 have a PAP with HPV?

Answer 43

Q5 years, PAP with cytology Q3 years

Question 44

If born on or after what year is it indicated to receive 2 doses of mumps vaccine?

Answer 44

1957

Question 45

What age does an individual receive Zostavax?

Answer 45

50, one time dose

Question 46

At what age do males start colonoscopy every 10 years?

Answer 46

50

Question 47

When should PSA levels be initiated and how often?

Answer 47

PSA levels every year >50 (and DRE)

Question 48

Annual PSA and DRE are indicated in what group?

Answer 48

African-American >40 and family hx of prostate CA

Question 49

Pt has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to DC?

Answer 49

65-70

Question 50

35 yo Asian-american is in good health. He is worried about life-prolonging measures. What is the most likely cause of death for a man like him?

Answer 50

Unintentional injury (if he’s African American, it’s Homicide < 35 and heart dz at 35)

Question 51

What is the leading cause of death in African Americans M ages 40-59?

Answer 51

CAD

Question 52

What is the leading cause of deaths in Hispanics in the US?

Answer 52

Heart disease