Exam 2 Flashcards
1
Q
A chronic cough lasts longer than: A. 3 weeks B. 8 weeks C. 6 months D. 1 year
A
B. 8 weeks
2
Q
You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex? A. Baker phenomenon B. Arnold reflex C. Cough reflex D. Tragus reflex
A
B. Arnold reflex
3
Q
Based on these patients’ histories, which of the following should receive fungal serology testing for their chronic cough?
A. A patient with a history of sickle cell disease
B. A patient with a history of multiple sclerosis
C. A patient with a history of celiac disease
D. A patient with a history of AIDS
A
D. A patient with a history of AIDS
4
Q
Which of these patients should be given a decongestant?
A. Gerta, a 41-year-old female with GERD
B. Christine, a 15-year-old female with pneumonia
C. Dan, a 60-year-old male with allergic rhinitis
D. Andy, a 26-year-old with cystic fibrosis
A
C. Dan, a 60-year-old male with allergic rhinitis
5
Q
Which of the following herbal supplements should be used cautiously in a patient with hypertension? A. Licorice B. Horehound C. Peppermint D. Jasmine
A
A. Licorice
6
Q
A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from: A. Metoprolol B. Clopidogrel C. Tadalafil D. Captopril
A
D. Captopril
7
Q
Lisa is a 25-year-old Hispanic female experiencing chest tightness, a feeling of suffocation, and feels like she “can’t get air in.” She has no current history of heart or lung disease and did not exercise leading up to this attack. Which of the following is the most likely cause for this dyspnea?
A. Severe chronic anemia
B. Congestive heart failure
C. Anxiety-related dyspnea
D. Chronic obstructive pulmonary disease (COPD)
A
C. Anxiety-related dyspnea
8
Q
Which of the following scales is useful to assess the degree of dyspnea with a score of 6 to 20?
A. Borg scale
B. Patient Health Questionnaire-9 scale
C. Visual analog scale
D. Global assessment of functioning scale
A
A. Borg scale
9
Q
Annie is a 30-year-old African American woman that complains of “coughing up blood.” What is a likely cause of her condition? A. Bronchogenic carcinoma B. Pulmonary embolus with infarction C. Mitral stenosis D. Bronchitis
A
C. Mitral stenosis
10
Q
African American patients seem to have a negative reaction to which of the following asthma medications?
A. Inhaled corticosteroids
B. Long-term beta-agonist bronchodilators
C. Leukotriene-receptor agonists
D. Oral corticosteroids
A
B. Long-term beta-agonist bronchodilators
11
Q
Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis? A. Asthma B. Emphysema C. Chronic bronchitis D. Influenza
A
C. Chronic bronchitis
12
Q
You are using the CURB-65 clinical prediction tool to decide whether Latisha, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Which of the following risk factors would increase Latisha’s chance of CAP-associated mortality and complications?
A. Temperature of 100F
B. Respiratory rate 22 breaths per minute
C. Hemoglobin 9.5 g/dL
D. History of diabetes mellitus
A
D. History of diabetes mellitus
13
Q
Fredericka is a 40-year-old Hispanic female with a history of diabetes mellitus, hypertension, and HIV. She has a tuberculosis (TB) skin test. What is the smallest diameter of induration that would indicate a positive result? A. 2 mm B. 5 mm C. 8 mm D. 10 mm
A
B. 5 mm
14
Q
Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TST)?
A. She is on a high-protein diet.
B. She is an adolescent.
C. She has been on a long-term corticosteroid therapy.
D. She just got over a cold.
A
C. She has been on a long-term corticosteroid therapy.
15
Q
Marci has been started on a TB regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically? A. Pyridoxine B. Thiamine C. Probiotic D. Phytonadione
A
A. Pyridoxine
16
Q
Which of the following patients is most likely to have squamous cell carcinoma?
A. Janice, a 70-year-old female and is a nonsmoker
B. Bill, a 65-year-old male with a 20-year history of smoking
C. Sophie, a 30-year-old female with a family history of lung cancer
D. David, a 90-year-old man whose brother passed away from lung cancer
A
B. Bill, a 65-year-old male with a 20-year history of smoking
17
Q
Amy has a history of lung cancer and is experiencing new-onset right side ptosis and miosis and says, “I’m so hot, but I’m not sweating.” Which of the following conditions can be attributed to her new-onset symptoms? A. Bell’s palsy B. Turner’s syndrome C. Murphy’s syndrome D. Horner’s syndrome
A
D. Horner’s syndrome
18
Q
Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?
A. The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated.
B. The cancer is in situ; it is spreading into the lymph nodes but the spread cannot be evaluated otherwise.
C. The cancer is less than 3 cm in size and has not spread to the lymph nodes or other parts of the body.
D. The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant spreading.
A
C. The cancer is less than 3 cm in size and has not spread to the lymph nodes or other parts of the body.
19
Q
Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do?
A. Hand him literature about smoking cessation at every visit.
B. Wait until he is ready to talk to you about quitting.
C. Document in the record that he is not ready to quit.
D. Continue to ask him at every visit if he is ready to quit.
A
D. Continue to ask him at every visit if he is ready to quit.
20
Q
Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?
A. He should stop smoking today.
B. He should stop smoking tomorrow.
C. His quit date should be in 1 week.
D. He will be ready to quit after the first 30 days.
A
C. His quit date should be in 1 week.
21
Q
Which information should be included when you are teaching your patient about the use of nicotine gum?
A. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.
B. Patients should not eat for 30 minutes prior to or during the use of the gum.
C. Initially, 1 piece is chewed every 30 minutes while awake.
D. Acidic foods and beverages should be encouraged during nicotine therapy.
A
A. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.
22
Q
Which of these sputum strains would one use to test for a viral respiratory culture? A. Gram stain B. Direct fluorescent antibody stain C. Wright-Giemsa stain D. Acid-fast stain
A
B. Direct fluorescent antibody stain
23
Q
What is the first-line recommended treatment against Group A beta-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis? A. Penicillin B. Quinolone C. Cephalosporin D. Macrolide
A
A. Penicillin
24
Q
Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity? A. Mild intermittent B. Mild persistent C. Moderate persistent D. Severe persistent
A
C. Moderate persistent
25
```
Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking?
A. Inhaled corticosteroid
B. Leukotriene-receptor antagonist
C. Systemic corticosteroid
D. Methylxanthines
```
A. Inhaled corticosteroid
26
```
Your patient is on theophylline for his asthma. You want to maintain his serum levels between:
A. 0 to 5 mcg/mL
B. 5 to 10 mcg/mL
C. 5 to 15 mcg/mL
D. 10 to 20 mcg/mL
```
C. 5 to 15 mcg/mL
27
```
George has COPD and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD?
A. Stage 1 mild COPD
B. Stage 2 moderate COPD
C. Stage 3 severe COPD
D. Stage 5 very severe COPD
```
A. Stage 1 mild COPD
28
```
Most nosocomial pneumonias are caused by:
A. Fungi
B. Viruses
C. Gram-negative bacteria
D. Pneumococcal pneumonia
```
C. Gram-negative bacteria
29
Which of the following statements regarding TST is true?
A. Tests should be read 48 hours after the injection.
B. The size of the TST reaction has nothing to do with erythema but is based solely on induration.
C. It is a type V T-cell-mediated immune response.
D. The diameter of the induration is measured in centimeters.
B. The size of the TST reaction has nothing to do with erythema but is based solely on induration.
30
```
Which obstructive lung disease is classified as reversible?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. COPD
```
A. Asthma
31
```
Which of the following asthma medications should be used cautiously with geriatric patients?
A. Atrovent
B. Ventolin
C. Singulair
D. Asmanex
```
B. Ventolin
32
Which statement about adenocarcinoma of the lung is accurate?
A. It is the least common type of lung cancer, representing approximately 5% to 10% of cases.
B. It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors.
C. It is more common in men than in women and occurs almost entirely in cigarette smokers.
D. It is aggressive, with rapid growth in primarily the liver and brain.
B. It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors.
33
Jason, age 62, has obstructive sleep apnea. What do you think is one of his contributing factors?
A. He is a recovering alcoholic of 6 years.
B. His collar size is 17 inches.
C. He is the only person in his family who has this.
D. He is extremely thin.
B. His collar size is 17 inches.
34
```
What is the pressure needed for continuous positive air pressure (CPAP) to abolish apneas, snoring, and oxyhemoglobin desaturations in all positions and during REM sleep?
A. 5 to 20 cm H2O
B. 10 to 25 cm H2O
C. 15 to 25 cm H2O
D. 20 to 35 cm H2O
```
A. 5 to 20 cm H2O
35
```
What is a procedure that can be performed in the outpatient setting for a patient with obstructive sleep apnea?
A. Mandibular advancement
B. Laser-assisted uvulopalatoplasty
C. Retroglossal obstruction removal
D. Uvulopalatopharyngoplasty
```
B. Laser-assisted uvulopalatoplasty
36
```
Tina is a 3-week-old who was recently diagnosed with influenza. Which of the following medications would be appropriate to treat her condition?
A. Liquid oseltamivir
B. Inhaled zanamivir
C. Inhaled oseltamivir
D. Liquid zanamivir
```
A. Liquid oseltamivir
37
```
The forced vital capacity is decreased in:
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Restrictive disease
```
D. Restrictive disease
38
```
What is the most common cause of CAP?
A. Streptococcus pneumoniae
B. Klebsiella pneumoniae
C. Legionella pneumoniae
D. Pseudomonas aeruginosa
```
A. Streptococcus pneumoniae
39
Which of the following patients would you expect to have a decreased response to TST?
A. Julie, a 50-year-old postal worker with hypertension
B. Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns
C. Jill, a 16-year-old cheerleader with type 1 diabetes
D. Mark, a 29-year-old tennis player who currently has a cold
B. Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns
40
```
Which of the following is a possible consequence of sleep apnea?
A. Asthma
B. Increased white blood cells
C. Insulin resistance
D. Hyperactivity
```
C. Insulin resistance
41
```
Which of the following conditions is associated with cigarette smoking?
A. Glaucoma
B. Increased sperm quality
C. Bladder cancer
D. Eczema
```
C. Bladder cancer
42
Marta is taking TB drugs prophylactically. How do you instruct her to take them?
A. Take them on an empty stomach to facilitate absorption.
B. Take them with aspirin (ASA) to prevent flushing.
C. Take them with ibuprofen to prevent a headache.
D. Take them with food to prevent nausea.
A. Take them on an empty stomach to facilitate absorption.
43
Which of the following statements regarding pulmonary function and cigarette smoking is true?
A. Cigarette smoking causes an increase in circulating immunoglobulin levels.
B. Cigarette smoking has no increased risk of COPD.
C. Cigarette smoking decreases mucus production.
D. Cigarette smoking increases the risk of pneumothorax.
D. Cigarette smoking increases the risk of pneumothorax.
44
```
How much nicotine does an average cigarette contain?
A. 5 to 10 mg
B. 10 to 15 mg
C. 15 to 20 mg
D. 20 to 25 mg
```
C. 15 to 20 mg
45
```
Madeline is a smoker in a primary-care visit with her provider. After her provider asks if she is willing to quit, she says she has decided to quit, has bought nicotine gum, and is interested in hearing about Chantix. Which of the following steps is Madeline in regarding behavioral changes and her attempts at cessation?
A. Precontemplation
B. Action
C. Maintenance
D. Preparation
```
D. Preparation
46
Eleanor would like to quit smoking, but she is unsure of the benefits, as she is 60 years old. Which of these is a benefit to quitting smoking that her provider should inform her of?
A. Enhanced taste and smell
B. Improved hearing
C. Decreased risk of diabetes mellitus
D. Decreased risk of sexually transmitted diseases
A. Enhanced taste and smell
47
```
The barrel-chest characteristic of emphysema is a result of:
A. Chronic coughing
B. Hyperinflation
C. Polycythemia
D. Pulmonary hypertension
```
B. Hyperinflation
48
```
Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD?
A. 3 hours
B. 6 hours
C. 11 hours
D. 15 hours
```
D. 15 hours
49
Which of these patients should be evaluated with serum alpha-antitrypsin levels?
A. Jamie, a 70-year-old female with COPD with a history of smoking
B. Ron, a 43-year-old male with COPD with a history of smoking
C. Leslie, a 60-year-old female with clinical emphysema and no history of smoking
D. Marshall, a 55-year-old male with clinical emphysema and no family history of early-onset COPD
B. Ron, a 43-year-old male with COPD with a history of smoking
50
```
Which ethnic group has the highest lung-cancer incidence and mortality rates?
A. African American men
B. Scandinavian men and women
C. Caucasian women
D. Asian men
```
A. African American men
51
1. What of the following patients is a candidate for statins?
A. Jerry is a 55-year-old male with a history of syncope.
B. Christa is a 65-year-old female with a history of myocardial infarction (MI).
C. Manny is a 75-year-old male with a 10-year cardiovascular risk of 6.5%.
D. April is an 80-year-old female with a low-density lipoprotein (LDL) level of 180.
B. Christa is a 65-year-old female with a history of myocardial infarction (MI).
52
```
Which of the following is a chest wall syndrome?
A. Myocardial infarction
B. Angina
C. Costochondritis
D. Pericarditis
```
C. Costochondritis
53
```
Which of the following may help a clinician to determine whether palpitations are caused by a potentially lethal cardiac rhythm?
A. Holter monitoring
B. Complete blood count (CBC)
C. Thyroid panel
D. Computed axial tomography (CAT) scan
```
A. Holter monitoring
54
A blood pressure (BP) of 150/90 is considered:
A. Stage 2 hypertension
B. Hypertensive
C. Normal in healthy older adults
D. Acceptable if the patient has diabetes mellitus (DM)
C. Normal in healthy older adults
55
Lifestyle modifications to manage hypertension (HTN) include:
A. Maintaining a body mass index of 17
B. Restricting dietary sodium to 5 grams per day
C. Engaging in exercise or physical activity for 90 minutes a day
D. Limiting beer intake to 24 ounces per day
D. Limiting beer intake to 24 ounces per day
56
```
Mary has hypertension and previously had a stroke. Which hypertensive drug has been shown to reduce stroke?
A. Chlorthalidone
B. Metoprolol
C. Amlodipine
D. Losartan
```
A. Chlorthalidone
57
```
Which high-density lipoprotein (HDL) level is considered cardioprotective?
A. Greater than 30
B. Greater than 40
C. Greater than 50
D. Greater than 60
```
D. Greater than 60
58
You are assessing Sigred for metabolic syndrome. Which of her parameters is indicative of this syndrome?
A. Her waist is 36 inches.
B. Her triglyceride level is 140 mg/dL.
C. Her BP is 128/84.
D. Her fasting blood sugar (BS) is 108 mg/dL.
A. Her waist is 36 inches.
59
```
Which type of angina do you suspect in Harvey, who complains of chest pain that occurs during sleep and most often in the early morning hours?
A. Stable angina
B. Unstable angina
C. Variant (Prinzmetal’s angina)
D. Probably not angina but hiatal hernia
```
C. Variant (Prinzmetal’s angina)
60
```
A patient is undergoing a cardiac stress test. Which of the following parts of their history could cause a false-positive reading?
A. Patient is on labetalol.
B. Patient is a man.
C. Patient is on amlodipine.
D. Patient has a potassium level of 4.
```
A. Patient is on labetalol.
61
Which of these patients is at a higher risk for developing deep vein thrombosis?
A. Jerry, a 64-year-old man with a history of epilepsy
B. Samantha, a 45-year-old female undergoing a hysterectomy
C. Diane, a 15-year-old female with type 1 diabetes
D. Ben, a 23-year-old male with a history of a pneumothorax
B. Samantha, a 45-year-old female undergoing a hysterectomy
62
```
Claire is a patient complaining that her left leg is cool, pale, smaller than her right, and has thick toenails. Which condition may she be experiencing?
A. Peripheral artery disease
B. Anemia
C. Deep vein thrombosis
D. Pulmonary embolism
```
A. Peripheral artery disease
63
```
In which type of atrioventricular (AV) block does the pulse rate (PR) interval lengthen until a beat is dropped?
A. First-degree AV block
B. Second-degree Mobitz I AV block
C. Second-degree Mobitz II AV block
D. Third-degree AV block
```
B. Second-degree Mobitz I AV block
64
```
What is the term for light-headedness, feeling faint, and muscular weakness with a cardiovascular origin?
A. Presyncope
B. Vertigo
C. Dizziness
D. Myocardial infarction
```
A. Presyncope
65
```
A delta wave on the electrocardiogram (ECG) may be present in which condition?
A. Prinzmetal’s angina
B. Bundle branch block
C. Wolff–Parkinson–White syndrome
D. Aortic stenosis
```
C. Wolff–Parkinson–White syndrome
66
```
Which heart sound is associated with decreased elasticity of the left ventricle in left ventricular hypertrophy?
A. A physiologic split S2
B. A fixed split S2
C. S3
D. S4
```
D. S4
67
```
Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of:
A. Severe asthma
B. A common valvular lesion
C. Severe hypertension
D. A prosthetic heart valve
```
D. A prosthetic heart valve
68
```
Data from the Framingham Heart Study suggests that individuals who are normotensive at 55 years of age have how much lifetime risk of developing hypertension?
A. 65%
B. 75%
C. 80%
D. 90%
```
D. 90%
69
```
Which pain characteristic is usually indicative of angina pectoris?
A. Fleeting
B. Moving
C. Diffuse
D. Localized
```
C. Diffuse
70
Which of the following is the proper way to take a blood pressure measurement?
A. Patient is in a reverse Trendelenburg position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 5 minutes before measurement
B. Patient is in a sitting position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 5 minutes before measurement
C. Patient is in a sitting position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 3 minutes before measurement
D. Patient is in a reverse Trendelenburg position, cuff size has a bladder length of 70% and a width of 30% of arm circumference, patient has rested for 5 minutes before measurement
B. Patient is in a sitting position, cuff size has a bladder length of 80% and a width of 40% of arm circumference, patient has rested for 5 minutes before measurement
71
```
What percentage of patients with angina pectoris will have simultaneous dyspnea, caused by transient increase in pulmonary venous pressures that accompany ventricular stiffening during an episode of myocardial ischemia?
A. About 20%
B. About 30%
C. About 50%
D. Almost all
```
B. About 30%
72
Which of the following patient complaints indicates palpitations are due to increased catecholamine production?
A. “I feel like my heart is pounding out of my chest and I have been sitting for an hour.”
B. “I feel like my heart is in a vise and I can’t breathe.”
C. “I feel like my heart is beating strongly after I just worked out.”
D. “I feel like my heart is skipping beats.”
C. “I feel like my heart is beating strongly after I just worked out.”
73
```
What is the most common presenting complaint in congestive heart failure?
A. Weight loss
B. Palpitations
C. Syncope
D. Dyspnea
```
D. Dyspnea
74
Which of the following is true of peripheral edema?
A. It is always independent of underlying disorders.
B. Peripheral edema occurs more frequently in men than in women.
C. When it involves the lower extremities, it may be caused by cardiac conditions.
D. It is the accumulation of tissue fluid within organ systems.
C. When it involves the lower extremities, it may be caused by cardiac conditions.
75
Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should be used under the tongue every 5 minutes for three doses. What should be done if the pain has not been relieved after three doses?
A. 911 should be called, and the patient should be transported immediately to the emergency department.
B. One more dose of NTG may be tried.
C. The person should be given two aspirin to chew.
D. A portable defibrillator should be located to ascertain the cardiac rhythm.
A. 911 should be called, and the patient should be transported immediately to the emergency department.
76
```
For the best therapeutic effect after an MI, thrombolytics should be administered within the first 3 hours (ideally 30 minutes) of symptom onset. Studies have shown, however, that thrombolytic therapy can be of benefit up to how many hours after the initial presentation of MI symptoms?
A. 6 hours
B. 8 hours
C. 10 hours
D. 12 hours
```
D. 12 hours
77
When teaching post-MI patients about their NTG tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are packaged and should not be put in another pill box or remain in areas that are or could become warm and humid. Once opened, the bottle must be dated and discarded after how many months?
A. 1 month
B. 3 months
C. 6 months
D. As long as the tablets are kept in this special bottle, they will last forever.
C. 6 months
78
```
There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage are patients hospitalized or treated with specialized interventions or hospice care for refractory symptoms of heart failure despite medical therapy?
A. Stage A
B. Stage B
C. Stage C
D. Stage D
```
D. Stage D
79
```
There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage do patients have refractory symptoms of heart failure?
A. Stage A
B. Stage B
C. Stage C
D. Stage D
```
D. Stage D
80
```
Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test?
A. Brain natriuretic peptide
B. C-reactive protein
C. Serum albumin
D. Erythrocyte sedimentation rate
```
A. Brain natriuretic peptide
81
```
If a pulmonary embolus is suspected, which testing should be performed?
A. Ultrasound
B. Magnetic resonance imaging (MRI)
C. V/Q scan
D. D-dimer
```
C. V/Q scan
82
```
Which of the following doses of statins decrease LDL by up to 50% on average?
A. Pravastatin 40 mg
B. Simvastatin 20 mg
C. Atorvastatin 80 mg
D. Fluvastatin 40 mg
```
C. Atorvastatin 80 mg
83
What is true regarding the treatment of cilostazol?
A. It causes vasoconstriction.
B. It can be used when a patient has a degree of heart failure.
C. It is used to treat leg pain due to blockages in the leg veins.
D. It causes platelet aggregation.
D. It causes platelet aggregation.
84
Which of the following medications can cause hyperlipidemia?
A. High dose diuretics
B. Exercising 30 minutes every day
C. Hyperthyroidism
D. Angiotensin II receptor blocker (ARB) use
A. High dose diuretics
85
```
Which of the following complementary therapies may be helpful if a patient has orthostatic hypotension?
A. Magnesium
B. Beta-glucan
C. Selenium
D. Hawthorn
```
D. Hawthorn
86
```
In the CHADS2 Index for the stroke risk score for AF, the “A” stands for:
A. Anticoagulation
B. Autoimmune disease
C. Age
D. Antihypertension
```
C. Age
87
```
Which of these murmurs is also called a 50/50 murmur?
A. Aortic sclerosis
B. Hemic murmur
C. Systolic ejection murmur
D. Diastolic murmur
```
A. Aortic sclerosis
88
Which of the following statements about dabigatran is true?
A. It is difficult to keep the patient in therapeutic range.
B. Anticoagulation cannot be immediately reversed.
C. This agent is for the management of valvular atrial fibrillation.
D. It has a longer half-life than warfarin.
B. Anticoagulation cannot be immediately reversed.
89
```
What value on the ankle-brachial index diagnoses peripheral artery disease?
A. Less than 0.25
B. Less than 0.50
C. Less than 0.90
D. Greater than 1
```
C. Less than 0.90
90
Your patient with permanent atrial fibrillation asks what other options he has to warfarin. You tell him:
A. There is a permanent implantable device, but you will have to continue the warfarin when you have it.
B. We could try dabigatran, but it would require more laboratory monitoring.
C. Rivaroxaban is a good alternative because it has an established antidote.
D. Apixaban is an alternative medication because it does not necessitate dose titration.
D. Apixaban is an alternative medication because it does not necessitate dose titration.
91
```
You just started Martha on HTN therapy. The Eighth Joint National Committee recommends that if her goal BP is not reached in what length of time, you should increase the initial drug or add a second drug to it?
A. 1 month
B. 3 months
C. 6 months
D. 1 year
```
A. 1 month
92
```
Janice is a 65-year-old Caucasian female with a history of osteoporosis and new-onset hypertension. Which of the following medications is appropriate as first line for Janice’s hypertension?
A. Benazepril
B. Hydrochlorothiazide
C. Amlodipine
D. Clonidine
```
B. Hydrochlorothiazide
93
```
Fred is a 76-year-old man with a history of hypertension who recently suffered a post-myocardial infarction. Which of the following antihypertensive medications is appropriate?
A. Hydrochlorothiazide
B. Furosemide
C. Spironolactone
D. Lisinopril
```
D. Lisinopril
94
```
The care provider is assessing an ECG electrical axis, which shows a negative complex in lead I and a positive complex in augmented vector foot (aVF). Which describes this axis deviation?
A. Normal axis
B. Left axis deviation
C. Right axis deviation
D. Extreme right axis deviation
```
C. Right axis deviation
95
```
Which of the following results might you see in a physical examination of a male patient with hypertension?
A. S2 heart sound
B. Distended neck veins
C. Rhonchi
D. Waist measurement 36 inches
```
B. Distended neck veins
96
In which patient do premature ventricular contractions NOT need to be treated?
A. Kelly, a 25-year-old female with an allergy to bee stings
B. Mary, a 50-year-old female with a history of untreated anxiety
C. Randy, a 45-year-old male with a history of hypotension
D. Bill, a 65-year-old male with a history of angina
A. Kelly, a 25-year-old female with an allergy to bee stings
97
What is the most common form of heart disease in a patient with atrial fibrillation?
A. Hypertension
B. Rheumatic heart disease
C. Angina
D. Coronary artery disease associated with heart failure
D. Coronary artery disease associated with heart failure
98
```
What does digitalis compete with at binding sites on the cell membrane?
A. Magnesium
B. Potassium
C. Sodium
D. Calcium
```
B. Potassium
99
```
Which of the following will help a provider determine whether a patient is experiencing paroxysmal supraventricular tachycardia (PSVT) or ventricular tachycardia (VT)?
A. An obstructed P wave
B. Ability to calculate PR interval
C. Frog sign
D. Chvostek’s sign
```
C. Frog sign
100
A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis, which of the following questions should be asked?
A. “Do you have a history of liver disease?”
B. “What medications are you currently taking?”
C. “Have you noticed swelling in your ankles?”
D. “Do you have an autoimmune condition?”
B. “What medications are you currently taking?”
101
The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions?
A. Repeat the test.
B. Refer to a nephrologist.
C. Measure the serum protein.
D. Obtain a blood urea nitrogen (BUN) and creatinine.
B. Refer to a nephrologist.
102
The clinician is speaking with Bernadette, who has recently been diagnosed with urinary incontinence. She has had this condition for a number of years, she is 5 feet 5 inches, and she weighs 140 pounds. Which of the following should the health-care provider be aware of?
A. It is uncommon that Bernadette has this condition because she is female.
B. Most patients should wait 3 months for follow-up after diagnosis.
C. Since Bernadette has a regular body mass index, she probably has a positive body image.
D. Bernadette may be suffering from depression and may need a psychiatric consult.
D. Bernadette may be suffering from depression and may need a psychiatric consult.
103
```
A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria?
A. NSAIDs
B. Rhubarb
C. Vitamin A
D. Red meat
```
A. NSAIDs
104
A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a diagnosis of lower UTI?
A. Thick, green discharge
B. Fever, chills, costovertebral angle (CVA) tenderness
C. Blood in urine and frequency
D. Foul-smelling discharge, perineal itch
C. Blood in urine and frequency
105
Which of the following patients is most likely to have urge incontinence?
A. Mary, a 35-year-old female with a history of four vaginal deliveries
B. Devon, a 40-year-old male with a history of multiple sclerosis
C. Dan, a 67-year-old male with a history of diabetes mellitus
D. Cheryl, a 95-year-old female who takes Norpace daily
B. Devon, a 40-year-old male with a history of multiple sclerosis
106
```
A 30-year-old patient presents with pain on urination. The urine microscopy of clean-catch urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis?
A. Lower urinary-tract infection
B. Chlamydia infection
C. Candidiasis
D. Pyelonephritis
```
A. Lower urinary-tract infection
107
```
A patient presents with CVA tenderness and a several-day history of high fever, chills, and dysuria. Which of the following diagnoses is most likely given the above information?
A. Pyelonephritis
B. Cystitis
C. Renal calculi
D. Bladder tumor
```
A. Pyelonephritis
108
Which of the following information patients with a UTI can receive Bactrim DS?
A. Mary, a 25-year-old who is 25 weeks pregnant
B. Donna, a 55-year-old with an allergy to sulfa
C. Lisa, a 33-year-old who is breastfeeding her 3-week-old daughter
D. Tiffany, a 16-year-old with a hypersensitivity to penicillin
D. Tiffany, a 16-year-old with a hypersensitivity to penicillin
109
```
Which of the following Macrobid doses is appropriate to treat a lower UTI?
A. 200 mg bid 14 days
B. 100 mg bid 5 days
C. 500 mg daily 8 days
D. 800 mg daily 2 days
```
B. 100 mg bid 5 days
110
```
A patient is seen in the office complaining of severe flank pain and hematuria. The clinician should assess this patient for which risk factor for poststreptococcal glomerulonephritis?
A. Hypertension
B. Constipation
C. Tubal ligation
D. Diabetes
```
A. Hypertension
111
```
A patient is diagnosed with urge incontinence. Before prescribing Detrol LA, the provider should question the patient about which of these contraindications to this medication?
A. Diarrhea
B. Parkinson’s disease
C. Closed-angle glaucoma
D. Breast cancer
```
C. Closed-angle glaucoma
112
A patient is diagnosed with overactive bladder. Which of the following instructions should be given to this woman?
A. “Limit the amount of water that you drink.”
B. “Eliminate caffeine from your diet.”
C. “Wear panty liners.”
D. “You should not attempt pregnancy.”
B. “Eliminate caffeine from your diet.”
113
A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy. Which of the following actions should be taken next?
A. Send a urine specimen for microscopy and evaluate for fungal colonies.
B. Increase the dose of antibiotic.
C. Order a cystoscopy.
D. Order a different antibiotic.
A. Send a urine specimen for microscopy and evaluate for fungal colonies
114
```
Which of the following are predisposing factors for pyelonephritis?
A. Pregnancy
B. Dehydration
C. Smoking
D. Alkaline urine
```
A. Pregnancy
115
Which of the following types of proteinuria is associated with Hodgkin’s disease?
A. Tamm-Horsfall proteinuria
B. Tubulointerstitial area involvement
C. Altered glomerular capillary permeability
D. Bence Jones proteinuria
D. Bence Jones proteinuria
116
When proteinuria is detected in a low-risk patient, which laboratory testing should be ordered in addition to Bence Jones proteins?
A. Serum glucose
B. Lipid panel
C. Hemoglobinopathy
D. Cerebrospinal fluid (CSF) lumbar puncture
B. Lipid panel
117
```
Jeremy is a 27-year-old who comes to the clinic complaining of red-tinged urine. The clinician performs a urine dipstick and finds that the protein is 2+. Which of the following from Jeremy’s history is related to this finding?
A. He is training for a marathon.
B. He recently broke a toe.
C. He began taking Lexapro 2 weeks ago.
D. He works in an office setting.
```
A. He is training for a marathon.
118
Which of the following is true regarding the cause of isolated hematuria?
A. It is usually caused by anemia.
B. It can be due to bleeding in the urethra.
C. It is can be due to hemoglobinopathies.
D. It is usually due to sickle cell disease.
B. It can be due to bleeding in the urethra.
119
```
Which of the following medications may be linked to dysuria?
A. Vitamin A
B. Mirena
C. Paxil
D. Gabapentin
```
C. Paxil
120
```
A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be managed?
A. 3-day course of oral antibiotics
B. Hospitalization
C. Encourage cranberry juice intake
D. 6-week course of antibiotics
```
B. Hospitalization
121
```
A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses?
A. Pancreatitis
B. Urinary tract infection
C. Prostate tumor
D. Gastroesophageal reflux disease
```
A. Pancreatitis
122
Which of the following instructions should be given to the patient with nephrolithiasis?
A. Take ibuprofen, 600 mg every 8 hours.
B. Take Tums for stomach upset.
C. Drink more black tea.
D. Increase intake of vegetables, like spinach.
A. Take ibuprofen, 600 mg every 8 hours.
123
Which of the following patients is at risk for developing urinary-tract cancer?
A. The 45-year-old woman who is 10 lbs underweight
B. The 78-year-old man who smokes three packs of cigarettes a day
C. The 84-year-old man who worked in an office setting
D. The 25-year-old woman who has a lactose allergy
B. The 78-year-old man who smokes three packs of cigarettes a day
124
```
Which of the following medications will help reduce urinary excretion of nephrolithiasis-forming substances?
A. Furosemide
B. Triamterene
C. Calcium supplement
D. Hydrochlorothiazide
```
D. Hydrochlorothiazide
125
Ryan has a UTI and has been prescribed Ceclor. Which of the following side effects should he be made aware of?
A. Emesis
B. Abdominal discomfort if taken without food
C. Nausea
D. Flatulence
C. Nausea
126
```
A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer the patient to a nephrologist for which of these treatments?
A. Chemotherapy
B. Nephrectomy
C. Palliative treatment
D. Radiation
```
B. Nephrectomy
127
A patient has just had a total nephrectomy for renal cell carcinoma. Which of the following follow-up strategies is appropriate?
A. Computed tomography (CT) scan of abdomen and renal fossa in 3 to 6 months
B. Magnetic resonance imaging (MRI) of abdomen and kidneys in 2 to 4 months
C. X-ray of abdomen and renal fossa in 6 to 8 months
D. No follow-up is necessary.
A. Computed tomography (CT) scan of abdomen and renal fossa in 3 to 6 months
128
```
An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following data from the history is considered a risk factor for this type of cancer?
A. History of alcoholism
B. Sedentary lifestyle
C. Obesity
D. 65-year smoking history
```
D. 65-year smoking history
129
```
A 40-year-old woman presents to the clinic with complaints of dull and achy flank pain and hematuria. She also notes, “I think I have a mass in my stomach.” She works in a chemical plant and has a sedentary lifestyle. Which of the following parts of her history lead the clinician to believe she may have renal cell carcinoma?
A. Age
B. Gender
C. Works in chemical plant
D. Sedentary lifestyle
```
C. Works in chemical plant
130
```
Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer?
A. Kidneys, ureter, bladder x-ray
B. Cystoscopy with biopsy
C. Magnetic resonance imaging
D. Urine tumor marker (NMP22)
```
B. Cystoscopy with biopsy
131
A 78-year-old man says he has been diagnosed with Stage 0 bladder cancer and asks the provider what that means. Which is the best response?
A. “There is no such thing as Stage 0 cancer.”
B. “You have cancer that has spread to the surrounding tissue.”
C. “Your cancer has spread to other organs.”
D. “Your cancer must be cured by removing your bladder.”
C. “Your cancer has spread to other organs.”
132
Talia has bladder cancer that has grown into the fatty tissue surrounding the bladder and to her vagina. The cancer has not spread to distant sites or lymph nodes. What is an appropriate treatment option?
A. Palliative care only
B. External beam radiation therapy
C. Only chemotherapy is appropriate
D. Radical cystectomy and lymph node resection
D. Radical cystectomy and lymph node resection
133
The patient is diagnosed with acute renal failure (ARF). Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia?
A. Patient is on lisinopril
B. Nephrolithiasis
C. Recent infection where gentamicin was used in treatment
D. Ureteral obstruction
A. Patient is on lisinopril
134
```
The patient is diagnosed with ARF. Which of the following conditions is the most common cause?
A. Renal calculi
B. Acute tubular necrosis
C. Cardiac failure
D. Acute glomerulonephritis
```
B. Acute tubular necrosis
135
```
Danielle presents to the clinic, saying “I do not feel like I want to eat.” She also notes she is experiencing lethargy, nausea, headache, and muscle cramps. She “did not go to the bathroom a lot” yesterday. Which of the following stages of acute kidney injury (AKI) is Danielle in?
A. Initiating stage
B. Oliguric stage
C. Diuretic stage
D. Recovery stage
```
A. Initiating stage
136
```
Which of the following physical examination manifestations are consistent with a patient in ARF?
A. Weight gain
B. Glycosuria
C. Irritability
D. Hypotension
```
D. Hypotension
137
```
Laqueena has chronic kidney disease (CKD). Her glomerular filtration rate (GFR) is 33 mL/min per 1.73 m2 of body surface area. Which of the stages does her GFR fall under, as defined by the Third National Health and Nutrition Examination Survey?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
```
C. Stage 3
138
```
Which of the following examination findings should be expected in a patient with CKD?
A. Weak, thready pulse
B. Auscultatory crackles
C. Hypotension
D. Pleural friction rub
```
B. Auscultatory crackles
139
Which of the following strategies is useful when managing hypertension in a patient with CKD?
A. Keep HbA1c of less than 7.5%.
B. For a patient with proteinuria of more than 1 g/day, target BP is 135/85 mm Hg.
C. Avoid systolic BP less than 100 mm Hgc.
D. For a patient with proteinuria of less than 1 g/day, goal BP is no more than 130/80 mm Hg.
D. For a patient with proteinuria of less than 1 g/day, goal BP is no more than 130/80 mm Hg
140
Carol has CKD. Her creatinine levels are now 12 mg/dL. She would like to know what to expect next. What does the provider tell her?
A. Due to her advanced renal failure, her survival time without intervention is 100 to 150 days.
B. She does not require intervention and she will require dialysis once her creatinine levels reach 15 mg/dL.
C. She requires dialysis and must have an arteriovenous graft this week to start dialysis in 1 week.
D. She will be placed on the transplant list once her creatinine levels are greater than 16 mg /dL.
A. Due to her advanced renal failure, her survival time without intervention is 100 to 150 days.
141
```
A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the examination?
A. Lumbar puncture
B. Family history of cardiac problems
C. Contrast venography
D. Pelvic exam
```
D. Pelvic exam`
142
```
Which of the following is a condition that results in colicky abdominal pain?
A. Peptic ulcers
B. Glisson’s capsule around the liver
C. Peritoneum irritation
D. Gallstones
```
D. Gallstones
143
```
A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation?
A. Multivitamin
B. Magnesium hydroxide
C. Pepto-Bismol®
D. Ibuprofen
```
C. Pepto-Bismol®
144
Which of the following is an appropriate strategy to manage constipation?
A. Mildly exercise after breakfast.
B. Five timed minutes on the toilet in which to defecate.
C. Drink at least 48 ounces of fluids daily.
D. Immediately begin pharmacologic treatment.
A. Mildly exercise after breakfast.
145
```
A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis?
A. Gastroenteritis
B. Recent use of Imodium
C. Lack of dietary fiber
D. Decreased physical activity
```
A. Gastroenteritis
146
Cameron, 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes antacids with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain?
A. The pain seems better when he smokes to relieve his nerves.
B. Coffee and fried foods don’t bother him.
C. He wakes at night coughing with a bad taste in his mouth.
D. He likes to wear loose clothing.
C. He wakes at night coughing with a bad taste in his mouth.
147
```
Gail, a 35-year-old female patient, is seen in the clinic in the morning. She complains of abrupt onset of nausea, vomiting, colicky abdominal cramps, and profuse watery diarrhea that began last night. Her vitals are BP: 110/70, HR: 110, temperature: 99F, RR: 12. She recently came back from a vacation in Switzerland, ate leftovers for dinner last night, and had a cold 2 weeks ago. Which of the following is the most probable cause of her condition?
A. Staphylococcus
B. Shigella
C. Rotavirus
D. Entamoeba histolytica
```
A. Staphylococcus
148
Hannah is a patient that just had an appendectomy after a diagnosis of appendicitis and had no complications. Which of the following patient education points is correct?
A. “You will need to take laxatives to encourage defecation post-surgery.”
B. “You will need to stay in the hospital for 2 weeks to recover.”
C. “Your diet will be advanced when bowel sounds return.”
D. “I will put you on narcotics to manage your pain.”
C. “Your diet will be advanced when bowel sounds return.”
149
Which of the following patients should be referred to a hepatologist?
A. Patient with persistent elevation of HBsAg
B. Patient with anti-HAV IgG
C. Patient with IgG anti-HBs
D. Patient with anti-HEV
A. Patient with persistent elevation of HBsAg
150
```
A 29-year-old is seen in the office with complaints of pain in his chest and belly. He quit smoking 6 months ago. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer® and Pepto-Bismol®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer?
A. His use of Pepto-Bismol
B. His age
C. His use of Alka-Seltzer
D. His smoking cessation
```
C. His use of Alka-Seltzer
151
```
Which of the following causes of gastrointestinal bleeding is found in the lower gastrointestinal tract?
A. Erosive esophagitis
B. Duodenal ulcer
C. Meckel’s diverticulum
D. Gastric ulcer
```
C. Meckel’s diverticulum
152
Which of the following is most effective in diagnosing acute appendicitis?
A. History and physical
B. Sedimentation rate
C. Kidney, ureter, and bladder x-ray
D. Complete blood count (CBC) with differentials
A. History and physical
153
Which of the following is true of appendicitis?
A. Appendicitis is more common in Asian countries.
B. Family history of appendicitis does not increase a patient’s risk of having appendicitis.
C. Appendicitis is most common between the ages of 40 and 60.
D. If appendicitis occurs in infants, it is associated with higher morbidity.
D. If appendicitis occurs in infants, it is associated with higher morbidity.
154
```
Which of the following is associated with celiac disease (celiac sprue)?
A. Malabsorption
B. Constipation
C. Rectal bleeding
D. Esophageal ulceration
```
A. Malabsorption
155
```
A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis?
A. Endometriosis
B. Yersinia enterocolitica infection
C. Appendicitis
D. GERD
```
A. Endometriosis
156
Robin is a 57-year-old female presenting with diffuse abdominal pain. Which of the following statements from the provider to Robin is correct?
A. “It does not matter that you feel pain not only in your stomach but also in your shoulder.”
B. “Does moving around change the nature of your pain?”
C. “All causes of abdominal pain do not necessitate a surgical referral.”
D. “I noticed on examination that your stomach is rigid, and you stated your pain is quite severe. It is only necessary for a nurse to see you concerning this problem.”
B. “Does moving around change the nature of your pain?”
157
```
A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be?
A. Obtain a complete history.
B. Order a barium enema.
C. Schedule a Bernstein’s test.
D. Prescribe a trial of antispasmodics.
```
A. Obtain a complete history.
158
```
A 28-year-old patient is seen in the clinic with colicky abdominal pain, particularly after meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely?
A. Her age
B. Frequent constipation
C. Pain after meals
D. Colicky abdominal pain
```
A. Her age
159
```
A 28-year-old patient is seen with complaints of diarrhea. Which of the following responses to the history questions would help the primary-care provider (PCP) establish the diagnosis of irritable bowel syndrome (IBS)?
A. Feels relief after urination
B. Pain wakes up patient from sleep
C. Defecates in the middle of the night
D. Pain is precipitated by eating
```
D. Pain is precipitated by eating
160
```
Which of these is one of the most common dietary triggers of IBS?
A. Gluten-free items
B. Lactose
C. Honey
D. Meat
```
B. Lactose
161
Which of the following patients has an increased risk of epigastric hernia?
A. Mark, a 45-year-old African American male with chronic obstructive pulmonary disease
B. Gladys, a 93-year-old Hispanic female with dyslipidemia
C. Tony, a 33-year-old Asian male with hypertension
D. Whitney, a 22-year-old Caucasian female with anemia
A. Mark, a 45-year-old African American male with chronic obstructive pulmonary disease
162
```
Elaine is a 32-year-old Hispanic woman who is 33 weeks pregnant. She complains that when she wipes after defecation she noticed “a red streak on the toilet paper.” Which of the following should be included in the differential diagnosis?
A. Gastric ulcer
B. Rectal prolapse
C. Diverticulitis
D. Irritable bowel syndrome
```
B. Rectal prolapse
163
A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following should the PCP include in the explanation of the pathology report?
A. This is not premalignant tissue.
B. This tissue is not resistant to gastric acid.
C. This tissue supports healing of the esophagus.
D. This tissue does not have an increased risk of developing esophageal adenocarcinoma.
C. This tissue supports healing of the esophagus.
164
Which of the following dietary instructions should be given to a patient with GERD?
A. Eliminate coffee.
B. Drink hot toddies to relieve stomach distress.
C. Recline and rest after meals.
D. Increase the amount of spicy foods.
A. Eliminate coffee.
165
After typical groin hernia surgery, the patient should be instructed to:
A. Avoid work for 3 weeks.
B. Stay in the hospital for 2 weeks.
C. Avoid heavy lifting for 4 to 6 weeks.
D. Return to normal activities after 1 month.
C. Avoid heavy lifting for 4 to 6 weeks
166
```
A patient is diagnosed with Giardia lamblia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment?
A. Vancomycin
B. Penicillin
C. Metronidazole
D. Bactrim
```
C. Metronidazole
167
A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis?
A. Very early
B. 3 to 4 hours after perforation
C. Late in inflammation
D. Appendicitis never presents with vague pain
A. Very early
168
```
The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion?
A. Use of fish oil vitamin
B. Ethanol avoidance
C. Cigarette smoking
D. Prednisone use
```
C. Cigarette smoking
169
```
A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin. Which of the following could be a cause of this problem?
A. Increased bilirubin uptake
B. Increased bilirubin excretion
C. Biliary obstruction
D. A serum bilirubin level of 0.5 mg/dL
```
C. Biliary obstruction
170
```
Angela is a 30-year-old G0P0 biracial Asian and Caucasian woman. Her body mass index (BMI) is 22 and her history includes anemia, epilepsy, and bee-sting allergy. Which of the following parts of her patient history would increase her risk of cholelithiasis?
A. Nulliparity
B. Bee-sting allergy
C. BMI 22
D. Female gender
```
D. Female gender
171
```
A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about 1 month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point?
A. Stool culture
B. Liver enzymes
C. Antihepatitis D virus
D. Thyroid-stimulating hormone test
```
C. Antihepatitis D virus
172
```
On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis?
A. Anti-HAV IgM
B. HAV IgG
C. Anti-HCV
D. IgM anti-HBs
```
A. Anti-HAV IgM
173
A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings?
A. Decreased alanine aminotransferase and decreased aspartate aminotransferase
B. Elevated alkaline phosphatase
C. Decreased indirect bilirubin
D. Decreased white blood cells
B. Elevated alkaline phosphatase
174
```
Which of the following are included in the Ranson’s criteria for assessing the severity of pancreatitis at the time of diagnosis?
A. Blood glucose 180 mg/dL
B. Age 45 years old
C. Base deficit greater than 4 mEq/L
D. Serum LDH greater than 25 IU/L
```
C. Base deficit greater than 4 mEq/L
175
Donna is a 36-year-old African American woman with chronic pancreatitis. Which of the following are necessary to manage her condition?
A. One alcoholic drink a week maximum
B. NSAIDs, which are the only analgesic appropriate for pain relief
C. Treating serum glucose levels of 200 to 250 mg/dL
D. A low-fat diet of less than 50 g of fat per day
D. A low-fat diet of less than 50 g of fat per day
176
```
Which of the following diagnostic tests is ordered for a cecal volvulus bowel obstruction?
A. Barium enema
B. Colonoscopy
C. Endoscopy
D. Magnetic resonance imaging (MRI)
```
A. Barium enema
177
Which of the following is part of the treatment plan for the patient with IBS?
A. High-fiber diet
B. A discussion that the goal of treatment is to cure their disease
C. Daily laxatives
D. A conversation about their expected shorter life span
A. High-fiber diet
178
```
Leslie is a 35-year-old Caucasian woman who presents with weakness, anorexia, weight loss, and fatigue. Her history is significant for inflammatory bowel disease, Hashimoto’s thyroiditis, and cigarette smoking. Which of the following pieces of her history leads the clinician to believe she has primary sclerosing cholangitis?
A. Age
B. Gender
C. Inflammatory bowel disease
D. Smoker
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C. Inflammatory bowel disease
179
Carl has been diagnosed with Wilson’s disease. Which of the following should be included in his dietary education?
A. Avoid calcium-containing foods.
B. Increase protein intake with peanut butter.
C. Limit shrimp intake.
D. Increase fat intake by eating liver.
C. Limit shrimp intake.
180
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Ron has cirrhosis and now presents with altered mental status after increasing protein intake because he was trying to increase muscle mass. Which of the following diseases should the clinician be concerned about?
A. Hepatopulmonary syndrome
B. Hepatic encephalopathy
C. Hepatorenal syndrome
D. Spontaneous bacterial peritonitis
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B. Hepatic encephalopathy
