exam 2

Question 1

Which of the following objects on x ray is NOT radiopaque?
A.	 Bone
B.	Barium
C.	Muscle
D.	Fat

Answer 1

Rationale: Bone, barium, and muscle are more dense and show up as various shades of white. Fat is low density tissue and shows up black on x ray. Fat is considered radiolucent.
Site for question/rationale: PowerPoint/lecture: Understanding Radiology - Dr. Rita Dello Stritto, slides 5-6

Question 2

1.	You are working in the ICU and your ventilated patient’s oxygen saturation levels have dropped from 96-97% to 92-93%.  You order a stat portable chest x ray to assess for possible causes.  You know that a stat portable chest x-ray will be which view, unless otherwise specified?
A.	 PA
B.	AP
C.	Lateral
D.	Oblique

Answer 2

Answer: B
Rationale: Your patient is bedbound and the most feasible view to obtain is the AP view. PA views require a patient to stand. Lateral and oblique views are sometimes obtained, but due to the difficulties of a bedbound patient, not as feasible are less likely obtained.
Site for question/rationale: PowerPoint/lecture: Understanding Radiology - Dr. Rita Dello Stritto, slides on handout page 3-6

Question 3

You are working in the Emergency Room and just received a patient who injured his left 2nd and 3rd digit with a circular saw.  The fingers contain several superficial and deep lacerations.  Xray shows no bony involvement.  Flexor and extensor tendon function appears to be intact.  You prepare to anesthetize the fingers with digital blocks.  Considering that the irrigation of wounds and repair may take more than 30 minutes, what medication would be the most appropriate to use for the digital blocks? 
A.	 Bupivicaine 0.5% with epinephrine
B.	Lidocaine 1% with epinephrine
C.	Lidocaine 2%
D.	Bupivicaine 0.5%

Answer 3

Answer: D. Bupivicaine 0.5%
Plain lidocaine will last only about 30 minutes, which will not give you adequate time to repair the lacerations. You risk having to stop, perform additional infiltration, and wait for the medication to have affect. Digital blocks take several minutes to cause anesthesia to the entire digit. Lidocaine with epinephrine, and Bupivicaine with epinephrine is contraindicated as this can cause dangerous vasoconstriction in an area with limited blood supply. This can lead to loss of the digit. Bupivicaine is the optimal choice, as it will allow for several hours of anesthesia, which will also alleviate the patient’s pain for several hours.

Question 4

Which of the following are absolute contraindication for cryosurgery?
A. Verrucous lesion on hand of a patient with moderately controlled Crohn’s disease
B. Actinic keratosis on the lower leg of a patient with diabetes type 2
C. Patient with a dermatofibroma on the forearm
D. Molloscum contagiousum on abdomen of patient who is on steroids for an asthma exacerbation.

Answer 4

Rational: Answer is B. Patient’s with high risk of poor circulation and wound healing, such as type 2 diabetics, should never had cryosurgery performed to their lower extremities. This could cause a chronic diabetic ulcer/wound and/or worsening infection that could lead to cellulitis, and subsequent amputation. Cryosurgery is not recommended in someone with severe Crohn’s disease due to high circulating cryoglobulins. Dermatofibromas are difficult to treat with cryosurgery but are not contraindicated to treatment. A patient on high dose steroids in a relative contraindication, but not an absolute contraindication.

Question 5

3.	Which of the following anatomical locations would it be appropriate for staple removal of a laceration at 7 days?
A.	 Torso
B.	Knee
C.	Elbow
D.	Scalp

Answer 5

Answer: Torso
Rationale: Staples can be removed from the torso in 7-10 days. This will minimize scar formation from the staples. Areas under high skin tension, like the knee and elbow, generally require 10-14 days before removal to ensure adequate tensile strength and prevention of wound dehiscence. Scalp lesions are typically in the hair line, so scarring is not a concern unless the patient is bald. They are typically removed in 10-14 days.

Question 6

1. The CAGE acronym consists of four words in a 4-question screening test for alcohol abuse. Which of the following acronyms (underlined) is Incorrect?
   A. Have you ever felt you needed to Cut down on your drinking?
   B. Have people Angered you by criticizing your drinking?
   C. Have you ever felt Guilty about drinking?
   D. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Answer 6

Rationale: B. The correct acronym for “A” in CAGE stands for Annoyed. All of the other acronyms are correct.

Question 7

1.	The PHQ-9 depression screening tool calls for consideration of major depressive disorder if at least 5 of the shaded areas are checked (including questions #1 and #2).  Additionally, in order to diagnose major depression disorder which of the following conditions must be ruled out:
A.	 Family history of depression
B.	Normal bereavement
C.	Past suicide attempt
D.	History of anxiety

Answer 7

Correct Answer: B Normal bereavement
Rationale: Normal bereavement is a situation of depressed mood related to a sudden loss of a close person/relative or other situation/status (business, income, job, friendship) that may result in temporary depression but is short term. Patients are still able to function and accept comfort/support from others. The other items listed are all contributing factors that may make the diagnosis of major depressive disorder more likely.
Site for question/rationale: Explanatory notes in Patient Health Questionnaire (PHQ-9), Mental Health Module

Question 8

1Which of the following would be considered a secondary headache?
A.	 Migraine Headache
B.	Spinal Headache
C.	Cluster Headache
D.	Tension Headache

Answer 8

Answer: B Spinal Headache
Rationale: Migraine, cluster, and tension headache are all primary headaches with no clear etiology. Spinal headaches are often the result of a lumbar puncture where there was release of CSF fluid or leak.

Question 9

All the following are causes of non-allergic rhinitis symptoms except.
A.	Cold temperatures
B.	Viral infection
C.	Smoke
D.	Dust mites

Answer 9

Answer: D Dust mites
Rationale: Dust mites are a common cause of allergic rhinitis, as they cause an antibody response. Answers A, B, and C generally do not cause IgE antibody to release histamine from mast cells.

Question 10

You are examining a patient who has a history of Grave’s disease.  Your patient’s eyes appear to be “bulging out”.  Another term to describe this exam finding would be:
A.	 Amblyopia
B.	Proptosis
C.	Keratoconus
D.	Strabismus

Answer 10

Answer: B Proptosis
Rationale: Proptosis is the appearance of the eyes “bulging out” and is often seen in Grave’s disease, or hyperthyroidism. Amblyopia is also known as “lazy eye” which may seem to be an eye out of alignment (pseudo strabismus) and often poorer vision in that eye due to underutilization. Strabismus is known as “crossed eyes” and occurs when eyes do not align on the same object. Keratoconus is when the normally round cornea becomes thin and cone shaped.
Site for question/rationale: Eyes handout. HEENT module.

Question 11

1. Question: A 65 year old female is involved in a motor vehicle collision and arrives to the ED with complaints of RUQ abdominal pain associated with restraint use. A small bruise is noted to the area. The APRN performs a bedside FAST exam and examines the RUQ to ensure no free fluid is present in which potential space?
   a. Pouch of Douglas
   b. Morison Pouch
   c. Pericardium
   d. Urinary bladder

Answer 11

Answer: B
Rationale for why the answer is correct: The Morison Pouch is a potential space that is examined in the RUQ and LUQ of the abdomen. This potential space is the area inferior to the liver and posterior to the right kidney.
Site for question/rationale: Ultrasonography video @21:25, Dr. Steven Branham

Question 12

Question: When assessing for cardiomegaly, the APRN ensures to order which view of the chest X-ray for a more accurate image?

a. PA view
b. AP view
c. Lateral view
d. Oblique view

Answer 12

Answer: A
Rationale for why the answer is correct: A PA view of a CXR provides a more accurate depiction of the size of the heart due to its closer proximity to the film and lower distortion.
Site for question/rationale: Understanding Radiology PowerPoint, slide #19 , Dr. Rita Dello Stritto

Question 13

Question: The APRN is evaluating a 52 year old male who presented to the clinic for evaluation of a pink papule with telangiectatic vessels and rolled borders around a depressed center, located on the right aspect of the nose. The APRN correctly identifies this lesion as most likely being a:

a. Squamous cell carcinoma
b. Melanoma
c. Basal cell carcinoma
d. Adenoma

Answer 13

Answer: C
Rationale for why the answer is correct: A basal cell carcinoma usually presents as a pink or flesh colored papule with raised borders and a depressed center, translucent, and telangiectatic vessels or ulceration. Basal cell carcinomas are locally invasive and aggressive and are the most common malignancy in Caucasians.
Site for question/rationale: Dermatology video @3:52, Dr. Mercedes Day

Question 14

Question: A 4 month old infant’s mother arrives to the clinic due to what appears to be dandruff or dry skin on the infant’s head. On examination, the APRN identifies well-demarcated, erythematous plaques with greasy appearing scales. This conditions is most likely:

a. Kaposi sarcoma
b. contact dermatitis
c. erythema multiforme
d. seborrheic dermatitis

Answer 14

Answer: D
Rationale for why the answer is correct: Seborrheic dermatitis, or “cradle cap”, is often seen in infants ages 3 weeks to 12 months. The cause of this condition is unknown but it is chronic and may recur throughout the lifespan.
Site for question/rationale: Dermatology video @12:30, Dr. Mercedes Day

Question 15

1. Question: An 18 month old patient is taken to the clinic by his mother due to a fine, sandpaper-like rash on the trunk. As per his mother, the patient had also been having fever, fussiness, and had not been wanting to eat as usual. The APRN suspects the patient is presenting with a _______ rash associated with ______ infection.
   a. Scarlatina, Group streptococcus A
   b. Róseola, Sixth disease
   c. Slapped cheek, Fifth disease
   d. Molluscum contagiosum, poxvirus

Answer 15

Answer: A
Rationale for why the answer is correct: Scarlatina rash is often associated with Group streptococcus A infection and typically lasts 4-5 days. Scarlatina rash often begins in the trunk and spreads to the extremities.
Site for question/rationale: Dermatology video @12:05, Dr. Mercedes Day

Question 16

1. Question: The APRN is evaluating a 5 year old child whose parents were concerned due to difficulty with school performance. Teachers and counselors are concerned the child may have attention deficit hyperactivity disorder (ADHD). Which of the following behaviors would be most in agreement with this diagnosis?
   a. Frequent fidgeting, being unable to sleep due to being anxious, thoughts of harming self
   b. Easily getting distracted, speaking without waiting for his turn, do not seem to listen or follow through
   c. Frequently feeling sad, depressed, or losing interest in pleasurable activities
   d. Hearing voices that aren’t actually there, hallucinating

Answer 16

Answer: B
Rationale for why the answer is correct: ADHD presents with ongoing inattention and/or hyperactivity with impulsivity, often displayed as overlooking details, not seeming to listen or follow directions, fidgeting and squirming, talking non-stop, and trouble waiting their turn.
Site for question/rationale: Common Mental Health Disorders video @3:30, Dr. Mercedes Day

Question 17

1. Question: The mother of a 14 year old male is concerned due to her son’s recent involvement in activities away from societal norms (e.g. stealing, bullying, fighting) as well as aggression towards animals and destruction of property. The APRN identifies these behaviors congruent with:
   a. Bipolar disorder
   b. Depression
   c. Conduct disorder
   d. Generalized anxiety disorder

Answer 17

Answer: C
Rationale for why the answer is correct: Conduct disorder involves behaviors away from societal norms and meeting of at least 3 criteria within 12 months, with the most recent criterion being met within the past 6 months. Criteria include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules.
Site for question/rationale: Common Mental Health Disorders video @6:53, Dr. Mercedes Day

Question 18

Question: A patient is concerned due to the increase in frequency and intensity of her headaches in the recent days. As per the patient, her headaches used to occur monthly, however, they are occurring almost daily now and worsen with coughing, sneezing, and are now awakening her in the morning. The APRN correctly recommends:

a. a CT of her head to identify any lesions, tumors, or macroscopic abnormalities
b. for the patient to continue monitoring her headaches and return in a month for follow-up
c. OTC medications for symptomatic relief since these are expected findings due to her history of headaches
d. obtaining a stat MRI

Answer 18

Answer: A
Rationale for why the answer is correct: Due to the change in her headache pattern and the fact that these headaches are now awakening her in the morning, the APRN should assess any masses via head CT as her symptoms can occur with increased intracranial pressure.
Site for question/rationale: To Scan or Not to Scan in Headache article from HEENT module, paragraph 2

Question 19

Question: After evaluating a patient for a frontal headache, the APRN differentiates between potential primary and secondary causes. The APRN is aware that which of the following may cause a secondary headache?

a. Poor posture
b. Stress
c. Poor sleep or sleep disturbances
d. Carbon monoxide poisoning

Answer 19

Answer: D
Rationale for why the answer is correct: Carbon monoxide poisoning is a potential cause of a secondary headache. While primary headaches occur due to over activity or problems with pain-sensitive structures in the head, secondary headaches occur as symptoms of a disease or disorder that activate pain-sensitive nerves.
Site for question/rationale: Headaches PDF in HEENT module, under examples of primary and secondary headaches

Question 20

Question: A 18 year old female presents to the clinic with complaints of runny nose, sneezing, and congestion for 3 days. As per the patient, she has not had any fever and has not undergone any new activities other than taking care of her friend’s cat. The APRN identifies this as likely being allergic rhinitis and understands the pathophysiology involves:

a. Activation of mast cells by allergens via IgE-mediation and histamine release
b. Suppression of mast cells and thus swelling of the nasal mucosa
c. Release of histamine via epithelial cells
d. An infectious process as a result of the allergen

Answer 20

Answer: A
Rationale for why the answer is correct: Allergic rhinitis occurs due to allergen activation of IgE-mediated mast cells. This activation promotes histamine release by the mast cells which in turn leads to capillary leakage, swelling of the nasal mucosa, congestion, rhinorrhea, and sneezing.
Site for question/rationale: Nose PDF in HEENT module, 5th paragraph

Question 21

1. Question: A nurse practitioner is reviewing a PA view of a chest x-ray of a 52-year-old male. The clavicles bilaterally straight, and there are eight spaces between the ribs. The cardiac silhouette is greater than ½ the width of the chest. What are the three differential diagnoses for this CXR?
   A. Pulmonary embolus, pericardial effusion, and GERD
   B. Congestive heart failure (CHF), cardiomyopathy, and pericardial effusion
   C. Pulmonary embolus, cardiomyopathy, and GERD
   D. You cannot measure the size of the heart on a PA view

Answer 21

Answer: B. Congestive heart failure (CHF), cardiomyopathy, and pericardial effusion
Rationale for why the answer is correct: The heart’s silhouette should not exceed greater than half the chest’s total width. If the silhouette is > ½ the chest’s total width, there is a factor causing inflammation or fluid accumulation. Answer choices A and C have distractors, and answer choice D is incorrect. The PA view is the only view where you can determine the size of the heart.
Site for question: “Basic Radiology” Dr. Stritto, slides 33-34

Question 22

Question: Which of the following are the four types of Kaposi sarcoma?
A. Classic, endemic, patch, and plaque
B. Nodular, patch, iatrogenic, and papular
C. AIDS associates, patch, nodular, and classic
D. Classic, endemic, iatrogenic, and AIDS acquired

Answer 22

Answer: D. Classic, endemic, iatrogenic, and AIDS acquired
Rationale for why the answer is correct: The four types of Kaposi sarcoma are classic, endemic, iatrogenic, and AIDS acquired. The other answer choices have the stages of Kaposi sarcoma as distractors.

Question 23

Question: A six-year-old boy is brought to the clinic by his mother with the chief complaint of a rash around his mouth. Upon inspection, you notice yellow, pus-filled vesicles below his nose and around his mouth. His mother states that the vesicles arose after the patient had a few days with a runny nose. Based on these symptoms, which dermatologic condition would have the highest priority in your differential diagnoses? 
A.	Impetigo 
B.	Dermatitis
C.	Eczema
D.	Actinic keratitis

Answer 23

Answer: A. Impetigo
Rationale for why the answer is correct: Impetigo presents as yellow, pus-filled vesicles.
Site for question/rationale: “Skin Disorders” lecture, Dr. Sun and Dr. Moore, minute 5:54

Question 24

Question: As an APRN, you cannot perform incision and drainage procedures on the following areas (select all that apply):
A.	Face
B.	Elbow
C.	Shoulder
D.	Palmar aspect

Answer 24

Answer: A. Face; B. Elbow; D. Palmar aspectRationale for why the answer is correct: As an APRN, IND procedures on the face, elbow, palmar aspects, and plantar aspects are procedures that should be referred out to a specialist.
Site for question

Question 25

All the following are true about bipolar disorder except (select two): A. It is characterized by severe and significant mood swings B. To be diagnosed with bipolar disorder, a person must have four manic episodes followed by four depressive episodes in their lifetime C. There may be a period of up to three years between episodes of mania and depression D. There are three subtypes of bipolar disorder: bipolar I, bipolar II, and bipolar III

Answer 25

1. Answer: B. and D. Rationale for why the answer is correct: To be diagnosed with bipolar disorder, a person must have one manic and one depressive episode in their lifetime. There are two subtypes of bipolar disorder: bipolar I and bipolar II. Site for question/rationale: "Common Mental Health Disorders

Question 26

1. Question: Which of the following is not true about youth suicidality (select all that apply)? A. Suicide is the third leading cause of death in this age group B. Early identification and treatment of patients at elevated risk for suicide is a key suicide prevention strategy C. Assessing for suicidality should be done indirectly to avoid the iatrogenic risk of asking youths questions about suicide D. Adolescents feel more comfortable discussing risk-taking activities with specialists than with their PCPs

Answer 26

Answer: A., C., and D. Rationale for why the answer is correct: Suicide is the second leading cause of death in this population; assessing for suicidality should be addressed by using direct questions, as studies have refuted the myths concerning the iatrogenic in asking about suicidality; and adolescents feel more comfortable discussing risk-taking activities with their PCPs rather than specialists. Site for question/rationale: NIMH Toolkit Ask Suicide Screening Questions (asQ) Information Sheet

Question 27

1. Question: Which of the following are considered "red flags" with headaches (select all that apply)? A. A patient over the age of 55 who is experiencing new headaches and does not have a history of headaches B. A patient with periorbital headaches that wakes them up at night C. A patient who describes their headache as a "thunderclap" type of headache A patient with chronic migraines who describes having difficulty concentrating

Answer 27

Answer: A., C., and D. Rationale for why the answer is correct: New headaches in patients who are > 55 years, with no history of headaches, thunderclap headaches, and changes in signs and symptoms in patients with chronic migraines are all red flags for hemorrhages in or around the brain. Site for question/rationale: "Headache Differentials" Lecture, Dr. Moore and Dr. Hilliard, minute 7:00

Question 28

Question: Which statement concerning migraine and cluster headaches is correct? A. Migraines are more commonly seen in women and are usually experienced in the middle of the night. In contrast, cluster headaches are more typically seen in males and can fluctuate with hormones. B. Migraines and cluster headaches are experienced equally between males and females. C. Migraines are more commonly seen in males and are usually experienced in the middle of the night. In contrast, cluster headaches are more typically seen in women and can fluctuate with hormones. D. Migraines are more commonly seen in women and usually fluctuate with hormones. In contrast, cluster headaches are more typically seen in males and generally are experienced in the middle of the night.

Answer 28

Answer: D. Migraines are more commonly seen in women and usually fluctuate with hormones. In contrast, cluster headaches are more typically seen in males and generally are experienced in the middle of the night.

Question 29

According to the American Academy of Pediatrics and The American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines, the following children should be referred for the placement of tympanostomy tubes (select all that apply)? A. At-risk children (e.g., speech, language, or learning problems) with unilateral or bilateral otitis media with effusion that is unlikely to resolve quickly and persists for 3 months or longer B. Recurrent episodes of acute otitis media with or without effusion in infants and young children C. Children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy D. Eustachian tube dysfunction that is chronic or recurrent and unresponsive to medical management; atelectasis of the middle ear that is chronic (with or without retraction pocket)

Answer 29

Rationale for why the answer is correct: In infants and young children, amoxicillin prophylaxis should be the first step in preventing a recurrent episode of acute otitis media, and if this fails, then the patient should be referred for tympanostomy tube placement. Site for question/rationale: "ENT Referral for Tympanostomy Tubes in Children" Clinical KeyAnswer: A, C, D.

Question 30

``` Question: The APRN is assessing a chest radiograph, PA and lateral, of Sylvia an 18-year-old female presenting today for productive cough for 1 week. Upon visualization you are unable to completely visualize the right hemidiaphragm in the PA view and thoracic spine in the lateral view. What is the most likely diagnosis? Answer: A) Asthma B) Cystic Fibrosis C) Pneumonia D) Bronchopulmonary dysplasia ```

Answer 30

C: Rationale for why the answer is correct: These findings are consistent with a RLL pneumonia. In asthma you would expect to see hyperinflation of the lung and bronchial wall thickening. In cystic fibrosis you would expect to see thick-walled bronchiectasis. In BPD you would expect to see hyperinflation.

Question 31

Question: An APRN student is discussing ultrasound technique with their preceptor, which statement by the student would indicate a need for further education? Answer: A) In color mode red means that you are looking at an artery and blue means that you are looking at a vein B) A linear probe is most useful when placing an ultrasound guided peripheral IV C) You should always use sterile covers and gel when performing an ultrasound inside of a body cavity D) It is within the APRNs scope of practice to conduct point of care ultrasound testing

Answer 31

A: Rationale for why the answer is correct: Color indicates the direction of flow, not the type of vessel. Red is towards, and blue is away. The other answer choices are correct statements.

Question 32

``` Question: April, a 4-month-old infant, presents today to the clinic for a rash per mother report. Upon inspection you notice well demarcated, erythematous plaques with greasy looking scales to the umbilicus area. What is your leading diagnosis for this patient? Answer: A) Fifth disease B) Molluscum Contagiosum C) Scarlatina D) Seborrheic dermatitis ```

Answer 32

D:Rationale for why the answer is correct: The rash described here is characteristic of “cradle cap” a common dermatological finding in children ages 3 weeks to 12 months. Scarlatina produces a “sandpaper” like exanthem. Fifth disease produces an erythematous malar rash with circumoral pallor. Molluscum contagiosum produces flesh colored dome shaped papules.

Question 33

Question: The APRN is assessing a middle-aged Caucasian male for a new onset skin lesion. The APRN is concerned and has decided to refer the patient to a dermatologist. What is the most important information for the APRN to include in their referral? Answer: A) The patient’s insurance information B) The patient’s past medical history C) A complete medication reconciliation of the patient’s current medications D) A description of the size, location, character, color, and distinguishing features of the skin lesion

Answer 33

D:Rationale for why the answer is correct: An accurate description of the lesion is necessary for subsequent providers to accurately identify and assess the lesion in question. The past medical history and medication reconciliation is important and could contribute to the skin lesion. Insurance information is important for billing. Site for question/rationale: Dr. Amy Moore and Dr. Grace Sun’s presentation over skin lesions beginning at 10:06.

Question 34

Question: As an APRN in the ED you are preparing to perform a laceration repair on Steven a 34-year-old male who injured himself with a saw at work. He states that he can not remember when he received his last tetanus vaccination but says he is up to date on vaccines. Which of the following is true about tetanus prophylaxis? A) Tdap for anyone over the age of 7 who has not been updated in the past 5 years B) Tell the patient to follow up with their PCP since he does not know C) Tdap for anyone over the age of 7 who has not been updated in the past 10 years D) Tetanus prophylaxis is not needed for someone who claims to be up to date on their vaccines

Answer 34

A: Rationale for why the answer is correct: Anyone over the age of 7 should be updated every 5 years if they have a tetanus prone wound. If they do not have a tetanus prone wound, they should be updated every 10 years. The APRN should not delay updating the vaccination by telling the patient to follow up with their PCP. The APRN should recommend vaccination for anyone they cannot confirm has been vaccinated within the past 5 years.

Question 35

Question: You are conducting a newborn screening on Sophia, a 2-day old infant, what response from the mother would raise concern for postpartum depression? Answer: A) “I was so glad to go home, I wasn’t able to sleep well in the hospital” B) “This is my first baby; I am scared to be at home alone with her” C) “I am choosing to bottle feed because I can’t look at my baby while breastfeeding” “My partner has been helpful during nighttime awakenings allowing me to sleep as much as possible

Answer 35

Rationale for why the answer is correct: This response would indicate a lack of bonding between the infant and the mother. It is normal to have some anxiety about bringing a new baby home, especially if it is the first child as parents often feel like they do not know how to care for the baby yet. The other two responses indicate a normal sleep pattern.

Question 36

Question: Which of the following statements is false regarding suicide screening in youth? Answer: A) Suicide in the healthcare setting only occurs in the behavioral health unit B) A suicide screening should be conducted at every visit in the inpatient, emergency department, and primary care setting C) A “yes” to any question #1-4 on the ASQ is considered a positive screen D) Number 5 on the ASQ screening assesses acuity

Answer 36

A: Rationale for why the answer is correct: 25% of suicides that occur within the hospital have occurred in non-behavioral health settings such as a general medical unit or the emergency department. The other choices are true regarding screening for suicide in youth. Site for question/rationale: Depression Screening Information for Youth Handout within the mental health module.

Question 37

``` Question: You are the APRN caring for Aaron, a 2-year-old male, who presents to your ED today for a fall from the couch approximately 2 feet off the ground while playing with a sibling. The fall was witnessed by the mother who denies loss of consciousness (LOC) or vomiting. The patient has no past medical history, is acting appropriately for age, and there is no evidence of trauma on your physical exam. What is your plan for this child? Answer: A) MRI head with and without contrast B) CT with contrast C) CT without contrast D) Continued observation ```

Answer 37

D: Rationale for why the answer is correct: A minor closed head injury without neurologic changes or risk factors have been shown not to benefit from radiographic imaging. Some indications for imaging include neurologic deficits, midline spinal tenderness, altered level of consciousness, substance intoxication, and presence of a distracting injury.

Question 38

Question: You are caring for Nancy, a 51-year-old female with a history of migraine headaches for which she manages at home with Imitrex. She calls your clinic and states “I am having the worst headache I’ve ever had in my life. I have already taken my Imitrex, Motrin, and Tylenol and I haven’t had any relief”. What do you advise your patient to do at this time? Answer: A) Give the medications more time to kick in B) Tell the patient you will send a prescription for Benadryl and Compazine to their pharmacy C) Advise the patient to proceed to the emergency department D) Refer the patient to a neurologist

Answer 38

C: Rationale for why the answer is correct: When a patient reports they are experiencing the worst headache of their life it is prudent to advise them to go to the ED to have an emergency scan done to rule out a brain bleed. Benadryl and Compazine are often administered along with an NSAID as a “migraine cocktail”. Referring the patient to a neurologist does not solve the acute problem. Telling the patient to wait could delay care for a potentially life-threatening illness. Site for question/rationale: Dr. Moore and Dr. Hillard’s presentation over headaches beginning at 4:11.

Question 39

Question: You are seeing a 17-year-old male patient with a chief complaint of sore throat. All of the following are distinguishing features for mononucleosis except? Answer: A) Enlarged posterior cervical lymph nodes B) Fever C) Onset acute or gradual D) Nasal congestion

Answer 39

D: Rationale for why the answer is correct: Nasal congestion is more common with viral pharyngitis or postnasal drip as a result of allergic rhinitis. Enlarged posterior cervical lymph nodes, fever, and acute or gradual onset are all common findings with mononucleosis. Site for question/rationale: Dr. Amy Moore and Dr. Grace Sun’s presentation over HEENT time stamp 11:00-15:55.

Question 40

``` Question: As the APRN in the ED you are responsible for performing eFAST exams for all Level I and Level II trauma patients that present to the ED. When using the ultrasound to assess a 19-year-old male for intraabdominal bleeding, free fluid in which in anatomical pouch could be cause for concern or further evaluation? A) Morrison’s pouch B) Pouch of Douglas C) Bladder D) A+B ```

Answer 40

Answer: D Rationale for why the answer is correct: In a male patient, free fluid or blood in both Morrison’s pouch and/or pouch of Douglas would be a cause for further evaluation. The pouch of Douglas may have fluid in it that is not cause for concern, typically in females but should always be cause for further interpretation and evaluation. Free fluid in the bladder likely represents urine, unless a urinary catheter is present.

Question 41

Question: Which statement about the general characteristics of x-ray is NOT true? A) More dense objects appear more “black” B) Objects with greater density are more difficult to penetrate with x-ray C) Glass will not appear on x-ray D) Fluid will appear “black” on x-ray

Answer 41

Answer: A Rationale for why the answer is correct: Greater density objects on x-ray are more difficult for x-ray to penetrate and appear “white” on x-ray. Examples of this include bone, muscle, barium. Glass does not appear on x-ray, unless it is plated glass that contains lead. Fluid, along with air, fat, and plastic is less dense and will appear “white” on x-ray.

Question 42

Question: The APRN is completing pre-procedural treatment teaching with a 50-year-old female undergoing cryotherapy for a wart on the palmar surface of her hand. The APRN knows teaching was successful when the patient states which of the following? A) this treatment can cause severe pain B) I will require a follow up visit in approximately 1 week C) I need to make sure to use sunscreen on the area once healed D) this is a procedure that is well suited for dark colored skin

Answer 42

Answer: C Rationale for why the answer is correct: Cryotherapy for warts is a procedure that can be performed in office with minimal pain and no follow up or aftercare. The treatment is best for those with light colored skin and the treatment area after removal can be more susceptible to sunburns. Therefore, using sunscreen on the area once healed would be the correct answer.

Question 43

Question: A 55-year-old Caucasian male with an extensive family history of skin cancer comes into the clinic for a mole check. When evaluated the mole has irregular borders, is three shades of red, and the patient states he feels the mole has been growing in size. When determining what type of skin biopsy to perform, what characteristic of the mole would lead you to choose a punch biopsy over a shave biopsy for this lesion? A) A punch biopsy is easier than a shave biopsy B) A punch biopsy requires no anesthetic C) The lesion involves the dermis D) A shave biopsy cannot be performed in office

Answer 43

Answer: C Rationale for why the answer is correct: The punch biopsy is the preferred method for conditions of the skin that may involve the dermis layer of the skin. Both of the punch biopsy and shave biopsy can be used in conjunction with anesthetic and both procedures can be performed in office by a trained professional.

Question 44

Question: The patient demonstrates understanding to the APRN’s discussion on skin cancer by making which of the following statements A) “I am not at risk because I am less than 45 years old” B) “I should be suspicious of moles that are round in shape” C) “I should be alert for anything on my skin that changes in size or color” D) “I am less at risk because I am fair-skinned”

Answer 44

Answer: C Rationale for why the answer is correct: The patient should be suspicious for skin cancer in any lesion that meets the ABCDE criteria including: asymmetry, border irregularities, color variation, diameter>6mm, and evolution. Although skin cancer is more common in those >50 years, it still can be a risk in those <50 years. Skin lesions round in shape with no irregular borders do not meet the ABCDE criteria. Fair skinned individuals are more at risk for skin cancer

Question 45

Question: Which characteristic is most consistent with conduct disorder? A) Inability to focus or pay attention in school B) Feeling consistently “on edge” C) Destruction of school property D) Interrupting others, especially in classroom settings

Answer 45

Answer: C Rationale for why the answer is correct: The inability to focus or pay attention in school is more characteristic of ADHD. The feeling consistently “on edge” is characteristic of generalized anxiety disorder. Interrupting others, especially in classroom settings is also more consistent with ADHD. Conduct disorder is characterized by aggression to people or animals, destruction of property, deceitfulness and/or theft, and serious violation of rules making C the answer

Question 46

Question: A 29-year-old female presents to the ED for evaluation of “erratic behavior.” The ARPN performs a history and physical and notes that the patient hasn’t been sleeping lately and feels as if “she doesn’t need sleep” despite not sleeping much in the past 3 days. The patient also reports to periods of feeling “hopeless.” The patient states these mood swings can persist for months at a time. The APRN is suspicious for Bipolar disorder, when differentiating between Bipolar I and Bipolar II the ARPN know that which of the following is more consistent with Bipolar I disorder? A) At least one depressive episode including feelings of helplessness and hopelessness B) Episodes of mood changes that can last up to several months C) Significant mood swings D) At least one manic episode and one depressive episode during lifetime

Answer 46

Answer: B Rationale for why the answer is correct: Bipolar I and Bipolar II are differentiated by the length of time of the manic episodes. In Bipolar II, a manic episode only has to be present for 4 days to meet the characteristic criteria. In Bipolar I, episodes can range from a few hours to several months. A depressive episode, significant mood swings, and at least one manic and one depressive episode are all characteristic of both Bipolar I and Bipolar II.

Question 47

``` Question: The use of fluorescein staining would be most useful in the diagnosis of? A) Ocular hypertension B) Cataracts C) Trauma related injury D) Macular degeneration ```

Answer 47

Answer: C Rationale for why the answer is correct: Fluorescein staining involves staining the conjunctiva to look for irregularities, abrasions, and/or trauma. Ocular hypertension is caused by an increase in pressure in the eyelid and would not be diagnosed with fluorescein staining. Macular degeneration is disturbance of the retina and would need to be looked at with an ophthalmoscope. Cataracts is an eye disease in which the lens becomes opaque and vision is obscured and would not be diagnosed with fluorescein staining.

Question 48

``` Question: The APRN is evaluating a patient in the ED with purulent drainage from the nose. The APRN diagnoses viral rhinosinusitis rather than bacterial sinusitis correctly by which of the following attributes? A) Symptoms present for >10 days B) Presence of sinus pain C) Presence of congestion D) Fever last <48 hours ```

Answer 48

Answer: D Rationale for why the answer is correct: Viral rhinosinusitis and bacterial sinusitis share many of the same attributes, but a few important distinctions exist. In viral rhinosinusitis, fever (if present) is typically 24-48 hours compared to the fever>48 hours that is commonly present in acute bacterial sinusitis. Viral and bacterial sinusitis can both present with sinus pain and congestion. The symptom duration of viral sinusitis is usually less than 10 days, while in bacterial sinusitis symptom duration is typically greater than or equal to 10 days.

Question 49

Question: The presence of which “red flags” should alert the provider that the patient may be experiencing secondary headache rather than primary headache? A) Headache that occurs in clusters B) Light flashing prior to headache onset C) “Band-like” headache D) New onset of headache>50 years old

Answer 49

Answer: D Rationale for why the answer is correct: “Red flag” symptoms of headaches include: change in headache pattern, new onset headache in those>50, seizures, headache with systemic or neurological symptoms such as fever, focal neurological deficits, new onset headache in morning, headache that is worsened with coughing, sneezing, straining, sudden onset headache, or “worst headache of life”. The most common primary headaches include migraine with aura (often presents with sensory disturbance such as flashing light), cluster or pattern type headaches, and tension type headaches that are often described as “band like”

Question 50

1. Question: A new NP started her clinical rotation today at a local hospital. The physician that she is working for advised her to tell the tech to perform an eFAST on a patient that was in a car accident yesterday. What does the acronym eFAST mean? A. Question: Emergency fast acting sonography test B. Extended focused assessment sonography for trauma C. Extended frequency assessment sonography for trauma D. None of the above

Answer 50

Answer: B. Extended Focused Abdominal Scan for Trauma Rationale for why the answer is correct: Ultrasound has emerged as sensitive and reliable tool to evaluate patients presenting to the emergency department. Site for question/rationale: Ultrasound + presentation PP side 25

Question 51

Question: What are the benefits of Point of Care Ultrasound (POCUS). A. Inpatient and outpatient B. Ability to directly see your finds vs. inferred by physical exam and historical finds C. No ionizing radiation D. All the above

Answer 51

Answer: D. All the above Rationale for why the answer is correct: All the answers were discussed in the video by Dr. Branham. POCUS is a safe, effective imaging tool that can be used at the bedside vs. taking the patient to the machine.

Question 52

``` Question: You are providing a teaching to young adults at a local health fair about skin cancer. One topic that was discussed is the identification of a melanoma. Select all the characteristics of this type of skin cancer you will educate the young adults. A. Asymmetry B. Border irregularities C. Color variegation D. All the above ```

Answer 52

Answer: D. All the above Rationale for why the answer is correct: A symmetry: one half of a mole or birthmark looks different from the other half, B: order: irregular edge, C: color is not consistent, may include shades of brown, black, pink, red or white.

Question 53

``` Question: Kaposi sarcoma is an infection with a virus called Kaposi sarcoma associated with Herpes Virus (KSHV). What are the lesions types that associated with Kaposi’s tumor’s? A. Patch stage B. Plaque stage C. Nodular stage D. All the above ```

Answer 53

Answer: D. All the above Rationale for why the answer is correct: there are thin walled vascular spaces are visible in the upper dermis with a spare mononuclear cell infiltrate of lymphocytes plasma cells and macrophages, the vascular spaces increasing number than inflammatory infiltrate is more dense and spindle cell bundles accumulate around the areas, the tumor is more solid and there are well defined nodules which consist of large vesicles of spindle shaped endothelial cells.

Question 54

``` Question: What diagnostic tools can be used to help diagnosis skin conditions? A. Punch/ Shave biopsy B. BMP/ CMP C. Ultrasound D. Urinalysis ```

Answer 54

Answer: A. Punch / shave skin biopsy Rationale for why the answer is correct: Shave and punch biopsy are essential procedures for providers that manage skin conditions.

Question 55

Question: A new FNP is conducting an assessment in the outpatient clinic on a patient with depression who has been talking about how “it would be better if he wasn’t here anymore”. What questions are important for the FNP to ask the patient? A. Do you have any children that you can go and visit for a couple of days? B. Do you have trouble sleeping, eating and or concentrating? C. Who lives with you? D. Are you married or divorce?

Answer 55

Answer: B. Do you have trouble sleeping, eating and or concentrating? Rationale for why the answer is correct: Depression is a serious medical condition in which a person feels very sad, hopeless, unimportant, and unable to live a normal life.

Question 56

1Question: A new FNP is caring for a patient with bipolar disorder who recently got admitted to an outpatient clinic and is experiencing a manic episode. What are some signs and symptoms of a manic episode? A. Extreme happiness, irritable, hyperactivity, and feeling like they can do anything. B. Feeling restless, wound-up or on edge C. Difficulty concentrating or mind going blank D. Difficulty controlling feelings of worry

Answer 56

Answer: A. Extreme happiness, irritable, hyperactivity, and feeling like they can do anything. Rationale for why the answer is correct: This is a period of predominantly elevated, expansive, or irritable mood accompanied by some of the following symptoms: inflated self-esteem, decreased need for sleep, talkativeness, flight of ideas, distractibility, hyperactivity, hypersexuality, and recklessness.

Question 57

1. Question: You are interviewing a patient who is seeking relief for frequent headaches. Which description is consistent with signs and symptom of a migraine headache? A. It only happens at night B. Its only on one side of the head C. Pain that has lasted 4 days D. Patient stated that he lost his sense of taste and smell

Answer 57

Answer: B its only on one side of the head Rationale for why the answer is correct: Occipital neuralgia neuralgia A severe pain due to damaged nerves. Site for question/rationale: Video (Headache Differentials) Dr. Moore and Dr. Hilliard 2:10

Question 58

``` Question: You are assessing an 80-year-old female who was diagnosed with glaucoma on her right eye 10 years ago. Two weeks ago, she started to have visual problems and wanted to know if everything is fine. Which symptom indicates a high priority needed for reassessment for intraocular pressure? A. Burning in the eye B. Inability to see colors C. Increased sensitivity to light D. Gradual vision changes ```

Answer 58

Answer: D gradual vision changes Rationale for why the answer is correct: Is an indication of increased intraocular pressure. Site for question/rationale: Eye handout

Question 59

``` Question: You are working in an outpatient clinic assessing a 50-year-old man with a chief complaint of drainage that goes down to the back of his throat, pain, tenderness and swelling around the eyes, cheeks, nose, and forehead. Which of the following is causing this patient to have these signs and symptoms? A. Allergic rhinitis B. Seasonal allergies C. Sinusitis/ rhinosinusitis D. Perennial allergic rhinitis ```

Answer 59

Answer: C. Sinusitis Rationale for why the answer is correct: This is caused by viruses or bacteria that infect the sinuses and begin to multiply. The sinus lining swells and blocks the channels that drain the sinuses. This may cause mucus and pus to fill up the nose and sinus cavities Site for question/rationale: Nose handout

Question 60

1. Question: A 6-year-old male is seen in the ED holding his left arm. His mother tells you that he was playing at the park and fell from the monkey bars. You suspect him to have a fracture or break in his arm. Which of the follow X-Rays would you order to confirm your diagnosis? a. PosteroAnterior (PA) b. Lateral (Lat) c. Oblique d. All of the above

Answer 60

Answer: D: All of the above – PA, Lat, and oblique Rationale for why the answer is correct: According to Dr. Rita A Dello Stritto’s lecture on Radiology from Novice to Expert, she discusses that for extremity diagnoses you need 3 views. AP/PA, lateral, and oblique due to the body being 3-demensional and X-rays not. You may be able to see a fracture in on view, but not the other.

Question 61

Question: You see a patient who comes in with a complaint of abdominal pain and a history of blunt trauma to his abdomen 2 days prior. You do an extended focused abdominal scan for trauma (eFAST) to assess for all the following EXCEPT a. Is there free fluid in the pericardial cavity b. Is there a pelvic fracture c. Is there free fluid in the chest cavity Is there a pneumothorax

Answer 61

Answer: B: is there a pelvic fracture Rationale for why the answer is correct: According to Dr. S. Branham’s lecture on “Principles for Ultrasound for the ACNP Student” the reason for doing an eFAST is to assess for blood in the chest and abdomen. The principle questions to this study are is there free fluid in the pericardial cavity? Is there free fluid in the peritoneal cavity? Is there free fluid in the chest cavity? And Is there a pneumothorax? Ultrasounds are used for soft tissue and fluids, not necessarily great for bone but can see fractures. This test is not preformed for fractures

Question 62

Question: A small, less than 5-mm diameter circumcised papules containing serous material is a a. Bullae b. Pustules c. Vesicles d. Cysts

Answer 62

Answer: C. Vesicles Rationale for why the answer is correct: This is the definition of a Vesicle is “a small, less than 5-mm diameter circumcised papules containing serous material” (Rhoads et al., 2015, p.263). A Bullae is larger than 5mm. A Pustules is a papule containing purulent material. A cyst is an enclosed cavity with a lining that contains a liquid or semisolid material.

Question 63

Question: Mr. Jones, 60-year-old Caucasian male is seen today for a new “bump” on his neck. He states that it has recently appeared and grown quickly over the last week. Your exam findings are that it is firm to the touch, shiny, flesh-colored, and is an intracutaneous nodule. You ask Mr. Jones if it hurts as you palpate it and he confirms that it does not. You schedule a biopsy and further diagnostic studies. Prior to the results what is your leading differential diagnosis? a. Kaposi Sarcoma b. Basal cell carcinoma c. Merkel cell carcinoma d. Squamous cell carcinoma

Answer 63

Answer: C: Merkel cell carcinoma Rationale for why the answer is correct: Merkel cell carcinoma is a rare and aggressive cutaneous carcinoma. It has rapid growth, is painless, firm, non-tender, shiny, flesh colored or bluish-red, intracutaneous nodule. It is normally found on the head and/or neck region. Site for question/rationale: Dr. M. Day “Dermatology” at approximately 7min 40 second mark of lecture.

Question 64

Question: A 5-year-old patient who is diagnosed with Group A Streptococcus pharyngitis. He presents with an erythematous, fine papular rash that has progressed from localized on the trunk throughout all extremities. During your physical assessment you find that the rash is 1-2 mm in diameter and sandpaper-like exanthem. He has pharynx appears erythematous with exudates present and a strawberry-like tongue. What is your leading diagnosis on this child? a. Scarlatina b. Impetigo c. Roseola d. Pityriasis Rosea

Answer 64

Answer: A: Scarlatina Rationale for why the answer is correct: Scarlatina is common in the pediatric population. It is normally 1-2 mm in diameter that is erythematous and papular rash that spreads from trunk to extremities. Presents with sandpaper-like texture rash, large tonsils, submandibulalr adenopathy, and a strawberry – like tongue. Rash lasts 4-5 days. Site for question/rationale: Dr. M. Day “Dermatology” at approximately 26 minutes and 52 seconds.

Question 65

Question: A mother is concerned about her 12-year-old’s behavior over the last 12 months. He consistently sneaks out and stays out all night with older friends without her consent. A couple of months ago he was suspended from school for starting a physical altercation with a younger classmate. Their neighbor has accused him of breaking into his home at night and stealing personal items last week. His behavior seems to be getting worse and he tends to deny any accusation. What is the most likely diagnosis? a. ADHD b. Conduct disorder c. Bipolar d. Oppositional Defiant Disorder

Answer 65

Answer: B: Conduct disorder Rationale for why the answer is correct: Conduct disorder is diagnosed at school age or teenagers. Societal norms or rules are violated. They have had 3 or more of the criteria within the last 12 months, or 1 or more within the last 6 months. Criteria: Aggression to people or animals. Destruction of property. Deceitfulness or theft. Serious violation of rules.

Question 66

Question: The hallmark signs of schizophrenia are the following. • Delusions. • Hallucinations (auditory, visual, olfactory, tactile). • Incoherent speech. • Problems in behavior including catatonic behavior • Lack of emotional expression and/or lack of purposeful activity To appropriately diagnose a patient with schizophrenia they must exhibit how many of these signs over how long? a. Must have all signs for at least 1-month b. Must have 2 or more for at least 1-month c. Must have 3 or more for at least 3 months d. Must have 1 or more for at least 3 months

Answer 66

Answer: B: Must have 2 or mother for a least 1-month Rationale for why the answer is correct: Schizophrenia is a mental disorder that the patient must suffer from 2 of the 5 symptoms for at least 1-month.

Question 67

Question: Typically occurring in cyclical patterns, this type of headache is one of the most painful and tends to awaken the patient in the middle of the night with intense pain in or around one eye on one side of the head. What type of headache is this? a. Cluster headache b. Tension Headache c. Migraine d. Secondary Headache

Answer 67

Answer: A: Cluster Headache Rationale for why the answer is correct: Cluster headaches occur in cyclical patterns or clusters, they are extremely painful and commonly awakens you in the middle of the night with pain in or around one eye on the same side of the head.

Question 68

Question: A patient is seen with the following complaints. Febrile for the past 2 days, has had unilateral sinus pain, pus-like drainage from the right nare, congestion, and positive for postnasal drip. Upon assessment you not red, purulent nasal mucosa and negative for nasal pruritus. During the history you learn that she feels as if there are no specific triggers to her recent symptoms. Which of the following is your leading differential diagnosis? a. Acute Viral Rhinosinusitis b. Acute Bacterial Rhinosinusitis c. Allergic Rhinitis d. Non-allergic Rhinitis

Answer 68

Answer: B: Acute Bacterial Rhinosinusitis Rationale for why the answer is correct: With acute bacterial rhinosinusitis you will typically find a fever for greater than 48 hours, plus or minus purulent (pus) drainage unilateral, congestion, postnasal drainage, unilateral sinus pain, red, purulent nasal mucosa. The patient will normally be negative for nasal pruritus and triggers. Duration of symptoms until improvement is > 10 days.

Question 69

1. Question: What is the term for poor vision in an eye that does not receive adequate use during early childhood? a. Strabismus b. Proptosis c. Amblyopia d. Keratoconus

Answer 69

Answer: C: Amblyopia Rationale for why the answer is correct: Amblyopia, also known as Lazy eye is poor vision in an eye that does not receive adequate use during early childhood. Strabismus is crossed eyes. Proptosis is bulging eyes. Keratoconus is thin and coned shape cornea.

Question 70

Question: What is the purpose of the FAST exam? A- To look at detailed vessels of the heart B- To look for blood in the chest and abdomen C- To look for DVTs in extremities D- To look for blood in the brain

Answer 70

Answer: B Rationale for why the answer is correct: The FAST exam is used to look for fluid in the abdominal and chest cavities. It is also used to recognize pneumothorax. This is helpful with trauma patients entering the ER to help rule in or out emergent diagnoses.

Question 71

``` Question: Who is most at risk for developing melanomas? A- White adult men B- Black adult men C- Latino adult men D- Black adult women ```

Answer 71

Answer: A Rationale for why the answer is correct: White men older than 50 are at higher risk for developing a melanoma due the fairness of their skin and the time exposed to sun. Other factors include greater than 25 nevi, and red hair.

Question 72

``` Question: Which is not a stage of Kaposi sarcoma? A- patch B- plaque C- lymphatic D- nodular ```

Answer 72

Answer: C | Rationale for why the answer is correct: The 3 stages of Kaposi sarcoma are patch, plaque, and nodular stages.

Question 73

``` Question: Which biopsy type is best for cosmetic results? A- Shave method B- Punch method C- Blade method d. Excision ```

Answer 73

Answer: B Rationale for why the answer is correct: Punch method for biopsy is quick, easy, and has less scarring than the other options listed. It may only need 1 to 2 stitches to close.

Question 74

``` Question: Which of the following is not a characteristic of conduct disorder? A- Aggression towards animals B- theft C- verbal arguing with parents D- violation of the law, arrests ```

Answer 74

Answer: C Rationale for why the answer is correct: The other 3 answers are all characteristics of conduct disorder along with aggression towards people and destruction of property

Question 75

``` Question: What is ADHD? A- Constant worrying B- Ongoing inattention and/or hyperactivity C- A made-up issue D- Feeling down for 6 months or more ```

Answer 75

Answer: B Rationale for why the answer is correct: The definition for ADHD is ongoing inattention and/or hyperactivity, usually diagnosed in school aged children.

Question 76

Question: What is the most helpful when diagnosing an ear problem? A- Thorough history and physical assessment B- Culturing discharge C- CT scan D- CBC

Answer 76

Answer: A Rationale for why the answer is correct: By performing a thorough history and physical assessment, the provider should be able to rule in or out diagnoses based off reported symptoms and physical findings. It is not useful to culture discharge, a CT scan is expensive and only warranted after a referral to EENT specialist for non-resolving symptoms, and a CBC is not useful for diagnosing ear problems.

Question 77

``` Question: A symptom of congestion is a definitive diagnosis for which nasal problem? A- Bacterial sinitis B- Allergic rhinitis C- Non allergic rhinitis D- None of the above ```

Answer 77

Answer: D Rationale for why the answer is correct: When diagnosing problems of EENT, it is important to get a thorough HPI, as well as PMI and physical assessment of the patient. It is not helpful nor correct to ask a few questions and then start ordering diagnostics.

Question 78

Question: A 60 y/o male with a history of cluster headaches is being seen today. Which statement by him would be considered a “red flag” and is cause for immediate intervention (sent to the ER)? A- “I have pain in my right eye only” B- “My pain woke me from my sleep” C- “I’ve had this headache for 3 days” D- “This is the worst pain I’ve ever had”

Answer 78

Answer: D Rationale for why the answer is correct: The first 3 answers are typical of cluster headaches. Red flags for headaches include the worst pain a patient has experienced, thunderclap headaches, difficulty thinking and talking, and a sudden change from previous headaches. All of these red flags should be sent for an immediate CT scan to rule out a head bleed. This is considered a medical emergency. Site for question/rationale: Headache lecture by Amy Moore and Tara Hillard, 4 mins