exam 2 Flashcards
Which of the following objects on x ray is NOT radiopaque? A. Bone B. Barium C. Muscle D. Fat
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
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: 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
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: 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.
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.
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.
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: 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.
- 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?
Rationale: B. The correct acronym for “A” in CAGE stands for Annoyed. All of the other acronyms are correct.
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
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
1Which of the following would be considered a secondary headache? A. Migraine Headache B. Spinal Headache C. Cluster Headache D. Tension Headache
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.
All the following are causes of non-allergic rhinitis symptoms except. A. Cold temperatures B. Viral infection C. Smoke D. Dust mites
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.
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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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
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: 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: 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: 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: 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: 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: 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: 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.
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)
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: 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
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: 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
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.
