Exam 3 Flashcards
1
Q
Which of the following is a correct recommendation of when to begin prostate screening?
A. Men with no symptoms of prostate cancer and who are in good health should start screening at age 60.
B. Asian American men should start screening at age 45.
C. Men who have had a brother diagnosed with prostate cancer before the age of 65 should start screening at 45.
D. Caucasian men should start screening at age 55.
A
C. Men who have had a brother diagnosed with prostate cancer before the age of 65 should start screening at 45.
2
Q
A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following is the most common sign of a prostatic problems in men with nocturia? A. Psychogenic nocturia B. Urethral polyp C. Irritative posterior urethral lesion D. Benign prostatic hypertrophy
A
D. Benign prostatic hypertrophy
3
Q
A 76-year-old man is seen in the office for complaints of urinary tract infection (UTI). The clinician should explore which of these causes of UTI in men?
A. Urethral polyps
B. Epididymitis
C. Selective serotonin reuptake inhibitor (SSRI) medication
D. Prostatodynia
A
B. Epididymitis
4
Q
A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?
A. Refer to urologist immediately.
B. Obtain a computed tomography (CT) scan.
C. Instruct the patient to elevate the scrotum.
D. Prescribe ibuprofen.
A
A. Refer to urologist immediately.
5
Q
An 82-year-old man is seen in the primary-care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses? A. Prostatodynia B. Lupus disease C. Trichomoniasis infection D. Fungal infection
A
D. Fungal infection
6
Q
Which of the following would be an appropriate treatment for a patient with mild benign prostatic hyperplasia (BPH)? A. Referral to urologist for surgery. B. Prescribe a trial of tamsulosin. C. Recommend cranberry supplements. D. Have a period of watchful waiting.
A
D. Have a period of watchful waiting.
7
Q
A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?
A. Testosterone level
B. Prostate-specific antigen
C. Nocturnal penile tumescence and rigidity
D. Prolactin level
A
A. Testosterone level
8
Q
Peter is a 40-year-old male with a recent diagnosis of low testosterone. Which of the following counseling points is correct regarding low testosterone?
A. Testosterone deficiency is due to hypergonadism.
B. Abstaining from cigarette smoking has no effect on testosterone
C. Lowering your HbA1c may improve your testosterone levels.
D. Stress has no effect on testosterone levels.
A
C. Lowering your HbA1c may improve your testosterone levels.
9
Q
Which of the following should be considered in a patient presenting with erectile dysfunction? A. Diabetes mellitus B. Hypotension C. Wellbutrin D. UTI
A
A. Diabetes mellitus
10
Q
A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis? A. Peyronie’s disease B. Damage to the pudendal artery C. Scarring of the urethra D. Testicular torsion
A
A. Peyronie’s disease
11
Q
The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? A. Erectile dysfunction B. Glaucoma C. Hypotension D. Headache
A
A. Erectile dysfunction
12
Q
Which of the following is an aerobic gram-negative bacteria involved in prostatitis? A. Streptococcus faecalis B. Pseudomonas C. Staphylococcus D. Diphtheroids
A
B. Pseudomonas
13
Q
The 56-year-old man with chronic prostatitis should be treated with levofloxacin for how long? A. 3 to 7 days B. 14 to 21 days C. 4 to 6 weeks D. 6 to 12 weeks
A
C. 4 to 6 weeks
14
Q
John presents with complaints of a “weird feeling that hurts” in his buttocks. He notes that he often feels urgency to urinate and defecate, but “nothing comes out” when he tries. Which of the following diagnoses is most likely? A. Urinary tract infection B. Prostatitis C. Erectile dysfunction D. Peyronie’s disease
A
B. Prostatitis
15
Q
A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate. He is not a long-distance runner. Which of the following would lead you to a diagnosis of prostatodynia versus prostatitis?
A. Long-distance runners are more likely to have prostatodynia than prostatitis.
B. Prostatodynia presents with signs and symptoms of prostatitis, but without inflammation.
C. Prostatodynia usually has a bacterial origin, whereas prostatitis has a relation to internal urethral sphincter problems.
D. Patients with prostatodynia usually have a history of recurrent UTIs, whereas patients with prostatitis do not.
A
B. Prostatodynia presents with signs and symptoms of prostatitis, but without inflammation.
16
Q
A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism? A. Escherichia coli B. Staphylococcus aureus C. Chlamydia trachomatis D. Pseudomonas aeruginosa
A
C. Chlamydia trachomatis
17
Q
Carl is a 24-year-old male who presents with scrotal pain that radiates to his flank. It manifested 3 hours ago. He also complains of pain at the tip of his penis, cloudy urine, and urethral discharge. Which of the following conditions is most likely? A. Testicular torsion B. Epididymitis C. Prostatodynia D. Prostatitis
A
B. Epididymitis
18
Q
Which test is used to confirm a diagnosis of epididymitis?
A. Urinalysis
B. Gram stain of urethral discharge
C. Complete blood cell count with differential
D. Ultrasound of the scrotum
A
D. Ultrasound of the scrotum
19
Q
Treatment for epididymitis includes which of the following? A. Warm sitz baths B. Scrotal elevation C. Masturbation D. Heat application
A
B. Scrotal elevation
20
Q
Which of the following data is indicative of testicular torsion? A. Absent cremasteric reflex B. Pain relieved on testicular elevation C. Testicle very low in the scrotum D. Swollen scrotum with “red dot sign”
A
A. Absent cremasteric reflex
21
Q
A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?
A. The scrotum will be dark.
B. The scrotum will appear light pink or yellow.
C. The scrotum will appear milky white.
D. The internal structures will be clearly visible.
A
B. The scrotum will appear light pink or yellow.
22
Q
During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious? A. A nodular and unusually firm gland B. A smooth gland C. A tender gland D. A boggy gland
A
A. A nodular and unusually firm gland
23
Q
A patient presents complaining of pain and enlarged testes that feel like “a bag of worms.” Which diagnosis should the provider most likely assess for? A. Prostate cancer B. Varicocele C. Hydrocele D. Testicular cancer
A
B. Varicocele
24
Q
Which of the following is a complementary therapy for BPH? A. Red raspberry leaf tea B. Saw palmetto C. Black cohosh D. Vitamin A
A
B. Saw palmetto
25
A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which understanding of the Jewett rating system?
A. The cancer involves the seminal vesicles.
B. There is metastatic disease to regional lymph nodes.
C. The cancer is confined to the capsule.
D. There is metastasis to distant organs.
A. The cancer involves the seminal vesicles.
26
```
A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects?
A. May have cold flashes
B. May have hot flushes
C. May have increased libido
D. May have testicular torsion
```
B. May have hot flushes
27
```
A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following risk factors leads the clinician to suspect potential testicular cancer?
A. Patient is 65 years old
B. Prior cryptorchidism
C. Family history of colon cancer
D. Living in a city
```
B. Prior cryptorchidism
28
```
What is the treatment of choice for a patient diagnosed with testicular cancer?
A. Radical orchidectomy
B. Lumpectomy
C. Radiation implants
D. Chemotherapy
```
A. Radical orchidectomy
29
```
A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan?
A. Every month
B. Every 3 to 4 months
C. Every 6 to 12 months
D. Every year
```
B. Every 3 to 4 months
30
Tyler is a 16-year-old male who the clinician is counseling on sexually transmitted infections (STIs). Which statement made by the clinician is correct?
A. “Untreated gonorrhea can lead to many health problems, and if it is not treated it can lead to a syndrome that affects your entire body called disseminated gonococcal infection.”
B. “Most STIs are untreatable, and, if contracted, you will have potentially fatal health complications.”
C. “Though STIs are treatable, gonorrhea isn’t and always results in permanent penile damage.”
D. “The only untreatable STI is chlamydia, and it is also the most common.”
A. “Untreated gonorrhea can lead to many health problems, and if it is not treated it can lead to a syndrome that affects your entire body called disseminated gonococcal infection.”
31
The clinician is seeing Jalissa, a 17-year-old patient, for a well woman’s exam. She mentions that she has been depressed and has been yo-yo dieting because she feels “so fat.” She marked “no” to whether she feels safe in her home on her intake form, and mentions she is worried about getting STIs from her boyfriend of three months. Which of the following is the correct way to interact with the patient, based on her history?
A. “The amount of time allotted for your well woman exam does not allow time to talk about depression today.”
B. “I know you said you are concerned about your body image, but your weight looks good to me.”
C. “You mentioned on your intake form that you do not feel safe in your home. Why is that?”
D. “You’ve been dating your boyfriend for three months, but you haven’t had an STI screening yet? That’s not safe.”
C. “You mentioned on your intake form that you do not feel safe in your home. Why is that?”
32
Which of these patients needs a cervical cancer screening?
A. Lisa, a 45-year-old patient who has atypical squamous cells of uncertain significance (ASCUS) and a human papillomavirus (HPV) positive Pap 1 month ago
B. April, a 26-year-old patient who had a negative Pap with negative HPV 1 year ago
C. Sondra, a 66-year-old patient who had a negative Pap with negative HPV 11 years, 6 years, and 1 year ago
D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago
D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago
33
Which of the following is true of the IUD (intrauterine device)?
A. The IUD is 95% effective at preventing pregnancy.
B. The IUD has an inhibitory effect on sperm capacitation.
C. The IUD can only be inserted at menses.
D. The IUD can only be inserted in women with multiparity.
B. The IUD has an inhibitory effect on sperm capacitation.
34
Alice has been diagnosed with breast cancer. Its TNM staging is T2, N1, M0. She would like to know what this means. Which statement made by the clinician is accurate?
A. “Your tumor is 4 cm, has metastasized to a moveable lymph node, but has not metastasized to another location.”
B. “Your tumor is 5.5 cm and has not metastasized to lymph nodes or anywhere else.”
C. “Your tumor is 1.5 cm, has metastasized to a moveable lymph node, but has not metastasized to another location.”
D. “Your tumor is 3 cm, has metastasized to a moveable lymph node, and has only metastasized to supraclavicular lymph nodes.”
A. “Your tumor is 4 cm, has metastasized to a moveable lymph node, but has not metastasized to another location.”
35
```
A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?
A. Human papillomavirus
B. Endometrial hyperplasia
C. Vaginismus
D. Polycystic ovarian syndrome
```
A. Human papillomavirus
36
```
A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea?
A. Ceftriaxone
B. Doxycycline
C. Acyclovir
D. Metronidazole
```
A. Ceftriaxone
37
```
A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to?
A. Gonorrhea
B. HPV
C. Chlamydia
D. Trichomoniasis
```
C. Chlamydia
38
```
A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding?
A. Trichomonas
B. Bacterial vaginosis
C. HPV
D. Herpes simplex virus
```
B. Bacterial vaginosis
39
```
Which of the following medications is the treatment of choice for Trichomonas?
A. Metronidazole
B. Ceftriaxone
C. Diflucan
D. Doxycycline
```
A. Metronidazole
40
A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?
A. “It is probably just a cyst because that is the most common breast mass.”
B. “We will order a mammogram and ultrasound to help establish a diagnosis.”
C. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”
D. “Because your lump is painful, it is most likely not cancer.”
B. “We will order a mammogram and ultrasound to help establish a diagnosis.”
41
Tina is an 18-year-old female who would like to start using the transdermal contraceptive patch. Which of the following instructions should the clinician discuss with Tina?
A. Obesity can decrease the effectiveness of the patch.
B. The patch should be applied to the buttocks or breasts.
C. The patch is changed every 10 days.
D. If a patch becomes detached for less than 24 hours, it cannot be reapplied.
A. Obesity can decrease the effectiveness of the patch.
42
```
A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?
A. Pregnancy test
B. Pelvic ultrasound
C. Endometrial biopsy
D. Platelet count
```
A. Pregnancy test
43
```
A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia?
A. Menopause
B. Dehydration
C. Excess progesterone
D. Excess lubrication
```
A. Menopause
44
```
A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?
A. Fluconazole
B. Estrogen vaginal cream
C. Metronidazole
D. Doxycycline
```
A. Fluconazole
45
```
A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive?
A. Pregnancy test
B. Complete blood cell count
C. Thyroid-stimulating hormone
D. Urine dip for protein
```
A. Pregnancy test
46
```
A 40-year-old woman is seen for her yearly examination. She is single and not in a monogamous relationship. Her social history includes smoking cigarettes “occasionally” and drinking about two beers a day. Her body mass index (BMI) is 25. She is requesting birth control. Which of the following methods would be best and most effective for this patient?
A. Transdermal contraceptive patch
B. Oral contraceptive
C. Condom
D. Vaginal contraceptive sponge
```
C. Condom
47
A 44-year-old patient with breast cancer is prescribed tamoxifen by her surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate?
A. “You must be having menopause.”
B. “The hot flashes are a result of the antiestrogenic effects of tamoxifen.”
C. “Tamoxifen use has no increased incidence of endometrial cancer.”
D. “The drug will have no effect on vaginal lubrication.”
B. “The hot flashes are a result of the antiestrogenic effects of tamoxifen.”
48
```
A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes?
A. Pelvic inflammatory disease
B. Oral contraceptive use for 15 years
C. Early menarche
D. Diet high in soy protein
```
A. Pelvic inflammatory disease
49
```
When assessing a woman for infertility, which of the following tests should be done first?
A. Hysterosalpingogram
B. Magnetic resonance imaging (MRI)
C. Analysis of partner’s sperm
D. Estrogen level
```
C. Analysis of partner’s sperm
50
A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause?
A. “Are you sexually active?”
B. “How long have you been underweight?”
C. “Was your mother pregnant with you when she was of advanced maternal age?”
D. “Have you noticed any changes in your moods lately?”
B. “How long have you been underweight?
51
```
What is the most common cause of secondary amenorrhea?
A. Pregnancy
B. Pituitary dysfunction
C. Inadequate estrogen levels
D. Genetic disorders
```
A. Pregnancy
52
```
A 22-year-old woman is diagnosed with premenstrual syndrome. Which of the following lifestyle changes should the clinician suggest to help minimize the patient’s symptoms?
A. At least 4 cups of green tea daily
B. Regular exercise
C. Take vitamin A supplements
D. Eat a diet high in iron
```
B. Regular exercise
53
```
A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of secondary dysmenorrhea?
A. Pelvic inflammatory disease
B. Endometriosis
C. Sexually transmitted infections
D. Ovarian cyst
```
B. Endometriosis
54
```
A 26-year-old woman tells the clinician that she has endometriosis, because she has frequent pelvic pain. The clinician also should consider which of these differential diagnoses?
A. Diverticulitis
B. Cholelithiasis
C. Kidney stones
D. Ovarian cysts
```
D. Ovarian cysts
55
```
Which of the following would be appropriate treatment for a woman with mild endometriosis?
A. Oral contraceptives
B. Leuprolide acetate injections
C. Nafarelin nasal spray
D. Hysterectomy
```
A. Oral contraceptives
56
```
A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses?
A. Postmenopausal syndrome
B. Infertility
C. Mittelschmerz
D. Polyp
```
D. Polyp
57
```
A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first?
A. Transvaginal ultrasound
B. Endometrial biopsy
C. MRI
D. Abdominal computed tomography scan
```
A. Transvaginal ultrasound
58
```
Dorothy is a 45-year-old female who complains of a mass in her left breast, dull nipple pain, tenderness of the left nipple, and pasty left nipple discharge. Which of the following conditions should the clinician be most suspicious for?
A. Intraductal papilloma
B. Hamartomas
C. Duct ectasia
D. Fibroadenoma
```
C. Duct ectasia
59
A 45-year-old woman is seen because of irregular menstrual periods. Her follicle-stimulating hormone (FSH) level is 48 mIU/mL, and her luteinizing hormone (LH) level is elevated. She asks the clinician what this means. Which would be the best response?
A. “You are approaching menopause.”
B. “You have a hormonal imbalance.”
C. “Your FSH is normal, but your pituitary is making too much LH.”
D. “There is an imbalance between your ovaries and pituitary.”
A. “You are approaching menopause.”
60
```
Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal?
A. Pregnancy
B. Estrogen level
C. Progesterone level
D. LH level
```
A. Pregnancy
61
A 60-year-old woman is seen for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at age 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer?
A. Her numerous pregnancies
B. Her age at menopause
C. Her father’s history of lung cancer
D. Her grandmother’s history of colon cancer
D. Her grandmother’s history of colon cancer
62
```
Which of the following medications is an oral estrogen product for women with menopause?
A. Provera 2.5 mg
B. Estrace 0.01%
C. Alora 0.025 mg
D. Premarin 0.3 mg
```
D. Premarin 0.3 mg
63
Which of the following is an alternative treatment for breast tenderness with premenstrual syndrome?
A. Evening primrose oil 250 mg orally up to 3 times daily 2 to 3 days before menses
B. Black cohosh 40 to 200 mg orally daily
C. Vitamin B complex 50 mg orally daily
D. Jasmine essential oil aromatherapy
A. Evening primrose oil 250 mg orally up to 3 times daily 2 to 3 days before menses
64
```
A 47-year-old woman presents with complaints of pain with intercourse, intense itching “down there,” and states “it looks different down there.” She denies bleeding, foul odor. Which of the following diagnoses should the clinician consider most likely?
A. Atrophic vaginitis
B. Trichomoniasis
C. Candidiasis
D. Vulvar lichen sclerosus
```
D. Vulvar lichen sclerosus
65
```
One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?
A. Bone
B. Synovium
C. Tendons
D. Fascia
```
B. Synovium
66
```
You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
A. Articular
B. Inflammatory
C. Nonarticular
D. Noninflammatory
```
A. Articular
67
```
Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
A. Decreased C-reactive protein
B. Hyperalbuminemia
C. Morning stiffness
D. Weight gain
```
C. Morning stiffness
68
Which of the following statements concerning the musculoskeletal examination is true?
A. The uninvolved side should be examined initially and then compared to the involved side.
B. The part of the body that is causing the patient pain should be examined first.
C. When possible, the patient should not be asked to perform active ROM exercises to avoid causing pain.
D. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.
A. The uninvolved side should be examined initially and then compared to the involved side.
69
```
You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM but cannot move it above gravity. Which numeric grade of muscle strength would you give this patient?
A. 1
B. 2
C. 3
D. 4
```
B. 2
70
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis?
A. History of hypertension
B. Her affected shoulder is also her dominant arm.
C. Her history of type 1 diabetes
D. Her work as a secretary predisposes her to repetitive motions.
C. Her history of type 1 diabetes
71
Jennifer is an 18-year-old woman who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
A. Anterior dislocations are not painful, and ROM is normal.
B. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
C. X-rays are the only diagnostic testing appropriate to assess a dislocation.
D. Most traumatic dislocations are posterior.
B. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
72
Fred has been diagnosed with a trigger finger of the ring finger. Which of the following management strategies is appropriate?
A. Surgical removal of the tendon sheath
B. NSAIDs
C. Local anesthetic injection into the tendon sheath
D. Splinting
C. Local anesthetic injection into the tendon sheath
73
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
A. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel.
B. People with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel.
C. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel.
D. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance.
B. People with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel.
74
Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
A. The goal of treatment is to prevent flexion and extension movements of the wrist.
B. Splints are not used in carpal tunnel syndrome, because they restrict complete movement of the fingers and wrist.
C. Corticosteroid injections are encouraged in the treatment of carpal tunnel syndrome.
D. Treatment that encourages fluid retention, to keep the joints lubricated, is an emphasis of treatment.
A. The goal of treatment is to prevent flexion and extension movements of the wrist.
75
Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
A. Morning stiffness and limited mobility of the lumbar spine
B. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
C. Fever, chills, and elevated erythrocyte sedimentation rate
D. Pathologic fractures, severe night pain, weight loss, and fatigue
B. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
76
The clinician has instructed Sirius, a 23-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
A. “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.”
B. “You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.”
C. “You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.”
D. “It is important to take NSAIDs on an empty stomach in order to increase absorption.”
A. “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.”
77
```
Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
A. Gastrocnemius weakness
B. A reduced or absent ankle reflex
C. Numbness in the lateral foot
D. Saddle area anesthesia
```
D. Saddle area anesthesia
78
Which of the following statements is true concerning the management of the client with a herniated disc?
A. Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use.
B. An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred.
C. Intolerable pain for more than a 3-month period is an indication for surgical intervention.
D. Most disc hernias require opioids for long term pain relief.
C. Intolerable pain for more than a 3-month period is an indication for surgical intervention.
79
```
John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
A. Valgus stress test
B. McMurray circumduction test
C. Lachman test
D. Varus stress test
```
B. McMurray circumduction test
80
```
The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
A. Apprehension sign
B. Bulge sign
C. Thumb sign
D. Lachman sign
```
A. Apprehension sign
81
The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?
A. Ability to bear weight immediately after the injury
B. Development of minor ankle swelling after the injury
C. Slight bruising over the injury site 2 days after injury
D. Crepitation with palpation or movement of the ankle
D. Crepitation with palpation or movement of the ankle
82
Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician?
A. “Complementary therapies should be considered only if surgical interventions are not successful.”
B. “I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition.”
C. “I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai chi, are being studied for use in the treatment of osteoarthritis and acupuncture can be used and is safe and well tolerated.”
D. “It would be crazy to use complementary therapies to treat such a serious condition.”
C. “I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai chi, are being studied for use in the treatment of osteoarthritis and acupuncture can be used and is safe and well tolerated.”
83
```
Chris is a 28-year-old male who complains of lower back pain that began 3 days ago. The pain is worse when he stands or bends, and it is somewhat relieved when he sits. The clinician performs the straight-leg raise test and it is negative. Plain film x-ray is positive. Which diagnosis is most likely?
A. Osteoarthritis
B. Spinal stenosis
C. Scoliosis
D. Muscle strain
```
D. Muscle strain
84
```
A clinician has performed a synovial fluid analysis and the results are as follows: visual analysis: turbid and yellow, viscosity: decreased, 52,000 white blood cells (WBCs) per mm3, polymorphonuclear leukocytes (PMNs): 75%, protein: 5 g/dL. Which of the following conditions could this result be attributed to?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Septic arthritis
```
D. Septic arthritis
85
Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways?
A. By increasing the erosive activity of osteoclasts
B. By promoting osteoclastogenesis
C. By inhibiting osteoclast apoptosis
D. By increasing the activity of osteoblasts
D. By increasing the activity of osteoblasts
86
Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis?
A. Bone alkaline phosphatase levels
B. Urinary N-telopeptide assay
C. Bone mass density measurement by densitometry
D. Magnetic resonance imaging
C. Bone mass density measurement by densitometry
87
```
What is the recommended daily calcium intake for men 70 years and younger?
A. 500 mg/day
B. 750 mg/day
C. 1,000 mg/day
D. 1,500 mg/day
```
C. 1,000 mg/day
88
```
Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?
A. Taking bisphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs.
B. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying.
C. This class of drugs can be taken at any time of the day without regard to meals.
D. This class of drugs should be taken with orange juice to increase absorption.
```
B. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying.
89
```
Which of the following medications is appropriate to treat Paget’s disease?
A. Boniva
B. Fosamax
C. Reclast
D. Forteo
```
C. Reclast
90
Which of the following statements concerning fibromyalgia is true?
A. Muscle pain that is caused by the development of trigger points within the muscle cannot occur concurrently with fibromyalgia.
B. A cause of myalgia can be fibromyalgia.
C. Bursitis cannot coexist with pain from fibromyalgia.
D. Fibromyalgia is an inflammatory musculoskeletal disorder.
B. A cause of myalgia can be fibromyalgia.
91
```
One of the most frequent presenting signs/symptoms of osteoporosis is:
A. Goiter
B. Abnormal serum calcium
C. Elevated urine biochemical markers
D. Bony fracture
```
D. Bony fracture
92
Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening 1 week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
A. Ecchymosis, edema, and erythema over the lateral epicondyle
B. Pain at the elbow that radiates into the forearm and pain and weakness with gripping objects
C. Inability to supinate and pronate the arm
D. Inability to flex or extend the elbow against resistance
B. Pain at the elbow that radiates into the forearm and pain and weakness with gripping objects
93
```
A clinician is examining a vertebral fracture, and the examination and diagnostic findings have shown a compression of the anterior column that includes both endplates. What type and subtype are these?
A. Compression fracture, type A
B. Burst fracture, type B
C. Seat-belt type injury, level two
D. Fracture-dislocation, shear
```
A. Compression fracture, type A
94
Which of the following would lead the clinician to suspect a tumor when paired with low back pain?
A. Minor trauma with sneezing in elderly with osteoporosis
B. History of spinal procedure
C. Sudden loss of bowel or bladder function
D. Unintended weight loss >10% of body weight in 6 months
D. Unintended weight loss >10% of body weight in 6 months
95
A 70-year-old female fell 2 weeks ago and developed immediate pain in her left elbow on the lateral epicondyle. She thought she just bruised it, but is now worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. During your examination, you find she has moderate swelling and ecchymosis, but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
A. Make an immediate referral for an orthopedic surgical evaluation without further assessment.
B. Tell her that it takes time for these bruises to improve, so she should be patient.
C. Prescribe a splint for her left wrist and begin corticosteroid injections.
D. Send her to the emergency room for reduction of this obvious wrist fracture.
C. Prescribe a splint for her left wrist and begin corticosteroid injections.
96
```
Debbie is a 43-year-old female being evaluated for a wrist injury. The clinician is assessing for median nerve compression by having Debbie maintain forced flexion of her wrist for 1 minute with the dorsal surface of each hand pressed together. Which of these tests did the clinician just perform?
A. Allen’s test
B. Phalen’s test
C. Tinel’s sign
D. Finkelstein’s test
```
B. Phalen’s test
97
```
In which of these athletes is posterior impingement syndrome most commonly seen?
A. Cross country runner
B. Swimmer
C. Soccer player
D. Ballet dancer
```
D. Ballet dancer
98
The clinician is assessing Sally’s diffuse hip pain. How should the clinician begin the examination?
A. Begin the range-of-motion examination with an assessment of the motion that causes pain.
B. Physical examination of the hip must first assess its position at rest.
C. The patient should move the hip prior to radiographic studies to determine whether they are necessary.
D. Flexion and extension of the affected hips’ extremity should only be performed with the knee straight.
B. Physical examination of the hip must first assess its position at rest.
99
```
Felice is a 66-year-old female who complains that walking and prolonged standing causes pain and weakness in her legs and buttocks. She expresses that she has short-term relief when she leans on the shopping cart. When she sleeps on her back, she sometimes wakes up in the night in pain. Which of the following diagnoses is most likely?
A. Multiple sclerosis
B. Herniated lumbar disc
C. Lumbar spinal stenosis
D. Cervical spondylosis
```
C. Lumbar spinal stenosis
100
```
Which of the following is a risk factor for overuse syndrome with tendonitis?
A. Body mass index <18
B. Hypothyroidism
C. Rheumatoid arthritis
D. Cardiac disease
```
C. Rheumatoid arthritis
101
```
Which diagnostic test is the diagnostic gold standard for patients that have tendonitis and have failed conservative treatment?
A. Plain x-ray films
B. Magnetic resonance imaging (MRI)
C. Computed tomography (CT) scan
D. Surgical exploration
```
B. Magnetic resonance imaging (MRI)
102
```
Connie is a 63-year-old seamstress who presents with pain at the base of her right thumb on abduction and extension of her right thumb. She also complains of pain on the radial side of her right wrist with lifting. Which of these diagnostic tests will help to determine if she has de Quervain’s tenosynovitis?
A. Allen’s test
B. Phalen’s maneuver
C. Tinel’s sign
D. Finkelstein’s test
```
D. Finkelstein’s test
103
Gladys has begun taking Prolia for osteoporosis. Which of the following should be included in teaching about this medication?
A. This medication is an oral pill daily.
B. This medication decreases the risk of infection.
C. It is contraindicated in the event of hypocalcemia.
D. A drug holiday every 8 months is recommended.
C. It is contraindicated in the event of hypocalcemia.
104
```
Willow is a 67-year-old female and her bone mineral density is more than 1 SD below the young adult reference mean. What is her diagnosis?
A. Normal bone mineral density
B. Osteopenia
C. Osteoporosis
D. Severe osteoporosis
```
B. Osteopenia
105
```
A patient is 66 inches in height, weighing 200 lbs, and newly diagnosed with type 2 diabetes mellitus (DM). The A1c is 7.1%. What is the best initial treatment?
A. No treatment at this time
B. Diet and exercise
C. Diet, exercise, and metformin
D. Diet, exercise, and exogenous insulin
```
C. Diet, exercise, and metformin
106
The clinician suspects that a patient seen in the office has hyperthyroidism. Which test should the clinician order on the initial visit?
A. Sensitive thyroid-stimulating hormone (TSH) assay and T4
B. Free T4 and serum calcium
C. Nuclear scintigraphy with radiolabeled iodine (123I)
D. Magnetic resonance imaging
A. Sensitive thyroid-stimulating hormone (TSH) assay and T4
107
Which statement made by a patient with type 1 diabetes indicates successful teaching regarding general guidelines for exercise?
A. “I will not exercise if my blood sugar is 315.”
B. “I should just check my blood glucose after exercise.”
C. “I should eat more carbohydrates if my blood glucose is less than 200.”
D. “I will exercise when my urine ketones are positive but blood sugar is 260.”
A. “I will not exercise if my blood sugar is 315.”
108
A male patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
A. Administer glucagon subcutaneously.
B. Have him drink 4 ounces of juice.
C. Call 911.
D. Ask him about his usual eating habits.
B. Have him drink 4 ounces of juice.
109
```
A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which condition that the patient also has would be a contraindication to taking metformin?
A. Ulcerative colitis
B. Inflammatory bowel disease
C. Chronic obstructive pulmonary disease
D. Renal disease
```
D. Renal disease
110
```
A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which test should be ordered next?
A. Serum calcium
B. Thyroid-stimulating hormone
C. Electrolytes
D. Urine specific gravity
```
B. Thyroid-stimulating hormone
111
The clinician has been doing diabetic teaching for a patient with type 1 diabetes with no retinopathy. Which statement by the patient would indicate that teaching has been effective?
A. “As long as I don’t need glasses, I don’t have to worry about going blind.”
B. “I know I need to have my eyes checked every 2 years.”
C. “My primary doctor will check my eyes.”
D. “I will see my eye doctor when my vision gets blurry.”
B. “I know I need to have my eyes checked every 2 years.”
112
A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense and +1 Achilles reflex. Which of the following would be an appropriate treatment?
A. Tricyclic antidepressants
B. Angiotensin-converting enzyme inhibitors
C. Aspirin
D. Insulin
A. Tricyclic antidepressants
113
After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?
A. Suggest the patient use a heating pad to improve circulation.
B. Refer to a podiatrist for a foot-care treatment plan.
C. Send the patient for acupuncture treatments.
D. Recommend increased intake of vitamin B12.
B. Refer to a podiatrist for a foot-care treatment plan.
114
```
Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She is also having problems sleeping at night. On physical examination, the clinician finds an irregular heartbeat and hyperactive reflexes. The differential diagnosis should include which condition?
A. Myxedema
B. Thyrotoxicosis
C. Cushing’s syndrome
D. Pan-hypopituitarism
```
B. Thyrotoxicosis
115
The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which information?
A. RAI prevents the peripheral conversion of T4 to T3.
B. RAI binds free T4.
C. RAI destroys thyroid tissue.
D. RAI reduces freely circulating iodine.
C. RAI destroys thyroid tissue.
116
```
A patient is diagnosed with hypothyroidism. Which electrocardiogram change should the clinician observe as a manifestation of the disease?
A. Sinus bradycardia
B. Atrial fibrillation
C. Supraventricular tachycardia
D. U waves
```
A. Sinus bradycardia
117
```
After 6 months of Synthroid therapy, the clinician should expect which result in the repeat thyroid-stimulating hormone studies?
A. Elevated
B. Normal
C. Low
D. Undetectable
```
B. Normal
118
```
Which laboratory finding should the clinician observe in a patient with untreated Graves’ disease?
A. Elevated TSH
B. Decreased T3
C. Decreased TSH receptor antibody test
D. Elevated antithyroglobulin antibodies
```
D. Elevated antithyroglobulin antibodies
119
The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate teaching has been effective?
A. “I’ll take my pill before breakfast.”
B. “I know to take my Glucotrol at bedtime.”
C. “It is important to take my medication right after I eat.”
D. “Since I only like to eat two meals a day, I can take the pill between my meals.”
A. “I’ll take my pill before breakfast.”
120
A male patient with diabetes asks the clinician why he needs to check his blood sugar at home even when he feels good. Which response by the clinician would be most appropriate?
A. “Control of glucose will help postpone or delay complications.”
B. “Regularly checking blood sugar will help you.”
C. “Monitoring glucose will promote a sense of connectedness.”
D. “Because you know it is the right thing to do for your disease.”
A. “Control of glucose will help postpone or delay complications.”
121
```
How often should the clinician examine the feet of a person with diabetes?
A. Every year
B. Every 6 months
C. Every 3 months
D. Every visit
```
D. Every visit
122
```
The clinician sees a patient who has a body mass index (BMI) of 32.4 kg/m2. How would the clinician classify this patient?
A. Overweight
B. Obesity Class 1
C. Obesity Class 2
D. Obesity Class 3
```
B. Obesity Class 1
123
```
Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
A. Elevated uric acid level
B. Elevated blood urea nitrogen
C. Decreased urine pH
D. Decreased C-reactive protein
```
A. Elevated uric acid level
124
Which blood test would confirm a diagnosis of diabetes mellitus?
A. A1c 5.5%
B. Fasting plasma glucose level of 120 mg/dL
C. Oral glucose tolerance test 250 mg/dL (2-hour level)
D. Random plasma glucose level 175 mg/dL
C. Oral glucose tolerance test 250 mg/dL (2-hour level)
125
```
Which test should the clinician order to confirm Charcot foot?
A. Bone scan of lower extremities
B. Computed tomography (CT) scan
C. X-ray of the foot
D. Culture of the foot ulcer
```
C. X-ray of the foot
126
```
A vegetarian patient with gout asks the clinician about foods to avoid. The clinician should advise the patient to avoid which of the following foods?
A. Rice
B. Carrots
C. Spinach
D. Potatoes
```
C. Spinach
127
```
The clinician should question the patient with suspected gout about use of which of these medications?
A. Antihypertensives
B. Thiazide diuretics
C. Cardiac glycosides
D. Potassium supplements
```
B. Thiazide diuretics
128
The clinician finds numerous nodules on the thyroid of a 65-year-old woman. The clinician suspects thyroid cancer. Which data would be most significant for this patient?
A. A history of enlarged tonsils in the 1940s
B. Recent exposure to mumps
C. Vegetarian diet
D. Allergy to iodine
A. A history of enlarged tonsils in the 1940s
129
```
Which of the following is essential for diagnosing thyroid cancer?
A. Fine needle aspiration biopsy
B. Thyroid ultrasound
C. Computed tomography scan
D. Magnetic resonance imaging
```
A. Fine needle aspiration biopsy
130
Which of the following is a common sign of type 2 DM?
A. Anorexia
B. Recurrent yeast infection
C. Fluid overload
D. Elevated high-density lipoprotein cholesterol
B. Recurrent yeast infection
131
```
Which medication can cause hyperglycemia?
A. Prednisolone (Omnipred)
B. Metformin (Glucophage)
C. Levothyroxine (Synthroid)
D. Cephalexin (Keflex)
```
A. Prednisolone (Omnipred)
132
```
Which laboratory test result is diagnostic for hypoglycemia?
A. A1c 7.0%
B. Fasting blood sugar of 75 mg/dL
C. Glucose level 43 mg/dL
D. Random glucose level 64 mg/dL
```
C. Glucose level 43 mg/dL
133
```
Which medication for type 2 diabetes mellitus would be contraindicated during pregnancy?
A. Insulin
B. Metformin (Glucophage)
C. Glipizide (Glucotrol)
D. Acarbose (Precose)
```
C. Glipizide (Glucotrol)
134
```
A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which condition should be included in the differential diagnosis?
A. Peripheral vascular disease
B. Pheochromocytoma
C. Cushing’s disease
D. Acromegaly
```
B. Pheochromocytoma
135
Which action would the clinician take to elicit Chvostek’s sign?
A. Check serum level of glucose after drinking a glass of juice.
B. Tap the facial nerve below the zygomatic arch anterior to the earlobe.
C. Press into the lower quadrant of the abdomen and release quickly.
D. Pump a blood pressure cuff 20 mm Hg above the patient’s systolic pressure.
B. Tap the facial nerve below the zygomatic arch anterior to the earlobe.
136
```
The clinician should examine which area for gynecomastia?
A. Female’s vagina
B. Male’s breast
C. Male’s penis
D. Female’s ovaries
```
B. Male’s breast
137
Which slightly elevated laboratory result would the clinician observe in a patient with idiopathic hirsutism?
A. Free testosterone
B. Luteinizing hormone (LH)/follicle-stimulating hormone (FSH)
C. Serum calcium
D. Albumin
A. Free testosterone
138
```
The clinician is assessing for the most common cause of increased neck size. Which area would the clinician exam?
A. Salivary glands
B. Lymph nodes
C. Thyroid
D. Trachea
```
C. Thyroid
139
```
Which “P” is a component of “the 3 P’s” of diabetes mellitus?
A. Pain
B. Paresthesia
C. Pallor
D. Polyphagia
```
D. Polyphagia
140
```
A woman presents with new-onset hoarseness with hemoptysis. For which condition should the clinician focus an examination?
A. Hyperthyroidism
B. Pheochromocytoma
C. Cushing’s syndrome
D. Thyroid cancer
```
D. Thyroid cancer
141
Which statement by the patient would indicate teaching has been successful regarding management of Cushing’s syndrome at home?
A. “I will take cortisone on an empty stomach.”
B. “I will stay away from large crowds.”
C. “I will maintain a low-protein diet.”
D. “I will avoid foods high in potassium.”
B. “I will stay away from large crowds.”
142
The patient presents to the clinic with a “buffalo hump,” weight gain, easy bruising, and hyperpigmentation. Which initial diagnostic test should the clinician order?
A. 1 mg overnight dexamethasone suppression test
B. Abdominal computer tomography scan
C. RAI uptake testing
D. Early-morning salivary cortisol
A. 1 mg overnight dexamethasone suppression test
143
```
The clinician suspects a patient has Addison’s disease. Which clinical manifestation would the clinician observe upon a physical examination?
A. Moon face
B. Central obesity
C. Hyperpigmentation
D. Myxedema coma
```
C. Hyperpigmentation
144
Which hydrocortisone dose would the clinician prescribe for a patient with Addison’s disease?
A. 25 to 50 mg daily
B. 0.5 to 0.2 mg daily
C. 20 mg in the morning and 10 mg in early evening
D. 2 to 4 mg in the morning and 1 to 2 mg in the evening
C. 20 mg in the morning and 10 mg in early evening
145
```
The patient with type 1 diabetes is exhibiting Kussmaul respirations, anorexia, fatigue, and increased thirst. Which condition should the clinician manage?
A. Hypoglycemia
B. Somogyi effect
C. Diabetic ketoacidosis
D. Hyperosmolar hyperglycemic syndrome
```
C. Diabetic ketoacidosis
146
```
The patient has hyperosmolar hyperglycemic syndrome. Which laboratory findings would the clinician observe?
A. Plasma bicarbonate 8 mEq/L
B. Blood glucose level 40 mg/dL
C. Serum osmolality 420 mOsm/kg
D. Blood pH 7.20
```
C. Serum osmolality 420 mOsm/kg
147
Which question should the clinician ask to determine the most frequent cause of diabetic ketoacidosis?
A. “How often are you taking the insulin?”
B. “Which type of infection have you experienced recently?”
C. “What type of diet have you been following?”
D. “Is there any reason you don’t like taking your medications?”
B. “Which type of infection have you experienced recently?”
148
```
A patient with type 1 diabetes has diabetic ketoacidosis. Which first-line treatment should the clinician prescribe?
A. NPH insulin
B. Regular insulin
C. IV normal saline
D. Thiazolidinedione
```
B. Regular insulin
149
A nondiabetic patient has idiopathic hypoglycemia. Which dietary instruction should the clinician share with the patient?
A. Follow a low-protein, high-carbohydrate diet
B. Allow caffeine at each meal
C. Avoid nuts and seeds
D. Eat six small meals a day
D. Eat six small meals a day
150
```
The clinician is using the HALT acronym to help a patient identify overeating triggers. What does the “T” represent?
A. Tired
B. Tense
C. Temper
D. Threats
```
A. Tired
151
```
The patient weighs 350 lbs and is on a weight loss program. After 6 months, which ideal weight in pounds should the clinician observe?
A. 335
B. 325
C. 315
D. 305
```
C. 315
152
Which instruction should the clinician include in patient teaching regarding management of obesity?
A. Occasionally skipping meals is acceptable.
B. Try to use nonstick cookware when baking or frying.
C. High-intensity physical activity is recommended.
D. Exercise for about 100 minutes per week.
B. Try to use nonstick cookware when baking or frying.
153
```
The patient has metabolic syndrome. The patient is at increased risk for which condition?
A. Anxiety disorder
B. Gallbladder disease
C. Diabetes mellitus
D. Hyperparathyroidism
```
C. Diabetes mellitus
154
```
A 45-year-old male presents with throbbing podagral pain and tophi in the ear pinnae. Which medication should the clinician prescribe for this acute attack?
A. Colchicine (Colcrys)
B. Probenecid (Benemid)
C. Allopurinol (Zyloprim)
D. Pegloticase (Krystexxa)
```
A. Colchicine (Colcrys)
