Exam 4 Flashcards
- Question: A 75 y/o male c/o worsening, right shoulder pain x 4 months. He states that he has tried OTC Tylenol, but it doesn’t seem to help very much. What is a possible differential diagnosis?
a. Dislocation
b. Fracture
c. Osteoarthritis
d. Given his age, more than likely a fall
Answer: C
Rationale for why the answer is correct: Pt is passed the acute pain phase. Osteoarthritis is a chronic cause for pain
Site for question/rationale: shoulder pain handout page 2
- Question: Your patient with chronic right shoulder pain, will need labs ordered to further help diagnosis. Which lab would be appropriate to order?
a. Chem 20
b. Lab cannot help diagnosis this problem
c. CBC & sed rate
d. A1C, TSH, UA
Answer: C
Rationale for why the answer is correct: CBC will help check for infection and Sed rate helps to check for inflammation. Both of these findings could be the reason for the chronic shoulder pain
Site for question/rationale: shoulder pain handout page 5
- Question: A 25 y/o male, a daily runner, c/o left knee pain that appears to have gotten worse lately, especially when he has to walk down his apartment stairs. He has a positive J-sign. What is a J-sign?
a. J-sign is when the knee is swollen & warm
b. J-sign is when the patella increases in size when the leg is extended
c. J-sign is when the patella jumps laterally when the leg is fully extended
d. J-sign is when the patella jumps laterally when the leg is bent
Answer: C
Rationale for why the answer is correct: This is the correct answer for J-sign
Site for question/rationale: knee pain handout page 2
- Question: An 18 y/o female, recent college student, is brought into the ED for c/o nuchal rigidity, temp 99, and slightly confused. What work up will need to be ordered for this pt?
a. CBC, blood culture only
b. CBC, blood culture, lumbar puncture
c. CBC, blood culture, CMP, MRI
d. No test needed as this is more than likely a virus caused by her being in the dorms
Answer: B
Rationale for why the answer is correct: Checking for elevated WBC and a lumbar puncture is crucial for establishing the diagnosis of bacterial meningitis, so need to examine CSF
Site for question/rationale: neuro ppt. handout, page 4
- Question: A caretaker expresses that her 85 y/o grandfather seemed normal yesterday, but today he seems slightly incorherent, unfocused on his usual daily activities, and seems to be unaware of anything. It appeared that he had gotten better around lunch time, but around 2pm, he became incoherent again. What is the likely diagnosis for this patient?
a. This is typical behavior for someone this age
b. Definitely Alzheimer’s
c. Delirium
d. Insomnia- make sure pt is getting adequate rest
Answer: C
Rationale for why the answer is correct: Pt developed symptoms in a short period and symptoms fluctuated throughout the day, this is delirium
Site for question/rationale: Dr. Vandergriff, neuro part 1, Time 5:44
- Question: You are teaching a family member about Parkinson’s disease. Which statement would mean that more teaching is needed?
a. The disease is a progressive neurodegenerative disease
b. If I notice any shuffling, short stepped gait, must notify the provider right away
c. It is normal for him to have a stooped posture
d. It is normal for his handwriting to keep getting smaller and smaller
Answer: B
Rationale for why the answer is correct: This is a normal magnification of Parkinson’s. Will not have to notify the provider right away
Site: Dr. Vandergriff, neuro part 2
- Question: What is the most accurate predictor of kidney disease?
a. BUN/Creatinine
b. Glomerular filtration rate
c. There is no lab test that can predict kidney disease
d. Chem 20
Answer: B
Rationale for why the answer is correct: GFR helps to predict kidney disease and is the most accurate
Site for question/rationale: renal diagnosis handout, Dr. Seth, page 3
- Question: Which lab is used to adjust drug dosages?
a. GFR
b. BUN
c. Creatinine Clearance
d. CMP
Answer: C
Rationale for why the answer is correct: This is the correct lab use to adjust drug dosages, as it shows that the kidneys are able to clear drugs through the kidney. Certain drugs should not be given or should be adjusted, if pt has kidney damage.
Site for question/rationale: Dr. Seth, renal diagnosis handout, page 4
- Question: What should be done prior to ordering a CT scan w/contrast for a patient?
a. Check CBC
b. Nothing need to be done, just send the patient to radiology
c. Check kidney function, creatinine
d. Check sodium/potassium level
Answer: c
Rationale for why the answer is correct: Dye can damage the kidney further if pt has kidney failure already
Site for question/rationale: Dr. Seth, renal diagnosis handout, page 5
- Question: What causes the urinalysis PH to rise if is left setting?
a. Due to blood, calcium, sodium in the urine
b. Due to patient being overhydrated
c. Due to something patient ate prior to urinating
d. Due to ammonia in the urine breaking down
Answer: D
Rationale for why the answer is correct: This is what causes the urine to breakdown, should place in the refrigerator to slow this process down
Site for question/rationale: urinalysis handout page 2, Dr. Seth
- Question: The NEUXUS and CCS guidelines have the same sensitivity for evaluating trauma patients’ need for radiography.
A. True
B. False
Answer: A
Rationale for why the answer is correct: The present study showed that the two guidelines have the same sensitivity for dealing with trauma patients and evaluating their need for radiography.
Site for question/rationale: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214507/
2. Question: What does the Kehr’s sign indicate? A. Liver injury B. Spleen injury C. Left shoulder injury D. Right shoulder injury
Answer: B
Rationale for why the answer is correct: A spleen injury will radiate directly to the left shoulder.
Site for question/rationale: Dr. Shelly Seth “Shoulder Pain” presentation (timestamp 14:00)
3. Question: Which one of these is NOT an inflammatory arthritis? A. Osteoarthritis B. Rheumatoid arthritis C. Psoriatic arthritis D. Undifferentiated arthritis
Answer: A
Rationale for why the answer is correct: Inflammatory arthritis includes rheumatoid arthritis, gout, systemic lupus erythematosus (SLE), psoriatic arthritis, undifferentiated arthritis
Site for question/rationale: Hand Pain and Swelling presentation by Dr. Shelly Seth (time 1:00)
4. Question: A patient is brought in my ambulance after a car accident and you assess his mental status right away. He only opens his eyes in response to pain, he is making sounds that can’t be comprehended, and he is withdrawing to pain. What Glasgow Coma score would this patient receive? A. 5 B. 7 C. 11 D. 8
Answer: D
Rationale for why the answer is correct: There are 3 categories in which a patient is scored. This particular patient receives a score of 8 based on his s/s
Site for question/rationale: Dr. Kent Vandergriff’s Neuro handout, slide 3
5. Question: What labs are appropriate to order for a patient who presents with confusion and delirium without a known cause? (check all that apply) A. CMP B. Urine culture C. Glucose D. PT, PTT
Answer: A, B, C
Rationale for why the answer is correct: Serum electrolytes, creatinine, glucose, calcium, complete blood count, urinalysis, urine drug screen, and urine culture are reasonable for most patients when a cause is not immediately obvious.
Site for question/rationale: Dr. Kent Vandergriff’s Neuro handout, “labs” slide
- Question: What are the classic triad of symptoms for acute bacterial meningitis?
A. Hypothermia, nuchal rigidity, confusion
B. Fever, nuchal rigidity, change in mental status
C. Change in mental status, nuchal rigidity, shivering
D. Fever, nuchal rigidity, hypertension
Answer: B
Rationale for why the answer is correct: The classic triad of acute bacterial meningitis consists of: Fever (Most common usually > 38ºC, nuchal rigidity (stiff neck), change in mental status, small percentage may have hypothermia. (Rarely patients have a normal temperature)
Site for question/rationale: Dr. Kent Vandergriff’s Neuro handout
7. Question: What is the most accurate predictor of kidney disease? A. Glomerular Filtration Rate B. Creatinine C. BUN D. None of the above
Answer: A
Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease. It usually done by a nephrologist
Site for question/rationale: Renal Testing for Diagnosis presentation by Dr. Shelly Seth
8. Question: What are two contraindications for a kidney biopsy? A. Uncontrolled hypertension B. Single kidney C. Recent surgery D. Pt greater than >75 years old
Answer: A, B
Rationale for why the answer is correct: Contraindications include: sepsis, uncontrolled HTN, hemorrhagic diathesis, parenchymal infection or malignancy, solitary or horseshoe kidney (unless it is transplanted), uncooperative patient
Site for question/rationale: Renal Testing for Diagnosis presentation by Dr. Shelly Seth
- Question: The collection of the 24-hour urine starts with the patient voiding (completely emptying bladder) and discarding the first urine passed in the morning.
A. True
B. False
Answer: A
Rationale for why the answer is correct: The 24-hour urine sample starts after the initial void because that is urine that was formed overnight.
Site for question/rationale: https://www.labcorp.com/resource/urine-specimens
10. Question: What GFR level signifies kidney failure? A. 30-40 B. <15 C. 20-25 D. <22
Answer: B
Kidney damage with normal kidney function GFR >90
Kidney damage with mild loss of kidney fx 60-89
Mild to moderate kidney dysfunction 45-59
Moderate to severe kidney dysfunction 30-44
Severe kidney dysfunction 15-29
Kidney failure <15
Site for question/rationale:
https://www.kidney.org/atoz/content/gfr
1. A 35-year-old female presents to your office complaining of clumsiness, burning and prickling sensation in right hand. She has a positive Tinel test, what is her likely her diagnosis? A. Osteoporosis B. Reiter’s Disease C. Carpel Tunnel Syndrome D. Fifth’s Disease
Answer: C
A Tinel test is used to help diagnose carpel tunnel syndrome by tapping the affected nerve that will produce a tingling sensation in hand. Although osteoporosis can affect the wrist it is normally diagnosed in older female adults past menopause. Reiter’s disease affects the joints, eyes and urethra of males 20-40 years old. Fifth’s disease is normally found in children.
Site for question/rationale: Hand Swelling and Pain handouts by Dr. Shelly Seth
- A 68-year-old male presents to the clinic complaining of pain, paresthesia and swelling to left hip. He has a history HTN and left hip replacement 6 months ago, what diagnostics might the APRN consider when determining a diagnosis?
A. Arthrocentesis
B. CT of the hip
C. Jobes Test
D. Anti-citrullinated protein antibody test
Answer: B
Rationale for why the answer is correct: Acceptable diagnostics for hip pain include plain x-ray 3 view, CT scan, and MRI. Arthrocentesis of an artificial joint should only be done by Ortho. Jobes test refers to shoulder ROM and the anti-citrullinated is specific to rheumatoid arthritis
Site for question/rationale: Hip pain handouts by Dr. Shelly Seth slide 7 - 9
- Which of the following is NOT low back pain clinical pearl:
A. Loss of bowel or bladder
B. Radiating pain into the leg along a dermatome
C. Morning stiffness lasting more than 60 minutes
D. Back pain with history of cancer
Answer: C
Rationale for why the answer is correct: Loss of bowel or bladder indicates cauda equina syndrome, which is an emergency. Radiating pain into the leg along a dermatome indicates a ruptured disc. Back pain with a history of cancer needs to be ruled out for metastatic disease. Morning stiffness greater than 60 minutes relates to rheumatoid arthritis.
Site for question/rationale: My back hurts handouts by Dr. Shelly Seth slide 3
- The classic triage of acute bacterial meningitis symptoms consist of which of the following (select all that apply)?
A. Change in mental status
B. Fever greater than 38 °C
C. Altered lachrymal and salivary gland secretion
D. Nuchal rigidity
Answer: A, B, D
Rationale for why the answer is correct: Altered lacrimal and salivary gland secretions is a clinical feature of Bell’s palsy, all other presenting symptoms are the classic triad of acute bacterial meningitis.
Site for question/rationale: Neuro handouts slide 11
5. A 21-year-old female presents to the clinic with a sudden onset of facial drooping on her left side of face and excessive drooling. She has a history of herpes simplex, asthma and just received her flu vaccine, which of the following is your probable diagnoses? A. Bell's palsy B. Bacterial meningitis C. Guillain-Barré D. Parkinson's
Answer: A
Rationale for why the answer is correct: Clinical features of Bell’s palsy are altered lacrimal and salivary gland secretion, sudden onset of unilateral facial paralysis, inability to close affected eye, disappearance of nasolabial fold, and altered taste to two thirds of tongue. Herpes simplex virus activation is the likely cause of Bell’s palsy in most cases.
Site for question/rationale: Neuro handouts slide 13-14
- A 52-year-old male comes into the clinic complaining of a sudden “thunderclap” headache. He also has a history of hypertension and diabetes, what is the next step by the APRN?
A. Order a MRI of the head
B. Order serologic testing for Lyme disease
C. Order a lumbar puncture to rule out bacterial meningitis
D. Send immediately to emergency room
Answer: D
Rationale for why the answer is correct: A sudden onset of a “thunderclap” headache or the “worst headache of my life” may signal a subarachnoid hemorrhage. Patients must be referred to the emergency room as soon as possible for evaluation due to a high mortality rate.
Site for question/rationale: Neuro handouts slides 29 - 30, and slides 45-47
7. A 73-year-old male presents to the clinic with nausea, vomiting, and flank pain. The patient has a history of chronic kidney disease, hypertension, and peptic ulcer disease. The APRN would like to prescribe a renal dose of antibiotic, which laboratory value is most important? A. Glomerular filtration rate B. Serum creatinine C. BUN D. Creatinine clearance
Answer: D
Rationale for why the answer is correct: Creatinine clearance is measurement used to adjust drug dosages.
Site for question/rationale: Renal testing for diagnoses handout by Dr. Shelly Seth slide 12
8. A 73-year-old male presents to the clinic with nausea, vomiting, and flank pain the patient has a history of chronic kidney disease, hypertension, and peptic ulcer disease. The APRN would like to order diagnostics to rule out kidney stones, which is most appropriate test for this patient? A. CT with contrast B. MRA with contrast C. Renal biopsy D. Renal ultrasound
Answer: D
Rationale for why the answer is correct: Since this patient has chronic kidney disease it is best to avoid contrast for diagnostic testing to avoid complications. A renal ultrasound can be used at the bedside and no contrast is needed, it also can identify hydronephrosis, urine flow, differentiate cyst from masses, and stones.
Site for question/rationale: Renal testing for diagnoses handout by Dr. Shelley Seth slide 14 -22
- A 40-year-old woman presents to the clinic with urinary frequency and discomfort. The APRN orders a microscopic urinalysis that reveals hematuria, pyuria, and bacterial casts, what is the next appropriate action?
A. Have the patient return to clinic in 1 week for repeat urinalysis
B. Treat patient for acute pyelonephritis
C. Repeat urinalysis to rule out contamination
D. Refer to nephrologist
Answer: B
Rationale for why the answer is correct: Based on the bacterial cast present and microscopic urinalysis and patient’s symptoms, this is an indication of acute pyelonephritis. A microscopic urinalysis is more accurate compared to a UA dipstick, which may have false positives.
Site for question/rationale: Urinalysis handouts by Dr. Shelly Seth slides 4, 11, 12, 14, 15
10. A 55-year-old man presents to the clinic with a productive cough, fever, and shortness of breath. He has a history of hypertension, diabetes, and he is a smoker. He has been seen in the clinic several times and has been prescribed antibiotics; the APRN would like to order additional diagnostics, which is the most appropriate? A. Lumbar puncture B. Gram stain, C&S of sputum C. Urinalysis D. Gram stain, CNS of pleural fluid
Answer: B
Rationale for why the answer is correct: It is possible that the patient is being prescribed antibiotics that are not sensitive to particular bacteria. The Gram stain should be order when infection is suspected, unknown origin of fever, and fluid accumulation in wrong place. The culture and sensitivity will give antibiotic specifics.
Site for question/rationale: Fluid analysis handouts by Dr. Shelley Seth slides 3- 8
1. Question: A patient is coming in with a chief complaint of “Shoulder Pain.” After gathering their HPI and performing a PE, you diagnose them with arthritis. As a NP you know that the most common place to develop arthritis is in what articular surface? A. Sternoclavicular B. Acromioclavicular C. Glenohumeral D. Scapulothoracic
Answer: C
Rationale for why the answer is correct: The most common place to develop arthritis of the shoulder and the most problematic area is the Glenohumeral.
Site for question/rationale: Shoulder Pain presentation by Dr. Shelly Seth, 3:45. (In Red font)
2. Question: Morning stiffness lasting more than \_\_ minutes indicates an inflammatory process. A. 30 minutes B. 60 minutes C. 90 minutes D. 20 minutes
Answer: B
Rationale for why the answer is correct: CLINICAL PEARL: Morning stiffness lasting more than 60 minutes indicates an inflammatory process.
Site for question/rationale: Hand Pain and Swelling presentation by Dr. Shelly Seth, 2:00.
3. Question: When a patient presents with a chief complaint of “Hip Pain.” The most important diagnostic tests to Rule Out infection include all EXCEPT: A. Sed Rate B. CBC C. CRP D. CMP
Answer: D
Rationale for why the answer is correct: A Sed rate, CBC, and CRP are all labs that could indicate Infection or Inflammation.
Site for question/rationale: Hip Pain presentation by Dr. Shelly Seth, 8:20.
4. Question: Clinicians must be aware that delirium can still occur at normal therapeutic levels with which drugs? A. Digoxin B. Lithium C. Quinidine D. All of the Above
Answer: D
Rationale for why the answer is correct: Digoxin, Lithium, and Quinidine can all cause delirium even at therapeutic drug levels.
Site for question/rationale: Neurology Presentation 1 by Dr. Kent Vandergriff, 7:15.
5. Question: The Classic Triad of Acute Bacterial Meningitis consists of all of the following EXCEPT: A. Elevated WBC B. Fever C. Stiff Neck D. Change in Mental Status
Answer: A
Rationale for why the answer is correct: The Classic Triad of Acute Bacterial Meningitis includes Fever >38°C, Nuchal Rigidity (Stiff Neck), Changes in Mental Status, and occasionally Hypothermia (Rarely patients have a normal temperature).
Site for question/rationale: Neurology Presentation 1 by Dr. Kent Vandergriff, 9:05.
6. Question: A 62-year-old patient presents to the ED with a sudden onset of a severe headache. The patient describes it as “the worst headache they have ever had.” The Nurse practitioner should automatically suspect that this is a: A. Migraine Headache B. Tension Headache C. Thunderclap Headache D. Cluster Headache
Answer: C
Rationale for why the answer is correct: A sudden onset of a severe headache is known as a Thunderclap Headache and the patient usually describes it as “the worst headache they have ever had in their life.” It should be considered a subarachnoid hemorrhage until proven otherwise.
Site for question/rationale: Neurology Presentation 2 by Dr. Kent Vandergriff, 3:30.
7. Question: Which test is the most accurate predictor of kidney disease? A. GFR B. BUN C. Serum Creatinine D. Urinalysis
Answer: A
Rationale for why the answer is correct: The most accurate predictor of kidney disease is GRF. The GFR on lab reports is an “estimated” result. To do the test, a patient is given a marker that will clear through the glomerular filtration system and be measured. This is normally done by a nephrologist.
8. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 7:05. Question: When adjusting a medication dose, you should consider which lab? A. GFR B. Creatine Clearance C. BUN D. 24-hour urine protein
Answer: B
Rationale for why the answer is correct: Creatinine Clearance is measurement used to adjust drug dosages. (RED FONT)
Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 14:34.
9. Question: Your patient presents to the clinic with elevated blood pressures at 36 weeks gestation. What lab work would you expect to order on the patient suspected to have preeclampsia? A. BUN B. Creatine Clearance C. GFR D. 24-hour urine protein
Answer: D
Rationale for why the answer is correct: Preeclampsia is an indication to order a 24-hour urine.
Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 16:18.
10. Question: All of the following tests would be appropriate to diagnose a kidney stone EXCEPT: A. CT with contrast B. CT without contrast C. Renal US D. KUB
Answer: A
Rationale for why the answer is correct: CT scan stone protocol is that NO contrast be used. The calcium alone will show up.
Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 19:50.
- Question: Which is not part of the four muscles of the rotator cuff?
a. Supraspinatus
b. Subscapularis
c. Tres minor
d. Glenohumeral
Answer: D- glenohumeral
Rationale for why the answer is correct: Supraspinatus, Subscapularis, Tres minor, and Infraspinatus are the four muscles of the rotator cuff.
Site for question/rationale: “CC: My shoulder hurts” by Dr. Shelly Seth Pg.3
- Question: What is not an example of chronic shoulder pain?
a. Peripheral nerve entrapment
b. Rotator cuff injury
c. Osteoarthritis
d. Adhesive capsulitis
Answer: A- Peripheral nerve entrapment
Rationale for why the answer is correct: Peripheral nerve entrapment is an example of referred shoulder pain that is distal to the spinal column.
Site for question/rationale: “CC: My shoulder hurts” by Dr. Shelly Seth Pg. 2
- Question: Which of these clinical pearls is most accurate?
a. RA is not symmetrical, and OA is symmetrical
b. OA is always symmetrical
c. OA is usually not symmetrical, and RA is symmetrical
d. RA is always symmetrical
Answer: C- OA is usually not symmetrical, and RA is symmetrical
Rationale for why the answer is correct: RA is rheumatoid arthritis from inflammatory arthritis that is symmetrical, and OA is osteoarthritis from degenerative arthritis that is usually not symmetrical.
Site for question/rationale: “CC: My hand hurts” by Dr. Shelly Seth Pg. 1
- Question: What part of the body does bacterial meningitis infect?
a. The pia and the CSF in the subarachnoid space.
b. The arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles.
c. The dura mater and the CSF in both the subarachnoid space and the cerebral ventricles.
d. The dura mater and the CSF in the cerebral ventricles.
Answer: B- the arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles.
Rationale for why the answer is correct: - Bacterial meningitis infects the arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles.
Site for question/rationale: Top 10 Neuro Diagnosis in Acute & Primary Care Presentation PowerPoint Pg. 4
- Question: Which is not a presenting symptom of bacterial meningitis?
a. Fever >100.4f
b. Diplopia
c. Hypothermia
d. Nuchal rigidity
Answer: B- diplopia
Rationale for why the answer is correct: Fever above 100.4f, hypothermia, and nuchal rigidity are all symptoms of bacterial meningitis. Rarely patient’s have a normal temperature with bacterial meningitis.
Site for question/rationale: Top 10 Neuro Diagnosis in Acute & Primary Care Presentation PowerPoint Pg. 4
- Question: What is most likely the cause of Bell’s Palsy in most cases?
a. Herpes simplex virus activation
b. Viral meningitis
c. Intracranial bleeding
d. Syphilis exposure at birth
Answer: A- herpes simplex virus activation
Rationale for why the answer is correct: Herpes simplex virus activation is the likely cause of Bell’s palsy in most cases.
Site for question/rationale: Top 10 Neuro Diagnosis in Acute & Primary Care Presentation PowerPoint Pg. 5
- Question: What is the most accurate predictor of kidney disease?
a. BUN
b. Creatinine
c. CMP
d. GFR
Answer: D- GFR
Rationale for why the answer is correct: GFR is the most accurate predictor of kidney disease.
Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 3
- Question: A GFR should be considered with all the following except:
a. Extremes of age and body size
b. Severe malnutrition or obesity
c. Athlete exercising 5x days/week
d. Pregnancy
Answer: C- athlete exercising 5x days/week
Rationale for why the answer is correct: Extremes of age and body size, severe malnutrition, pregnancy, and many more should all be considered for a GFR.
Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 3
- Question: What is the measurement used to adjust drug doses?
a. Creatinine clearance
b. CMP
c. Peak & trough levels
d. A1C
Answer: A- creatinine clearance
Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug doses.
Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 4
- Question: What are contraindications to ordering a CT scan with dye?
a. Patient taking metformin
b. Renal disease
c. Multiple myeloma
d. All of the above
Answer: D- all of the above
Rationale for why the answer is correct: Elevated creatinine, taking metformin, dehydration, allergies to dye, history of renal disease, and multiple myeloma are all contraindications for ordering and administering dye for a CT scan.
Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 6
- Question: A healthy 26-year-old comes into the clinic with complaint of knee pain. She states that the pain is right behind her kneecap and intensifies when walking downstairs. She is an avid runner who just finished up her 3rd marathon last month. You exam her and the J-sign is positive upon assessment. Which of the following is the most likely diagnosis?
a. Pattellofemoral Pain Syndrome
b. Patellar Tendinitis
c. Prepatella Brusitis
d. Osgood-Schlatters disease
Answer: A: Patellofemoral Pain Syndrome
Rationale for why the answer is correct: Patellofemoral pain syndrome is the most common cause of anterior knee pain and occurs in 16-25% of injuries in runners. It is pain behind or around the patella aggravated by weight-bearing activities. The pain is worsened with activities such as squatting or descending stairs.
Site for question/rationale: Dr. Shelly Seth “Knee Pain” presentation on slide 9 at minute 7
- Question: According to the NEXUS (National emergency x-radiography utilization study) a trauma patient must meet all of the follow criteria to not be required cervical spine imaging EXCEPT:
a. Not intoxicated
b. Alert and stable
c. Only one distracting injury
d. No midline spinal tenderness
Answer: C: Only one distracting injury
Rationale for why the answer is correct: According to NEXUS trauma patients who do not require cervical spine imaging require ALL of the follow: alert and stable, No focal neurologic deficit, No altered LOC, not intoxicated, no midline spinal tenderness, and NO distracting injury
- Question: Your patient comes in with the complaint of back pain. You have him raise his leg and note pain at approximately 40 degrees. You determine that this means the test is positive and he may have a herniated disk. Which of the following is the test that you just performed?
a. Hawkins Kennedy Test
b. Straight Leg Raise
c. Jerk Test
d. Posterior impingement sign
Answer: B: Straight Leg Raise (SLR) – This is the most common test is the SLR during a physical exam for the complain of back pain. It is a positive test for a possible herniated disk. The remaining tests are Shoulder specialty tests.
Rationale for why the answer is correct:
Site for question/rationale: Min 8:15
- Question: Which of the following is not part of the acronym SNOOP for red flags with headaches?
a. S: Systemic symptoms
b. N: Neurologic symptoms
c. O: Onset is new or sudden
d. P: Prodrome or Aura
Answer: D: Prodrome or Aura
Rationale for why the answer is correct: SNOOP stands for Systemic symptoms, Neurologic symptoms, Onset is new or sudden, Other associated conditions or features, Previous headache history
Site for question/rationale: Dr. Kent Vandergriff’s lecture on “Top 10 Neuro Diagnosis in Acute and Primary Care” Slide 28-29
- Question: A 65 year old presents with stopped posture, shuffling gait, hypophonia, bradykinesia, and tremors. Based on these presenting symptoms what would be your leading diagnosis?
a. Parkinson’s Disease
b. Guillain Barre Syndome
c. Bell’s Palsy
d. Multiple Sclerosis
Answer: A: Parkinson’s Disease
Rationale for why the answer is correct: Clinical assessment of the signs and symptoms associated with Parkinson’s disease are tremor, bradykinesia, rigidity, postural instability. There clinical manifestations are related to craniofacial, visual, musculoskeletal, and gait. The mean age of dx is 70.5 y/o, uncommon in less than 40 y/o, and incidence increases with > 60y/o.
Site for question/rationale: Dr. Kent Vandergriff’s lecture on “Top 10 Neuro Diagnosis in Acute and Primary Care” Slide 32-35
- Question: A patient comes in with a complaint of the “worst headache of my life”. She states that it started about 3 hours ago and will not go away or decrease in severity even with OTC medication taken 2 hours ago. Based on the patient’s complaint you need to evaluate for a Subarachnoid Hemorrhage (SAH). Which of following is the gold standard to identify and treat diagnosis?
a. Head CT
b. Lumbar Puncture
c. 4 Vessel cerebral angiogram
d. MRI
Answer: C: Formal 4 cerebral angiogram
Rationale for why the answer is correct: the Formal 4 cerebral angiogram is gold standard and utilized to identify and coil aneurysm. CT is good for diagnosis in >90% of cases if within 24 hours. LP is mandatory if there is suspicion of SAH despite a normal CT
Site for question/rationale: Dr. Kent Vandergriff’s lecture on “Top 10 Neuro Diagnosis in Acute and Primary Care” Slide 41
- Question: Which of the follow labs are measured to adjust drug dosages?
a. Cystatin C
b. BUN
c. Creatinine Clearance
d. GFR
Answer: C: Creatinine clearance
Rationale for why the answer is correct: Creatinine clearance is the correct measurement for adjusting drug dosages. Though the other labs are used for kidneys they are not specifically used to change your medication dosages.
Site for question/rationale: “Diagnosing Renal Problems: Diagnostic Tests for Renal Diseases” By Dr. Shelly Seth at min 11:20 - 14:30- and slide 10 & 12
8. Question: Your patient comes in with a suspected UTI. You duo a UA and note the following. What differential diagnosis would you be most suspicious of? • Nitrites: Positive • RBCs < 2RBCs/hpf • Casts – Many WBC casts • Yeast: None a. Pyelonephritis b. Glomerulonephritis c. Tubular necrosis d. Tamm-Horsfall mucoprotein
Answer: B: pyelonephritis
Rationale for why the answer is correct: WBC cases come from the kidney tubule and reflect pyelonephritis. Whereas Tamm-Horsfall mucoprotein is an incidental finding of hyaline casts, RBC casts indicate glomerulonephritis, and epithelial casts tubular necrosis.
Site for question/rationale: “Urinalysis” by Dr. Shelly Seth slide 15 at approx. min 14
- Question: Which of the following is not included in the patient’s instructions for collecting 24-hour urine specimen?
a. Upon rising the first morning, urinate emptying your bladder completely into specimen container and note exact time and print it on the container label
b. Refrigerate the collected urine between all voidings and keep it in a cool place
c. Collect all urine voided for 24 hours after the first void in the container provided by the physician. All urine passed during the 24-hour time period (day or night) must be saved. Urine passed during bowel movements also collected.
d. Take the 24-hour specimen to the physician’s office or laboratory as soon as possible, placing it in a portable cooler or insulated bag to maintain cool temperature in transit.
Answer: A: Upon rising the first morning, urinate emptying your bladder completely into specimen container and note exact time and print it on the container label.
Rationale for why the answer is correct: According to lapcorp, the patient instructions is to urinate their first morning urine into the toilet, and then begin the 24 hour collect post 1st morning void.
Site for question/rationale: Urine Specimens | Labcorp. (2021). Labcorp. https://www.labcorp.com/resource/urine-specimens
- Question: The patient has a GFR of 20. What stage of chronic kidney disease would this place them in?
a. Stage 1
b. Stage 2
c. Stage 4
d. Stage 5
Answer: C: Stage 4
Rationale for why the answer is correct: Stage 4 indicates severe loss of kidney function. The GFR for stage 4 is 29 to 15.
Site for question/rationale: Estimated Glomerular Filtration Rate (eGFR). (2020, September 14). National Kidney Foundation. https://www.kidney.org/atoz/content/gfr
1. Question: A 9-year-old boy presents to the clinic after soccer practice and he complains of pain to his left shoulder. He has a positive Kehr’s sign. What is your leading diagnosis? A. Rotator cuff injury B. Impingement syndrome C. Spleen laceration D. Shoulder fracture
Answer: C
Rationale for why the answer is correct: A positive Kehr’s sign is indicative of a spleen laceration.
Site for question/rationale: “My Shoulder Hurts” presentation by Dr. Seth, minute 3:20
2. Question: A patient presents to the clinic with hand pain, conjunctivitis, urethral discharge and urethritis. What is your leading diagnosis for this patient? A. Reiter’s disease B. Lyme Disease C. Uveitis, temporal arteries D. None of the above
Answer: A
Rationale for why the answer is correct: Patient’s with Reiter’s disease present with hand pain, conjunctivitis, urethral discharge and urethritis.
Site for question/rationale: “My hand hurts” presentation by Dr. Seth minute 8:20
- Question: _______ is symmetrical and __________ is usually not symmetrical.
A. Osteoarthritis and Rheumatoid arthritis
B. Rheumatoid arthritis and Osteoarthritis
C. Rheumatoid arthritis and Psoriatic arthritis
D. Psoriatic arthritis and Osteoarthritis
Answer: B
Rationale for why the answer is correct: A clinical pearl to remember is that RA is symmetrical and OA is usually not symmetrical. In addition, the metacarpal joints and wrists are painful in RA while the distal interphalangeal and proximal interphalangeal joints are painful in OA.
Site for question/rationale: “My hand hurts” presentation by Dr. Seth minute 2:11
4. Question: A patient comes into the ER via ambulance and they are unresponsive. What is their Glasgow coma scale score? A. 0 B. 3 C. 15 D. 5
Answer: B
Rationale for why the answer is correct: The Glasgow coma scale ranges from 3-15 it measures 3 different areas (Eye opening, Best verbal response and Best motor response). An unresponsive patient would be scored a 3 according to the Glasgow coma scale
Site for question/rationale: “Top Ten neuro diagnosis in acute and primary care part one” presentation by Dr. Vandergriff minute 2:45
5. Question: You suspect a patient has acute bacterial meningitis. Which of the following signs would this patient have? A. Fever greater than 38 degrees C B. Nuchal rigidity (stiff neck) C. Change in mental status D. All of the above
Answer: D.
Rationale for why the answer is correct: The classic triad of acute bacterial meningitis consists of Fever greater than 38 degrees C, Nuchal rigidity (stiff neck) and change in mental status Rarely do patients present with a normal temperature.
Site for question/rationale: “Top Ten neuro diagnosis in acute and primary care part one” presentation by Dr. Vandergriff minute 9:20
- Question: Which of the following would be the classic triad for a patient with normal pressure hydrocephalus?
A. Psychosis, gait disturbance and urinary incontinence
B. Dementia, headaches and gait disturbances
C. Dementia, gait disturbance and urinary incontinence
D. Headaches, gait disturbance and dementia.
Answer: C.
Rationale for why the answer is correct: The classic triad presentation for NPH-normal pressure hydrocephalus would be Dementia, gait disturbance and urinary incontinence
Site for question/rationale: “Top Ten neuro diagnosis in acute and primary care part two” presentation by Dr. Vandergriff minute 15:45
7. Question: Which lab value must you look at to adjust drug dosages? A. Creatine Clearance B. BUN C. Estimated GFR D. BMP
Answer: A
Rationale for why the answer is correct: Creatine clearance is the measurement used to adjust drug dosages.
Site for question/rationale: “Renal testing for diagnosis” presentation by Dr. Seth minute 14:35
8. Question: Which test is the most accurate predictor of kidney disease? A. BUN B. Glomerular filtration rate C. Serum Creatine D. Urinalysis
Answer: B
Rationale for why the answer is correct: The Glomerular filtration rate is the most accurate predictor of kidney disease; this test is usually ordered by a nephrologist and it is done with a 24-hour urine.
Site for question/rationale: “Renal testing for diagnosis” presentation by Dr. Seth minute 7:30
- Question: A which of the following are true about (gadolinium contrast)?
a. It can cause nephrogenic systemic fibrosis and renal failure
b. Do not use with patients in acute kidney injury
c. If used on patients on dialysis, they must immediately dialyze after the test
d. All of the above is true.
Answer: D
Rationale for why the answer is correct: All of the above was true regarding the use of gadolinium contrast It can cause nephrogenic systemic fibrosis and renal failure, do not use with patients in acute kidney injury and If used on patients on dialysis, they must immediately dialyze after the test. A nephrologist MUST be involved as well and they will be the ones ordering this Site for question/rationale: “Renal testing for diagnosis” presentation by Dr. Seth minute 24:05
- Question: What is the normal urinalysis pH range?
a. 7.35-7.45
b. 4.5-8.0
c. 1.0-4.5
d. 8.0-14
Answer: B
Rationale for why the answer is correct: the normal range of urinalysis pH range is 4.5-8.0. acidity/alkalosis corresponds with metabolic state of patient.
Site for question/rationale:” Urinalysis” presentation by Dr. Seth slide 2
- Question: Shoulder pain can be.
a. Atrinsic
b. Extrinsic
c. Intrinsic
d. All the above
Answer: C
Rationale for why the answer is correct: The intrinsic qualities of something have to do with its nature.
Site for question/rationale: DR. Seth Shoulder pain handout.
- Question: Patient comes into office with complains of hand pain, states he was on vacation in Indiana on a hunting trip. There was a lot of forest and it was very moist. Other complaints by patient involve neurological concerns and a large red wheel or annular red plaque on left leg. What does this patient present with.
a. Reiter’s disease
b. SLE
c. Lyme disease
d. Stephen Johnson’s Syndrome
Answer: C
Rationale for why the answer is correct: Lyme disease presents with neurological concerns, and large red annular plaque where tick bite was observed.
Site for question/rationale: DR. Seth Hand pain and swelling PP
- Question: Patient presents to clinic complaining of nausea, vomiting, fever, some weight loss and fatigue. Upon assessment a large macular “Butterfly Rash” is noticed on the patients face. As a practitioner the first disease process that comes to mind is.
a. Lyme disease
b. Reiter’s disease
c. Rheumatoid arthritis
d. Systemic Lupus Erythematous
Answer: D
Rationale for why the answer is correct: Systemic Lupus presents with the classic “Butterfly Rash.”
Site for question/rationale: Dr. Seth Hand and swelling PP
- Question: Patient presents to clinic with acute peripheral facial palsy of unknown cause. Eyebrow sagging, mouth drooping. Stroke is ruled out for this patient. As a provider you know that this presentation is classic for.
a. Guillain Barre Syndrome
b. Meningitis
c. Bell’s Palsy
d. Multiple Sclerosis
Answer: C
Rationale for why the answer is correct: Classic presentation of Bell’s Palsy is facial paralysis, drooping mouth, sagging eyebrow, usually diagnosed upon ruling out stroke.
Site for question/rationale: Neuro PP Bell’s Palsy
- Question: What is the mnemonic that is used for the presence of serious underlying disorders that can cause acute or subacute HA.
a. FAST
b. SNOOP
c. SMART
d. BEFAST
Answer: B
Rationale for why the answer is correct: This widely used Mnemonic of SNOOP helps detect causes of secondary headache with significant morbidity and mortality.
Site for question/rationale: Neuro PP Handout
- Question: A 25- year- old present to the clinic with neurological deficits that mimic Parkinson’s disease. As a provider you know that Parkinson’s is usually uncommon in people under the age of.
a. 25
b. 30
c. 40
d. 75
Answer: C
Rationale for why the answer is correct: According to the power-point progressive neurodegenerative disease Parkinson disease is uncommon in people younger than 40. Incidence of the disease increases rapidly over 60 years, with a mean age at diagnosis of 70.5
Site for question/rationale: Neuro PP
- Question: What labs are usually drawn for initial Kidney testing.
a. UA, Serum Creatinine, BUN, GFR.
b. UA, Creatinine serum, BNP, MCV
c. CBC, CMP, BNP, UA
d. Urinalysis, Creatinine Clearance, Complete metabolic panel, Glomerular filtration rate.
Answer: A
Rationale for why the answer is correct: According to power point the basic labs for kidney testing are UA, Serum Creatinine, BUN, GFR. These simple blood tests and urine tests can help identify problems with the kidneys.
Site for question/rationale: Renal Testing for Diagnosis PP
- Question: What is the normal PH of a urinalysis?
a. 8.35-8.45
b. 4.5 – 8
c. 3.5-5
d. 6
Answer: B
Rationale for why the answer is correct: Many factors affect urine PH, environment, heat, cold.
Site for question/rationale: Urinalysis PP Dr. Seth.
- Question: Which lab is the most accurate predictor of Kidney Disease?
a. GFR
b. Serum Creatinine
c. BUN
d. 24 hr urine collection.
Answer: A
Rationale for why the answer is correct: GFR is a test used to check how well the kidneys are functioning. It estimates how much blood passes through the glomeruli each minute.
Site for question/rationale: Renal Testing for Diagnosis PP. Dr. Seth.
- Question: Which lab is used primarily to adjust drug dosages.
a. Blood, Urea, Nitrogen
b. LFTs
c. Creatinine clearance
d. Nitrates
Answer: C
Rationale for why the answer is correct: The amount of blood the kidneys can make creatinine free each minute. The waste product from normal wear and tear of your muscles which passes through the kidneys. This process helps doctors understand how well the kidney is functioning and can help them adjust medication for those who are at risk for inadequate functioning of the renal system.
Site for question/rationale: Renal Testing for Diagnosis PP. Dr. Seth.
1. Question: A 1-year-old patient arrives to the ED with limited range of motion of the left arm and pain with movement. After further investigation mom reports the patient’s big sister was pulling her around the house by both arms when the patient started screaming and refused to move her left arm. Which is the most likely diagnosis given symptoms and mechanism of injury? Answer: A. Rotator Cuff Injury B. Supracondylar Fracture C. Nurse Maid’s Elbow D. Impingement Syndrome
Rationale for why the answer is correct: Nurse Maids elbow occurs in children from 6 months to 5 years and is a very common diagnosis. It occurs with pulling or swinging motions and involves the subluxation of the radial head. It can easily be put back with a simple hyper pronation and supination movement. Analgesics can be given to reduce inflammation and help with pain.
Site for question/rationale: Found in the Nurse Maid’s Elbow presentation power point in Canvas under Module 7 slide #1.
2. Question: What are the most appropriate and least invasive tests to order and perform on a patient you suspect to have osteonecrosis of the hip? Answer: A. Arthrocentesis, US, CBC, CRP B. Xray, CBC, CRP, Sed Rate C. CT, CRP, Sed Rate D. MRI, CBC, CRP
Rationale for why the answer is correct: A plain view Xray of the hip joint is the best radiological test to perform that is the least invasive mechanism to diagnose osteonecrosis of the hip. In addition, a CBC, CRP, and Sed Rate should be drawn to evaluate for infection and inflammation.
Site for question/rationale: Found on slides #7/8 on the Hip Pain Handout found under Module 7 in canvas.
- Question: Which symptoms are the most indicative of a diagnosis of Systemic Lupus Erythematosus (SLE)?
Answer:
A. Hand pain, fever, fatigue, and a malar rash
B. Symmetrical hand pain, fever, fatigue, and chest pain
C. Hand pain, conjunctivitis, and urethral discharge
D. Hand pain, annular red plaque, and neurological changes/issues
Rationale for why the answer is correct: A malar rash is a tell-tale sign of SLE in combination with the other preceding symptoms this diagnosis can be likely believed. Other symptoms of SLE include weight loss, chest pain, nausea, vomiting, diarrhea, personality changes, and a photosensitive rash. The other answers indicate either RA, Reiter’s Disease, or Lyme’s disease.
Site for question/rationale: Found in the Hand Swelling and Pain Handout on power point slide #9 from Module 7.
4. Question: A 30-year-old male presents with progressive muscle weakness that occurred symmetrically and absent deep tendon reflexes. What is your leading differential diagnosis? Answer: A. Parkinson’s Disease B. Stroke C. Subarachnoid Hemorrhage D. Guillain Barre Syndrome
Rationale for why the answer is correct: Guillain Barre Syndrome is an acute immune-mediated polyneuropathy are classified under GBS. A heterogenous condition with several variant forms that presents with as a monophasic paralyzing illness provoked by a preceding infection. Clinical manifestations include a progressive and symmetric muscle weakness and absent of decreased deep tendon reflexes. Usually starts from the most distal part of the body and works in an upward fashion resulting in respiratory muscle weakness and ventilator support.
Site for question/rationale: Found in the Neuro power point under Module 7 slide # 20.
5. Question: What diagnostic tests are important in the diagnosis of Bacterial Meningitis? Answer: A. CBC, Blood cultures, and LP B. CBC, Sed Rate, CRP, and CT C. CBC, CMP, and CT D. CBC, Sed Rate, CT, and LP
Rationale for why the answer is correct: Bacterial Meningitis is an inflammatory disease of the leptomeninges and is defined by an abnormal number of WBC’s in the CSF. The symptoms present with fever, nuchal rigidity, and change in mental status. The workup includes CBC, Blood Cultures, Lumbar Puncture, and possible CT if mass or high ICP is suspected.
Site for question/rationale: Found in the Neuro power point under Module 7 slide #9.
- Question: What are clinical manifestations and features found in a patient with Bell’s Palsy?
Answer:
A. Masked facial expression, eyelid apraxia, hypophonia
B. Unliteral facial paralysis, inability to close eye, disappearance of nasolabial fold
C. Sudden headache described as the worst headache of their life, photophobia, blurred vision
D. Numbness of face, difficulty speaking, blurred vision
Rationale for why the answer is correct: Bells Palsy is known as acute peripheral facial palsy with unknown cause. Clinical manifestations of Bells Palsy include sudden onset, usually within hours, of unilateral facial paralysis, eyebrow sagging, mouth drooping, inability to close eyelid, disappearance of nasolabial fold, altered secretion of lacrimal and salivary glands, and loss of taste on anterior 2/3 of the tongue.
Site for question/rationale: Found in the Neuro power point under Module 7 slide #10.
- Question: What are some differential diagnoses that are found in a patient with exudative fluid?
Answer:
A. CHF, Cirrhosis, Hypoalbuminemia
B. Peritoneal dialysis, Pericarditis, Malignancy
C. Nephrotic causes, PE
D. Pneumonia, PE, Pancreatitis
Rationale for why the answer is correct: Exudative fluid is usually secreted from inflamed tissue and contain cells or cellular substances. An exudative effusion needs analysis and treatment. Some causes include pneumonia, malignancy, PE, pancreatitis, recent GI surgery, and trauma.
Site for question/rationale: Found in the Fluid Analysis power point under Module 8 slide # 27.
8. Question: What are some differential diagnoses associated with blood in the urine? Answer: A. UTI B. Kidney stone C. Proteinuria D. Tumor
Rationale for why the answer is correct: When RBC’s are found in a urinalysis there are numerous diagnoses that require a follow up. These diagnoses include kidney stone, damage to the kidney, and bladder cancer.
Site for question/rationale: Found in the Fluid Analysis power point under Module 8 page 5.
- Question: Which question regarding history is the most appropriate and pertinent question a provider should ask when evaluating and assessing a patient for a urinary tract infection?
Answer:
A. “Do you have hematuria, polyuria, urgency, or any flank pain?”
B. “Do you have any history of kidney disease?”
C. “Have you ever had any recent resting with dye?
D. “Have you ever been diagnosed edema, hypertension, or diabetes?”
Rationale for why the answer is correct: When evaluating for a UTI the most appropriate question for a provider to ask is regarding any blood, pain, increased frequency/urgency/polyuria and or any flank pain. The other answers are important secondary questions to evaluate PMH and any previously diagnosed cardiovascular/renal problems.
Site for question/rationale: Found in the Renal Diagnosis power point under Module 8 page #1.
10. Question: What test is the most accurate predictor of Kidney Disease? Answer: A. Creatinine Clearance B. Glomerular Filtration Rate C. 24 Hour Urine D. Renal Ultrasound
Rationale for why the answer is correct: Glomerular Filtration Rate is the most accurate predictor of kidney disease. This test is done by a nephrologist and is usually an estimated amount. The patient is given a marker that will clear through the glomerular system and measured. The GFR should be considered with extremes of ages, and body size, malnutrition or obesity, musculoskeletal disease, vegetarian diet, rapidly changing kidney function, and or pregnancy.
Site for question/rationale: Found in the Renal Diagnosis power point under Module 8 page #3.
- Question: Referred left shoulder pain caused by diaphragmatic irritation secondary to a ruptured spleen is called?
a. Kerr’s sign
b. Murphy’s point tenderness
c. Kernig’s sign
d. McBurney’s point tenderness
Answer: A
Rationale for why the answer is correct: Kerr’s sign occurs when free blood in the abdomen irritates the diaphragm which causes nerve pain that refers to the left shoulder.
Site for question/rationale: Dr. Seth’s lecture “Shoulder Pain Diagnostics” (3:15)
- Question: After performing a physical exam on a patient who complains of shoulder pain. The provider decides to perform a single AP shoulder X-Ray. This is appropriate because?
a. A one-view film will show anything that could be wrong
b. The provider is trying to be cost effective therefore a one-view is acceptable
c. There were not obvious signs of injury on the physical exam
d. This is not appropriate. At least 2 views need to be performed.
Answer: D
Rationale for why the answer is correct: Performing a single view on an X-ray is not comprehensive enough to show the provider possible injury in the shoulder. The provider needs to visualize the shoulder from a minimum of 2 views.
Site for question/rationale: “Shoulder series” (15:30)
- Question: A common difference when diagnosing rheumatoid arthritis (RA) versus osteoarthritis (OA) is?
a. RA pain is usually in either the left OR right wrist
b. RA is caused by overworked/overused joints
c. RA is usually symmetrical, OA is usually asymmetrical
d. Only a few highly specialized providers can distinguish and diagnose RA/OA
Answer: C
Rationale for why the answer is correct: RA is a systemic process and affects joints on both sides of the body. OA is typically caused by an overused joint (the right hand in right-handed people) and common on one side of the body.
Site for question/rationale: Dr. Seth’s lecture “Hand Pain and Swelling Diagnostics” (2:45)
- Question: Parkinson’s disease is a diagnosis typically based on what clinical symptoms?
a. Headache, younger than 40 y/o, and progressive muscle paralysis
b. Erect posture, increased coordination, and exophthalmos
c. Tremors, stooped posture, shuffling gait, bradykinesia
d. Muscle weakness that starts in the legs and progresses towards the head
Answer: C
Rationale for why the answer is correct: Parkinson’s is a progressive disease characterized by tremors, bradykinesia, rigidity, shuffling gait, and postural instability. This is a diagnosis made by the clinician based on manifestations.
Site for question/rationale: Dr. Vandergriff’s lecture “Neuro Part II” (7:00)
- Question: Symptomatic seizures are those that occur…?
a. Unrelated to a medical condition
b. Over a lifetime and will require lifelong treatment
c. In front of a medical professional witness
d. In the setting of an acute medical condition such as hypoglycemia or hyponatremia. Low risk for lifelong seizures.
Answer: D
Rationale for why the answer is correct: Symptomatic seizures are related to an acute medical condition that causes a seizure such as electrolyte imbalance, traumatic brain injury, or meningitis.
Site for question/rationale: Dr. Vandergriff’s lecture “Neuro Part II” (8:00)
- Question: An APRN suspects a patient is suffering from a subarachnoid hemorrhage. The non-contrast CT results are normal. What is the APRN’s next diagnostic study to verify his suspicion?
a. Lumbar puncture
b. Contrast CT
c. Cranial Ultrasound
d. Test for nuchal rigidity
Answer: A
Rationale for why the answer is correct: LP is mandatory in suspected SAH with normal head CT. Findings of LP will be xanthocromia, elevated RBC, and opening pressure
Site for question/rationale: Dr. Vandergriff’s lecture “Neuro Part II” (14:05)
- Question: Regarding renal testing, what is a serum test that changes quickly with dehydration and illness that is used to calculate medication dosages?
a. GFR
b. BUN
c. BNP
d. Creatine
Answer: D
Rationale for why the answer is correct: Creatine is a useful serum lab test that is used to calculate renal function and adjust medication regiments. Unlike GFR, it is easy to test and changes quickly with disturbances in the body.
Site for question/rationale: Dr. Seth’s lecture “Diagnosing Renal Problems” (12:00)
- Question: In order to differentiate between a renal cyst and a renal mass, a good test to order is?
a. KUB
b. CT scan
c. Ultra Sound
d. 24-hour urine
Answer: C
Rationale for why the answer is correct: Question: A renal US is a way to avoid contrast and is able to differentiate between renal cysts and masses. This allows the provider to determine the next course of treatment based on findings.
Site for question/rationale: Dr Seth’s lecture “Diagnosis Renal Problems” (16:45)
- Question: Nitrates, leukocytes, WBCs, WBC casts, and bacteria are all elements of a urinalysis reviewed by the APRN to determine if a patient has what condition?
a. Pyelonephritis
b. Dehydration
c. Bladder cancer
d. Urinary tract infection
Answer: D
Rationale for why the answer is correct: The items listed are primarily what ab APRN will review when diagnosis a UTI. These elements will show an increase in number compared to a “normal” urinalysis.
Site for question/rationale: Dr. Seth’s lecture “Diagnostics Urinalysis” (1:25)
- Question: The lab test that determines a patient’s kidney function and helps the APRN determine the stage of kidney disease is?
a. eGFR
b. Creatine
c. BUN
d. Sodium and potassium
Answer: A
Rationale for why the answer is correct: eGFR >90 reveals 90+ percent of the patient’s kidney function remails. <90 begins to show a decline in function and can be interpreted as a percent of kidney function.
Site for question/rationale: (Estimated Glomerular Filtration Rate (EGFR), 2020)
- Question: A patient is being seen following a motor vehicle collision and reports left shoulder pain despite no discernible acute fracture. The pain is not worsened during manipulation of the shoulder. What does this most likely indicate?
a. Glenohumeral strain
b. Neural impingement
c. Positive Jobes test
d. Positive Kehr’s sign
Answer: d) Positive Kehr’s sign
Rationale for why the answer is correct: Following a traumatic event (e.g., motor vehicle collision), patients may experience blunt abdominal trauma resulting in splenic laceration. The hallmark sign for splenic laceration is a positive Kehr’s Sign where the patient reports referred left shoulder pain.
Site for question/rationale: Module 7: Musculoskeletal, Seth, Shoulder pain diagnostics. Time mark at 13:30, slide 14.
- Question: A patient is being seen by the APRN for reports of back pain. What patient data requires emergent intervention?
a. Difficulty with hand movements
b. History of prostate cancer
c. Recent onset of incontinence
d. Radiating leg pain
Answer: c) Recent onset of incontinence
Rationale for why the answer is correct: A patient reporting lower back pain with new onset of loss in bowel or bladder function is suggestive of Cauda Equina syndrome. Cauda Equina syndrome is an emergency and requires a prompt MRI and admission to the hospital for higher level of care. While lower back pain in addition to history of prostate cancer may be suggestive of metastatic cancer and necessitates further testing, it does not require emergent intervention. Difficulty with hand movement in association with back pain may indicate a possible pinched nerve, whereas radiating leg pain may indicate a ruptured disc; both of which are not the medical priority.
Site for question/rationale: Module 7: Musculoskeletal, Seth, Back pain diagnostics. Time mark at 03:04, slide 3.
- Question: A patient is being seen today for hand pain but shows no overt signs of dermatological symptoms or sensory loss. The patient’s spouse says they have not been the same since their last hike. What diagnosis is most likely?
a. Lyme disease
b. Psoriatic arthritis
c. Sjorgen’s disease
d. Temporal arteritis
Answer: a) Lyme disease
Rationale for why the answer is correct: Lyme disease may cause hand pain and is commonly diagnosed by its hallmark annular red plaque. However, in instances when the plaque does fade, the APRN should be suspicious of Lyme disease in the presence of neurological alteration and recent history of travel to areas greatest at risk for ticks (e.g., wooded areas). Psoriatic arthritis is distinguished by plaques on the hand, Sjorgen’s by dry mouth, and temporal arteritis by vision loss and eye pain.
Site for question/rationale: Module 7, Seth, Hand pain and swelling diagnostics. Time mark at 09:18, slide 11.
- Question: A 65-year-old male is being seen today by the APRN. The APRN notices diminished neurological function. Which of the following clinical manifestations does not aid in diagnosing Parkinson’s disorder?
a. Ascending weakness
b. Bradykinesia
c. Postural instability
d. Tremor
Answer: a) Ascending weakness
Rationale for why the answer is correct: Parkinson’s disease is a progressive neurodegenerative disease with increased incidence over the age of 60 years. Early diagnosis of Parkinson’s disorder is influenced by presence of tremor, bradykinesia (i.e., slow movement), postural instability, and muscular rigidity. Ascending weakness is suggestive of Guillain Barre.
Site for question/rationale: Module 7: Neuro, Vandergriff, Neuro Part II. Time mark at 06:41.
- Question: When interpreting the cerebrospinal fluid results following a lumbar puncture, which result would suggest bacterial meningitis?
a. Glucose: 75 mg/dL
b. Neutrophil percentage: 60%
c. Protein: 32 mg/dL
d. White blood cell count: 4,000/microL
Answer: d) White blood cell count: 4,000/microL
Rationale for why the answer is correct: Bacterial meningitis can be diagnosed using a lumbar puncture. A white blood cell count of 1,000-5,000/microL, neutrophil percentage greater than 80%, protein count greater than 200 mg/dL, and/or a glucose of less than 40 mg/dL would be indicative of bacterial meningitis.
Site for question/rationale: Module 7: Neuro, Vandergriff, Neuro Part I. Time mark at 10:07.
- Question: Which of the following assessment groupings collectively make up what is known as the classic triad of normal pressure hydrocephalus (NPH)?
a. Bradykinesia, masked facial expression, shuffling gait
b. Dementia, gait disturbance, urinary incontinence
c. Fevering, nuchal rigidity, altered mental status
d. Unilateral facial paralysis, loss of taste, altered lacrimal gland secretion
Answer: b) Dementia, gait disturbance, urinary incontinence
Rationale for why the answer is correct: The classic triad of normal pressure hydrocephalus is dementia, gait disturbance, and urinary incontinence. Parkinson’s disease may be identified by dementia, gait disturbance (e.g., shuffling gait), bradykinesia, rigidity, tremor, masklike expression, and postural instability. The classic triad of bacterial meningitis is fevering, nuchal rigidity, and altered mental status. Bell’s palsy may be identified by unilateral facial paralysis, loss of taste on the anterior tongue, altered lacrimal and salivary gland secretion.
Site for question/rationale: Module 7: Neuro, Vandergriff, Neuro Part II. Time mark at 15:25.
- Question: On interpretation of a patient’s urinalysis, the APRN notes presence of RBC casts. What pathology is this most indicative of?
a. Acute pyelonephritis
b. Diabetes mellitus
c. Glomerulonephritis
d. Tubular necrosis
Answer: c) Glomerulonephritis
Rationale for why the answer is correct: Presence of RBC casts indicates glomerulus or tubule bleeding within the kidneys, and is commonly caused by a recent streptococcal infection. Bacterial casts will be present during acute pyelonephritis, whereas tubular necrosis is associated with epithelial casts. Diabetes mellitus is more associated with glycosuria and proteinuria.
Site for question/rationale: Module 8, Seth, Diagnostic Urinalysis. Time mark at 14:25, slide 15.
- Question: When analyzing the protein levels in a patient’s urinalysis, the APRN correctly understands:
a. Dipstick testing is not positive until 150 mg
b. Over-hydration will increase protein levels
c. Microalbuminuria is required when testing diabetic patients
d. Radiocontrast may create a false negative
Answer: c) Microalbuminuria is required when testing diabetic patients
Rationale for why the answer is correct: Diabetic patients will require a microalbuminuria in addition to the urinalysis for more accurate evaluation, as well as a serum creatinine and BUN. The APRN should also be mindful that over-hydration will decrease protein levels, and that dehydration, stress, radiocontrast, and exercise may create false positives. Additionally, dipstick testing does not indicate positivity until 300-500 mg/day.
Site for question/rationale: Module 8, Seth, Diagnostic Urinalysis. Time mark at 05:55, slide 7.
- Question: When managing a patient with renal disease, the APRN correctly understands:
a. ARBs should be selected in place of ACE inhibitors
b. Creatinine clearance is used to adjust drug dosages
c. Gadolinium contrast is safer than iodine contrast
d. Serum creatinine is the best predictor for kidney disease
Answer: b) Creatinine clearance is used to adjust drug dosages
Rationale for why the answer is correct: Creatinine clearance is the preferred measurement used when adjusting drug dosages. Patients with renal disease taking ACE inhibitors, ARBs, NSAIDs, and COX inhibitors should be cautioned due to potential renal injury. Further, gadolinium contrast should be avoided in acute kidney injury and may cause nephrogenic systemic fibrosis, as well as renal failure. Glomerular filtration rate is the best predictor for kidney disease.
- Question: An elderly patient is admitted to the ICU who is severely malnourished and shows signs of neglect. The APRN suspects the patient is at high risk for renal disease. In collaboration with a nephrologist, what diagnostic would the APRN anticipate to best predict renal disease?
a. BUN
b. Glomerular filtration rate
c. Serum Creatinine
d. Urinalysis
Answer: b) Glomerular filtration rate
Rationale for why the answer is correct: Glomerular filtration rate is the most accurate predictor of renal disease and is commonly performed by a nephrologist. Patients with extremes in age or body size, and have extremes in nutrition (e.g., malnourished, obesity) should have a glomerular filtration rate performed. While a BUN, serum creatinine, and urinalysis will assist in determining renal status, the best predictor for renal disease is glomerular filtration rate.
Site for question/rationale: Module 8, Seth, Diagnosing Renal Problems. Time mark at 07:00, slides 7-8.
- According to Nexus criteria which of the following scenarios would NOT require C-spine imaging (assume age is less than 65 years and remainder of history and physical exam findings are normal)?
a. Midline tenderness at C3-4, alert and stable, ambulating with steady gate
b. No altered level of consciousness, no focal neurologic deficits, no distracting injuries.
c. Intoxicated, alert and stable, no midline spinal tenderness
d. Alert and stable, no focal neurological deficits, complains of severe left femur pain
Answer: B. Rationale for why the answer is correct: According to Nexus criteria, Trauma patients who do not require cervical spine imaging require all of the following: • alert and stable • no focal neurologic deficit • no altered level of consciousness • not intoxicated • no midline spinal tenderness • no distracting injury Site for question/rationale: Ramos and Morgan, “NEXUS Criteria.” https://radiopaedia.org/articles/nexus-criteria?lang=us
- What condition is considered contraindication for performing joint arthrocentesis?
a. Prepatellar Bursitis
b. Concurrent cellulitis at the effusion site
c. History of knee replacement
d. History of Gout
Answer: B
Rationale for why the answer is correct: Arthrocentesis at artificial joint sites can be performed but should be referred to Orthopedic Surgery. Joint aspiration is contraindicated where there is preexisting or suspect cellulitis.
Site for question/rationale: Seth, “Knee Pain, 14:02.
- All of the following except this finding raises concern for lumbar disc herniation.
a. Positive straight leg raise test
b. Pain that radiates down one or both legs
c. Radiculopathy (numbness or tingling down part of one or both legs).
d. Skin discoloration
Answer: D
Rationale for why the answer is correct: Disc herniation may present with any of the following:
Abrupt or gradual pain, Pain with radiation, Numbness and tingling is a often, Changes to bowel or bladder function, Possible asymmetric Deep Tendon Reflexes, Abnormal or positive Straight Leg Raise rest.
Site for question/rationale: Rhoads, “Low Back Pain,” p. 188.
- You are seeing a patient with complaint of “hand pain” who works as a software programmer. He describes pain and numbness in the thumb and second digit of the dominant hand. On exam you appreciate decreased grip strength in the affected hand. The patient also reports worsening symptoms at night. You suspect Carpal Tunnel Syndrome. What other diagnostics would you order?
a. Ultrasound
b. CT with contrast
c. Both A&B
d. Neither A nor B
Answer: A
Rationale for why the answer is correct: “Routing use of MRI or CT has no role in the diagnosis of carpal tunnel syndrome…Ultrasound or MRI may be used to detect space-occupying lesions in and around the carpal tunnel.”
Site for question/rationale: Clinical Key, “Carpal Tunnel Syndrome,” Imaging.
- What psychiatric disturbances are related to the treatment of Parkinson’s disease?
a. Vivid dreams and nightmares, visual hallucinations, paranoid psychosis
b. Hypomania, decreased libido, auditory hallucinations
c. Auditory hallucinations, Agitation, Mania
d. Suicidal ideation, depression, compulsive behaviors
Answer: A
Rationale for why the answer is correct: Symptoms related to treatment of Parkinson’s disease include:
• Vivid dreams and nightmares
• Visual hallucinations with a clear sensorium
• Hallucinations with confusion
• Mania, impulse control disorders (e.g., hypersexuality, problem gambling), dopaminergic drug addiction
• Paranoid psychosis
Site for question/rationale: Clinical Key, “Parkinson’s Disease.”
- All patients presenting with symptoms of fever, altered level of consciousness, and a stiff neck must have which diagnostic test performed immediately?
a. MR Brain with and without contrast
b. CT of the cervical spine without contrast
c. Lumbar Puncture
d. EEG
Answer: C
Rationale for why the answer is correct: Lumbar Puncture with CSF analysis and cultures are “crucial” diagnostic testing for suspected bacterial meningitis
Site for question/rationale: Vandergriff, “Common Neuro Diagnosis in Acute & Primary Care, part 1,” 10:02.
- When a 24-hour urine collection is in process, the patient should keep the collected urine specimen:
a. In any type of jar or container at room temperature
b. In the provided container at room temperature
c. In any type of jar or container in a cool place or refrigerated
d. In the provided container in a cool place or refrigerated
Answer: D
Rationale for why the answer is correct: Patients are instructed to refrigerate collected urine or keep it in a cool place in the container provided. The container may contain a preservative.
Site for question/rationale: Labcorp, “Routine 24-hour Urine collection.”
- Nitrites found in urinalysis are indicative of what condition?
a. Bacteria in urine
b. Kidney Stone
c. Dehydration
d. Pregnancy
Answer: A
Rationale for why the answer is correct: Nitrites are secreted by bacteria found in urine if bacteria are present (typically Gram-negative bacteria)
Site for question/rationale: Seth, “Urinalysis,” 9:46.
- When considering estimates of creatinine clearance in morbidly obese patients which scenario is most likely to provide precise and accurate estimates:
a. Lean Body Weight estimate based on Total Body Weight and Body Mass Index, incorporated into the Cockroft -Gault equation
b. Modification of Diet in Renal Disease and Ideal Body Weight in the Cockcroft-Gault equation
c. Salazar-Corcoran equation and use of Total Body Weight or Adjusted Body Weight
d. All of the above
Answer: A
Rationale for why the answer is correct: Demirovic, Pai and Pai concluded the following in their study. “Use of MDRD4 and IBW in the Cockcroft-Gault equation underestimated CL(cr), while the Salazar-Corcoran equation and use of TBW or ABW in the Cockcroft-Gault equation overestimated this value. Substitution of fat-free weight or LBW in the Cockcroft-Gault equation provided unbiased estimates of CL(cr).”
Site for question/rationale: Demirovic, Pai and Pai, “Estimation of Creatinine Clearance in Morbidly Obese Patients.”
- Which of the following applies to the utilizing renal ultrasound?
a. Cannot differentiate cysts from masses
b. Cannot identify stones
c. Uses contrast
d. None of the above
Answer: D
Rationale for why the answer is correct: Renal ultrasound can be used to identify hydronephrosis, urine flow, differentiate masses from cysts, identify renal, and does not use contrast.
Site for question/rationale: Seth, “Diagnosing Renal Problems”, starting at 16:31.
1. Question: Referred shoulder pain is commonly NOT from which of the following areas of the body? A. Neck B. Chest C. Abdomen D. Foot
Answer: Foot
Rationale for why the answer is correct: The most common areas of referred shoulder pain are the neck, chest, and abdomen, seen in cases where the shoulder pain is not intrinsic. Neck-think neural impingement at the level of the cervical spine. Chest-think peripheral nerve entrapment distally to the spinal column. Abdomen-think diaphragmatic irritation, seen in spleen laceration, perforated viscous (gas), infection, ruptured ectopic pregnancy.
Site for question/rationale: Dr. Shelly Seth’s “Shoulder Pain” voice thread presentation at time stamp 1:11 and 2:07
- Question: Upon your assessment, which of the following findings would lead you to suspect rheumatoid arthritis as opposed to osteoarthritis?
A. Distal interphalangeal joint pain
B. Metacarpal joint and wrist pain bilaterally
C. Proximal interphalangeal joint pain
D. Pain that is attributed to the right shoulder from a history of softball participation
Answer: Metacarpal joint and wrist pain bilaterally
Rationale for why the answer is correct: Metacarpal joints and wrist are more painful in RA and it is usually symmetrical. In OA, the distal interphalangeal and proximal interphalangeal joints are more painful and it is usually not symmetrical. OA pain can also be attributed to sports participation or the overuse of a joint.
Site for question/rationale: Dr. Shelly Seth’s “Hand Pain and Swelling” voice thread presentation
- Question: Which of the following is an important question to ask the patient if he/she complains of hip pain, and your assessment reveals an elevated temperature, chills, and recent fevers?
A. Do you have anyone else your household with hip pain?
B. Have you been exercising on a stationary bike?
C. Have you noticed any recent weight gain?
D. Do you have an artificial hip?
Answer: Do you have an artificial hip?
Rationale for why the answer is correct: In an infection, it is common for bacteria to seed themselves into the artificial joint, often leading to removal of that infected joint and antibiotic treatment for ~6 weeks.
Site for question/rationale: Dr. Shelly Seth’s “Hip Pain” voice thread presentation at time stamp 3:40
4. Question: Your patient with knee pain tells you he has a history of a knee replacement 2 years prior. What diagnostic tool will you NOT use for this patient? A. CT B. XR C. MRI D. Ultrasound
Answer: MRI
Rationale for why the answer is correct: MRI cannot be used when there is any hardware or metal in the body, like from a previous knee replacement. An ultrasound, XR, or CT scan would not be contraindicated diagnostics secondary to a patient’s history of knee replacement.
Site for question/rationale: Dr. Shelly Seth’s “Knee Pain” voice thread presentation at time stamp 13:00 (Also known as “I think I need a cane and a handicapped parking sticker”)
5. Question: What GCS score would you give to a patient who opens his eyes only to pain, is confused when responding to questions, and localizes to pain? A. 4 B. 9 C. 11 D. 15
Answer: 11
Rationale for why the answer is correct: This patient assessment correlates to a GCS of 11 with eye opening = 2, best verbal response = 4, and best motor response = 5.
Site for question/rationale: Dr. Kent Vandergriff’s “Neurology 1 presentation” voice thread at time stamp 2:10
6. Question: A pneumonic used to help the clinician remember the red flags for the presence of serious underlying disorders that can cause acute or subacute headaches is ¬¬\_\_\_\_\_\_\_\_? A. PQRST B. SNOOP C. CAGE D. OLDCARTS
Answer: SNOOP
Rationale for why the answer is correct: SNOOP stands for systemic symptoms, neurologic symptoms, onset is new, other associated conditions/features, and previous headache history.
Site for question/rationale: Dr. Kent Vandergriff’s “Neurology 2 presentation” voice thread at time stamp 2:00
7. Question: Accurate diagnosis of Parkinson’s disease is facilitated by the clinician’s early recognition of its characteristic signs and associated symptoms, that do NOT include: \_\_\_\_\_? A. Tremors B. Seizures C. Bradykinesia D. Postural instability
Answer: Seizures
Rationale for why the answer is correct: Parkinson’s disease is facilitated by the clinician’s early recognition of its characteristic signs and associated symptoms including tremor, bradykinesia (slow movement), rigidity, and postural instability.
Site for question/rationale: Dr. Kent Vandergriff’s “Neurology 2 presentation” voice thread at time stamp 6:50
8. Question: Which lab value is the most accurate predictor of renal disease? A. GFR B. Cr C. K D. BUN
Answer: GFR
Rationale for why the answer is correct: Glomerular filtration rate is the most accurate predictor of kidney disease. Usually done by a nephrologist, the patient is given a marker that will clear through the glomerular system, and a measurement of clearance is taken.
Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” voice thread presentation at time stamp 7:01
9. Question: You are checking a patient’s home medication list before ordering a CT scan and decide to stop which of the medications below, as it is nephrotoxic? A. Vitamin D B. Metformin C. ASA 81mg D. Lisinopril
Answer: Metformin
Rationale for why the answer is correct: Metformin is nephrotoxic, in that if the kidneys are not functioning as they should filtering the metformin, this medication can build up to toxic levels.
Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” voice thread presentation at time stamp 20:45
10. Question: Relative and absolute contraindications for a kidney biopsy include all of the following except \_\_\_\_\_\_\_? A. sepsis B. uncontrolled HTN C. age > 75 years D. uncooperative patient
Answer: age > 75 years
Rationale for why the answer is correct: Renal biopsy contraindications include: sepsis, uncontrolled HTN, hemorrhagic diathesis, parenchymal infection/malignancy, solitary kidney, and an uncooperative patient.
Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” voice thread presentation at time stamp 29:00
- A 16-year-old patient comes into the clinic complaining of anterior knee pain. She reports she’s currently in track in school and has noticed her knee usually hurts when she’s walking down the stairs. You perform an examination on her and note she has a positive J sign. This may be indicative of:
a. Prepatellar bursitis
b. Patellofemoral pain syndrome
c. Patellar tendinitis
d. Osgood Schlatter’s
Answer: B. Patellofemoral pain syndrome
Rationale for why the answer is correct: Classic presentation of patellofemoral pain syndrome is pain in the anterior knee when squatting or descending stairs. The J sign is when the patella jumps laterally when the leg is fully extended.
Site for question/rationale: Shelly Seth, Knee Pain Diagnostics presentation, 6:57 – 8:04
- The ____________ (fill in the blank) joint in the shoulder joint is the one most affected by conditions such as arthritis.
a. Supraspinatus
b. Acromioclavicular
c. Glenohumeral
d. Infraspinatus
Answer: C. Glenohumeral
Rationale for why the answer is correct: The glenohumeral joint is the joint most affected by conditions such as arthritis.
Site for question/rationale: Shelly Seth, Shoulder Pain Diagnostics lecture, 3:33 – 3:45.
- When differentiating between rheumatoid arthritis (RA) and osteoarthritis (OA), all of the following are true except:
a. The metacarpal joints are painful in RA
b. The distal and proximal interphalangeal joints are painful in OA
c. RA is usually unilateral
d. OA is usually due to wear and tear
Answer: C. RA is usually unilateral
Rationale for why the answer is correct: Clinical pearls include: metacarpal joints are painful in RA. The distal and proximal interphalangeal joints are painful in OA, RA is symmetrical, and OA is not, OA is usually due to wear and tear.
Site for question/rationale: Shelly Seth, Hand pain and swelling lecture, 1:54 – 3:13.
4. A 20-year-old male presents to the clinic complaining of headache, fatigue, generalized malaise for 3 days. Upon assessment, you note: GCS 13 HR: 115 BP: 126/78 RR: 23 O2 sat: 99% Temp: 38.6 Your differentials for this patient should include: a. Subarachnoid hemorrhage b. Bell’s palsy c. Bacterial meningitis d. Guillain-Barre syndrome
Answer: c. Bacterial meningitis
Rationale for why the answer is correct: Bacterial meningitis presenting symptoms classic triad include: fever >38, nuchal rigidity, and change in mental status. The above patient currently presents w/ 2 of the 3 symptoms in the classic triad. The other 3 diagnoses do not fit the presenting symptoms.
Site for question/rationale: Kent Vandergriff, Neuro lecture, Part 1, 9:09 – 9:45.
- A 38-year-old female presents to the clinic with sudden onset paralysis to the right side of her face. She has no past medical history. Upon assessment you note she has right eyebrow sagging, a right flattened nasolabial fold, drooping right side of her mouth, a fever blister to her left upper lip and an absent blink reflex to her right eye. She has no other focal neurologic deficits. Which of the following statements are correct?
a. You need to go to the emergency room as soon as possible
b. We need to schedule a stat CTA of your head
c. We are going to start you on anti-thrombolytic therapy
d. You can expect recovery within 6 months
Answer: D. you can expect recovery within 6 months
Rationale for why the answer is correct: Bell’s palsy is a clinical syndrome characterized by sudden onset unilateral facial paralysis. Although idiopathic, herpes simplex activation is likely a cause. Clinical manifestations include, sudden onset unilateral facial paralysis, eyebrow sagging, flattened nasolabial fold, inability to close eye, +/- loss of taste to the anterior 2/3 of tongue, and altered secretion of lacrimal and salivary glands. Patients usually have a recovery to some degree within 6 months.
Site for question/rationale: Kent Vandergriff, Neuro lecture, Part 1, 10:50 – 12:57.
- All of the following clinical manifestations are true of Parkinson’s disease except:
a. Craniofacial abnormalities such as a masked facial expression
b. Musculoskeletal abnormalities such as a shuffling gait and stooped posture
c. Nonmotor cognitive disorders such as psychosis and sleep disturbances
d. Craniofacial abnormalities such as a unilateral facial droop
Answer: d. Craniofacial abnormalities such as a unilateral facial droop
Rationale for why the answer is correct: Clinical manifestations of Parkinson’s disease include: 1. craniofacial abnormalities such as a masked facial expression, hypophonia, 2. Visual (hypometric saccades, eyelid opening, apraxia), 3. Musculoskeletal abnormalities such as micrographia, stooped posture shuffling gait, short-stepped gait, freezing and 4. Nonmotor cognitive dysfunction such as psychosis, mood disorders, sleep disturbances, fatigue, autonomic disturbances, olfactory, pain and sensory disturbances and dermatologic (seborrhea).
Site for question/rationale: Kent Vandergriff, Common neuro diagnoses in acute and primary care, Part 2, 5:33 - 6:33.
- A 68-year-old male presents to the clinic complaining of pruritus, n/v, and swelling to bilateral ankles. You are reviewing his labs and note he has an acute kidney injury. Which of the following concerns you the most?
a. He takes 800mg of Ibuprofen for his chronic low back pain every 8 hours
b. He takes Tums for his reflux three times a day
c. He takes a One a day Men’s multivitamin daily
d. He takes 0.4mg Tamsulosin daily
Answer: a. He takes 800mg of Ibuprofen for his chronic low back pain every 8 hours
Rationale for why the answer is correct: A patient showing signs and symptoms of renal impairment should have a complete historical evaluation to include, medications. Medications that should be stopped in a patient showing signs of renal impairment include NSAIDs, COX inhibitors, ACE inhibitors and ARBs.
Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 2:25 – 2:50
- You are going to prescribe an antibiotic for a patient that has renal failure. In order to estimate the correct dosage for the patient, you must look at the:
a. BUN
b. Creatinine
c. GFR
d. Creatinine clearance
Answer: d. creatinine clearance
Rationale for why the answer is correct: Creatinine clearance is used to adjust drug dosages.
Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 12:54 – 14:42.
- A patient with a history of HTN, DM, HLD, ESRD, with HD on MWF requires an emergent heart cath. Upon reviewing his chart, you:
a. Should ensure the patient has Lasix ordered
b. Ensure nephrology is consulted
c. Should ensure the patient has 0.9% NS + 20 KCL running at 100cc/hr
d. Should ensure the patient eats before the procedure
Answer: B. Ensure nephrology is consulted
Rationale for why the answer is correct: A patient receiving a heart catheterization is going to be receiving contrast. You want to ensure nephrology is consulted for stat HD post procedure.
Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 24:35 – 25:30.
- The following are all indications for a renal biopsy, except
a. Nephrotic syndrome with no current explanation
b. Transplant rejection with no current explanation
c. Solitary kidney with no current explanation
d. Persistent proteinuria with no current explanation
Answer: c. Solitary kidney
Rationale for why the answer is correct: Contraindications for a renal biopsy include: sepsis, uncontrolled hypertension, hemorrhagic diathesis, parenchymal infection or malignancy, solitary or horseshoe kidney unless transplanted or uncooperative patient.
Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 28:25 – 29:20.
- Question: Jerome, your 16-year-old male patient, is in your office complaining of shoulder pain. During the history portion of your assessment you discover he is the star quarterback at Small Town High School and he got sacked multiple times during the game on Friday night. Nothing in your assessment is abnormal. Which of the following could explain his shoulder pain?
a. Kerr’s sign, signifying a splenic laceration
b. A malar rash that looks like a “butterfly”
c. He has undiscovered ankle fracture
d. Murphy’s Sign is positive
Answer: A
Rationale for why the answer is correct: With this specific patient a lacerated/injured spleen is most likely, so he would have a positive Kerr’s sign.
Site for question/rationale: Shelly Seth’s My Shoulder Hurts Presentation, slide 14.
- Question: Which of the following is a differentiating characteristic between Rheumatoid Arthritis and Osteoarthritis?
a. RA is a symmetrical joint pain, redness, and inflammatory process; it occurs in the morning.
b. RA is due to overuse and is usually unilateral
c. OA is a symmetrical joint pain, redness, and inflammatory process; it occurs in the morning.
d. OA is due to overuse and is usually symmetrical, involving joints on both right and left side of body
Answer: A
Rationale for why the answer is correct: It is the only answer choice where each statement is correctly matched with the disease process.
Site for question/rationale: Shelly Seth’s My Hands Hurt Presentation, slide 3.
- Question: A patient comes into your clinic with complaints of back pain. Upon further questioning, he reluctantly admits loss of bowel and bladder control. What would be your next intervention?
a. Obtain a multiple view X-ray
b. CT scan
c. Stool and urine cultures, UA, BMP
d. Call and ambulance
Answer: D
Rationale for why the answer is correct: This patient is exhibiting signs of cauda equine syndrome. It is a medical emergency.
Site for question/rationale: Shelly Seth’s My Back Hurts Presentation, slide 3.
- Question: As you are rounding on your patients, you note Mr. White to open his eyes spontaneously, respond verbally to your questions in an appropriate and oriented manner, and obey commands. Which of the following is most correct?
a. Mr. Smith is a 3 on the Glasgow Coma Score which means he is appropriate and non-comatose. No intervention needed.
b. Mr. Smith is a 3 on the Glasgow Coma Score which means he is severely comatose and needs to be intubated immediately.
c. Mr. Smith is 15 on the Glasgow Coma Score which means he is appropriate and non-comatose. No intervention needed.
d. Mr. Smith is a 15 on the Glasgow Coma Score which means he is severely comatose and needs to be intubated immediately.
Answer: C
Rationale for why the answer is correct: Glasgow Coma Score ranges from 3-15; lower numbers are associated with being more comatose; intubation is needed for a score less than 8. Mr. Jones is optimally performing in each GCS category, so his score is a 3.
Site for question/rationale: Module 7, Mr. Vandergriff’s Neuro lecture, slide 3.
- Question: Jane, an otherwise healthy 40-year-old female, is in the ER with complaints of a “really high” fever, stiff neck, and, per her husband, a change in mental status. What labs would you consider ordering?
a. LP, cultures, CBC
b. X-ray, PT/PTT/INR
c. LP, Ultrasound, glucose
d. UA, CBC, BMP
Answer: A
Rationale for why the answer is correct: This patient is presenting with signs of meningitis. The listed labs will rule in/confirm this diagnosis.
Site for question/rationale: Module 7, Mr. Vandergriff’s Neuro lecture, slides 11 & 12.
- Question: Which of the following could be indicative of an emergent diagnosis manifesting as a headache?
a. A headache that is sudden in onset, a “thunderclap headache” or “the worst headache of my life”
b. A headache that occurs on someone < 50 years old
c. A headache that presents in an otherwise healthy individual
d. A headache in a patient who maintains baseline neuro exam
Answer: A
Rationale for why the answer is correct: Headaches with these types of characteristics can indicate a more serious etiology like subarachnoid hemorrhage.
Site for question/rationale: Module 7, Mr. Vandergriff’s Neuro lecture, slides 27 & 30.
- Question: Which of the following labs indicates the need to adjust a drug dosage?
a. Elevated BUN/CRE
b. Decreased LFT’s
c. Decreased Creatinine Clearance
d. Hyperkalemia
Answer: C
Rationale for why the answer is correct: A decreased creatinine clearance is indicative of kidney disease. Many drugs are excreted renally, so a decreased clearance would let the provider know that drug dose may need to be changed to decrease nephrotoxicity and further kidney damage.
- Question: What should be considered before ordering a CT with contrast?
a. Creatinine, level of hydration
b. IV access, patient preference
c. 24-hour urine results, CBC
d. UA & culture and sensitivity results
Answer: A
Rationale for why the answer is correct: These indicators can help the practitioner decide how well the kidneys will filter out the contrast, and the risk of complication.
Site for question/rationale: Module 8, Shelly Seth’s Renal Testing for Diagnosis Presentation, slide 17.
- Question: Which of the following patients cannot get a renal biopsy?
a. Marcy, a 20-year-old in renal failure, who is in the ICU due to sepsis.
b. George, a 75-year-old, who is otherwise healthy
c. Sally, a 50-year-old, who has a history of UTI’s
d. Harold, a 100-year-old who was born with a horseshoe kidney. He is here for his annual nephrologist appointment s/p transplant 50 years ago.
Answer: D
Rationale for why the answer is correct: Harold is the only patient who has a contraindication to renal biopsy.
Site for question/rationale: Module 8, Shelly Seth’s Renal Testing for Diagnosis Presentation, slide 23.
- Question: When reviewing your morning labs on Aurora, who currently has a UTI, what would you expect to see on her UA?
a. + Nitrites, Bacteria > 100,000, WBC casts
b. pH > 10, ketones, nitrites +
c. RBC’s, WBC casts, Glucose > 200
d. Bilirubin +, Bacteria > 100,000, WBC casts
Answer: A
Rationale for why the answer is correct: these elements will be present on a patient with a UTI
Site for question/rationale: Module 8, Shelly Seth’s Urinalysis Presentation, slide 3.
- Question: What is NOT true about the NEXUS criteria?
A. Is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging.
B. Has a 99.6% sensitivity for ruling out cervical spine injury in the original study validating the criteria
C. It may not be reliable with patients over the age of 65
D. Trauma patients who meet the criteria of being alert and stable do not require cervical spine imaging.
Answer: D
Rationale for why the answer is correct: Trauma patients who do not require cervical spine imaging require ALL of the following: Alert and stable, no focal neurologic deficit, no altered level of consciousness, not intoxicated, no midline spinal tenderness, no distracting injury.
Site for question/rationale: Nexus criteria
2. Question Which of the following should NOT be considered in acute shoulder pain (less than two weeks)? A. Trauma B. Rotator Cuff Injury C. Fractures D. Dislocations
Answer: B
Rationale for why the answer is correct: Rotator cuff injury, impingement syndrome, adhesive capsulitis, and osteoarthritis are all part of chronic should pain.
Site for question/rationale: Shoulder pain handout slide 4-5
- Question: Why would the APRN order a CT scan with contrast of the hip for a patient with hip pain?
A. To look at vessels and blood flow
B. To measure bone density
C. To assess fractures
D. A CT scan with contrast of the hip is never ordered
Answer: A
Rationale for why the answer is correct: A CT scan with contrast is used for better definition. The contrast is used to look at the vessels and blood flow. A DEXA scan is used to measure bone density and fractures can be seen with plain Xray (3 views).
Site for question/rationale: Hip pain handout slide 7
4. Question: If a patient has a Glasgow Coma Scale of less than 8, the APRN can expect the patient to be: A. Alert and oriented B. Intubated C. Referred to psych ward D. Stable and being discharged home
Answer: B
Rationale for why the answer is correct: The Glasgow Coma Scale assess eye opening, best verbal response, and best motor response. The total score can range from 3-15. Someone who is completely unresponsive would score a 3, less than 8 the patient should be intubated.
Site for question/rationale: Neurology presentation part 1 3:38
- Question: SNOOP is a reminder of danger signs (red flags) for the presence of serious underlying disorders that can cause acute or subacute headaches. What does the S in SNOOP stand for?
A. Sundowning, Stressors, Somatic complaints
B. Social Anxiety, Suffering, Stress
C. Systemic symptoms: illness, fever, weight loss, cancer, pregnancy, immunocompromised
D. Sunlight, Slow reflexes, Seizures
Answer: C
Rationale for why the answer is correct: S stands for systemic symptoms, illness, fever, weight loss, cancer, pregnancy, immunocompromised. N stands for neurologic symptoms or abnormal signs, confusion, impaired alertness or consciousness, papilledema, focal neurologic symptoms, meningism, seizures. O stands for Onset is new (especially over 50) or sudden (thunderclap). O stands for Other conditions such as illicit drugs, toxic exposure, HA awakens from sleep, worse with Valsalva maneuvers, precipitated by cough, exertion, or sexual activity. P stands for Previous HA history with HA progression or change in attack frequency, severe clinical features.
Site for question/rationale: Neurology presentation part 2, 2:17
6. Question: What is NOT a Non-Motor cognitive dysfunction of Parkinson’s disease? A. Mood disorders B. Fatigue C. Olfactory dysfunction D. Shuffling gait
Answer: D
Rationale for why the answer is correct: Non-Motor cognitive dysfunctions are included in ABC. Shuffling gait is a motor symptom.
Site for question/rationale: Neurology presentation part 2 6:10
7. Question: What medications are significant for a patient with renal problems? Select ALL A. Tylenol and NSAIDS B. ACE inhibitors and ARB’s C. COX inhibitors and Tylenol D. COX inhibitors and NSAIDS
Answer: B and C
Rationale for why the answer is correct: Medications that are significant for a patient with renal problems include NSAIDS, COX inhibitors, ACE inhibitors, and ARB’s. If you see a patient with renal problems or acute kidney injury on any of these medications, you will stop them automatically.
Site for question/rationale: Diagnosing Renal Problems presentation 2:30
8. Question: What initial labs will the APRN order for the patient with renal problems? Select all A. Urinalysis and serum Creatinine B. 24-hour urine collection and BUN C. BUN and GFR D. Culture and Susceptibility
Answer: A and C
Rationale for why the answer is correct: The initial labs for the patient with renal problems include urinalysis, serum creatinine, BUN, GFR
Site for question/rationale: Diagnosing Renal Problems presentation 6:31
9. Question: What lab is the most accurate predictor of Kidney Disease? A. BUN B. Serum Creatinine C. 24-hour urine collection D. GFR
Answer: D
Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease and is usually done by a nephrologist.
Site for question/rationale: Diagnosing Renal Problems presentation 7:08
10. Question: All of the following are part of the top three culture and sensitivity fluid analysis for a patient with a fever of unknown origin, Except? A. Sputum B. Lumbar puncture CSF C. Blood D. Urine
Answer: B
Rationale for why the answer is correct: The top three culture and sensitivity fluid analysis for a patient with a fever of unknown origin include sputum, blood, and urine.
Site for question/rationale: Fluid Analysis presentation 0:51
- Question: How is the Hawkins-Kennedy test performed?
a) internal rotation with the shoulder flexed to 90°
b) shoulder abducted and extended 90°
c) arm internally rotated across patients back
d) arms at sides and elbows flexed at 90°
Answer: a) internal rotation with the shoulder flexed to 90°
Rationale for why the answer is correct: Hawkins-kennedy test is performed by internal rotation with the shoulder flexed to 90°. It tests for rotator cuff impingement.
Site for question/rationale: Shoulder special tests 0:42
- Question: A previously healthy 48-year-old woman presents to the clinic with right shoulder pain for the past 2 months. The pain is worse in the morning, but improves by noon. During this time, she has also had bilateral wrist pain and occasional hip pain. She is not on any prescribed medications, but takes acetaminophen and ibuprofen in alternating doses with minimal relief. She has a sedentary lifestyle. Which of the following most strongly indicates serologic testing for rheumatoid arthritis in this patient?
a) Failure to respond to analgesics
b) Female
c) Multiple joint pain for 2 months
d) Sedentary lifestyle
Answer: c) Multiple joint pain for 2 months
Rationale for why the answer is correct: RA is a systemic disease and involves numerous joints. Clinical guidelines state a minimum of 5 joint involvement before diagnosis can be made.
Site for question/rationale: Hand Pain and swelling lecture 16:57
- Question: Which of the following is the most appropriate step in management of a patient with a clinical diagnosis of carpal tunnel syndrome that has caused no sensory deficits and has not disrupted sleep or daily function?
a) Intravenous steroids
b) Splinting
c) Opiates
d) Open surgery
Answer: b) splinting
Rationale for why the answer is correct: Splinting allows the compressed nerve to rest and heal due to restrictive motion.
Site for question/rationale: Hand pain and swelling lecture 19:04
- Question: A 56-year-old man presents to your clinic with a difficulty maintaining his balance and posture. He does not have any medical conditions. A physical examination reveals a tremor in his hands. He walks with a stooped posture. Which is most likely the diagnosis?
a) Parkinson’s
b) Multiple Sclerosis
c) Epilepsy
d) Low back pain
Answer: a) Parkinson’s
Rationale for why the answer is correct: Symptoms of parkinson’s include difficulty balancing, stooped posture and tremors,
Site for question/rationale: Neurological part 2 5:32
- Question: Which of the following differentiates meningitis from other types of CNS infections?
a) Headache
b) Altered mental status
c) Fever
d) Neck stiffness
Answer: d) Neck Stiffness
Rationale for why the answer is correct: Neck stiffness is a classic symptom of meningitis.
Site for question/rationale: Neurology part 1 9:20
- Question: A 55-year-old male is brought to the ER. His wife says that they were doing their morning exercise routine when he suddenly started acting strange. Upon questioning, the patient says that he does not know where he is located. A physical examination reveals chewing movements. What is the most likely diagnosis?
a) Seizures
b) Head trauma
c) Dementia
d) Parkinson’s
Answer: a) seizures
Rationale for why the answer is correct: Seizures are sudden changes in behavior.
Site for question/rationale: Neurology part 2 7:10
- Question: 65 year old male presents to the clinic with “the worst headache of my life”. The Nurse Practitioner knows that a thunderclap headache is suggestive of…
a) Migraine
b) Subarachnoid hemorrhage
c) Tension headache
d) Meningitis
Answer: b) Subarachnoid hemorrhage
Rationale for why the answer is correct: Thunderclap headaches are typically associated with subarachnoid hemorrhage.
Site for question/rationale: Neurology part 2 3:29
- Question: Which of the following can accurately measure creatinine clearance?
a) Arterial blood sample
b) 24 hour urine sample
c) 22 hour urine sample
d) Venous blood sample
Answer: b) 24 hour urine sample
Rationale for why the answer is correct: 24 hour urine gives a more complete picture than just the spot test.
Site for question/rationale: Renal Diagnostics Slide 13
- Question: 35 year old female has elevated nitrates on her UA. What causes an elevation in nitrates?
a) Protein
b) Glucose
c) Gram negative bacteria
d) Yeast
Answer: c) Gram negative bacteria
Rationale for why the answer is correct: UTI caused by Gram negative bacteria can be detected on a UA due to the secretion of nitrates by the bacteria.
Site for question/rationale: Urinalysis slide 11
- Question: What is NOT a possible cause of pyuria?
a) Tumor
b) Stones
c) Infection
d) Overactive bladder
Answer: d) Overactive bladder
Rationale for why the answer is correct: Overactive bladder in the urine do not cause pyuria.
Site for question/rationale: Urinalysis slide 14
1. Question: The NEXUS criteria have a sensitivity of 99.6% of ruling out? A. Pregnancy B. Cervical spine injury C. Pneumonia D. Hip fracture
Answer: B. Cervical spine injury
Rationale for why the answer is correct: National Emergency X-Radiography Utilization Study (NEXUS) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging; this criteria has a 99.6% sensitivity of ruling out cervical spine injury.
Site for question/rationale: NEXUS criteria article by Dr. Joao Ramos and Dr. Matt A. Morgan et al.; under the musculoskeletal module.
- Question: In the Canadian C-spine Rules, what is considered a high-risk factor that requires cervical spine imaging?
A. The patient is 60 years of age.
B. The patient fell from an elevation of 1 foot.
C. The patient is complaining of paresthesia to the bilateral upper extremities.
D. The patient is 18 years old in an MVA going approximately 30 mph with minor impact to the rear end.
Answer: C. The patient is complaining of paresthesia to the bilateral upper extremities.
Rationale for why the answer is correct: High-risk factors include age greater than 65, paresthesia in extremities, or a dangerous mechanism. A dangerous mechanism is considered a fall from an elevation greater than 3 feet or five stairs, axial load to the head, high-speed motor vehicle collision (e.g.,>100 km/hr. or 60 mph, rollover, ejection), bicycle collision, or motorized recreational vehicles.
Site for question/rationale: Canadian C-spine rules article by Dr. Joao Ramos and Dr. Matt A. Morgan et al.; under the musculoskeletal module.
3. Question: What type of joint is the glenohumeral joint? A. Synovial joint B. Hinge joint C. Condyloid joint D. Ball-and-socket joint
Answer: D. Ball-and-socket joint.
Rationale for why the answer is correct: The glenohumeral joint is a ball-and-socket joint that you will have the most arthritis problems.
Site for question/rationale: Shoulder Pain presentation by Dr. Shelly Seth at timestamp 3:40-3:50 and 5:35-5:45.
- Question: A 45-year-old female presents to the Emergency Department with a fever of 39.0 Celsius, a stiff neck, and episodes of confusion that started two days ago. What examination/testing would you consider performing?
A. Serologic testing for Lyme Disease
B. Lumbar puncture for bacterial meningitis
C. No testing is required.
D. The patient’s symptoms will disappear after controlling fever with Tylenol only.
Answer: Lumbar puncture for bacterial meningitis.
Rationale for why the answer is correct: The classic triad for acute bacterial meningitis consists of fever greater than 38 degrees Celsius, nuchal rigidity (stiff neck), change in mental status, and a small percentage have hypothermia. A lumbar puncture is an examination of cerebrospinal fluid (CSF), which is crucial for establishing bacterial meningitis diagnosis.
Site for question/rationale: Neurology 1 presentation by Dr. Kent Vandergriff at timestamp 9:15-10:08.
5. Question: What is the likely cause of Bell’s palsy? A. Herpes simplex virus activation B. Hepatitis C C. Chlamydia trachomatis D. Staphylococcus aureus
Answer: A. Herpes simplex virus activation.
Rationale for why the answer is correct: Bell’s palsy and idiopathic facial paralysis are no longer considered synonymous, as HSV activation can most likely cause Bell’s palsy.
Site for question/rationale: Neurology 1 presentation by Dr. Kent Vandergriff at timestamp 11:04-11:23.
6. Question: A 30-year-old male presents to the Emergency Department complaining of progressive muscle weakness causing difficulty walking. During your history-taking, he states that he had the flu last week, and now this week, he has developed muscle weakness. What would you most likely suspect? A. Tension headache B. Parkinson’s disease C. Guillain-Barre syndrome D. Hemorrhagic stroke
Answer: C. Guillain-Barre syndrome.
Rationale for why the answer is correct: Guillain-Barre syndrome most often presents as an acute monophasic paralyzing illness provoked by a preceding illness.
Site for question/rationale: Neurology 1 presentation by Dr. Kent Vandergriff at timestamp 15:20-15:54.
- Question: When do you order a culture and sensitivity?
A. Fever of unknown origin
B. Chest pain with exertion
C. After you have started the antibiotic for seven days
D. None of the above.
Answer: A. Fever of unknown origin.
Rationale for why the answer is correct: Culture and sensitivity should be ordered when an infection is suspected, there is a fever of unknown origin or fluid in the wrong place.
Site for question/rationale: Fluid Analysis presentation by Dr. Shelly Seth at timestamp 1:05-
8. Question: At what stage is it considered kidney failure, and what is the percentage? A. Stage 1; 50 % B. Stage 5; less than 15% C. Stage 4; 29 to 15% D. D. Stage 5; 45%
Answer: B. Stage 5; less than 15%
Rationale for why the answer is correct: As kidney disease worsens, the GFR percentage decreases. Stage 5 is considered kidney failure, and it is a GFR of less than 15%.
Site for question/rationale: Found in the article Estimated Glomerular Filtration Rate (eGFR) (2021), by the National Kidney Foundation; in the module under renal.
9. Question: What can affect the urinalysis? A. Hot baths B. Cold showers C. Food, medications, and dehydration D. Washing your hands
Answer: C. Food, medications, and dehydration.
Rationale for why the answer is correct: Urinalysis can be affected by food, medications, dehydration, fluid overload, or urine sitting out greater than an hour.
Site for question/rationale: Urinalysis presentation by Dr. Shelly Seth at timestamp 2:33-3:33.
10. Question: When diagnosing a urinary tract infection which markers do you look at? A. Nitrites-positive B. Bacteria >100K C. Leukocyte esterase- small D. All the above.
Answer: D. All the above
Rationale for why the answer is correct: When diagnosing a urinary tract infection, the markers you need to look at are nitrites, WBC, leukocytes esterase, casts, and bacteria in a urinary analysis.
Site for question/rationale: Urinalysis presentation by Dr. Shelly Seth at timestamp 1:15-1:25.
- A38 yo female presents with complaints of hand. During your ROS you find that she has been experiencing fever, abdominal pain, fatigue, and recent weight loss. On exam you note thinning hair and a malar rash. What is the most likely differential for this patient?
a. Osteoarthritis
b. Rheumatoid Arthritis
c. Lyme disease
d. Systemic Lupus Erythematosus (SLE)
Answer: d. Systemic Lupus Erythematosus (SLE)
Rationale for why the answer is correct: The signs of SLE are fever, weight loss, fatigue, hair loss, chest pain, abdominal pain- n/v/d, personality change, malar rash, and photosensitive rashes.
Site for question/rationale: Cc: My hands hurt – Dr. Seth; Slide 9, video 6:46
- Which of the following is NOT a criterion for forgoing c-spine imaging according to the NEXUS rules?
a. alert and stable
b. no focal neurologic deficit
c. no altered level of consciousness
d. not intoxicated
e. < 65 years old
f. no midline spinal tenderness
Answer: e. < 65 years old
Rationale for why the answer is correct: Age is not one of the criteria for the NEXUS c-spine rules although they state that ≥ 65 yo the criteria may not be reliable.
Site for question/rationale: NEXUS criteria webpage
- Which of the following are possible differentials of medial knee pain? Select all that apply.
a. Iliotibial band syndrome
b. Medial meniscus injury
c. Baker’s cyst
d. MCL injury
e. Bursitis
Answer: b., d, & e.
Rationale for why the answer is correct: Medial meniscus injury, MCL injury, Bursitis are all medial differentials. Iliotibial band syndrome is a lateral knee differential. Baker’s cyst is a posterior differential.
Site for question/rationale: cc: I think I need a cane….and a handicapped parking sticker. – Dr. Seth slide 14; video 10:54
- A 38 yo presents with altered mental status. Family states they found the patient confused and repeating words that make no sense. During your exam you note that the patient opens her eyes and moves her extremities spontaneously but keeps saying words that make no sense to the context. You can understand the words; they just do not fit with what is going on. What score would you give for the Glasgow coma scale?
a. 15 (4/5/6)
b. 13 (4/3/6)
c. 12 (3/4/5)
d. 11 (4/3/4)
Answer: b. 13 (4/3/6)
Rationale for why the answer is correct: The Glasgow coma scale calculation begins with eye opening so that is the first score and since she opens her eyes spontaneously, she gets a 4. The second score is voice with a total of 5 points possible. She says understandable but inappropriate words, so she gets a score of 3. The last score is motor function with a possible score of 6. She moves extremities spontaneously, so she gets a 6. Added up the total score is 13 and they are displayed as E/V/M so 4/3/6.
Site for question/rationale: Neurology 1 presentation – Dr. Vandergriff; slide 3: video 1:51
- Your patient is a 28 yo male presenting with c/o headache, a stiff neck, and confusion. You suspect bacterial meningitis and begin the workup. You perform an LP and examine the CSF. Which of the following is indicative of bacterial meningitis?
a. neutrophils 30%, protein 60 mg/dL, glucose 72 mg/dL
b. neutrophils 60%, protein 110 mg/dL, glucose 54 mg/dL
c. neutrophils 84%, protein 226 mg/dL, glucose 32 mg/dL
d. none of the above
Answer: c. neutrophils 84%, protein 226 mg/dL, glucose 32 mg/dL
Rationale for why the answer is correct: When looking at CSF in bacterial meningitis, the neutrophils most often are >80%, protein is >200 mg/dL, and glucose <40 mg/dL
Site for question/rationale: Neurology 1 presentation – Dr. Vandergriff; slide 12: video 9:52
- Which of the following is an acronym used when assessing for “red flags” in headaches?
a. SNOOP
b. TCLAP
c. PONS
d. None of the above
Answer: a. SNOOP
Rationale for why the answer is correct: Red flags in headaches are Systemic symptoms, Neurological symptoms, New or sudden Onset, Other associated symptoms (trauma, drug use, toxins, awakens from sleep, worse with Valsalva, precipitated by exertion, cough, or sex, and Previous headache hx with change in frequency, severity, or change in clinical features.
Site for question/rationale: Neurology 2 presentation – Dr. Vandergriff; slides 28-29: video 2 1:54
- A 68 yo male presents with c/o headache for the past 2 hours that he describes as “the worst headache I’ve ever had” and had a sudden onset. He has a history of atrial fibrillation and CAD. He has nausea and vomited once. The family said he fainted for approximately 1 minute. His v/s are as follows: HR-78 IR, RR-18, B/P-179/102, SpO2- 92% RA, Temp- 98.2 F. Which of the following is the most likely differential for this patient?
a. Meningitis
b. Subarachnoid hemorrhage
c. Migraine
d. Cluster headache
Answer: b. Subarachnoid hemorrhage
Rationale for why the answer is correct: A subarachnoid hemorrhage presents as the worst headache ever with sudden onset. This patient has a history of A-fib so is probably on blood thinners which put them at risk for SAH.
Site for question/rationale: Neurology 2 presentation – Dr. Vandergriff; slides 45-46: video 2 12:45
- Which of the following tests is the most accurate predictor of kidney disease?
a. Serum creatinine
b. Blood Urea Nitrogen (BUN)
c. Bun/creatinine ratio
d. Glomerular filtration rate (GFR)
Answer: d. Glomerular filtration rate (GFR)
Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease but it is not used as much as the other tests because of its complexity. To perform an accurate GFR a “marker” is injected into the patient and usually performed in sequence with a 24-hour urine.
Site for question/rationale: Diagnosing Renal Problems – Dr. Seth; Slide 8. Video 7:00
- You are collecting a 24-hour urine on a patient to determine if there is damage to his kidney. Which of the following education is incorrect?
a. Begin urine collection in the morning and discard the first voiding at the beginning of the collection.
b. Do not collect urine during a bowel movement.
c. Maintain your normal amount of fluids during the collection period.
d. On the second morning of collection, void at the same time as the previous morning and add this void to the collection, ending the 24-hour collection.
Answer: b. Do not collect urine during a bowel movement.
Rationale for why the answer is correct: Urine is collected even during bowel movements. Collection is initiated in the morning with the first voiding discarded and every voiding following collected. The second morning the patient should void at the same time as the previous morning which ends collection. Changes in fluid intake may affect the collection volume and skew the results.
Site for question/rationale: Lab Corps 24-hour urine collection and results website
- You have a culture and sensitivity report on a patient you are treating. Which of the following interpretations on the culture and sensitivity report would tell you that the antibiotic you are considering is a good choice?
a. S
b. R
c. I
d. All the above
Answer: a. S
Rationale for why the answer is correct: S on the interpretations section of the C&S report indicates that the organism is sensitive/susceptible to that antibiotic, meaning the antibiotic will work. R means the organism is resistant to the antibiotic and it will not work. I means this antibiotic may work with higher doses or may not work and would most likely be a last resort choice. There are other considerations to choosing the right antibiotic of course, such as route, cost, and minimum inhibitory concentration.
Site for question/rationale: Fluid Analysis lecture – Dr. Seth; Slide 8, video 9:06
- Question: Which of the following associated with back pain indicate Cauda Equina Syndrome?
a) Radiating pain into leg
b) History of cancer
c) Numbness and tingling
d) Loss of bowel or bladder control
Answer: Loss of bowel or bladder control
Rationale for why the answer is correct: If they have back pain along with trouble going to the bathroom, this is an emergency (Cauda Equina Syndrome) depending on the severity you will either admit the to the hospital or get an MRI, they may end up having bowel or bladder loss for life.
Site for question/rationale: Low back pain lecture Minute 3:10
- Question After how many weeks would you consider low back pain to be chronic?
a) >6-9 weeks
b) 2 weeks
c) 4 weeks
d) 1 week
Answer: >6-9 weeks
Rationale for why the answer is correct: >6-9 weeks equals chronic pain
Site for question/rationale: Low back pain lecture Minute 5:30
- Question: What are important questions to ask when patient has back pain to check if patient has an infection going on?
a) Instrumentation, temperature, chills
b) Hobbies
c) Sports
d) Previous injury
Answer: Instrumentation, temperature, chills
Rationale for why the answer is correct: It is really important to know if patient is having temperature or chills as well as knowing if they have had instrumentation and previous surgeries to know if they have an infection going on.
Site for question/rationale: Low back pain lecture Minute 6:25
- Question: Which of the following is not a cause of delirium and confusion?
a) Substance intoxication
b) Withdrawal
c) Medication side effect
d)
Answer:
Rationale for why the answer is correct: delirium and confusion is a syndrome cause by a medical condition, substance intoxication, withdrawal, or medication side effect.
Site for question/rationale: Neuro lecture Part 1 Minute 4:50
- Question: Which of the following labs would you NOT order for a patient with delirium/confusion?
a) Serum Electrolytes
b) CBC
c) Urine drug screen
d) TSH
Answer: TSH
Rationale for why the answer is correct: reasonable labs to look at in the patient with delirium/confusion when a cause is not immediately obvious are serum electrolytes, creatinine, glucose, calcium, CBC, UA, urine drug screen, urine culture
Site for question/rationale: Neuro lecture Part 1 Minute 6:44
- Question: Which of the following is not 1 of the parts of the meninges?
a) Pia
b) Arachnoid
c) Dura maters
d) hypothalamus
Answer: Hypothalamus
Rationale for why the answer is correct: the meninges consist of 3 parts: the pia, arachnoid, and dura maters (PAD)
Site for question/rationale: Neuro lecture Part 1 Minute 8:30
- Question: In which of the following scenarios would you consider running a GFR?
a) Severe malnutrition or obesity
b) Disease of skeletal muscle
c) Vegetarian diet
d) All of the above
Answer: All of the above
Rationale for why the answer is correct: GFR should be considered doing when seeing anybody that has kidney disease and is being seen by nephrologist, Extremes of age and body size (child with renal problem), very obese or malnourished, disease of the skeletal muscle, paraplegia/quadriplegia, strict vegetarian diet can cause problems, rapidly changing kidney function, and pregnancy.
Site for question/rationale: Diagnosing renal problems lecture minute 8:00
- Question: Which lab measurement is used to adjust drug dosages?
a) Creatinine clearance
b) BUN
c) GFR
d) CBC
Answer: Creatinine Clearance
Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug dosages.
Site for question/rationale: Diagnosing renal problems lecture minute14:30
- Question: For which of the following would you NOT do a 24 hour urine test?
a) For hematuria with recurrent kidney stones
b) Children, when they have their first kidney stone
c) Abdominal pain
d) Pheochromocytoma
Answer: Abdominal pain
Rationale for why the answer is correct: it is done for hematuria with recurrent kidney stones, in children that have their first kidney stone because they should not be having kidney stones, for uncontrolled HTN to diagnose pheochromocytoma, preeclampsia, kidney disease and multiple myeloma, these are some of the reasons why you would do a 24 hours urine.
Site for question/rationale: Diagnosing renal problems lecture minute 14:45
- Question: Which of the following would you be able to observe when doing a KUB?
a) Stones
b) Neoplasms
c) Air
d) All of the above
Answer: All of the above
Rationale for why the answer is correct: when doing a KUB these are some of the things that it can look at stones, neoplasms, tumors, any disease process that causes a buildup of calcium, air which you should not have in the kidney. Also, soft tissue changes, you can look at it and see if the renal outline is not very sharp you would need to determine if it is an infection, inflammation, tumor.
Site for question/rationale: Diagnosing renal problems lecture minute 18:58
