exam one diagnostics Flashcards
Question: What is the first piece of information obtained for a patient seeking medical attention? a. Family history b. Symptoms c. Chief complaint d. allergies
Answer: Chief complaint Rationale for why the answer is correct: Gives the provider a general idea of possible diagnosis Site for question/rationale: text book- Differential Diagnosis pg 1
Question: How will the provider obtain more details after the general history is obtained? a. Ask more open-ended questions b. Use a directed history c. Have patient describe what they are feeling d. Just read previous notes from other providers
Answer: Use a directed history Rationale for why the answer is correct: patient may not offer pertinent symptoms unless prompted Site for question/rationale: text book- Differential Diagnosis pg 1
Question: When should diagnostic testing be ordered? a. Diagnostic tests are never needed b. Only if patient has good insurance c. With every problem that the patient has d. Only if necessary
Answer: Only if necessary Rationale for why the answer is correct: Only if necessary to yield an impact on the diagnosis & ultimate treatment of the problem Site for question/rationale: Differential Diagnosis pg 2
Question: What should the provider do with the patient’s symptoms? a. Nothing at all needs to be done b. Only document the symptoms the provider needs c. Make a list of patient’s symptoms & risk factors d. Order diagnostic test for each symptom
Answer: Make a list of patient’s symptoms & risk factors Rationale for why the answer is correct: This would help with noting positive & negative associated symptoms & helps look for significant signs of illness Site for question/rationale: Differential Diagnosis pg 3
Question: What is the treatment for hyponatremia? a. Correct less than 10mEq/L per 24 hours b. Correct 15mEq/L per 24 hours c. Correct 20 mEq/L per 24 hours d. Correct 25 mEq/L per 24 hours
Answer: Correct less than 10mEq/L per 24 hours Rationale for why the answer is correct: There is a risk with correcting with > 12mEq/L per 24 hours- Central Potine Myelinolysis (permanent flaccid paralysis, dysphagia, death) Site for question/rationale: Labs- BMP handout
Question: Why does the bilirubin level increase with renal failure? a. Due to too much sodium b. Due to the liver not filtering out the byproducts c. Due to the kidneys not filtering properly d. Due to not not drinking enough fluids
Answer: Due to the kidneys not filtering properly Rationale for why the answer is correct: Because with renal failure, there is a problem with the kidneys filtering and working properly, therefore having a bilirubin increase Site: Lab- handout CMP/LFT
Question: When should the provider order a colonoscopy for acute diverticulitis? a. Right away b. 4-6 weeks after resolution of symptoms c. In 12 months d. No colonoscopy necessary
Answer: 4-6 weeks after resolution of symptoms Rationale for why the answer is correct: The pain is in pain & has tenderness. It is better to wait 4-6 weeks after healing Site for question/rationale: Abdominal PDF
Question: What is the gold standard of diagnosis for intussusception? a. Abdominal xray b. Stool for occult blood c. Barium enema d. CBC, BMP
Answer: Barium enema Rationale for why the answer is correct: Provider will see coiled spring appearance. May also reduce the intussusception Site for question/rationale: abdominal pdf
Question: The patient presents to the clinic, c/o fishy odor, thing discharge, & vaginal itchiness. Which diagnosis should the provider suspect? a. Candidiasis b. Trichomomasis c. It is normal d. Bacterial vaginosis
Answer: Bacterial vaginosis Rationale for why the answer is correct: These are symptoms of BV. It is not normal. With trichomomasis, the discharge is frothy. Candidiasis- no odor Site for question/rationale: Womens Health PDF
Question: A 15-year-old male presents to the clinic with acute left testicle pain, nausea & vomiting. What should the provider recommend for testicular torsion? a. Apply an ice pack every 2-3 hours b. Refer to an urologist c. Refer to the ER d. Prescribe Ibuprofen and an antibiotic to decrease infection
Answer: Refer to the ER Rationale for why the answer is correct: lack of blood flow to the affected testicle, intervention must take place in the first 4-6 hours to salvage the testicle from infarction Site for question/rationale: Male reproduction PDF & Advanced Health Assessment & Clinical Diagnosis in Primary care- author Dains p 250
Question: You ask the patient what brings her in today for a visit and she states, “ My stomach has been hurting and I feel nauseous”. What section of the SOAP note would this piece of information pertain to? A) Subjective B) Objective C) Assessment D) Plan
Answer: A Rationale for why the answer is correct: “My stomach has been hurting and I feel nauseous” is the patient’s chief complaint. Patient’s chief complaint is subjective information. Site for question/rationale: Shelly Seth’s SOAP note presentation (11:15).
Question: Ms. Jennifer Wallace is a 5’3, 157pound, 17 year old female with a chief complaint of right upper quadrant abdominal pain, onset 2 days ago. She reports her pain as intermittent, dull, and achy. She states eating makes her pain worse and has no pain relief with Tylenol. Nausea and vomiting are associated symptoms, onset yesterday. She denies tobacco, alcohol, and illicit drug use. Which of the following does NOT belong in the HPI (History of Present Illness)? A) Chief complaint of right upper quadrant abdominal pain”. B) “She reports her pain as intermittent, dull, and achy”. C) “No pain relief from Tylenol”. D) “She denies tobacco, alcohol, and illicit drug use”.
Answer: D Rationale for why the answer is correct: The HPI should consist of information on why the patient is seeking care. OLDCARTS, OPQRST, and SOCRATES information is placed here. The patient’s social history is relevant on why the patient is seeking care and therefore does not belong in the HPI. Site for question/rationale: Shelly Seth’s SOAP presentation (11:20-13:35)
Question: Which of the following patients could be treated empirically? A) 25 year old female patient presents with suprapubic pain and urinary frequency. Treat empirically for UTI. B) 36 year old male patient presents with fever, chills, and nausea. Treat empirically for Influenza. C) 22 year old male patient presents with sore throat, swollen tonsils, low-grade fever, white patches on their tonsils, and sister recently had strep throat. Treat empirically for Strep throat. D) 19 year old female patient presents with dysuria and white vaginal discharge. Treat empirically for Chlamydia.
Answer: C Rationale for why the answer is correct: C has a HIGH percent probability of the patient having Strep without even having to test them. Since the patient has at least 90% probability based on clinical presentation, there is no need to test and they can be treated empirically. All of the other patients require further assessment/laboratory data because they have a median probability of having the disease. Site for question/rationale: Amy Morre’s Basics of diagnostics presentation (15:00-15:45).
Question: All of the following are true EXCEPT? A) If you’re ruling in a test, you want the specificity to be high. B) If you’re ruling out a test, you want the sensitivity to be high. C) Specificity indicates the likelihood of someone with a particular disease. D) Sensitivity indicates how soon the patient must be tested in order to get an accurate result.
Answer: D Rationale for why the answer is correct: Sensitivity does not indicate how soon the patient must be tested to get accurate results. Sensitivity is how well the test can detect a certain disease. All of the other statements are true. Site for question/rationale: Amy Moore’s Basics of diagnostics presentation (17:23-17:40 & 18:38-19:35).
Question: Which Leukocytes account for the largest percent of your WBC’s? A) Neutrophils B) Monocytes C) Lymphocytes D) Eosinophils
Answer: A Rationale for why the answer is correct: Neutrophils (45%-65%). Monocytes (2%-8%). Lymphocytes (15%-40%). Eosinophils (0%-5%). Site for question/rationale: CBC handout/voice thread presentation. Slide 9 labeled “Leukocytes (WBC’s)
Question: Which of the following is FALSE concerning Total Bilirubin? A) Must be > 2.5 to produce jaundice B) It is a by product of WBC’s destruction C) Elevated Direct (Conjugated) Total Bilirubin levels are likely related to gallbladder or pancreas problem. D) Elevated Indirect (unconjugated) Total Bilirubin levels are likely related to a liver problem.
Answer: B Rationale for why the answer is correct: Total Bilirubin is a by-product of RBC’s. All of the other answer choices are true. Site for question/rationale: CMP handout/voice threat presentation. Slides 8&9 labeled “Total Bilirubin”
- Question: Mr. Turner, a 23 year old male, presents with chief complaint of sudden onset right lower quadrant abdominal pain associated with nausea and vomiting. Exam reveals rebound tenderness and positive obturator sign. Which diagnostic testing is gold standard for this patient’s symptoms? a. CBC b. Urinalysis c. Abdominal CT D. Abdominal ultrasound
Answer: D Rationale for why the answer is correct: The chief compliant, associated symptoms, and exam indicate the patient has appendicitis. We can do a CBC to look for elevated WBC (>20,000 can indicate perforated appendix). We can also do a urinalysis to look for hematuria and pyuria (not every patient will have this). An abdominal CT is considered gold standard diagnostic for acute appendicitis in adults. Abdominal ultrasound could be used in the pediatric population to decrease risk of radiation exposure but not considered gold standard. Site for question/rationale: Abdominal/lab tests presentation by Dr. Amy Moore. Slide 4 & 7 (9:15-10:40)
Question: The American Academy of Gastroenterology has guidelines for pancreatitis diagnostics. Which of the following is NOT part of the diagnostic criteria for pancreatitis? a. Presence of abdominal pain b. Positive CT scan c. Elevated WBC higher than 16,000 d. Elevated serum lipase and/or serum amylase at least 3 times normal limits
Answer: C Rationale for why the answer is correct: A,B, and D are all part of the guideline. Elevated WBC higher than 16,000 is part of Ranson’s criteria for severity of acute pancreatitis that must be present on admission. Elevated Amylase alone cannot be used reliably and Lipase is preferred. Amylase and Lipase will rise initially but can trend down pretty quickly. Remember, alcoholics and people with multiple episodes of pancreatitis may not produce Amylase/Lipase enzymes so those would not be reliable for diagnosis. Site for question/rationale: Abdominal/lab tests presentation by Dr. Amy Moore. Slide 11 (14:59-16:50)
Question: Which of the following can NOT be diagnosed using a wet prep? a. Chlamydia b. Trichomoniasis c. Syphilis d. Bacterial vaginosis
Answer: C Rationale for why the answer is correct: A RPR (rapid plasma regain) blood test can be drawn to tell you how likely it is your patient has syphilis. If RPR is positive, you can confirm the positive results with a VDRL blood test. All of the others answer choices; an APRN can gather a sample and look at the sample using an NaCl wet mount. Just remember to use sterile saline because the KOH wet prep will destroy all elements but fungal (Woman’s Health Overview Diagnostics powerpoint, slide 4. Site for question/rationale: STI diagnostics presentation (18:40 Chlamydia can use wet prep) (11:40 Trichomonas can use wet prep) (16:55 Syphilis uses RPR). Woman’s Health Overview Diagnostics powerpoint, slide 2: Assessing vaginitis via wet prep.
Question: Which of the following is true? a. Mammograms should be performed every 1-2 years beginning from ages 40-50 and screening for breast cancer until the age of 75. b. Pap smears should start at age 21 and be performed every 5 years. c. A patient with no family history of colon cancer should get a colonoscopy at age 60. d. Adolescent women with a normal BMI don’t need their cholesterol levels checked until age 22.
Answer: A Rationale for why the answer is correct: A is true. B is false because Pap smears should be performed every 3 years. C is false because the gold standard is a colonoscopy at age 50 for those without family history. D is false because women need their cholesterol levels checked once between ages 9-11 and again at ages 17-21. Cholesterol levels should be checked despite the patient’s BMI.
Question: SOAP Notes include which sections: a. Severity, Objective, Analysis, Plan b. Severity, Onset, Aggravating/Alleviating factors, Palliation c. Subjective, Objective, Assessment, Plan d. Subjective, Onset, Analysis, Presentation
Answer: Subjective, Objective, Assessment, Plan Rationale for why the answer is correct: SOAP notes is an acronym that is a form of documentation for healthcare professionals to follow in order to evaluate and record patient interactions during appointments in order to evaluate and determine the best treatment option that coincides with the appropriate information gathered throughout the visit. This acronym stands for Subjective, Objective, Assessment, and Plan. Site for question/rationale: SOAP Note Presentation Video by Shelly Seth in Module 1
Question: When completing a patient’s history, the Review of Systems element is documented under which part of the SOAP note? a. Objective b. Plan c. Assessment d. Subjective
Answer: Subjective Rationale for why the answer is correct: Subjective data includes anything from personal views or experiences. This section is composed of the chief complaint, history of present illness, medical/ surgical/ family/ social history, review of systems, current medications, and allergies. Site for question/rationale: SOAP Note Presentation Video by Shelly Seth in Module 1
Question: Clinical Laboratory Improvement Amendments (CLIA) granted which tests as waived point of care tests? a. UA, urine pregnancy test, blood glucose, blood chemistry b. Hemoglobin, UA, wet prep, and semen analysis c. UA, blood chemistry, Fern test d. Pinworm exam, urine pregnancy test, hemoglobin
Answer: UA, urine pregnancy test, blood glucose, blood chemistry Rationale for why the answer is correct: UA, urine pregnancy tests, blood glucose, and blood chemistry are waived diagnostic point of care tests that are regulated by the CLIA. The CLIA requires clinical labs to be certified by Medicare and Medicaid services in order to accept human samples. Site for question/rationale: Basics of Diagnostics Video Module 1
Question: Which tests are examples of Provider-Performed Microscopy Procedures (PPM)? a. Wet mount, blood count, Fern test b. Wet mount, KOH prep, pinworm exam, semen analysis c. UA, KOH prep, Hemoglobin d. Chemistry, semen analysis, blood glucose
Answer: Wet mount, KOH prep, pinworm exam, semen analysis Rationale for why the answer is correct: PPM’s are procedures that are performed under a microscope by a provider. All of the above listed tests are tests that are not waived or point of care testing under the CLIA. Site for question/rationale: Basics of Diagnostics Video Module 1
Question: A patient arrives to the ED with nausea, vomiting, headache, and malaise. The patient rapidly declines and is now obtunded and seizing. Which diagnostic laboratory study should you order to determine the cause of the patient’s sudden neurological decline and what is your anticipated diagnosis? a. BMP- Hyponatremia b. BMP- Hyperkalemia c. CBC- Sepsis d. CBC- Anemia
Answer: BMP- Hyponatremia Rationale for why the answer is correct: Hyponatremia presents with neurological symptoms secondary to the formation of cerebral edema. When water enters the cells in the brain the cells begin to swell. Since the brain is encompassed in an enclosed skull it cannot expand leading to compression of the brain from cerebral edema resulting in a deterioration in neurological status. Site for question/rationale: BMP Video/Slides from Module 1: Slide #4
Question: A patient presents to your office with complaints of heat intolerance, palpitations, fatigue, weakness, and hair loss. Throughout your assessment you determine the patient has lost weight, is tachycardic, with rapid, deep tendon reflexes. Which laboratory tests should the NP order? a. BMP, CBC b. CMP, CBC c. TSH, T4, T3 d. TSH, T4, T3, CBC, LFT’s
Answer: TSH, T4, T3, CBC, LFT’s Rationale for why the answer is correct: Thyroid hormone levels should be an anticipated order to determine or eliminate if the cause of the patient’s symptoms is related to the thyroid gland itself or if it they are secondary symptoms to a different diagnosis. CBC and LFT’s should also be added to the diagnostic tests to rule out other disorders like thyroid cancer, liver, gallbladder, or pancreatic changes. In addition, these levels should be obtained and monitored prior to starting any antithyroid medication. Site for question/rationale: Endocrine & Autoimmune Disorders Video/Slides Module 1: Slide #3 and 4
Question: When examining the abdomen which technique should be employed first? a. Light Palpation b. Deep Palpation c. Inspection d. Auscultation
Answer: Inspection Rationale for why the answer is correct: Healthcare providers should lead with the least invasive technique and move towards to most invasive. Each body system should lead with inspection especially that of the abdomen. Auscultation, light palpation, deep palpation, and percussion should follow respectively. This allows the provider to slowly examine the abdomen in its entirety without causing extreme amounts of pain. This procedure should be completed with the patient lying supine. Site for question/rationale: Abdominal Test Video and Slides from Module 2: Slide #3
Question: A 4-week-old infant comes into your clinic today due to increased projectile vomiting and an inability to hold feeds down. After evaluation you noticed the infant has lost weight, has an olive shaped mass in the RUQ during palpation, and has a sunken fontanel. Which diagnostic procedures should the NP order? a. CMP, US, and upper GI Series b. Barium enema, abdominal x-rays, and BMP c. LFT’s, CBC, upper GI series d. US, LFT’s, BMP, and abdominal CT
Answer: CMP, US, and upper GI Series Rationale for why the answer is correct: These symptoms correlate to pyloric stenosis. The provider should order an upper GI series to evaluate for any abdominal abnormalities or a thin, elongated pyloric canal or “string sign”. A pyloric US is the definitive diagnostic test to diagnose pyloric stenosis. Lastly, a CMP should be drawn to evaluate for electrolyte imbalances from the babies consistent vomiting. Site for question/rationale: Abdominal Test Video and Slides Module 2: Slide #14
Question: A 65-year-old male has an appointment to see you after suffering from urinary hesitancy and urgency with occasional nocturia for the past 4 months. Upon assessment you notice a firm, smooth, symmetrical enlarged prostate. Which laboratory tests should the NP order to help her come to a diagnosis? a. UA, prostatic US, gram stain, fractional urine exam b. UA, prostatic US, postvoid residual, PSA, CT, and needle biopsy c. Prostatic US, PSA, CBC d. Syphilis serology, prostatic US, UA/Culture, needle biopsy
Answer: UA, prostatic US, postvoid residual, PSA, CT, needle biopsy Rationale for why the answer is correct: The patient’s symptoms represent what one would see on an exam of a male with BPH. Prostatic US, CT, and needle biopsy are the definitive diagnostic measures to determine if the patient has BPH or prostate cancer. UA can assess for infection, specific gravity, dehydration, glucose which all help eliminate differential diagnoses for this patient. If there is a residual amount left in the bladder after voiding this can indicate an enlarged prostate. A PSA level that is elevated indicates BPH while one that is lower can indicate prostate cancer. Site for question/rationale: Men’s Reproductive Health/Test Video and Slides Module 2: Slide #2
Question: A 21-year-old sexually active female presents to your office for her first PAP Smear. The patient doesn’t have any symptoms but states she has multiple sexual partners. The provider visualizes warts and the patient’s PAP came back abnormal. Which diagnostic tests can the provider anticipate? a. Nothing at this time. b. Colposcopy and biopsy c. CBC, US, Biopsy d. Cervicectomy
Answer: Colposcopy and biopsy Rationale for why the answer is correct: After visual inspection of the cervix and the presence of warts the provider should anticipate to send the female patient for a colposcopy and biopsy to determine the presence and type of HVP. The biopsy should be sent to rule out oncogenic
Question: Where in the SOAP note would you document your course of treatment? A. Subjective B. Objective C. Assessment D. Plan
Answer: D. Plan Rationale for why the answer is correct: The course of treatment that you identify and make a plan for should be documented in the plan section of the SOAP note. It is the last part of the note and will serve as a guide for what treatment the patient will need. Site for question/rationale: SOAP note presentation by Shelly Seth (~23:50 in video)
Question: A 43-year-old male comes into the clinic complaining of abdominal pain for the last 2 weeks. Where would you document this in the SOAP note? A. Subjective B. Objective C. Assessment D. Plan
Answer: A. Subjective Rationale for why the answer is correct: The chief complaint which is what the patient tells you why he/she is there to see you. Subjective information is whatever the patient tells you, not what you can observe. Site for question/rationale: SOAP Note Presentation by Dr. Mello, Dr. Moore, and Dr. Hilliard (at 1 minute in video)
Question: What tools can we use to help guide our decision on whether or not our diagnosis is probable before ordering diagnostic tests? Check all that apply A. Direct studies of disease probability B. Validated clinical prediction rules C. Prevalence of the disease in the population D. Clinical experience and judgement
Answer: A, B, D Rationale for why the answer is correct: Direct studies of disease probability are beneficial because there can be valuable information on the particular disease process in scholarly articles/research papers. Validated clinical prediction rules are carefully and thoughtfully developed based on s/s of the patient. The aim is to ‘rule in’ or ‘rule out’ a disease. Clinical experience and judgment is the least accurate as there are a vast array of s/s that a patient can present with and may or may not have a specific disease. Though, it can be helpful to narrow down differentials. Site for question/rationale: Diagnostic Process Video (timestamp 3:30)
Question: Which of the following are NOT required in order to get your differential diagnoses: A. Labs B. Assessment C. History of present illness D. Chief complaint
Answer: A Rationale for why the answer is correct: You cannot get your differential diagnoses without an assessment (including HPI and CC) The labs come after you have decided on your diagnoses. Site for question/rationale: Differential Diagnosis video w/ Dr. Moore (timestamp 6:10)
- Question: Which type of white blood cell (WBC) will be elevated during a viral illness? A. Neutrophils B. Lymphocytes C. Monocytes D. Basophils
Answer: B Rationale for why the answer is correct: Lymphocytes are the WBC’s that increase with viral illnesses such as a CMV, mono, and malignancies (leukemias, lymphomas). Site for question/rationale: Complete blood count presentation by Dr. Seth; slide 16
Question: A patient comes into the clinic complaining of diarrhea for the last 4 days. He states he recently travelled to Asia last week. Which type of white blood cell would be elevated if you suspected a parasitic infection? A. Basophils B. Monocytes C. Eosinophils D. Neutrophils
Answer: C Rationale for why the answer is correct: Worldwide, the main cause of elevated eosinophils is due to a parasitic infection. In the US, an increased eosinophil count is usually caused by a new-onset allergy the patient has developed. Site for question/rationale: Complete blood count presentation by Dr. Seth; slide 21
Question: A patient comes to the clinic with severe abdominal pain. What exam techniques will help rule in appendicitis? A. Psoas Sign B. Rovsing’s Sign C. Rebound tenderness D. All of the above
Answer: D. All of the above Rationale for why the answer is correct: There are multiple exam techniques that can be done to determine appendicitis. Rebound tenderness, heal tap, Psoas sign, Obturator sign, Rovsing’s sign, and cutaneous hyperesthesia will help rule in appendicitis. Site for question/rationale: Abdominal Presentation by Dr. Moore, slide 4
Question: When diagnosing pancreatitis, the enzymes lipase and amylase may not be produced by the body if the patient: A. Has diabetes B. Has a history of alcohol abuse C. Is bulimic D. None of the above
Answer: B Rationale for why the answer is correct: If the patient is an alcoholic or has consumed too much alcohol in their lifetime, their body may not produce lipase or amylase any longer. When you check their serum levels, none will be present. Site for question/rationale: Abdominal Presentation by Dr. Moore, slide 11
Question: Which method of testing can you use to diagnosis chlamydia? A. Cervical B. Vaginal C. Urine D. All of the above
Answer: D Rationale for why the answer is correct: These three methods have been proven effective in diagnosing chlamydia. Site for question/rationale: STI Diagnostics Presentation, timestamp 8:50
Question: Which characteristic lesion do providers sometimes not even test for but automatically just treat the infection based on the patient’s history? A. Gonorrhea B. Chlamydia C. Trichomoniasis D. Herpes Simplex Virus
Answer: D Rationale for why the answer is correct: The lesions that HSV produces are specific to that disease process therefore testing is not necessary. The provider can treat the patient with the antiviral. Site for question/rationale: STI Diagnostics Presentation, timestamp 14:00-16:00
Question: The Assessment portion of your SOAP note should contain which elements? a. Physical Exam of the patient b. Diagnosis, Differentials, and Problems identified c. A thorough Review of Systems d. The patients Chief Complain
Answer: B: Diagnosis, Differentials, and Problems Rationale for why the answer is correct: The assessment is a portion of your SOAP note in which you place any diagnoses, differentials, or problems that you have found potential or pertinent to the patient. Site for question/rationale: “SOAP Note Presentation” by Dr. Shelly Seth approximately around minute 23.
Question: In which area of your SOAP note should you use the mnemonic OLDCARTS to gather information from your patient? a. ROS (Review of Systems) b. PMH (Past Medical History) c. HPI (History of Present Illness) d. The Assessment
Answer: C: HPI (History of Present Illness) Rationale for why the answer is correct: Within the HPI you are obtaining pertinent information as to why the patient is here today. Using this mnemonic will help gain a clearer picture of the problem. Site for question/rationale: “SOAP Note Presentation” by Dr. Shelly Seth approximately at min 12:45
Question: Your Differential Diagnosis is formed with which of the following information? a. Chief Complaint b. History c. Physical Exam d. All of the above
Answer: D: All of the above Rationale for why the answer is correct: “Once the chief complaint, history, and physical examination are established, a list of possible diseases is formed ranking the most common diagnoses and the most serious or “non to miss” diagnoses” (Rhoads et al., 2015, p.2).
Question: Which of the following is a possible differential diagnosis for a patient? a. Pneumonia b. Cough c. Fatigue d. Shortness of Breath
Answer: A Rationale for why the answer is correct: Pneumonia is a potential diagnosis for a chief complaint, whereas the rest of the answers are simply symptoms that could be caused by the chief of complaint. Site for question/rationale: “Differential Diagnosis for Fatigue” by MD Mello, MD Hilliard, and MD Moore. Discussing the difference between symptoms that the patient presents with and possible diagnoses that may be the cause of such symptoms.
Question: Which of the following could cause a rise in Neutrophil / Band count? a. Vancomycin b. Parasitic Infection c. Hemolytic anemia d. Mononucleosis
Answer: A: Vancomycin Rationale for why the answer is correct: Parasitic infection would cause a rise in the Eosinophil count. Hemolytic Anemia would increase the Monocyte count. Mononucleosis would increase the Lymphocyte count. Site for question/rationale: “CBC” Voice thread Presentation by Dr. Shelly Seth slides 14-21
Question: Which of the following would NOT be a cause of hyperkalemia a. Renal Failure b. Diuretics c. Adrenal Insufficiency d. Ace Inhibitors
Answer: B: Hypovolemia Rationale for why the answer is correct: Renal failure, Adrenal insufficiency, and Ace Inhibitors are all sources of hyperkalemia – Diuretic use (such as Lasix) is a common cause of hypokalemia. Site for question/rationale: “BMP” VoiceThread by Dr. Shelley Seth - Slide 8-12
Question: A patient Positive for Murphy’s Sign would indicate which differential diagnosis? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Diverticulitis
Answer: C: Cholecystitis Rationale for why the answer is correct: A Positive murphy’s sign could indicate cholecystitis; whereas a positive Rovsing’s Sign would point towards appendicitis Site for question/rationale: Dr. Amy Moore’s VoiceThread presentation on “Common Abdominal Complaints” Slide 4
Question: A pediatric patient is brought in with the complaint of gas, distended abdomen, and vomiting. A biopsy is performed and found to have the absence of ganglion cells. Which of the follow would you suspect? a. Intussusception b. Hirschsprung’s Disease c. Pyloric Stenosis d. Colic
Answer: Hirschsprung’s Disease Rationale for why the answer is correct: An absence of ganglion cells found on a biopsy is an indication of Hirschspring’s. “String Sign” would indicate pyloric stenosis. A barium enema with the appearance of “coiled spring” is the gold standard for intussusception. Colic would not be the right diagnosis for this patient. Site for question/rationale: Dr. Amy Moore’s VoiceThread presentation on “Common Abdominal Complaints” Slide 14
Question: At what age are mammograms conducted? a. Starting at 35 years old, No later than 40 years old b. Starting at 40 years old, No later than 50 years old c. Starting at 45 years old, No later than 50 years old d. Starting at 50 years old, No later than 60 years old
Answer: B: Starting at 40 years old, no later than 50 years old Rationale for why the answer is correct: According to The American College of Obstetrics and Gynecologist mammograms should be performed starting at age 40 and no later than age 50 every 1 to 2 years. Site for question/rationale: Dr. Amy Moore slides on “Women’s health” Slide 5. The American College of Obstetrics and Gynecologists https://www.acog.org/topics/well-woman-health-care
Question: A patient states that his scrotum looks like “a bag of worms”. It is noted that on the left side are largely dilated veins within the scrotum. Which of the following diagnoses fit this description? a. Varicocele b. Hydrocele c. Spermatocele d. Testicular Torsion
Answer: A: Varicocele Rationale for why the answer is correct: According to Dr. Amy Moore’s lecture, which is referenced Hollier, A. (2013), Varicocele can resemble a “bag of warms” and is diagnosed with a doppler ultrasound. The veins in the scrotum (usually left side) are unusually large and dilated. Site for question/rationale: Dr. Amy Moore “Male Reproductive” Presentation – slide 6. Hollier, A. (2013). Clinical guidelines in primary care: A reference and review book. Lafayette, LA
Question: Pain would be an example of which portion of the SOAP note? a) S b) O c) A d) P
Correct answer A. Rationale for why the answer is correct: Any information that the patient reports that you can not verify by testing or examination is subjective information. Objective method is any information the provider can verify by examination or testing for example, blood pressure. Site for question/rationale: Dr. Seth’s SOAP note presentation beginning at 21:09.
Question: Which of the following must be included in the plan portion of the SOAP note? Answer: a) The patient’s height and weight b) Patient follow-up c) Chief complaint d) Physical exam findings
Answer : B Rationale for why the answer is correct: Patient follow-up and education should always be documented in the plan portion of the SOAP note. The plan does not need to include a summary subjective or objective information gathered previously during the exam. Site for question/rationale: SOAP note presentation under additional resources in module 1 at 6:26.
Question: What information is needed to help the provider form a differential diagnosis? Answer: a) A detailed health history b) Comprehensive physical exam c) Diagnostic testing d) All of the above
Answer D: Rationale for why the answer is correct: All portions of the exam contribute to clinical decision making and should be considered when forming a differential diagnosis. By neglecting any portion of the exam, the provider could misdiagnose or miss a life altering diagnosis. Site for question/rationale: - Differential diagnosis for fatigue, beginning at 1:15.
Question: At what point in the decision making process is it appropriate for the APRN to order diagnostic testing? Answer: a) As soon as the patient presents to the clinic. b) When the patient asks to have their labs checked c) When the provider has a working differential diagnosis d) When the provider has ruled out a diagnosis
Answer : C Rationale for why the answer is correct: Diagnostic testing should be used to help a provider rule in or rule out a diagnosis. If the provider has already ruled out a diagnosis performing diagnostics at that point would be poor stewardship. The APRN should have narrowed down a differential diagnosis prior to diagnostic testing. Site for question/rationale: Differential diagnosis for fatigue, 13:35.
Question: Dr. Day is precepting an APRN student in the hospital who asks why Dr. Day ordered a basal metabolic panel (BMP) instead of a complete metabolic panel (CMP) on their patient who has been admitted in the hospital for 7 days. What would be the most appropriate response from Dr. Day? Answer: a) There is no difference. b) I wanted to get a more complete picture of the patient’s health status. c) A BMP is more accurate than a CMP. d) A BMP changes more frequently than CMP and should be monitored more often.
Answer: D Rationale for why the answer is correct: A BMP is used for daily lab testing because it changes more frequently than a CMP. A CMP includes everything on a BMP plus total protein, total bilirubin, albumin, AST, ALT, and alkaline phosphatase. Therefore, a CMP does contain more information providing a more complete picture, however it does not need to be monitored every day. Accuracy of BMP and CMP should remain consistent when proper lab technique is used. Site for question/rationale: BMP voice thread slide # 2
Question: Ericka, an 18-year-old female, presents to your clinic today as a new patient. She states she has a history of iron deficiency anemia. What lab abnormality would you expect to see on her complete blood count (CBC)? Answer: a) MCV> 96 b) MCV< 80 c) MCV 80-96 d) Platelets >100,000
Answer : B Rationale for why the answer is correct: MCV <80 would indicate microcytic anemia commonly caused by iron deficiency. An MCV> 96 would indicate macrocytic anemia. An MCV of 80-96 in the presence of low hemoglobin and hematocrit would indicate a normocytic anemia, in the absence of low hemoglobin and hematocrit that range of MCV is normal. Platelets >100,000 are a normal finding. Site for question/rationale: Complete blood count voice thread slides 28-31, and 43.
Question: Amy, a 6-month-old female, presents to your clinic with a two-day history of vomiting and diarrhea. The patient’s caregiver reports decreased urine output and decreased appetite. What diagnostic testing should the APRN consider at this time? Answer: a) BMP b) Abdominal CT c) Influenza swab d) Stool culture
Answer A Rationale for why the answer is correct: The child is exhibiting signs of pediatric dehydration and the APRN should consider checking electrolytes for fluid replacement. Abdominal CT, influenza swab, or renal ultrasound could be indicated for the complaint of vomiting or diarrhea, however, to assess dehydration a BMP is the most correct answer for this scenario. Site for question/rationale: Dr. Moore’s presentation on abdominal pain, beginning at 7:00.
Question: A 35-year-old female patient presents to your clinic today with a chief complaint of right upper quadrant pain. After further assessment, the patient has a positive Murphey sign and leukocytosis present on her CBC. At this point, what is your leading diagnosis? a) Appendicitis b) Diverticulitis c) Irritable bowel syndrome d) Cholecystitis
Answer D Rationale for why the answer is correct: A positive Murphey sign is a hallmark sign of cholecystitis. Leukocytosis is also a common finding in cholecystitis. Leukocytosis can also be present in diverticulitis or irritable bowel syndrome; however, it is a non-specific indicator. Appendicitis is more likely to have positive rebound tenderness. Site for question/rationale: Dr. Moore’s presentation on abdominal pain at 4:55 and 10:44.
Question: Which of the following findings would be considered an abnormal finding in a gynecological exam? Answer: a) Many lactobacilli b) pH 5.0 c) Clear odorless discharge d) Scant white blood cells
Answer: B Rationale for why the answer is correct: Normal vaginal pH should be less than 4.5. Lactobacilli, clear odorless discharge, and a small amount of white blood cells are a normal finding. White blood cells are problematic when there is a large number present, or the patient is reporting gynecological symptoms. Site for question/rationale: Dr. Olenick’s presentation about Women’s Health Diagnostics on slide 7.
Question: Nicolas, a 1-month old infant, presents to your clinic today to establish care after being discharged from the NICU. The infant was born at 35 weeks gestation. Upon exam you discover cryptorchidism. What is your plan of care? Answer: a) Refer to urology b) Send the patient to the emergency room c) Reassess at the infants next well child visit d) This is a normal finding that requires no further attention
Answer : C Rationale for why the answer is correct: Cryptorchidism often resolves on its own, however, if it does not resolve by 4 months the patient should be referred to a urologist. Since the patient is less than 4 months, a referral to urology is not indicated at this time. This is not a medical emergency requiring transfer to the emergency department. This would be an abnormal finding requiring further assessment. Site for question/rationale: Dr. Moore’s presentation on male reproduction beginning at 9:20.
Question: When asking a patient about their medications, what MUST be included? Circle all that apply. A. Over the counter medications B. Prescribed medications C. Herbs/Supplements D. Water intake
Answer: A, B, C Rationale for why the answer is correct: When asking patients about their medication, OTC meds, prescribed medications, herbs, and supplements should be included. Water intake is not necessary. Site for question/rationale: SOAP Note presentation by Dr. Shelly Seth at 17:51 time
Question: The following information is recorded in the patient’s health history. The patient is accompanied by his mother and states, “I feel lousy and have a sore throat.” Identify under which category this statement belongs. A. Present illness B. Chief complaint C. Social history D. Physical exam
Answer: B. Chief complaint Rationale for why the answer is correct: The chief complaint is a concise statement describing why the patient is seeking medical attention, and it is always in quotation marks. Site for question/rationale: SOAP Note presentation by Dr. Shelly Seth at 11:18 time.
Question: A 39-year-old female presents to the clinic with complaints of fatigue. The CBC results come back with a hemoglobin of 10 g/dL and an MCV >100 fL. What would you suspect? A. Blood loss B. Iron deficiency C. Vitamin deficiency D. Anemia of chronic disease
Answer: C. Iron deficiency Rationale for why the answer is correct: MCV greater than 100 fL is called macrocytic and is usually caused by vitamin deficiency (folate or B12). MCV less than <80 fL could be due to iron deficiency, and MCV between 80-100 can be due to blood loss or anemia of chronic disease like in renal patients. Site for question/rationale: Differentials for Fatigue presentation by Dr. Inola Melo, Dr. Tara Hillard, and Dr. Amy Moore at 8:02 time.
Question: A 63- year old female presents to the ED with complaints of fatigue. She has a diagnosis of diabetes mellitus type 2, seizures, hypertension, and hyperlipidemia. As the provider, you start thinking of differential diagnosis. What is the differential diagnosis for this patient? A. Seizures and hyperlipidemia B. Fatigue and seizures C. Anemia and acute illness D. Alcohol abuse and hyperlipidemia
Answer: C. Anemia and acute illness Rationale for why the answer is correct: Differential diagnoses are the things that could be causing the chief complaint. Seizures and hyperlipidemia are diagnoses. Fatigue is the chief complaint. Anemia and acute illness are the differential diagnosis for fatigue. Site for question/rationale: Differential Diagnosis presentation by Dr. Amy Moore at 2:58 time.
Question: A basic metabolic panel is drawn on a patient. You notice that his sodium level is low at 118. 3% normal saline is ordered. In 24 hours, the sodium was corrected >12 mEq. What is the patient at risk for? A. Tented T waves B. V-fib C. Muscle cramping D. Permanent flaccid paralysis
Answer: D. Permanent flaccid paralysis Rationale for why the answer is correct: Central Pontine Myelinolysis can occur when sodium is corrected >12 mEq/24 hours. This can be a permanent problem causing permanent flaccid paralysis, dysphagia, and death. Tented T waves, v-fib, and muscle cramping is due to an imbalance of potassium levels. Site for question/rationale: Basic Metabolic Panel presentation by Dr. Shelly Seth, slide #7
Question: When the liver is not functioning correctly, what are possible signs? A. High PT/PTT and high platelets B. Confusion, MCV is high, fatigue C. Bleeding gums, low albumin levels D. Bleeding gums, high bilirubin, confusion, and unstable blood sugars
Answer: D. Bleeding gums, high bilirubin, confusion and unstable sugars Rationale for why the answer is correct: Signs that the liver is not functioning correctly are low albumin levels, ammonia levels high causing confusion, fatigue, unstable blood sugars, bruising, and bleeding gums. This is due to low platelet count, high PT/PTT levels, high MCV, and elevated bilirubin. Site for question/rationale: Complete Metabolic Panel presentation by Shelly Seth, slide #16
Question: A 35-year-old female presents to the emergency department with complaints of severe abdominal pain. Which position is the accurate way to inspect the abdomen? A. Fowler’s Position B. Prone Position C. Supine Position D. Lithotomy Position
Answer: C. Supine Position Rationale for why the answer is correct: Never inspect the abdomen with the patient sitting up. The ideal position to inspect the abdomen is lying down (supine position). You can have the patient do the Valsalva maneuver to look for rising abdominal hernias in this position. Site for question/rationale: Abdominal lab/test presentation by Dr. Amy Moore at 1:12 time
Question: A 25-year-old female presents to the emergency department complaining of nausea, vomiting, and abdominal pain that started last night. After examining the patient, you have a positive Murphy’s sign. Which exams will your order? A. CBC, CMP, and ultrasound B. CT scan and ultrasound C. HIDA Scan and ESR D. CBC, CMP, stool for occult blood, abdominal x-rays
Answer: A. CBC, CMP, and ultrasound Rationale for why the answer is correct: A positive murphy’s sign can indicate acute cholecystitis. Ultrasound is the most sensitive and specific study for the diagnosis of acute cholecystitis. 90-95% of patients will have gallstones. CT scan, stool occult, abdominal x-rays do not rule in cholecystitis. HIDA SCAN is ordered if the ultrasound is negative. A CBC and CMP would be ordered to obtain a white blood cell count, ALT, AST, alkaline phosphate, and bilirubin. Site for question/rationale: Abdominal lab/test presentation by Dr. Amy Moore, slide #8
Question: A 76-year old active female comes into the clinic for a regular women’s wellness check. Will you consider doing a mammogram on this patient? A. No, screening stops at age 75. B. Yes, continue to screen your patient. C. No, screening stops at age 50. D. Yes, because screening starts at age 75.
Answer: B. Yes, continue to screen your patient. Rationale for why the answer is correct: Most guidelines state to start mammogram exams at age 40 and continue screening until at least age 75. This does not mean to stop at age 75. So, the 76-year-old female could continue to have mammograms after 75 years of age. Site for question/rationale: Women’s Health Preventative Care presentation by Dr. Amy Moore, slide #5
Question: A 5-month-old premature baby comes to the clinic for a wellness check. The baby was diagnosed with cryptorchidism. During your assessment, you palpate the scrotum and find that one of the testes is still absent. Your next step would be? A. Make parents aware that the child will have testicular cancer when older. B. Refer to a urologist C. Have the child come back at 6 months since it should descend by 6 months D. All of the above
Answer: B. Refer to a urologist Rationale for why the answer is correct: The patient is at an increased risk for testicular cancer, but it does not mean the child will have testicular cancer. The testes should descend by 6 months; however, by 4 months if one or both testes remain absent by four months, the child should be referred to a urologist. Site for question/rationale: Male Reproductive Health presentation by Dr. Amy Moore, slide #4
What is the purpose of using quotation marks in your SOAP note? a. To quote what you said to the patient b. To separate differential diagnoses c. To quote what the patient said to you d. To bring attention to a finding
Answer: C Rationale for why the answer is correct: Quotations differentiate notes written by the provider from what was directly said by the patient. Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth
Select all that apply. When obtaining a patient’s history, which components are included in the medication history? a. Prescription medications b. Prescriber of medications c. Herbal preparations d. Supplements e. Over the counter medications
Answer: A, C, D, E Rationale for why the answer is correct: The prescriber is not always a necessary piece of information when collecting a patient’s medication list. Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth
What portions of the SOAP note can be used to rule out differential diagnoses? a. Review of systems b. Past medical/surgical history c. Physical examination d. All of the above
Answer: D Rationale for why the answer is correct: The review of systems, PMH, PE, and other portions of the SOAP note (FH, SH, medications, etc.) are all useful in identifying/ruling out differential diagnoses. Site for question/rationale: Differential Diagnosis video by Dr. Amy Moore
If none of the presenting symptoms/assessment findings/lab results point to any differential diagnoses, what must the provider do? a. Discharge the patient b. Refer the patient to a specialty provider c. Rethink the differential diagnoses and review the patient’s information again d. Call another provider in for help
Answer: C Rationale for why the answer is correct: If none of the findings are ruling in or out any differential diagnoses, the provider may need to edit their list and review the information again to avoid missing any key points. Site for question/rationale: Differential Diagnosis for Fatigue video
What may cause an elevated serum creatinine level? a. Volume depletion b. Overhydration c. Metabolic acidosis d. GI bleed
Answer: A Rationale for why the answer is correct: An elevated serum creatinine level may be caused by volume depletion, renal insufficiency, or renal failure. Site for question/rationale: BMP Voice Thread (slide 16)
Which of the following is NOT a method you should consider for correcting hyponatremia? a. Using 3% NS when the patient presents with neurological signs/symptoms b. Infusing NS via IV at a maximum of 10meq/L per 24 hours c. Forced diuresis with Lasix and IV NS d. Infusing NS via IV as fast as the patient tolerates in order to achieve prompt correction
Answer: D Rationale for why the answer is correct: Rapid correction of hyponatremia may lead to central pontine myelinolysis. Site for question/rationale: BMP Voice Thread (slide 7)
What is the gold standard exam for diagnosing intussusception? a. Plain abdominal x-ray b. Ultrasound c. Barium enema d. Stool for occult blood
Answer: C Rationale for why the answer is correct: The barium enema is the gold standard for diagnosing intussusception because it reveals a characteristic “coiled spring” appearance. It may also reduce the intussusception. Site for question/rationale: Abdominal Presentation by Dr. Amy Moore (slide 14)
What exam may the practitioner order for a suspected cholecystitis in a patient whose ultrasound came back normal? a. CBC b. LFTs c. Barium x-ray d. HIDA scan
Answer: D Rationale for why the answer is correct: A HIDA scan may be ordered to evaluate gallbladder function in a patient whose ultrasound is normal. Site for question/rationale: Abdominal Presentation by Dr. Amy Moore (slide 8)
How often should a 27-year-old woman have a pap smear exam if her previous pap smear was abnormal? a. Every 3 years b. At every appointment c. Every year d. Every 6 months
Answer: C Rationale for why the answer is correct: A woman 21-29 years old should have a pap smear exam every 3 years if her result is normal. If the patient has had an abnormal result, she should have an annual pap smear done. Site for question/rationale: Women’s Health presentation by Dr. Amy Moore (slide 4)
Question: A patient’s PSA result comes back at 29. What should the provider do at this time? a. Consider prostate cancer as a possible diagnosis b. Consider referring the patient to a urologist/surgeon c. Immediately start the patient on chemotherapy d. Answers a and b
Answer: D Rationale for why the answer is correct: Any PSA result over 10 should warrant a referral to a urologist/surgeon. A level above 20 is indicative of cancer, although prostate cancer may present with a normal PSA. Site for question/rationale: Men’s Health presentation by Dr. Amy Moore (slide 2)
Question: Subjective information in SOAP includes: A. Past medical history, physical examination, and ROS B. Vital signs, physical examination, diagnosis C. CC, HPI, PMH, surgical hx, social hx, medications, allergies, family hx, ROS D. Patient’s chief complaint
Answer: C Rationale for why the answer is correct: Subjective information is what the patient states. Objective information includes vital signs and physical assessment. The A represents assessment and consists of the actual diagnosis. The P represents plan and includes testing that ties to the diagnosis. Site for question/rationale: Module one SOAP presentation
Question The ROS includes: A. A review of all the patient’s systems B. A review of the patient’s systems pertinent to the CC. C. A review of the patient’s healthy systems D. A review of the patient’s systems related to past medical diagnoses
Answer: B Rationale for why the answer is correct: The ROS includes reviewing the patient’s systems related to the chief complaint. The ROS provides the APRN with essential and relevant information in formulating a diagnosis and differential diagnoses. Site for question/rationale: Module 1 SOAP presentation
A sensitivity test is used to: A. Rule in a disease B. Rule out a disease C. Diagnose a disease D. Rule in and rule out disease
Answer: B Rationale for why the answer is correct: Sensitivity tests are used to rule out a disease. Specificity tests are used to rule in a disease. Site for question/rationale: Module 1 diagnosis ppt slide 9
Question: Specificity tests will …. A. Have a negative or low LR (likelihood ratio) B. Be used to rule out a disease C. Have a high and low LR (likelihood ratio) D. Have a high or positive LR (likelihood ratio)
Answer: D Rationale for why the answer is correct: High specificity tests will yield high or positive LR. High sensitivity tests will generate a low or negative LR. Site for question/rationale: Module 1 diagnostic video
Question: The proper terminology for a low WBC count is? A. Leukopenia B. Leukocytosis C. Thrombocytopenia D. Polycythemia
Answer: A Rationale for why the answer is correct: The proper terminology for a low WBC count is leukopenia. Leukocytosis is a high WBC count, and polycythemia is an increased level of RBC. Site for question/rationale: Module 1 Lab WBC presentation slide 7
Question: What lab value is used to adjust TPN? A. Albumin B. Total protein C. CRP D. Pre-albumin
Answer: D Rationale for why the answer is correct: The half-life of albumin is 20 days; therefore, it is not a good indicator for TPN adjustments. The half-life for pre-albumin is two days, which is appropriate for TPN adjustments. Site for question/rationale: Module 1 Lab CMP video & presentation slide 7
Question: What test is the most sensitive and specific for cholecystitis? A. HIDA scan B. ERCP C. Ultrasound D. CT scan without contrast
Answer: C Rationale for why the answer is correct: An ultrasound is the most sensitive and specific study for cholecystitis. A HIDA scan can be done to determine the function of the gallbladder if the ultrasound is negative. Site for question/rationale: Common abdominal complaints slide 8
Question: What test is used to diagnose diverticulitis? A. Abdominal CT scan B. Colonoscopy C. Positive abdominal exam with CBC, WBC, CMP D. Abdominal MRI
Answer: A Rationale for why the answer is correct: Physical exam would include abdominal assessment, labs which include a CBC, WBC, and CMP, but these findings are not used to diagnose diverticulitis. A colonoscopy is not warranted with uncomplicated diverticulitis and, when done, should be scheduled 4-6 weeks after symptoms resolve. An abdominal CT is used to diagnose diverticulitis. Site for question/rationale: Abdominal lecture, slide 10
Question: A standard vaginal wet prep includes: A. Few lactobacilli, large amounts of WBCs, and no epithelia B. Large amounts of RBCs, a moderate number of lactobacilli, and no epithelia C. Predominance of lactobacilli, few WBCs or RBCs, and some epithelia D. No lactobacilli, a moderate number of WBCs, and no epithelia
Answer: C Rationale for why the answer is correct: Lactobacilli creates the acidic environment needed to kill or inhibit other bacterial growth. Site for question/rationale: Women Diagnostic lecture slide 7
Question: What is the gold standard test to diagnose testicular cancer A. Scrotal ultrasound B. Scrotal CT scan with contrast C. Biopsy D. Scrotal MRI
Answer: A Rationale for why the answer is correct: Upon physical examination, there may be an enlarging mass that does not transilluminate, but an ultrasound is needed to make a diagnosis. Site for question/rationale: Male reproductive lecture slide 7
Question: What does the acronym SOAP stand for? a. Subjective Observation Assessment Plan b. Subjective Objective Assessment Plan c. Situation Objective Assessment Plan d. Situation Objective Assignment Plan
Answer: B. Subjective Objective Assessment Plan Rationale for why the answer is correct: The best answer for this question is B. The question is asking what the acronym SOAP stands for. With this type of question for this subject to have only one answer out of the options provided. The reader must pay attention to the answers because there are multiple words the same in each acronym provided. Answers A, C, D are ruled out due to having the incorrect term in the SOAP. Site for question/rationale: See SOAP note presentation at 9:45.
Question: What are the categories of medications a Nurse Practitioner must ask your patient they are taking? a. Prescribed & Over-the-counter. b. Prescribed & Herbs/Supplements c. Prescribed only d. Prescribed, Over-the-counter, Herbs/Supplements
Answer: D. Prescribed, Over-the-counter, Herbs/Supplements Rationale for why the answer is correct: The best answer for this question is D. The question is asking the categories of medications must be asked by the Nurse Practitioner to assess the patient. Most Nurse Practitioner students forget to ask all THREE categories during the OSCE examinations. All answers have the correct answer in them but do not have all THREE categories, making A, B, C incorrect. Therefore, answer D is the only correct choice. Site for question/rationale: See SOAP Presentation at 17:19. Page 3 of OSCE SOAP Note
Question: When a patient comes into the clinic, what is the first piece of information the Nurse Practitioner obtained? a. Chief Complaint b. Review of Systems c. History d. Assessment
Answer: A. Chief Complaint Rationale for why the answer is correct: The best answer for this question is A. The question is asking the first piece of information the healthcare provider must obtain. A Nurse Practitioner must find out all the subjective information which is Chief Complaint, Review of Systems, and History. Knowing this information, we can eliminate D. As a Nurse Practitioner, however, the first step is to find out why the patient is in your clinic. The correct answer is A. Site for question/rationale: Rhodes & Jensen, p. 14 & Differential Diagnosis Presentation
Question: For the Nurse Practitioner, which threshold does she use to determine if the patient needs a diagnostic test? a. Treatment Threshold b. Test Threshold c. Disease Threshold d. System Threshold
Answer: B. Test Threshold Rationale for why the answer is correct: The best answer for this question is B. The question is asking which threshold would be used to determine if the patient needs a diagnostic test. For this question we must know the definitions of each threshold. In our Diagnostic Basic presentation, Dr. Moore only covers Treatment and Test Threshold, therefore we can eliminate C &D. The test threshold determines the probability we are going to order a lab for a patient. The treatment threshold is the probability above which the nurse practitioner most likely knows the diagnosis and treat the patient without doing a diagnostic test. Site for question/rationale: Diagnostic Presentation at 13:58.
Question: A 29 year old woman comes to your clinic complaining of frequent urination and having blurred vision. Patient’s mother, father, and brother have Type II Diabetes. Patient’s current BMI is greater than 40 and has a history of GDM with the last two pregnancies. As a NP, what lab test need to be ordered? a. CBC b. A1C & 2-hour Oral Glucose Tolerance Testing(OGTT) c. TSH d. CMP
Answer: B. A1C & 2 Hour Glucose Intolerance Test Rationale for why the answer is correct: According to Goyal &Jialal (2020), Diabetes can be diagnosed either by the hemoglobin A1C criteria or serum glucose concentration (2-hour serum glucose). In this test, the serum glucose level is measured before and 2 hours after the ingestion of 75 gm of glucose. DM is diagnosed if the serum glucose level in the 2-hour sample is more than 200 mg/dL. Site for question/rationale: Goyal, R. &Jialal, I. (2020). Diabetes Mellitus Type 2. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513253/
Question: A patient who had his wisdom teeth removed a month ago complains of a sore mouth, fever, and feels like he cannot catch his breath. Which test is ordered by the nurse practitioner? a. Blood urea nitrogen level b. Complete blood count c. Liver function study d. All the above
Answer: D. All the above Rationale for why the answer is correct: When checking for sepsis, the nurse practitioner must evaluate the CBC for elevation of elevated WBCs, Liver function tests (LFTs) and levels of bilirubin, ALP, and lipase are important in evaluating multiorgan dysfunction or pancreatitis/hepatitis. Increased BUN levels show severe dehydration or renal failure. Site for question/rationale: Bailey, K. & Kalil, A. (2020). Septic Shock Clinical Presentation. Medscape. https://emedicine.medscape.com/article/168402-workup#c8
Question: In adult patient presents to the clinic with left lower quadrant pain, nausea, and an elevated white blood cell count. which diagnosis is the most likely based on these symptoms? a. Acute cystitis b. Appendicitis c. Cholecystitis d. Diverticulitis
Answer: d. Diverticulitis Rationale for why the answer is correct: Presentation of diverticulitis includes classic left lower abdominal pain, nausea vomiting and possible elevations of WBC, CMP, CBC. An abdominal CT confirm the diagnosis. Site for question/rationale: power point: abdominal presentation; slide:10
Question: An adult patient presents with a report of epigastric pain, initially occurring intermittently but becoming persistent after eating spicy foods. The nurse practitioner tells the patient to take a deep breath, and asks, “Where do you feel the most pain?” The patient points to his RUQ. Which examination finding is described? a. Psoas Sign b. Obturator Sign c. Murphy’s Sign d. Rovsing’s Sign
Answer: C. Murphy’s Sign Rationale for why the answer is correct: The Murphy sign is used to assess for RUQ pain to help diagnose cholecystitis. When you palpate the gallbladder and find RUQ tenderness which is worse with inspiration, it helps your finding on cholecystitis. Site for question/rationale: Powerpoint: Abdominal Presentation. Slides: 4 &8
Question: 32 year old patient presents to the clinic with the history of the abnormal pap smear test and is HPV positive. The patient had a follow up colposcopy, which was negative for cervical intraepithelial neoplasia (CIN). When is the next Pap smear test due? a. 6 months b. 12 months c. 3 years d. 5 years
Answer: B. 12 months Rationale for why the answer is correct: According to the American College of Obstetricians and Gynecologist guidelines, if a colposcopy is negative for CIN and HPV is positive, repeat PAP smear and HPV testing should be done 12 months after. Site for question/rationale: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities. (2020). The American College of Obstetrics and Gynecologists https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/10/updated-guidelines-for-management-of-cervical-cancer-screening-abnormalities
Question: A 66 year old patient ask if they should have a Pap smear test this year. The patient had 2 negative HPV test in the past 10 years. Which is the best response? a. “ Because of your age and history Pap smear screenings are no longer needed.” b. “ Further testing is not needed if you are a heterosexual and in a monogamous relationship.” c. “Pap smears should be done every 3 years until the age of 70.” d. “Pap smears should be continued every year until the age of 65.”
Answer: A. “ Because of your age and history cytology screenings are no longer needed.” Rationale for why the answer is correct: According to the American College of Obstetricians and Gynecologist guidelines, if the patient has had negative HPV test in the last 20 years and adequate screening, the patient no longer needs to be screened. Site for question/rationale: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities. (2020). The American College of Obstetrics and GynecOLOGY
Question: What section in your SOAP are you going to place information the patient gives you. A. Subjective B. Objective C. Assessment D. Plan
Answer: A. Subjective Rationale for why the answer is correct: This is information the patient is stating to the NP during the interview process. Such as feelings, perception and concerns are gathered from the patient. Site for question: SOAP Note Presentation
Question: This is where you will record respiratory, skin, and observable data obtained during your patients visit. A. Subjective B. Objective C. Assessment D. Plan
Answer: B Objective Rationale for why the answer is correct: Objective assessment is data that is observed and measurable through observation, physical examination and laboratory findings. Site for question: FNP SOAP note Templet pg. 4 and 5
Question: Differential diagnosis involves making a list of possible medical conditions that could be causing a patient’s conditions. Which of the following will assist you in making a diagnosis? A. By speaking to friends and family B. By speaking to her pastor C. Conducting a medical history, physical examination and schedule diagnostic testing. D. Schedule a follow-up appointment in two weeks to see how she is doing.
Answer: C. Conducting a medical history, physical examination and schedule diagnostic testing. Rationale for why the answer is correct: A differential diagnosis looks at the possible disorders that could be causing your symptoms. It involves conducting a comprehensive medical history, physical exam and ordering several laboratory and diagnostic test. Site for question: Differential Diagnosis for Fatigue video
Question: What is the first step in writing a differential diagnosis A. Obtain a comprehensive history B. Develop a treatment plan C. Diagnosis based on history and physical examination D. Obtain the patients chief complaint and write common problems that present with that symptom.
Answer: D. Obtain the patients chief complaint and write common problems that present with that symptom. Rationale for why the answer is correct: Making a list of possible conditions that could be causing a patient’s symptoms. Site for question: Differential Diagnosis for Fatigue video
Question: That are the three main components that make up a CBC. A. Stem cells B. Bone cells C. RBC, WBC, and Platelets D. None of the above
Answer: C. RBC, WBC, and Platelets Rationale for why the answer is correct: C. The main components are RBC, WBC, and Platelets Site for question: CBC handout pg. 1 and 2
Question: _________ represents the size of a red blood cell on the CBC lab result. A. MCV B. MMC C. ATT D. RBC
Answer: A. MCV Rationale for why the answer is correct: A. An MCV (Mean Corpuscular Volume) blood test measures the size of the red blood cells. Site for question: CBC handout pg. 9
Question: The EMS arrives to the ER with a patient and states that the patient has a positive Murphy’s signs. What does that mean. A. When he takes a deep breath, he has pain when pressed in RUQ B. He has pain in the RLQ during left sided pressure C. He has pain in the tender area with pressure and quick release D. He has pain around his umbilicus
Answer: A. When he takes a deep breath, he has pain when pressed in RUQ Rationale for why the answer is correct: Murphy’s sign is useful for differentiating right upper quadrant abdominal pain for inflammation around the gallbladder. Site for question: Abdominal Presentation PP slide #4
Question: What test will you order to help you diagnose cholecystitis. A. Upper GI serious B. Lower GI serious C. HIDA Scan D. Colonoscopy
Answer: C HIDA Scan Rationale for why the answer is correct: HIDA scan is an imaging procedure used to diagnose problems of the liver, gallbladder and bile duct. Site for question: Abdominal Presentation PP slide #8
Question: AN NP will determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), she will ask the patient. A. Have you experience any erectile dysfunction B. Have you had hip pain C. Due you have a weak urinary stream D. What color is your urine
Answer: C Due you have a weak urinary stream Rationale for why the answer is correct: Patients with BPH have difficulties with force and frequency of urination, and nocturia. Site for question: Male reproductive health presentation video
Question: A patient is seen in your office and reports these findings when she performs a breast exam. Which one are you most concern. A. Nipple deviation/ Pulled in nipple B. Different sized breast C. Denser breast tissue on both breast D. A firm ridge along the bottom of each breast
Answer: A Nipple deviation/Pulled in nipple Rationale for why the answer is correct: A pulled in or a deviation of a nipple may be a clinical indicator of breast cancer or other medical problems. Site for question: Women’s Health PP slide#5
Question: Medical Conditions in what relatives should be listed under family history? a. Parents b. Parents and Children c. Parents, Children, and Siblings d. Grandparents, Parents, Siblings, and Children
Answer: d. Grandparents, Parents, Siblings, and Children Rationale for why the answer is correct: Always ask about these 4 relatives due to genetics. Site for question/rationale: Soap Note Lecture
Question: Why would quotation marks be place around the results of a diagnostic test in a SOAP note? a. The patient reported the results verbally to the NP. b. The results are the opinion of the NP. c. Results are always in quotation marks. d. The results are still pending.
Answer: a. The patient reported the results verbally to the NP. Rationale for why the answer is correct: The results are in quotation marks because the patient verbally reported them to the NP. The NP has not seen the results themselves. Site for question/rationale: SOAP note lecture
Which test is not granted waived status? a. Wet Mount b. Urine Pregnancy test c. Blood Glucose Monitor d. Blood Count
Answer: a. Wet Mount Rationale for why the answer is correct: Wet Mount’s are not waived due to requiring special training to perform the test. Training can be obtained through CMS Site for question/rationale: Slide 4 of Basic Diagnostics lecture
When can a differential diagnosis be made? a. After the chief complain is made. b. Once the chief complaint, history, and physical exams are established. c. After the diagnostic testing is completed. d. After the history is collected.
Answer: b. Once the chief complaint, history, and physical exam are established. Rationale for why the answer is correct: Differential diagnosis made too early or too late can result in errors. The history must be collected in its entirety to get a clear picture of the patient. Physical exam must be done to accurately diagnose the patient and to order the correct tests. Site for question/rationale: Differential diagnosis lecture: fatigue
Question: What condition would result in an elevated potassium level? a. Renal Failure b. Nausea/ Vomiting c. Volume Depletion d. Diuretics
Answer: a. Renal Failure Rationale for why the answer is correct: In Renal Failure, Kidneys are not working efficiently and can no longer remove excess potassium. Therefore, Potassium builds up in the body and causes levels to increase. Site for question/rationale: BMP lecture slide 9
Question: Total Bilirubin must be over what value to produce jaundice? a. 0.7 b. 2.5 c. 1.4 d. 1
Answer: b. 2.5 Rationale for why the answer is correct: Typically, total bilirubin must be over 2.5 to produce jaundice. Normal levels are 0.3-1. Therefore, levels must be well above normal levels to produce systemic effects. Site for question/rationale: Complete metabolic panel lecture slide 9
Question: What is Rovsing’s Sign? a. Pain in tender area with pressure and quick release b. Pain in RLQ during left-sided pressure c. Take a deep breath, pain when pressing RUQ. d. Pain when patient is lying on left side and right thigh is flexed backward.
Answer: B. Pain in RLQ during left sided pressure Rationale for why the answer is correct: palpation in the left iliac fossa may produce pain in the right iliac fossa Site for question/rationale: Abdominal lecture slide 4 under abdominal examination
Question: In a pediatric patient, a GI barium enema is performed resulting in a “coiled spring” appearance. What is the diagnosis? a. Pyloric Stenosis b. Hirschsprung’s Disease c. Normal appearance d. Intussusception
Answer: D. Intussusception Rationale for why the answer is correct: Intussusception is a condition in which the intestine folds into the section immediately ahead of it giving it a coiled spring appearance. Site for question/rationale: Abdominal Lecture slide 14 under Pediatric GI complaints.
Question: Which vaginal infection causes cottage cheese like discharge? a. Candidiasis b. Syphilis c. Trichomonas d. Bacterial Vaginosis
Answer: a. Candidiasis Rationale for why the answer is correct: Candidiasis (yeast infection) typically produces a thick, clumpy, white discharge that resembles cottage cheese. Site for question/rationale: Slide 10 on Women’s Health Overview of Diagnostics Part-2
Question: What male reproductive disorder is typically due to an STI? a. Hydrocele b. Varicocele c. Epididymitis d. Testicular Torsion
Answer: c. Epididymitis Rationale for why the answer is correct: Epididymitis is inflammation of the epididymis typically due to an STI such as Chlamydia or Trichomonas. Site for question/rationale: Male Reproductive lecture slide 4
Question: A patient states that feels tired because she cannot sleep at night and that she has been taking melatonin to see if it helps. These findings all belong in which part of the SOAP note? a. Objective b. Subjective c. Assessment d. Plan
Answer: B Rationale for why the answer is correct: These are all things that the person has said to us, therefore, there are subjective. Site for question/rationale: Dr. Mello, Hilliard and Moore’s SOAP note video
Question What should the NP ALWAYS include in a plan? a. Education and follow up b. Diagnostics c. Medications d. Referrals
Answer: A Rationale for why the answer is correct: Diagnostics, medications and referrals are not necessarily going to be needed for every situation. However, education and follow up plan should be included for all patient at every visit. Site for question/rationale: Drs. Mello, Hilliard and Moore’s SOAP note video.
Question: Which of the following components will affect your differential diagnoses? a. History b. Physical Examination c. Review of Systems d. All of the above
Answer: D Rationale for why the answer is correct: Your findings in the review of systems, physical examination and patient’s history will all affect (help narrow or broaden) your differential diagnosis Site for question/rationale: Dr. Amy Moore’s video on differential diagnosis.
Question: When determining differential diagnoses, what does “must not miss” mean? a. A must not miss differentlal diagnosis is one that the provider must not miss because it is the most common diagnosis for patient’s complaints b. A must not miss differentlal diagnosis is the one diagnosis that the patient has been diagnosed before so the provider has to include it in the differentials c. A must not miss differentlal diagnosis is a diagnosis that if missed could cause mortality or morbity in the patient.
Answer: C Rationale for why the answer is correct: A must not miss diagnosis is one that if missed could cause harm to the patient. Site for question/rationale: Illness script example
Question: A patient is found to have macrocytic anemia, what is the next lab diagnostic that the NP should order? a. Guaiac fecal occult blood test (gFOBT) b. Serum iron level c. B12 levels d. Folate levels
Answer: C &D Rationale for why the answer is correct: gFOBT would be good to test in a patient with normocytic anemia without an obvious; serum iron levels would be a lab diagnostic to order for someone with microcytic anemia; macrocytic anemias are frequently due to B12/folate deficiencies, therefore, drawing a B12 and folate level would be a good place to start. Site for question/rationale: Dr. Shelley Seth’s voice thread on CBC
Question: Which lab is a very specific reflection of the liver? a. ALT b. AST c. Alkaline phosphatase d. Albumin
Answer: A Rationale for why the answer is correct: AST can be secreted by other tissues in the body (heart, brain); Alkaline phosphatase can also increase with issues in the gallbladder and pancreas and it is secreted by bones; albumin may also be affected by renal disease, severe malnutrition, heart failure or DM. Site for question/rationale: Dr. Shelley Seth’s voice thread on CMP LFTs
Question: To diagnose pancreatitis, which diagnostic(s) need to be used? a. Elevated (greater than 3x’s normal) serum lipase and amylase and abdominal pain b. Abdominal pain and positive CT scan c. Positive CT scan and elevated (greater than 3x’s normal) serum lipase and amylase d. Positive CT scan and elevated (greater than 3x’s normal) serum amylase
Answer: B Rationale for why the answer is correct: Serum lipase and amylase may be back down to normal if not checked during early onset, alcoholism can skew results of serum lipase/amylase. Both abdominal pain and positive results on CT scan should be present to diagnose Site for question/rationale: Dr. Moore’s abdominal pain video
Question: What is the most sensitive and specific diagnostic for cholecystitis? a. Elevated WBCs (leukocytosis) b. Elevated alkaline phosphatase, AST, ALT and bilirubin c. Ultrasound d. HIDA scan
Answer: C Rationale for why the answer is correct: HIDA scan is used if US is negative; elevated WBCs and elevated alkaline phosphatase, AST, ALT and bilirubin are not specific AND sensitive Site for question/rationale: Dr. Moore’s abdominal pain video
Question: How often should a 21-29 year old average risk woman get a Pap Smear? a. Every 3 years b. Not needed if patient is not sexually active c. Every 5 years d. Annually
Answer: A Rationale for why the answer is correct: All of the guidelines state that a pap smear should be done every 3 years for all 21-29 year old women; annual pap smears are no longer recommended; for women 30-65, HPV + pap smear can be done in order to prolong interval of testing to every 5 years. Denial of sexual activity does not preclude need for pap smear. Site for question/rationale: Dr. Moore’s Women’s Health Preventative Care video and Women’s Health Screening Guidelines
Question: Which of the followings diagnostic tests would the NP order for a male that presents with scrotal pain that decreases with elevation of the testes and urethral discharge? a. Chlamydia/gonorrhea b. Fractional urination examination c. CT d. Scrotal US
Answer: A &D Rationale for why the answer is correct: Epididymitis often is due to an STI such as chlamydia and gonorrhea, urethral discharge is another symptom that could indicate an STI fractional urination exam is used in prostatitis; Scrotal US would also be valuable here. Site for question/rationale: Dr. Moore’s male reproductive video
Who do you all include in the family history? A. Grandparents and parents B. Parents, grandparents, siblings, and children C. However far back the patient can remember D. Including the family history is extra information
Answer: B. Rationale: You must include the parents, grandparents, siblings, and any children in the family history in order to help identify any genetic components Ref: (SOAP voice note lecture, minute 18:30)
What kind of information should go into the review of systems (ROS)? A. Physical exam B. Subjective information C. Objective D. Heart rate, temperature, and blood pressure
Answer: B. Rationale: Subjective information is the only information listed that should go into the ROS Ref: (SOAP voice note lecture, minute 20:20)
To rule IN a diagnosis, you would want which of the following? A. Low sensitivity B. High sensitivity C. Low specificity D. High specificity
Answer: D. Rationale: To rule IN a diagnosis, you would want a high specificity because it should be positive if it has a high specificity Ref: (Basic Diagnostics PP, slide 9)
To rule OUT a diagnosis, you would want which of the following? A. Low sensitivity B. High sensitivity C. Low specificity D. High specificity
Answer: B. Rationale: To rule OUT a diagnosis, you would want a high sensitivity. This means how well the test can detect the disease. It excludes the diagnosis if negative Ref: (Basic Diagnostics PP, slide 9)
What is one thing to know about lymphocytes and neutrophils? A. Lymphocytes often show viral infections whereas neutrophils show bacterial B. There is no major difference C. There are more lymphocytes than neutrophils D. They are equally present (in quantity) in the body
Answer: A. Rationale: Lymphocytes often show viral infections, neutrophils show bacterial. There are more neutrophils than lymphocytes in the body Ref: (CBC PP, slide 12 and 17)
Which is false about BMPs? A. Does not include albumin. B. Order if daily labs are needed. C. Only order it once a year. D. Includes BUN.
Answer: C. Rationale: BMPs are usually included in daily labs. It does not include albumin but does include BUN Ref: (BMP PP, slide 1)
What exam technique would you use when trying to rule in cholecystitis? A. Rebound tenderness B. Heal tap C. Murphy’s sign D. Psoas sign
Answer: C. Rationale: The other exams listed are for appendicitis Ref: (Common Abdominal Complaints PP, slide 5)
- If you see “coiled spring” which diagnosis are you likely going to rule in? A. Pyloric stenosis B. Hirschsprung’s C. Cholecystitis D. Intussusception
Answer: D. Rationale: The barium enema will show coiled spring in intussusception Ref: (Common Abdominal Complaints PP, slide 14)
Which recommendation regarding pap smears is true? A. Starting at age 21 until 29, every 3 years, if sexually active B. If there is a family history of ovarian cancer, check sooner C. If there was an abnormality at age 21, check again in 3 years D. Starting at age 21 until 29, every 3 years
Answer: D. Rationale: Pap smears should start at age 21 to 29, every 3 years if normal results in order to detect cervical cancer, regardless if they are sexually active Ref: (Women’s Health PP, slide 4)
Which one is false about testicular cancer? A. If corrected, there is no increased risk of testicular cancer with cryptorchidism B. Scrotal US is the gold standard for diagnosis C. Occurs ages 15-35 D. The testicular mass will be solid, firm, and nontender
Answer: A. Rationale: Even if corrected, there is still a 20-46x increased risk of testicular cancer with cryptorchidism. The rest of the information is correct about testicular cancer Ref: (Male Reproductive, slide 4 and 7)
In a SOAP note, objective data includes? a. Review of systems b. Chief complaint c. Physical exam d. History of present illness
Answer: Physical exam Rationale for why the answer is correct: Review of systems, chief complaint and history of present illness are obtained by patient interview and are subjective data. Physical exam is objective data obtained by the provider’s assessment. Site for question/rationale: SOAP note presentation by Dr. Seth in Module 1
Question: in OLD CARTS, a mnemonic used for describing the chief complaint, the C stands for describing the: a. Cause b. Character c. Corner d. Constitution
Answer: B. Character. Rationale for why the answer is correct: The character of a chief complaint is important when fully describing a patient’s chief complaint in the HPI. Site for question/rationale: Dr. Shelly Seth’s SOAP note presentation
The probabilistic method of decision-making is: a. Based on the provider’s experience b. Based on the provider’s pattern recognition c. Based on the provider’s gut instinct d. Based on the diagnostic of a provider’s test results
Answer: D. Rationale for why the answer is correct: D. Probabilistic method of decision-making is based on a provider’s test results and utilizes pre-test probabilities that a patient is likely to have a diagnosis prior to testing for a disease process. Provider’s experience and pattern recognition describe pattern recognition as a method of decision-making. Gut instinct is incorrect. Site for question/rationale: Basics of diagnostics presentation by Dr. Amy Moore. 10:00
Question: A provider would treat empirically when: a. A patient has a high probability of disease b. A patient has a low probability of disease c. A patient is below the test threshold d. A patient has a low treatment threshold
Answer: A Rationale for why the answer is correct: if a patient has a high probability of disease then the patient can be treated empirically. If a patient has a low probability of disease or is below the test threshold, you will not treat without doing further testing. A patient would need a high treatment threshold, not a low treatment threshold to empirically. Site for question/rationale: Basics of diagnostics presentation by Dr. Amy Moore. 15:30
Your patient has a total bilirubin of 3.0, you order an indirect and a direct bilirubin to further investigate. The indirect bilirubin results come back higher than normal levels. You know that a high indirect bilirubin most likely indicates a problem with the: a. Spleen b. Pancreas c. Gallbladder d. Liver
Answer: D Rationale for why the answer is correct: Indirect or unconjugated bilirubin, if elevated, indicates a problem in the liver. An elevated direct or conjugated bilirubin indicates a problem past the liver (in the gallbladder or pancreas). Bilirubin levels do not indicate problem in the spleen. Site for question/rationale: Dr. Shelly Seth’s CMP & LFT presentation. Slide 9.
Question: You suspect liver disease in your patient. You order LFTs and you notice that your GGT to ALP ratio is greater than 5. You know that this indicates: a. Shock Liver b. Alcoholic liver c. Gallbladder Disease d. Pancreatitis
Answer: B Rationale for why the answer is correct: GGT rises greater than ALP in alcoholism. A GGT ratio to ALP >5 indicates alcoholic liver. Site for question/rationale: Dr. Shelly Seth’s CMP & LFT presentation. Slide 18.
A diagnosis of pancreatitis would include all of the following diagnostics, except: A. Abdominal pain B. Positive Psoas sign C. Serum Lipase and/or Serum Amylase (>3x normal limits) D. CT scan
Answer: B. Positive Psoas sign Rationale for why the answer is correct: Pancreatitis diagnostics include 2 of 3 of the following: abdominal pain, Serum Lipase and/or Serum Amylase (greater than 3x normal limits, CT scan. Positive Psoas sign is diagnostic of appendicitis. Site for question/rationale: Common abdominal complaints by Dr. Amy Moore Slide # 11, minute 16:00.
Question: Your patient comes to you with a complaint of severe abdominal pain. The patient’s labs and physical exam are notable for the following: Leukocytosis (WBC 15,000), elevated ALT, AST, & bilirubin, and a positive Murphy’s sign. You know that the most likely diagnosis is _________, and you will order _________ to confirm your suspicions. a. Appendicitis, abdominal ultrasound B. Appendicitis, abdominal CT C. Cholecystitis, abdominal ultrasound D. Cholecystitis, abdominal CT
Answer: C. Cholecystitis, abdominal ultrasound Rationale for why the answer is correct: Cholecystitis is characterized by leukocytosis in >70% of patients, can have elevated Alkaline phosphatase, ALT, AST & bilirubin, and a positive murphy’s sign on physical exam. The most specific and sensitive study for cholecystitis is ultrasound. Appendicitis is diagnosed with abdominal CT. Site for question/rationale: Common abdominal complaints by Dr. Amy Moore. Slide 8.
Question: Pap smears are recommended every 3 years for patients aged 21 -29. A pap smear screens for the following: A. Ovarian cancer B. HPV C. Cervical Cancer D. Gonorrhea
Answer: C. cervical cancer Rationale for why the answer is correct: A pap smear tests for abnormal cells that lead to cervical cancer, a pap smear does not automatically test for HPV strains, unless abnormal cells are found. Ovarian cancer cannot be detected by a pap smear. Gonorrhea may be tested when a pap smear is completed but is not included in the pap smear test. Site for question/rationale: Women’s health presentation by Dr. Amy Moore, slide 4.
Question: Mr. H is a 20-year-old male with no past medical history. He presents to your clinic with complaints of a testicular mass that he has had for a while, but it is enlarging and states that his scrotum “feels heavy.” For a diagnostic work-up you know that the gold standard for diagnosing testicular cancer is: A. Abdominal CT B. Tumor markers C. Sperm count D. Scrotal ultrasound
Answer: D. Scrotal ultrasound Rationale for why the answer is correct: Scrotal ultrasound is the gold standard for diagnosing testicular cancer. Abdominal CT and tumor markers may be ordered as supporting diagnostics. Sperm count would not be ordered to diagnose testicular cancer. Site for question/rationale: Dr. Amy Moore’s Male Reproductive health presentation. Slide 7.
Question: A 24-year-old female presents to the clinic for “headache*3 weeks and nausea.” Which part of the patient’s history and physical would be considered objective information? Answer: A) The patient states the headache has a throbbing-like quality B) The patient reports a 4-pound weight loss in the last 3 weeks C) The patient has pale mucous membranes on exam D) The patient’s family medical history is positive for migraines
Answer: C Rationale for why the answer is correct: Objective information is information gathered by the provider. In this case, answers A, B, and D are all information given to the provider by the patient, with answer choice C being the only data collected by the provider themselves. Site for question/rationale: “Soap Note Presentation” video from Module 1 Marker 20:26-22:29
Question: A 57-year-old male presents to the emergency room for chest pain that began in the morning and persisted throughout the day. On exam, the patient is pale and diaphoretic with a BP 180/100, HR 104, RR 26, and T 37.0 oral. Where in the soap note would be the appropriate location to document the patient appearing pale and diaphoretic? Answer: A) Subjective information B) Chief complaint C) Patient assessment D) B or C
Answer: C Rationale for why the answer is correct: The patient appearing pale and diaphoretic is information gathered from the provider during a patient assessment. Although, this could be considered objective information, the most appropriate place for the documentation of a provider’s observation of a patient’s appearance is in the patient assessment section. Site for question/rationale: “Soap Note Presentation” video from Module 1 Marker 20:26-22:57
Question: What statement about the difference about differential diagnosis is not correct? Answer: A) A differential diagnosis may be a working diagnosis B) A differential diagnosis is always a new diagnosis C) A differential diagnosis is a plausible explanation of the patient’s current chief complaint D) A differential diagnosis explains some of the patient’s current symptoms, but maybe not all of the patient’s symptoms
Answer: B Rationale for why the answer is correct: A differential can be a working diagnosis while running additional testing and labs. A differential diagnosis is also a plausible explanation of the patient’s current chief complaint. The differential diagnosis does not always have to be a new diagnosis, because it can be an exacerbation of a previous diagnosis. Site for question/rationale: Dr. Seth’s video on “SOAP notes” Time Mark 23:55-24:50 in Module
Question: A 78-year-old patient presents to the emergency room with joint pain*1 week and fever of unknown origin. What is the best way to develop differential diagnoses? Answer: A) Complete a full history and physical, making sure to ask to follow up questions when appropriate B) Begin to create a differential list before asking the patient any follow up questions C) Ask as many questions as your time allows D) Look at the patient’s comorbidities because likely the differential is related
Answer: A Rationale for why the answer is correct: In the differential diagnosis video, Dr. Moore refers many times to the importance of completing a full history and physical with relevant follow up questions before deciding on differential diagnoses. Site for question/rationale: Dr. Moore’s “Differential Diagnosis” video from Module 1 Marker 4:57-5:03, 5:36-5:38, 6:04-6:13
Question: A 92-year-old patients with CKD presents to the ER for a fistula infection. The ER nurse draws a rainbow of labs and recognizes that which finding in the CBC best indicates that the patient has a bacterial infection rather than another type? Answer: A) An elevated WBC count B) An elevated monocyte count C) An elevated basophil count D) An elevated neutrophil count
Answer D Rationale for why the answer is correct: An elevated WBC count would be elevated in both a bacterial and viral infection. An elevated neutrophil count is more specific to a bacterial infection. An elevated basophil count would be expected most commonly in autoimmune type reactions or cancers of the bone. An elevated monocyte count would be elevated most often in chronic illness, hematological disorders, and malignancies. Site for question/rationale: Dr. Seth’s Lecture/Video on “CBC Lecture” in Module 1 Marker 8:10-8:26
Question: A 62-year-old patient presents to the ER for non-specific abdominal pain and a PMH positive for ETOH abuse. The patient additionally reports nausea without vomiting and intermittent bloating for the past 2 days. He states the pain has been steadily increasing and today he could barely make it out of bed. The provider orders a rainbow of labs with concern for pancreatic or ductal problems given the patient’s history. Which laboratory finding on the CMP would assist the provider in detecting a problem in the liver rather than in another organ? Answer: A) Elevated indirect (unconjugated) bilirubin B) Elevated ALT C) Elevated direct (conjugated) bilirubin D) Elevated WBC
Answer : A Rationale for why the answer is correct: The liver is the site of bilirubin conjugation, making an elevation in already conjugated bilirubin a problem that exists past the liver (since the liver has already conjugated the bilirubin). An elevation of unconjugated bilirubin is more specific to liver dysfunction because if the bilirubin is unconjugated the liver is not doing its’ job to conjugate it. An elevated WBC count in this case would not help distinguish between a liver rather than another organ injury. ALT elevation although can occur in liver dysfunction or injury can also be elevated in with other organ dysfunction, such as with the gallbladder so would not be the best test to differentiate between liver or other organ issues. Site for question/rationale: Dr. Seth’s “CMP/LFT” Lecture in Module 1 Slide #9 (including title slide)
Question: An 81-year-old female recently treated with at a local community hospital for Community Acquired Pneumonia where she was admitted for 5 days and completed her course of prescribed antibiotics. She now presents to the emergency room with generalized fatigue and diarrhea that she describes as “non-stop.” What patient finding would prompt the provider to send a stool culture? Answer: A) Recent course of antibiotics B) T 100.3 orally C) Diarrhea being described as “non-stop” for 1 day D) Non-specific complaint of fatigue
Answer: A Rationale for why the answer is correct: In the video, Dr. Moore discusses red flags on when to send a stool culture in a patient. She mentions antibiotic use, blood in stool, fever>101.3, leukocytes in the stool, as well as lactoferrin in the stool. This patient meets one of these criteria with the recent course of antibiotics, which would make this the most appropriate choice. Site for question/rationale: Dr. Moore’s video on “Abdominal lab/tests” at 6:13-6:46
Question: A 27-year-old patient familiar to the Emergency Department for ETOH withdrawal presents with diffuse abdominal pain. The provider orders a serum amylase and lipase, which were both markedly elevated. What further information is needed to diagnose the patient with pancreatitis? Amylase 215 U/L (normal values: 23-85 U/L) Lipase 206 U/L (normal values: 0-160 U/L) Answer: A) A CT scan will confirm the diagnosis of pancreatitis B) The patient meets the criteria for the diagnosis of pancreatitis C) A gastroenterology consult would be needed D) Check the patient’s current ETOH level and electrolytes
Answer: B Rationale for why the answer is correct: The patient meets the American Academy of Gastroenterology criteria for diagnosing pancreatitis presented in Dr. Moore’s video on Common Abdominal Complaints. The patient meets 2 of the 3 criteria including a complaint of abdominal pain and elevated serum lipase and/or serum amylase. Site for question/rationale: Dr. Moore’s video on “Abdominal labs/tests” Marker 15:01-16:39
Question: A 25-year-old woman comes to her OB/GYN clinic with complaints of white discharge from her vagina. The APRN performs a wet prep to assess for vaginitis. What finding from the NaCl wet prep would be suspicious for candidiasis? Answer: A) Many lacto-bacilli present B) Few WBCs present C) Clue cells present >20% D) Motile protozoa present
Answer B Rationale for why the answer is correct: According to slide 10 in the Women’s Health Diagnostics Lecture Part 2 by Patricia Olenick, few WBCs present would be the expected finding in a woman with candidiasis. Lacto-bacilli would be present in normal vaginal discharge. Clue cells>20% would be present in bacterial vaginosis. Finally, motile protozoa present would be characteristic of trichomoniasis. Site for question/rationale: Dr. Olenick’s “Women’s Health Diagnostic Overview Part 2” Lecture/Video in Module 1 Slide #10
Question: A 23-year-old male presents to the ER with an enlarged testicle. He reports the testicle is painless but “is really getting in the way.” As the APRN what is the best diagnostic study would be best to order on this patient to confirm your suspicion of testicular cancer? Answer: A) Abdominal CT scan B) Tumor markers C) The diagnosis can be made based on exam and physical findings D) Scrotal ultrasound
Answer D Rationale for why the answer is correct: According to Dr. Moore’s video on male reproductive diagnostics, a scrotal ultrasound is the gold standard for diagnosis of testicular cancer. The provider may order additional diagnostic studies such as tumor markers and CT, but they are not considered the gold standard. Site for question/rationale: Dr. Moore’s “Male Reproductive Health Presentation” Video/Lecture Slide #7 in Module 1
Question: When documenting the patient’s chief complaint, it important to: a. Use the patient’s own words in quotations b. Include a short summary of the events leading to the incident or illness c. Included the onset, location, duration, characteristics, alleviating factors, timing, exacerbating factors, and severity of the symptoms d. Dismiss the patient’s complaint if physical exam and diagnostic testing do not support the patient’s complaint
Answer: A – use the patient’s own words whenever possible. Rationale for why the answer is correct: The chief complaint is a statement by the patient of why they are seeking medical attention. It is usually quoted by the provider during the ROS. Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth, Time Mark 2:08
Question: Family history should include how many generations? a. 1 b. 2 c. 3 d. 4
Answer: D. Family history should include four generations: grandparents, parents, siblings and children (when applicable). Rationale for why the answer is correct: Family history should include investigating health history of patients’ immediate family going upwards (parents and grandparents), downwards (children) and sideways (siblings). Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth, Time Mark 3:57
Question: What is the type of decision making referred to as ‘probabilistic’? a. Recognizing the pattern of a disease process which leads you to a diagnosis b. Likelihood of presence of disease based on scientific estimates of disease prevalence in a given patient population c. Provider intuition based on clinical knowledge and experience of how often a patient with symptoms has any given disease d. Likelihood of a disease after diagnostic testing is performed
Answer: B Rationale for why the answer is correct: Probabilisitic decision making is based on scientific research that predicts the likelihood of a disease in a given population exhibiting specific signs and symptoms Site for question/rationale: Dr. Terry Shaneyfelt’s video on Diagnostic Process, Time Mark 1:21
Question: What is pre-test probability? a. Chance that the patient has a disease after further testing is performed b. The point at which diagnostic testing should be ordered c. Chance that the patient has a given disease prior to any further testing d. The point at which treatment should be given
Answer: C Rationale for why the answer is correct: Pre-test probability tells providers how likely it is that a patient has a disease or illness before any diagnostic testing is ordered. Patients who have a low pre-test probability likely do not need further testing. Site for question/rationale: Dr. Terry Shaneyfelt’s video on Diagnostic Process Time Mark 2:49
Question: What is the most common electrolyte abnormality? a. Hypokalemia b. Hyperglycemia c. Hyponatremia d. Hyperkalemia
Answer: C Rationale for why the answer is correct: Hypokalemia is the most common electrolyte abnormality. Site for question/rationale: BMP lecture by Dr. Shelly Seth, Time Mark 2:12
Question: A rise in eosinophils may be caused by a. Cancer b. Bacterial infection c. Chronic illness d. Parasitic infection
Answer: D Rationale for why the answer is correct: Rise in eosinophils may be caused by parasitic infection, allergies, addition of a new drug, or aspergillosis or Churg-Strauss syndrome in asthmatics. Site for question/rationale: CBC lecture by Dr. Shelly Seth, Time Mark 16:12
Question: A patient experiences pain when taking a deep breath and pressure is applied to the RUQ. What is this test called and what is it a positive sign for? a. Obturator sign; appendicitis b. Psoas sign; pancreatitis c. Murphy’s sign; cholecystitis d. Heel tap; peritonitis
Answer: C Rationale for why the answer is correct: Murphy’s sign is considered positive for cholecystitis when the patient has pain while taking a deep breath and pressure is applied to the right upper quadrant. Site for question/rationale: Dr. Amy Moore’s Abdominal lecture, Time Mark 4:54
Question: Leukocytosis, elevated liver function tests, and positive Murphy’s sign are indicative of what disease process? a. Appendicitis b. Gastroenteritis c. Hepatitis d. Cholecystitis
Answer: D Rationale for why the answer is correct: Cholecystitis is characterized by RUQ pain on inspiration, WBCs 12-20, elevated alkaline phosphates, ALT, AST and bilirubin, and elevated GGT if the bile duct is obstructed. Site for question/rationale: Dr. Amy Moore’s abdominal PowerPoint presentation, slide 8.
Question: The absence of one or both testes on palpation of the scrotum is called: a. Testicular torsion b. Cryptorchidism c. Epididymitis d. Spermatocele
Answer: B Rationale for why the answer is correct: Chryptorchidism is definite as the absence or one or both testes on palpation of the scrotum. Site for question/rationale: Dr. Amy Moore’s Male Reproductive PowerPoint presentation, slide 4
Question: On wet mount, the provider notes that a patient’s vaginal swab sample includes motile flagellated Protozoa and many WBCs. What is the most likely diagnosis? a. Candidiasis b. Bacterial vaginitis c. Trichomoniasis d. Chlamydia
Answer: C Rationale for why the answer is correct: Trichomoniasis is characterized by motile Protozoa and many WBCs on wet mount, itch, frothy gray or yellow discharge that is malodorous, and a “strawberry cervix”. Site for question/rationale: Dr. Olenick’s Women’s Health Diagnostic Overview Part 2 PDF, slide 10
Question: In what section of your SOAP note would the use of a mnemonic like OLDCARTS be most appropriate: A. History of Present Illness (HPI) B. Chief Complaint (CC) C. Past Medical History (PMH) D. List of Medications
Answer: History of Present Illness (HPI) Rationale for why the answer is correct: Use of a mnemonic like OLDCARTS will help the provider gather pertinent information related to the patient’s chief complaint, including onset, location, duration, character, aggravating/alleviating, region/radiating, timing, and severity/scale. The information gathered is used to form a thorough history of present illness (HPI). The chief complaint should be a shortened or condensed patient statement/quotation. The mnemonic would not help to illicit or provide the patient’s past medical history and/or list of medications. Site for question/rationale: Dr. Shelly Seth’s “SOAP Note Presentation” at time stamp 12:50
Question: What is not one of the three categories you as a provider should ask the patient when filling out the medication list in your SOAP note? A. Prescribed Drugs B. Over-the counter (OTC) Drugs C. Herbs/supplements D. Tobacco Use
Answer: Tobacco Use Rationale for why the answer is correct: The medication section of your SOAP note should include prescription drugs (including dose, route, frequency/schedule), any over the counter drugs (either currently in use or used occasionally), as well as any herbs/supplements used by the patient. It would be correct to address tobacco use in the social history section of your SOAP note, but tobacco should not be listed as a medication. Site for question/rationale: Dr. Shelly Seth’s “SOAP Note Presentation at time stamp 17:36
Question: A provider should utilize all of the following except ________ to help form his or her list of differential diagnoses during a patient’s initial visit? A. Chief Complaint (CC) B. Lab/Test Results C. History of Present Illness (HPI) D. Review of Systems (ROS)
Answer: Lab/Test Results Rationale for why the answer is correct: Patient chief complaint (CC), history of present illness (HPI) and review of systems (ROS) help the provider formulate a working differential diagnosis, whereas test results help to confirm the differential diagnosis you suspect. Making a list of your differential diagnoses is done prior to ordering and obtaining test results. Site for question/rationale: “Differential Diagnosis for Fatigue” video by Dr. Mello, Dr. Hilliard, and Dr. Moore at time stamp 15:25
Question: The provider begins to narrow down his/her list of differential diagnoses, knowing that _____ is an important factor to consider before ordering multiple laboratory tests. A. Cost B. Family presence C. Gender D. Age
Answer: Cost Rationale for why the answer is correct: Cost is always a factor when deciding to order which tests, how many tests, or to even order testing at all. If the patient does not have medical insurance, the patient’s insurance does not cover a test, or the patient cannot afford the out-of-pocket cost for a test, the provider must determine how to refer/provide patient resources for testing, or the provider must form another plan to confirm his or her differential diagnosis. Site for question/rationale: “Differential Diagnosis for Fatigue” video by Dr. Mello, Dr. Hilliard, and Dr. Moore at time stamp 13:41
Question: During clinicals, you are discussing possible causes of a patient’s macrocytic anemia. During the work-up, both the B12 and folate levels are normal, and the patient’s social history is negative for alcohol abuse. Your preceptor asks what lab or labs would be appropriate to order next, based on the most common causes of macrocytic anemia. The correct response is: A. Ferritin B. TSH C. Serum Iron D. Transferrin
Answer: TSH Rationale for why the answer is correct: A serum iron, Ferritin, or Transferrin would be ordered as part of the workup for microcytic anemia. TSH is the next lab in the workup for macrocytic anemia, after testing B12 and folate levels initially. Site for question/rationale: Dr. Shelly Seth’s voice thread presentation, “CBC” at time stamp 24:24, 24:50, and 26:45. All three places provide the answer with an excellent explanation, but time stamp 24:50 specifically states the potential for a test question similar to this one and makes a point to say that iron studies would be the incorrect/distraction choices.
Question: Why would you order a pre-albumin level instead of an albumin level? A. Pre-albumin values are profoundly affected by hydration. B. Pre-albumin is a standard part of the Complete Metabolic Panel (CMP) order set. C. Pre-albumin is used to evaluate response to treatment, as its half-life is 2 days. D. Pre-albumin levels are very slow to change, taking up to two weeks to normalize.
Answer: Pre-albumin is used to evaluate response to treatment, as its half-life is 2 days. Rationale for why the answer is correct: Hydration does not affect pre-albumin levels. Pe-albumin is not on a CMP. Albumin levels, not pre-albumin levels, are slow to change, taking up to 14 days to return to normal. Pre-albumin’s half life is 2 days, making it the better choice to evaluate a patient’s response to treatment, those who are depending upon protein for healing. Site for question/rationale: Dr. Shelly Seth’s voice thread presentation, “CMP/LFT’s” at time stamp 3:39
Question: During your abdominal exam, you suspect appendicitis, so you place your hand above the patient’s right knee and have them raise it. What technique did you just perform? A. Rebound tenderness test B. Rovsing’s Sign C. Obturator Sign D. Psoas Sign
Answer: Psoas Sign Rationale for why the answer is correct: Rebound tenderness is a technique where the provider presses down on the tender area and then does a quick release of pressure. Rovsing’s sign is pain in the RLQ when the provider places pressure on the patient’s left side. The obturator sign is where the provider will flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. While all these techniques are used to examine for appendicitis, psoas sign is the correct name of the performed maneuver/technique. Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Abdominal lab/tests” at time stamp 2:43
Question: You suspect your patient may have cholecystitis. The most sensitive and specific study for cholecystitis is: A. Ultrasound B. CT scan of the abdomen C. Abdominal Xray D. Barium enema
Answer: Ultrasound Rationale for why the answer is correct: Ultrasound is the most sensitive and specific test for cholecystitis because you are looking for gallstones. Abdominal CT scan would be used for appendicitis. Abdominal XR would be used for Hirschsprung’s Disease. Barium enema is the gold standard for intussusception. Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Abdominal lab/tests” at time stamp 11:27
Question: Mammogram screenings should be performed until at least what age? A. Age 45 B. Age 55 C. Age 65 D. Age 75
Answer: 75 Rationale for why the answer is correct: Screening mammograms should start around age 40 (if no family or past medical history of breast cancer) and continue until at least age 75 (can continue past age 75 if the patient would like to). Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Women’s Health – Preventative Care” at time stamp 14:47
Question: A 13-year-old male complains of sudden, acute, severe, unilateral scrotal pain and swelling. You strongly suspect testicular torsion and advise the patient to ______ ? A. Take a dose of OTC pain medication PRN and no sports for 1 week. B. Make an appointment to see you in the clinic within the next few days. C. Go immediately to the emergency room. D. Take a warm bath and avoid tight clothing for 48 hours.
Answer: Go immediately to the emergency room. Rationale for why the answer is correct: Testicular torsion is a medical, and potentially a surgical, emergency. Outcome is dependent upon the time of correction so early diagnosis and treatment is paramount. Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Male Reproductive Health Presentation” at time stamp 13:02
Question: What is the difference between “Subjective” and “Objective” data while gathering information in a S.O.A.P. note? Answer: A. Subjective information is what the provider sees and develops a plan on. B. Objective information is what the patient is complaining about in chief complaint. C. Subjective information is what you as the provider are told from the patient. D. Objective information is what you as the provider sees and does to the patient. E. Both A and B F. Both C, D
Answer: F Rationale for why the answer is correct: A common mistake is distinguishing between symptoms and signs. Symptoms are the patient’s subjective description and should be documented under the subjective heading, while a sign is an objective finding related to the associated symptom reported by the patient Site for question/rationale: Dr. Seth video on S.O.A.P note.
Question: When ordering a diagnostic test, what is the role of the test? A. To Rule in a diagnosis B. To Rule out a diagnosis C. To confirm the patient’s chief complaint D. Answer A, B are both correct, E. All of the above are correct.
Answer: D Rationale for why the answer is correct: Rule in- the goal is to confirm patient has the disease. Rule out- the goal is to confirm the patient doesn’t have the disease. Site for question/rationale: How to choose a diagnostic test you tube video.
Question: When ordering intricate diagnostic tests, what two parameters are important to consider. A. Patient age and gender B. Ethnicity and religious beliefs C. Sensitivity and specificity of test D. Patients insurance and coverage
Answer: C Rationale for why the answer is correct: Diagnostic testing can be very expensive. When intricate tests are ordered an important detail to consider is the sensitivity and specificity of the tests in order to rule in or out a diagnosis. Site for question/rationale: Differential Diagnosis for Advanced Practice Nurse Book, Pg 2, How to choose a diagnostic test you tube video, Dr Moore’s Basics of Diagnostics video.
Question: What makes up a CBC blood test A. BNP, RBC, WBC B. WBC, RBC, Platelets C. TSH, BNP, Platelets D. Basophils, Platelets, BNP
Answer: B Rationale for why the answer is correct: The complete blood count (CBC) is a group of tests that evaluate the cells that circulate in blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect a variety of diseases and conditions, such as infections, anemia and leukemia. Site for question/rationale: CBC handout
Question: What part of a CBC test is used to identify Worms, Parasites, and allergies A. Neutrophils B. Basophils C. Eosinophils D. Lymphocytes
Answer: C Rationale for why the answer is correct: Eosinophils are a type of disease-fighting white blood cell. Elevated Eosinophils most often indicates a parasitic infection, worms or allergies. Site for question/rationale: CBC handout
Question: What diagnostic test is used primarily first to diagnose cholecystitis due in part to its sensitivity and specificity. A. CT scan B. MRI C. Ultrasound D. PET scan
Answer: C Rationale for why the answer is correct: Ultrasound is more useful than CT and MRI for the initial evaluation of acute biliary disease. Site for question/rationale: Dr. Moore’s Abdominal video 12.03 on video
Question: In reference to chlamydia in females under the age of 25 that are sexually active. How often should these females be tested according to recommendations? A. Every 6 months B. Yearly C. Every 90 days D. Only if symptoms appear.
Answer: B Rationale for why the answer is correct: Because this group has the highest rate of infection, these women should consider getting screenings every year as well as when switching to a new sexual partner. Site for question/rationale: Sexually transmitted disease video 8.39 on video. Dr. Mello, Dr. Moore, Dr. Hilliard.
Question: What pathological process can urine hesitancy or the inability to completely empty the bladder during urination be indicative of. A. Benign Prostatic Hyperplasia B. Epididymitis C. Testicular Torsion D. Inguinal hernia
Answer: A Rationale for why the answer is correct: An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. Additionally, other presenting symptoms are enlarged symmetrical smooth prostate upon exam. Nodular prostate can be indicative of cancer. Site for question/rationale: Male reproductive video Dr. Moore 2.01 on video.
Question: Which mnemonic is best used to help be inclusive for criteria when questioning a patient’s complaint? A. OLD CARTS B. ABCDEF C. OLD SOCS D. There isn’t one
Answer: A- OLD CARTS Rationale for why the answer is correct: OLD CARTS is one of the mnemonics used to help providers see the complete picture of a patient’s complaint. The other answers were made up. Site for question/rationale: SOAP lecture by Shelly Seth, 12mins 47 secs
