exam one diagnostics Flashcards
Question: What Information does NOT contribute to the differential diagnosis? A. Subjective Data B. Objective Data C. Plan D. History
Answer: C. Plan
Rationale for why the answer is correct: The plan is not part of the differential diagnosis.
Site for question/rationale: Differential Diagnosis presentation by Amy Moore time 1:06
Question: Which blood test would be ordered to assess creatinine daily in a hospitalized patient? A. CBC B. CMP C. BMP D. Chem 10
Answer: B. BMP
Rationale for why the answer is correct: BMP is used for watching trends in daily labs.
Site for question/rationale: BMP presentation by Shelly Seth. Time 0:42
Question: If the leading diagnosis for a patient is gallstones, what lab value will be most elevated? A. Alkaline phosphatase (ALK) B. Alanine Aminotransferase (ALT) C. Aspartate Aminotransferase (AST) D. Bilirubin
Answer: A. Alkaline phosphatase
Rationale for why the answer is correct: ALK is secreted by the cells lining the ductal tubules in the gallbladder.
Site for question/rationale: CMP &LFT presentation by Shelly Seth. Time 8:09
Question: The diagnosis of pancreatitis is confirmed with at least 2 of 3 of the following. Which one is not included?
A. CT Scan
B. Serum Lipase and/or Serum Amylase 3x normal limit
C. Abdominal Pain
D. Urinary retention
Answer: D. Urinary retention
Rationale for why the answer is correct: All the other answers are included in the diagnosis of pancreatitis.
Site for question/rationale: Abdominal labs/tests presentation by Amy Moore. Time 14:55
Question: Which lab test(s) are diagnostic for Cushing’s syndrome? (select all that apply)
a. ACTH
b. Salivary cortisol (late night)
c. TSH
d. 24 hour urinary free cortisol
Answer: B and D
Rationale for why the answer is correct: Glucocorticoid excess results in excessive production of ACTH by the pituitary gland so these tests will tell us if cortisol levels are elevated, which is diagnostic for Cushing’s.
Site for question/rationale: Endocrine and Autoimmune Disorders by Dr. Moore, Slide 8 (Cushing’s Syndrome)
Question: What does an elevated C-reactive protein value indicate?
a. The patient has decreased kidney function
b. Inflammation is occurring somewhere in the body
c. The patient definitively has an auto-immune disorder
d. The patient has impaired liver function
Answer: B
Rationale for why the answer is correct: This test indicates inflammation however, it does not indicate where in the body it is occurring, or whether it is chronic or acute.
Site for question/rationale: Endocrine and Autoimmune Disorders by Dr. Moore, Slide 9 (Autoimmune Disease)
What angle should the heel be raised for the Heel Tap?
a. 10-20%
b. 20-30%
c. 30-40%
d. 40-50%
Answer: A
Rationale for why the answer is correct: This test is an alternative to the rebound tenderness that may suggest appendicitis. This is the indicated angle to be able to direct the force to the abdomen and test for tenderness.
Question: Which study is most sensitive and specific for cholecystitis?
a. Abdominal CT
b. X-ray
c. Ultrasound
d. Manual exam
Answer: C
Rationale for why the answer is correct: The gallstones are best visualized on an ultrasound. HIDA scan is the next step if US is negative.
Question: Prostrate massage is contraindicated for a patient with:
a. cryptorchidism
b. epididymitis
c. acute prostatitis
d. varicocele
Answer: C
Rationale for why the answer is correct: Prostate massage during an acute episode of prostatitis may result in an iatrogenic bacteremia.
Site for question/rationale: Male Reproductive Health Presentation
When do you first start developing differential diagnoses for a patient?
a. When you begin asking your patient about her medical history
b. As soon as you walk in the room and the patient provides her “chief complaint”
c. During the review of systems of the patient
d. After your physical exam of the patient
- Answer: B. as soon as you walk in the room and the patient provides her “chief complaint”
Rationale for why the answer is correct:
You should start thinking of differentials for your patient as soon as you know the chief complaint. Then as you move through the history, review of systems and physical exam you should start narrowing your differentials and ruling in or ruling out differential diagnoses.
All of these are included in the Basic Metabolic Panel (BMP) except:
a. Sodium
b. Creatinine
c. Potassium
d. Alanine Aminotransferase (ALT)
Answer: D. Alanine Aminotransferase (ALT)
Rationale for why the answer is correct:
Alanine Aminotransferase (ALT) is NOT included in a BMP but it is included in a CMP –
complete metabolic panel. BMP includes sodium, chloride, potassium, CO2, BUN, Creatinine, and Glucose.
Which set of symptoms or exam findings MOST likely represents Appendicitis?
a. Positive Murphy’s Sign, A lot of Abdominal Pain, Nausea, Positive Gallstones
b. Positive rebound tenderness around McBurney’s Point, RLQ pain, Positive Rovsing’s sign, Positive Obturator Sign, Positive Psoas Sign, Positive Heal Tap, Positive Cutaneous Hyperesthesia
c. Projectile vomiting, refusing to feed or eat
d. Colicky, jelly stools, abdominal pain, vomiting
Rationale for why the answer is correct:
Positive rebound tenderness around McBurney’s Point, RLQ pain, Positive Rovsing’s sign, Positive Obturator Sign, Positive Psoas Sign, Positive Heal Tap, Positive Cutaneous Hyperesthesia are all symptoms or exam findings of appendicitis. Positive murphy’s sign and being doubled over in abdominal pain, nausea and gallstones are symptoms or exam findings of cholecystitis, projectile vomiting and refusal to feed/eat is more common with pyloric stenosis (however, this could be possible with appendicitis also, but is not the BEST answer for this question) and colicky, jelly stools, abdominal pain, and vomiting are symptoms consistent with intussusception
Site for question/rationale:
Common Abdominal Complaints Presentation: slide 4, time in video: 3:00-4:50
Which test is most commonly used to diagnose Appendicitis?
a. HIDA scan
b. CT scan
c. Urinalysis
d. Ultrasound
Answer: B. CT Scan
Rationale for why the answer is correct:
CT scan is the most commonly used tool to diagnose appendicitis but consider radiation exposure and if CT scan is needed , urinalysis to check for hematuria and pyuria (but only 20% of patient with appendicitis will have hematuria/pyuria) or to rule out pregnancy in women, HIDA scan is used to check the function of the gallbladder if ultrasound is negative. Ultrasound is most sensitive and specific study to check for gallstones in patients with possible cholecystitis.
Your patient is a 22-year-old female who is sexually active that presents to clinic with symptoms of vaginal itching, burning and dysuria. Upon internal pelvic speculum exam, she is found to have curdy, cottage cheese vaginal discharge and a red and irritated vaginal wall. Based on your exam and patient’s symptoms she is most likely to be diagnosed with:
a. Trichomonas
b. Bacterial Vaginosis (BV)
c. Chalmydia
d. Vulvovaginal Candidiasis (yeast)
Rationale for why the answer is correct: Vulvovaginal candidiasis (yeast) presentation may include vaginal itching, burning, and dysuria and upon exam patient is usually found to have a red and irritated vaginal wall with curdy, cottage cheese discharge. Trichomonas the patient usually experiences vaginal irritation that is very itchy, and they may also have profuse discharge and a strawberry cervix or petechia on cervix and it is important to treat both partners. Bacterial Vaginosis usually presents with profuse foul fishy smelling discharge and upon exam it may look as though a cup of milk is poured into the vagina because the discharge pools in the vagina and may give the vaginal wall a shiny appearance. Chlamydia has mucopurulent discharge that may resemble green/yellow snot leaking from the cervix, the cervix will be angry, red and inflamed. The patient with chlamydia may also have what’s called cervical motion tenderness (chandelier sign) where they jump when you touch the cervix because it is painful.
Question: Procedures in the clinic that require additional training from the Advanced Practice Nurse to be performed are recognized by CMS as Provider- Performed Microscopy Procedures (PPM). Which of the following is NOT a PPM procedure per CMS guidelines?a.Urinalysis
bPoint of Care Glucose
cWet Mount
d Semen Analysis
Answer: B. Point of Care Glucose
Rationale for why the answer is correct: Point of Care Glucose testing is NOT a PPM procedure because it is a simple test performed at bedside or the point of care. Tests performed near the patient, including bedside, are waived by CMS under the Clinical Laboratory Improvement Amendment (CLIA) and do not require clinician oversight (provider performed).
LabQuestion: A provider sends off a complete blood count (CBC) to confirm a differential diagnosis of anemia in a female. What lab value would RULE IN the diagnosis of anemia?
a. Hemoglobin 10 g/dL
b. Hematocrit 39%
c. MCV 90 fl
d. WBC 6 K/uL
Answer: a. Hemoglobin 10 g/dL
Rationale for why the answer is correct: The normal value for Hemoglobin in a female is 12 to 14 g/dL, therefore 10 g/dL is low, indicating anemia. The other values are within normal range.
Site for question/rationale: Differential Diagnosis for Fatigue @ 8minutes:0seconds from Module 1: Diagnostic Reasoning/SOAP Note.
Question: A 29-year-old female is sent to the Emergency Care Center from their PCP for possible appendicitis. You send off a CBC, and the WBC comes back greater than 20,000. What is NOT reasonable to do next?
a. Consult the surgery team on call
b. Order a urinalysis to check for pregnancy
c. Order a STAT CT abdomen/pelvis
d. Call the PCP for the date of the patient’s last colonoscopy
Answer: d. Call the PCP for the date of the patient’s last colonoscopy
Rationale for why the answer is correct: With appendicitis, a WBC value greater than 20,000 indicates perforation. It is reasonable to consult surgery, check for pregnancy status, and confirm diagnosis with CT scan. It is not reasonable to work up preventative care at this time.
Site for question/rationale: Abdominal lab/tests presentation @ 10minutes:30seconds, found in Module 2 under Abdominal/Reproductive Health.
Question: Mr. Johnson is in the clinic today with complaints of frequent and painful urination. What test would you NOT expect to see ordered on his visit?
a. Urinalysis
b. PSA
c. Renal Function Panel
d. CT scan abdomen
Answer: CT scan abdomen
Rationale for why the answer is correct: Mr. Johnson likely has benign prostatic hyperplasia (BPH). Urinalysis, PSA, and renal function panel support this diagnosis. A CT scan is not indicated at this time for a diagnosis of BPH.
Site for question/rationale: Male Reproductive Health Presentation @ 4mintues:20seconds, found in Module 2 Abdominal/Reproductive Health
Question: You are the PCP for a 61-year-old postmenopausal female and want to perform education on the importance of Bone Density Scans. What factor would INCREASE your patient’s risk of osteoporosis?
a. Hormone replacement therapy (HRT) at age 59 years
b. Nonsmoker
c. African American race
d. Long-term steroid use related to asthma
Answer: d. Long-term steroid use related to asthma
Rationale for why the answer is correct: Long term steroid use increases the risk for osteoporosis. Not receiving HRT, a history of smoking, or white/Asian decent increase the risk of osteoporosis.
Site for question/rationale: Women’s Health- Preventative Care presentation @ 4minutes:30seconds, found in Module 2: Abdominal/Reproductive Health
Question: To determine whether a woman is pregnant, which type of diagnostic test should you perform first? A. PCR amplification pregnancy test B. Quantitative pregnancy test C. Rapid plasma reagin (RPR) test D. Qualitative pregnancy test
Answer: D. Qualitative pregnancy test
Rationale for why the answer is correct: To determine pregnancy, a simple qualitative (yes or no) test that can be done in the office should be your first step. A qualitative test will give you the levels of hormones to determine if the pregnancy is progressing. An RPR test is used to determine the presence of syphilis, and a PCR amplification pregnancy test does not exist
Question: Which of the following is not an example of Point-of-Care Testing (POCT)? A. Urine STD test B. Qualitative pregnancy test C. Quantitative hCG test D. Chem 8 panel
Answer: C. Quantitative hCG test
Rationale for why the answer is correct: The serum quantitative hCG test requires for a blood sample to be analyzed by a lab; the other tests are examples of POCT.
Site for question/rationale: “Women’s Health” presentation, slide 6; “Women’s Health Overview of Diagnostics” presentation, slide 30
Question: Which of the following is considered the gold standard for testicular cancer diagnosis? A. Chest CT scan B. Scrotal ultrasound C. Abdominal CT scan D. Biopsy
Answer: B. Scrotal ultrasound
Rationale for why the answer is correct: An ultrasound of the scrotum is considered the gold standard for the diagnosis of testicular cancer.
Site for question/rationale: “Male Reproductive” presentation, slide 7
Question: Which of the following is a common challenge novice practitioners face when developing a differential diagnosis list?
a) Finding the correct ICD codes for insurance reimbursement
b) Premature Closure or Diagnosis Discarding
c) Prioritizing the differential diagnosis in an appropriate order
d) Asking more experienced providers for assistance when developing a list
Answer: Premature Closure or Diagnosis Discarding
Rationale for why the answer is correct: Novice practitioners are often faced with a mountain of information to learn about thousands of diseases and the breadth of knowledge of the provider is correlated with the depth of one’s differential diagnosis. Novice providers typically do not have the vast exposure to various illnesses that seasoned practitioners do. A disease cannot be diagnosed and treated unless it is known to the provider.
Site for question/rationale: Rhoads, J., & Jensen, M. M. (2015). In Differential diagnosis for the advanced practice nurse (p. 20). Springer Publishing Company, LLC
Question: Which of the following total bilirubin levels could produce jaundice?
a) 2.2 mg/dL
b) 1.8 mg/dL
c) 3.2 mg/dL
d) 2.4 mg/dL
Answer: 3.2 mg/dL
Rationale for why the answer is correct: Total bilirubin levels must be above 2.5mg/dL to produce jaundice.
Site for question/rationale: CMP Handout
Other than a parasitic infection, which of the following is a common cause of elevated eosinophils in industrialized countries? a) Allergies b) Bacterial Infection c) Viral Infection Fungal Infection
Answer: allergies
Rationale for why the answer is correct: Causes of elevated eosinophils in industrialized countries is allergies.
Site for question/rationale: CBC Handout
Question: A 52-year-old male come into the emergency room with a chief complaint of abdominal pain. Upon further evaluation, the patient describes the pain as “intense” and states that “it does not let up”. Which of the following is a potential diagnosis based off of these symptoms that the provider must not miss?
a) Constipation
b) Bowel Obstruction
c) Diarrhea
d) Prostatitis
Answer: Bowel Obstruction
Rationale for why the answer is correct: Ischemic pain is often described as intense and continuous. Strangulation of the bowel from an obstruction is a common cause of ischemic pain.
Site for question/rationale: Rhoads, J., & Jensen, M. M. (2015). In Differential diagnosis for the advanced practice nurse (p. 25). Springer Publishing Company, LLC
Question: An 18-year-old male comes to the clinic for evaluation of penile lesions after participating in unprotected sex. The patient states he is sexually active, but with one partner whom he does not wear protection with. The patient states he is in his first semester of college and is “more stressed” than he thought. He describes the lesions as painful and occasionally itchy but denies any rashes. Which of the following should the provider put as the lead differential diagnosis?
a) Human Papillomavirus
b) Syphilis
c) Genital Warts
d) Herpes
Answer: Herpes
Rationale for why the answer is correct: Herpes is a sexually transmitted disease that has the characteristics of lesions that are painful, itchy, but does not have a rash.
Site for question/rationale: Rhoads, J., & Jensen, M. M. (2015). In Differential diagnosis for the advanced practice nurse (p. 412). Springer Publishing Company, LLC.
Question: A 26-year-old female comes to the clinic for vaginal irritation. The patient states she is sexually active and recently had unprotected sex with an individual she is not in a relationship with. She states she is having yellowish-greenish discharge that is foul-odorous and causes a burning pain on urination. Which of the following should be the lead diagnosis in the provider’s list of differential diagnosis?
a) Bacterial Vaginosis
b) Candidal vaginitis
c) Atrophic Vaginitis
d) Trichomonal Vaginitis
Answer: Trichomonal Vaginitis
Rationale for why the answer is correct: Trichomonal Vaginitis is a sexually transmitted infection caused by Trichomonas vaginalis. Its symptoms are notable for discharge that is diffuse, malodorous, and yellowish greenish. Patients are at an increased risk for contracting this illness when that participate in risky sexual behavior (i.e., no protection, multiple partners).
Site for question/rationale: Rhoads, J., & Jensen, M. M. (2015). In Differential diagnosis for the advanced practice nurse (p. 403). Springer Publishing Company, LLC
Question: When does the clinician begin formulating a list of differential diagnosis?
a) After reading the nurse’s triage, before seeing the patient
b) During the initial assessment of the patient’s age, gender, race, appearance, and presenting problem.
c) After the complete physical exam
d) During the planning stage
Answer: During the initial assessment of the patient’s age, gender, race, appearance, and presenting problem.
Rationale for why the answer is correct: The generation of hypothesis begins upon initial assessment of the patient. Age is often the most significant variable in narrowing the probabilities of a hypothesis. Gender, race, appearance, and the patient’s chief complaint assist the provider in formulating an initial list of differential diagnosis as they can quickly rule a disease process in or out.
Site for question/rationale: Dains, J.E., Baumann, L.C. & Scheibel, P. (2015). Advanced Health Assessment and Clinical Diagnosis in Primary Care (p. 1).
Question: All of the following are important to think about when ordering diagnostic testing EXCEPT:
A. Pretest probability
B. What you want to do with a test (rule in or rule out a disease)
C. Think about what you are going to do with the results of the test (implications)
D. The patients insurance coverage
Answer: D. The patient’s type of insurance coverage
Rationale for why the answer is correct: Accurately determining pretest probability will allow you to determine if you want to rule in or rule out a disease. Both of these are so important to think about when ordering diagnostic test but many providers skip this step. The patients TYPE (key word) of insurance coverage shouldn’t play a role in important factors when thinking about ordering diagnostic testing.
Question: ALK (Alkaline Phosphatase) increases in all of the following conditions EXCEPT: A. Asthma B. Pregnancy C. Liver problems D. Bone cancer
Answer: A. Asthma
Rationale for why the answer is correct: ALK will increase with ductal cell problems, gallbladder, pancreas and liver problems, pregnancy, and bone problems (growth, cancer, and fractures). Having asthma does not affect your ALK lab.
Question: You receive your patients BMP lab results back and notice that the patient’s potassium is low. As an APRN, you know that which of the following causes the patients potassium to be low: A. Rental failure B. Nausea and vomiting C. DKA D. Trauma
Answer: B. Nausea and vomiting
Rationale for why the answer is correct: Renal failure, DKA, and trauma all can be causes for HIGH potassium while nausea and vomiting is the only choice that causes low potassium.
Site for question/rationale: Diagnostics-BMP lab video by Shelley Seth
Question: When examining the cervix during a yearly well woman exam, the provider knows they must look for what key finding A. Position of the cervix B. Lesions on the cervix C. Scars on the cervix D. Texture of the cervix
Answer: B. Lesions on the cervix
Rationale for why the answer is correct: Lesions on the cervix are a key aspect of a pelvic exam. Lesions could indicate things like cervical cancer or an STI. The other answer choices are not key findings you look for when observing the cervix.
Site for question/rationale: Pg. 8 in Rhoads Differential Diagnosis book.
Question: Pertinent positive symptoms that would indicate a possible pelvic inflammatory disease (PID) include all of the following EXCEPT A. Burning on urination B. Greenish vaginal discharge C. Fever and lower abdominal pain D. Normal regular menses
Answer: D Normal regular menses
Rationale for why the answer is correct: Normal, regular menses wouldn’t indicate PID. However, burning on urination, greenish vaginal discharge and fever/lower abdominal or pelvic pain would.
Site for question/rationale: Rhodes Differential Diagnosis book Pg. 11
Question: If a patient has a high probability of a disease, which step would you take next based on test and treatment thresholds? A. Treat Empirically B. Send out for further testing C. No further interventions D. Follow up in a week
Answer: A
Rationale for why the answer is correct: A- A patient with signs and symptoms of a condition that are pathognomonic, no further testing is necessary.
Site for question/rationale: (slide 8)
