Module 2 Kelsey Primary Care Chapter 3 Practice Questions

Question 1

The most common form of skin cancer is:

A) squamous cell.
B) basal cell.
C) malignant melanoma.
D) basal cell nevus syndrome.

Answer 1

B) basal cell.

Reason: Basal cell carcinoma is the most common skin cancer, accounting for approximately 75% of all skin cancers. It affects nearly 1 million people per year in the United States.

Question 2

The term that best describes an individual’s pattern of emotional, romantic, and sexual attraction to other people is:

A) gender identity.
B) sexual drive.
C) sexual motivation.
D) sexual orientation.

Answer 2

D) sexual orientation.

Reason: Sexual orientation is a general term used to describe an individual’s pattern of emotional, romantic, and sexual attraction to other people. Common variations include heterosexual, homosexual (gay or lesbian), bisexual, pansexual, and asexual. Gender identity is the internal sense that one is female, male, or some variation of both.

Question 3

A patient’s blood test returns with a positive hepatitis B surface antigen (HbsAg), which suggests:

A) chronic liver disease.
B) previous infection with hepatitis B virus.
C) acute or chronic infection with hepatitis B virus.
D) recent vaccination.

Answer 3

C) acute or chronic infection with hepatitis B virus.

Reason: Positive HBsAg indicates acute or chronic infection with hepatitis B virus. Positive IgM anti-HBc indicates acute infection and disappears in 3 to 13 months.

Question 4

Which one of the following is consistent with a diagnosis of mild persistent asthma?

A) Symptoms fewer than twice a week
B) Daily symptoms
C) Symptoms cause mild interference with normal activities
D) Nocturnal symptoms less than twice per month

Answer 4

C) Symptoms cause mild interference with normal activities

Reason: Mild persistent asthma is characterized by daytime symptoms greater than two times per week but not daily; nocturnal symptoms three to four times per month; use of a short-acting beta-agonist inhaler to manage symptoms more frequent than 2 days per week, no more than one time a day and not daily; two or more exacerbations requiring oral corticosteroids over the last year; mild interference with normal activity; FEV1 greater than 80% predicted (normal FEV1/FVC ratio for age between exacerbations).

Question 5

A patient presents with signs and symptoms suggestive of a superficial phlebitis. Physical findings in this patient would include:

A) tenderness in the area of the involved vein.
B) edema of the involved extremity.
C) pale, cool skin in the area of involved vein.
D) a palpable venous cord.

Answer 5

A) tenderness in the area of the involved vein.

Reason: A localized area of edema, erythema, and tenderness of the involved vein in an extremity are suggestive of superficial phlebitis.

Question 6

Which one of the following is not a common finding with an innocent murmur?

A) Heard best with the patient supine
B) Increases with increased cardiac output
C) Increases with a Valsalva maneuver
D) Most frequently heard during systole

Answer 6

C) Increases with a Valsalva maneuver

Reason: Innocent murmurs are usually soft (grade 1 or 2), medium-pitch, systolic murmurs. They are heard best with the patient supine and disappear with standing or straining. They increase with increased cardiac output—for example, with pregnancy, exercise, or fever.

Question 7

Client education concerning the use of bupropion hydrochloride (Zyban) for smoking cessation should include:

A) discontinue smoking prior to initiation of this medication.
B) the medication should not be used for more than 8 weeks.
C) initiate the medication at least 1 week prior to smoking cessation.
D) side effects may include drowsiness and weight gain.

Answer 7

C) initiate the medication at least 1 week prior to smoking cessation.

Reason: Individuals should initiate bupropion hydrochloride sustained-release tablets (Zyban) 1 to 2 weeks before they stop smoking. This medication reduces the cravings that smokers experience.

Question 8

For which one of the following women would VFA with vertebral imaging be most appropriate?

A) A 40-year-old woman with history of low trauma fracture during adulthood
B) A 40-year-old woman on long-term glucocorticoid treatment
C) A 60-year-old woman with measured height loss of 2 cm or more
D) A 60-year-old woman with BMD T-score at or below –1.5

Answer 8

C) A 60-year-old woman with measured height loss of 2 cm or more

Reason: Vertebral imaging for VFA is available on most modern DXA machines. Vertebral fracture is consistent with diagnosis of osteoporosis independent of BMD results; consider VFA for women who are age 70 or older if the BMD T-score is at or below 1.0; women age 65 to 69 if the BMD T-score is at or below 1.5; and postmenopausal women with a low trauma fracture during adulthood, historical height loss of 4 cm or more, prospective height loss of 2 cm or more, and recent or ongoing long-term glucocorticoid treatment.

Question 9

Education for the woman with SLE should include which of the following?

A) She should not use hormonal contraception.
B) She should receive annual live attenuated influenza vaccine.
C) If she becomes pregnant, a cesarean section will be planned to avoid the stress of labor.
D) She should use sunscreen and sun-protective clothing when outdoors.

Answer 9

D) She should use sunscreen and sun-protective clothing when outdoors.

Reason: Photosensitivity is a characteristic of systemic lupus erythematosus. Malar skin rash and rash on other exposed body parts may occur with sun exposure. Sun exposure may also exacerbate disease activity.

Question 10

The World Health Organization standard for anemia diagnosis in nonpregnant women is hemoglobin less than:

A) 10 g/dL.
B) 11 g/dL.
C) 12 g/dL.
D) 13 g/dL.

Answer 10

C) 12 g/dL.

Reason: According to the World Health Organization, anemia is defined as hemoglobin < 12 g/dL for women and < 13 g/dL for men.

Question 11

A 29-year-old female with migraine headaches receives subcutaneous sumatriptan for the first time. After the injection, she experiences tightness of the throat and chest, flushing, and dizziness. You recognize that these symptoms represent a(n):

A) allergic reaction to the medication.
B) anxiety attack related to her headache.
C) contraindication to subcutaneous administration of the medication.
D) side effect that usually abates in a few minutes.

Answer 11

D) side effect that usually abates in a few minutes.

Reason: Sumatriptan is used for abortive treatment of migraine headache and may initially cause tightness of the throat/chest, flushing, numbness, tingling, and dizziness. This side effect typically abates in a few minutes and is not a contraindication for future use.

Question 12

For the client described in question 31, initial management of symptoms may include:

A) alosetron.
B) fiber supplements.
C) lubiprostone.
D) trial of elimination of dairy products.

Answer 12

D) trial of elimination of dairy products.

Reason: A 2-week trial of lactose-free, fructose-free, or sorbitol-free foods (one at a time) may be considered to rule out food intolerance in a patient who has bloating, gas, abdominal distention, and diarrhea. Alosetron should be limited to use in women with severe chronic diarrhea–predominant IBS not responsive to conventional therapy. Lubiprostone and fiber supplements may be appropriate for the patient with constipation-dominant IBS.

Question 13

Which one of the following types of vaccinations should not be given during pregnancy?

A) Bacterial vaccines
B) Inactivated virus vaccines
C) Live attenuated virus vaccines
D) Immunoglobulins

Answer 13

C) Live attenuated virus vaccines

Reason: Live attenuated virus vaccines are contraindicated during pregnancy. Rubella, measles, mumps, varicella, zoster, and the intranasal form of influenza vaccine (LAIV) are all live attenuated viruses.

Question 14

The patient in question 42 denies weight loss, dysphagia, and dark, tarry stools. What is your next step?

A) Order an endoscopic exam.
B) Start her on H2-receptor blockers.
C) Tell her to eat a snack before bedtime.
D) Refer her to a gastroenterologist.

Answer 14

B) Start her on H2-receptor blockers.

Reason: GI referral and diagnostic evaluation are needed if symptoms are chronic or refractory to therapy; if esophageal complications are suspected; or if the patient has dysphagia, weight loss, or evidence of GI bleeding. H2-receptor blockers inhibit acid secretions and are effective for less severe GERD.

Question 15

Approximately what percentage of tuberculosis infections cause active disease?

A) 75%
B) 60%
C) 30%
D) 10%

Answer 15

D) 10%

Reason: The asymptomatic state (latent TB infection) may last months to years, with 10% of patients ultimately developing active TB.

Question 16

A 45-year-old female presents with RUQ pain that radiates to the right infrascapular area. The pain is described as colicky and was precipitated by eating pizza. Onset of the symptom was a few hours ago, and the pain is beginning to ease. There was associated nausea and vomiting. The initial study of choice in this patient is:

A) plain abdominal radiograph.
B) ultrasound.
C) CT.
D) percutaneous transhepatic cholangiogram.

Answer 16

B) ultrasound.

Reason: This patient’s symptoms are consistent with acute cholecystitis. Ultrasound has a 95% sensitivity in detecting stones in the gallbladder. It is the best noninvasive imaging technique to diagnose acute cholecystitis.

Question 17

SLE is usually characterized by:

A) periods of exacerbation and remission.
B) slow, steady disease progression.
C) initial symptoms of typical skin eruptions.
D) remission in pregnancy.

Answer 17

A) periods of exacerbation and remission.

Reason: SLE is a chronic, inflammatory, multisystem disorder of the immune system characterized by periods of remission and exacerbation, with the course of disease being unpredictable and highly variable.

Question 18

In the United States, the most common cause of community-acquired bacterial pneumonia is:

A) Streptococcus pneumoniae.
B) Streptococcus pyogenes.
C) Haemophilus influenzae.
D) Legionella pneumophilia.

Answer 18

A) Streptococcus pneumoniae.

Question 19

The most common reason for painless rectal bleeding with defecation is:

A) external hemorrhoids.
B) internal hemorrhoids.
C) rectal polyps.
D) colorectal cancer.

Answer 19

B) internal hemorrhoids.

Reason: Internal hemorrhoids originate above the anorectal line, are covered by nonsensitive rectal mucosa, and are usually painless. They may present with bright red bleeding during defecation.

Question 20

Referral for neurologic evaluation of headaches is indicated when:

A) new headaches occur in an individual older than 50.
B) there is a family history of stroke.
C) focal neurologic deficits precede headache episodes.
D) migraine headache lasts more than 12 hours.

Answer 20

A) new headaches occur in an individual older than 50.

Reason: Reasons for referral for neurologic evaluation of headaches include a new type of headache occurring in an individual older than 50 years of age, sudden onset of the worst headache ever experienced, headaches increasing in severity or frequency, headache initiated by exertion, focal neurologic symptoms persisting after headache onset, headache subsequent to head trauma, and any other indicators of a potentially serious secondary cause.

Question 21

A factor not associated with exacerbation of facial acne is:

A) hormonal cycling.
B) topical corticosteroids.
C) fried foods.
D) cosmetics.

Answer 21

C) fried foods.

Reason: Factors that can exacerbate acne include hormonal cycling, use of topical corticosteroids, and contact with irritant oils or cosmetics.

Question 22

A 24-year-old female client with major depression tells you that she feels as if her life is falling apart with no hope of improving. She recently lost her job, had to move out of her apartment, and now lives with her sister. Her risk factors for a suicide attempt include:

A) age between 20 and 30 years.
B) female gender.
C) current living situation.
D) sense of hopelessness.

Answer 22

D) sense of hopelessness.

Reason: Risk factors for suicide in the individual with major depressive order include, but are not limited to, sense of hopelessness, substance abuse/family history of substance abuse, prior suicide attempt/family history of suicide attempt, living alone, medical illness, advanced age, and male gender.

Question 23

Anticholinergic agents may be used in the treatment of:

A) stress incontinence.
B) urge incontinence.
C) vestibulitis.
D) vulvodynia.

Answer 23

B) urge incontinence.

Reason: Management/treatment of urge incontinence includes bladder retraining with scheduled voiding, biofeedback, Kegel exercises, avoidance of bladder irritants, and use of anticholinergic agents (oxybutynin chloride [Ditropan], tolterodine tartrate [Detrol]).

Question 24

Physiologic dependence on a substance is defined as evidence of withdrawal symptoms and/or:

A) craving or strong desire to use the substance.
B) inability to carry out major obligations due to the substance use.
C) markedly increased amounts of the substance needed to achieve intoxication or desired effect.
D) unsuccessful attempts to cut down on or control substance use.

Answer 24

C) markedly increased amounts of the substance needed to achieve intoxication or desired effect.

Reason: Physiologic dependence on a substance is defined as evidence of characteristic withdrawal syndrome or use of the substance to avoid withdrawal and/or tolerance in which markedly increased amounts of the substance are needed to achieve intoxication or the desired effect.

Question 25

Physical findings that help the clinician make a diagnosis of bulimia would include:

A) erosion of tooth enamel.
B) hypotension.
C) presence of lanugo.
D) stress fractures.

Answer 25

A) erosion of tooth enamel.

Reason: Erosion of tooth enamel may occur in the individual with bulimia nervosa as a result of frequent induced vomiting that exposes enamel to gastric acid.

Question 26

Infiltrative ophthalmopathy (exophthalmos) is unique to:

A) Graves’ disease.
B) Hashimoto’s thyroiditis.
C) toxic multinodular goiter.
D) papillary thyroid carcinoma.

Answer 26

A) Graves’ disease.

Reason: Hyperthyroidism caused by Graves’ disease is characterized by exophthalmos (“bug eye”)

Question 27

Physical examination and laboratory test findings expected with a diagnosis of infectious mononucleosis include:

A) elevated basophils and eosinophils.
B) erythematous rash in the groin and axillary areas.
C) purulent nasal discharge.
D) tonsillar enlargement with exudate.

Answer 27

D) tonsillar enlargement with exudate.

Reason: Physical examination findings with infectious mononucleosis include tonsillar enlargement with exudate; palatal petechiae at the junction of the hard and soft palates (25% of cases); lymphadenopathy, particularly involving the posterior cervical chain; fever compatible with severity of infection; hepatomegaly (25%); and splenomegaly (50%). CBC will reveal lymphocytic leukocytosis with atypical lymphocytes common.

Question 28

A 65-year-old menopausal female had a deep vein thrombosis in her leg 2 years ago. She has a BMD T-score of –1.75. Which of the following medications would be the most appropriate for this client to prevent osteoporosis?

A) Alendronate
B) Calcitonin
C) Estrogen
D) Raloxifene

Answer 28

A) Alendronate

Reason: Alendronate is indicated for prevention and treatment of osteoporosis. Given the patient’s history of DVT, she should not use estrogen therapy or an estrogen agonist/antagonist because of the possible increased risk of a thromboembolic event. Calcitonin is indicated for treatment only; it is not appropriate for prevention.

Question 29

Good dietary sources for folic acid include:

A) chicken.
B) dried beans.
C) egg yolks.
D) milk.

Answer 29

B) dried beans.

Reason: Dried beans, leafy green vegetables, citrus fruits and juices, and fortified cereals are good dietary sources of folic acid.

Question 30

PrEP is contraindicated in individuals who:

A) are not in a monogamous relationship.
B) are pregnant.
C) have hepatitis B.
D) have severe renal function disorders.

Answer 30

D) have severe renal function disorders.

Reason: PrEP is contraindicated for individuals with severe renal function disorders. Laboratory tests for prospective PrEP recipients include renal function tests. Renal function tests should be repeated every 6 months while on PrEP.

Question 31

USPSTF recommendations for routine breast cancer screening include:

A) biennial mammograms starting at age 50.
B) breast self-examination starting at age 21.
C) clinical breast examination annually starting at age 30.
D) discontinue mammograms after age 65.

Answer 31

A) biennial mammograms starting at age 50.

Reason: The USPSTF recommends biennial mammograms for women 50 to 74 years of age.

Question 32

A 60-year-old presents with a pearly, translucent smooth papule with rolled edges and surface telangiectasias on her forehead. She notes that it has been there for at least a year but has recently increased in size. The lesion most likely represents which one of the following?

A) Squamous cell carcinoma
B) Basal cell carcinoma
C) Seborrheic keratosis
D) Malignant melanoma

Answer 32

B) Basal cell carcinoma

Reason: Basal cell carcinoma has several clinical variants; nodular basal cell is most common. Basal cell carcinoma presents as waxy, semitranslucent nodules with rolled borders that may have central ulcerations and telangiectasias. These nodules are slow-growing lesions.

Question 33

Diagnosis of SLE is made by:

A) abnormal ANA titer.
B) presence of at least four combined signs, symptoms, and laboratory findings.
C) presence of a specific hematologic disorder on a single occasion.
D) identification of an immunologic disorder such as abnormal anti-DNA.

Answer 33

B) presence of at least four combined signs, symptoms, and laboratory findings.

Reason: The American College of Rheumatology has set the SLE diagnostic criteria to include the presence of at least 4 of 11 criteria. These criteria include presence of specific dermatologic symptoms; arthritis; serositis; renal, neurologic, and hematologic conditions; positive ANA test; and other immunologic positive tests.

Question 34

Which one of the following is not suspected in the etiology of RA?

A) Autoimmune component
B) Environmental factors as triggers
C) Genetic predisposition
D) Joint trauma

Answer 34

D) Joint trauma

Reason: The exact etiology of RA is unknown, although it is suspected to have an autoimmune component influenced by genetic, environmental, and perhaps hormonal factors.

Question 35

RICE therapy refers to a:

A) nonpharmacologic therapy plan for muscle injuries.
B) bland diet therapy for nausea and vomiting.
C) weight-loss plan.
D) combination therapy for peptic ulcer disease

Answer 35

A) nonpharmacologic therapy plan for muscle injuries.

Reason: RICE is the mnemonic to remember the initial therapeutic strategy for muscle injuries. It stands for: Rest or immobilization of injured part Ice or application of cold Compression, elastic wrap Elevation of affected area

Question 36

Assuming a diagnosis of GERD for the patient in questions 42 and 43, you would advise that:

A) she probably has a hiatal hernia causing the reflux.
B) she will likely require surgery.
C) she should avoid dairy products.
D) high-fat foods and chocolate may aggravate the problem.

Answer 36

D) high-fat foods and chocolate may aggravate the problem.

Reason: High-fat foods, chocolate, and peppermint decrease lower esophageal pressure, making reflux more likely.

Question 37

The condition accounting for 90% of hyperthyroidism cases is:

A) Graves’ disease.
B) thyroiditis.
C) toxic goiter.
D) adenoma.

Answer 37

A) Graves’ disease.

Reason: Graves’ disease accounts for 90% of hyperthyroidism cases. This autoimmune condition is characterized by excess synthesis and secretion of thyroid hormone caused by antibodies that stimulate TSH receptors.

Question 38

A systolic click preceding a mid- to late systolic murmur is most likely caused by which one of the following?

A) Aortic stenosis
B) Mitral valve prolapse
C) Mitral valve stenosis
D) Idiopathic hypertrophic subaortic stenosis

Answer 38

B) Mitral valve prolapse

Reason: A mid- or late systolic click is usually caused by mitral valve prolapse. A late systolic murmur may be present in case of mitral valve regurgitation.

Question 39

Which one of the following statements concerning bulimia is correct?

A) Age of onset is usually early adolescence.
B) Amenorrhea is usually present.
C) The mortality rate for bulimia is higher than that for anorexia nervosa.
D) Impulsive behavior is a common characteristic.

Answer 39

D) Impulsive behavior is a common characteristic.

Reason: The typical age of onset for bulimia nervosa is late adolescence to early adulthood. The mortality rate for this eating disorder is lower than that for anorexia nervosa. Impulsive behaviors such as shoplifting, alcohol and drug abuse, and unsafe sexual behaviors are characteristic of bulimia nervosa.

Question 40

Which of the following statements regarding influenza vaccination during pregnancy is true?

A) Influenza vaccination should be given only if the individual has health problems that place her at high risk for complications with influenza.
B) Influenza vaccination may be safely given in any trimester of pregnancy.
C) Intranasal influenza vaccine is recommended for pregnant individuals to reduce the chances of side effects.
D) Influenza vaccination is contraindicated during pregnancy.

Answer 40

B) Influenza vaccination may be safely given in any trimester of pregnancy.

Reason: Administration of IIV is recommended for all individuals who will be in the second or third trimester of pregnancy during the influenza season. IIV is considered safe at any stage in pregnancy and during lactation. LAIV given intranasally is contraindicated in pregnancy.

Question 41

A 30-year-old client is taking an ACE inhibitor for hypertension and her BP today is 130/78 mm Hg. She is sexually active and is not currently using any contraception. Appropriate counseling would include:

A) she should increase the dosage of the ACE inhibitor to better control her BP prior to planning a pregnancy.
B) she should not take any antihypertensive medication if she is planning a pregnancy.
C) the best contraceptive choice would be combination hormonal contraception with the transdermal patch.
D) the use of an ACE inhibitor is contraindicated during pregnancy because it is associated with fetal anomalies.

Answer 41

D) the use of an ACE inhibitor is contraindicated during pregnancy because it is associated with fetal anomalies.

Reason: ACE inhibitors (e.g., captopril, enalapril) and ARBs (e.g., losartan, valsartan) are both contraindicated during pregnancy because of associated fetal anomalies.

Question 42

The primary goal of pharmacologic therapy for acute viral hepatitis B is:

A) prevention of secondary infection.
B) relief of symptoms.
C) reduction of infectivity.
D) prevention of complications.

Answer 42

B) relief of symptoms.

Reason: Nonpharmacologic treatment for acute hepatitis B infection includes activity as tolerated, hydration, adequate caloric intake in small feedings, discontinuation of all but essential medications, and avoidance of alcohol. Antiemetics may be indicated for nausea.

Question 43

A 42-year-old woman had a diagnosis of acute HBV infection 6 months ago. Expected laboratory test results, if the infection is resolved and she is now immune to HBV infection, include a positive:

A) HBV DNA test.
B) HBV e antigen test.
C) HBV surface antibody test.
D) HBV surface antigen test.

Answer 43

C) HBV surface antibody test.

Reason: A positive HBV surface antibody test indicates resolution of HBV infection and immunity to future infection. The test will also be positive in individuals with immunity as a result of HBV vaccination.

Question 44

An 18-year-old presents with open and closed comedones without inflammation. The most appropriate first-line treatment would be:

A) topical antibiotics.
B) oral tetracycline.
C) tretinoin cream (Retin-A).
D) isotretinoin (Accutane).

Answer 44

C) tretinoin cream (Retin-A).

Reason: Tretinoin cream is an effective comedolytic agent for mild, non-inflammatory acne that is applied topically to affected areas.

Question 45

A BMD test to screen for osteopenia/osteoporosis would be appropriate for all of the following women except:

A) a 40-year-old woman who smokes cigarettes and whose alcohol intake averages three drinks/day.
B) a 55-year-old woman who has a low BMI and her mother had a hip fracture at age 70.
C) a 60-year-old woman who has recently experienced a low-trauma fracture.
D) a 65-year-old woman who has no apparent risk factors associated with increased fracture risk.

Answer 45

A) a 40-year-old woman who smokes cigarettes and whose alcohol intake averages three drinks/day.

Reason: Screen all women 65 years of age or older for osteoporosis/osteopenia with a BMD test. Screen postmenopausal women younger than 65 years of age with risk factors associated with increased fracture risk. Risk factors include low BMI, history of low-trauma fracture, smoking, alcohol intake ≥ three drinks/day, and family history of hip fracture or osteoporosis.

Question 46

Which of the following is true concerning the treatment of RA?

A) NSAIDs and corticosteroids are important for long-term management.
B) The main mechanism of action of DMARDs is analgesia.
C) DMARDs and immunomodulating biologic agents may be combined if monotherapy is not effective.
D) Methotrexate is the preferred DMARD for use by pregnant women with RA.

Answer 46

C) DMARDs and immunomodulating biologic agents may be combined if monotherapy is not effective.

Reason: DMARDs are the preferred therapy for long-term management of RA. Immunomodulating biologic agents are commonly used for individuals with RA who have toxicity and/or intolerance, or who cannot find relief with nonbiologic DMARDs; they may be used as initial therapy for individuals with severe RA, and they may be used in combination with DMARDs.

Question 47

Metabolic syndrome is defined as having at least three of a set of five risk factors. One of these risk factors for women is:

A) blood pressure of 150/90 mm Hg or higher.
B) HDL-C of 40 mg/dL or less.
C) triglycerides of 200 mg/dL or higher.
D) waist circumference greater than 35 inches.

Answer 47

D) waist circumference greater than 35 inches.

Reason: Metabolic syndrome is defined as presence of at least three of five risk factors. For women, these include abdominal obesity/ waist circumference > 35 inches, triglycerides ≥ 150 mg/dL, HDL-C < 50 mg/dL, blood pressure ≥ 130/85, and fasting glucose ≥ 110 mg/dL.

Question 48

Those individuals most often affected by infectious mononucleosis are:

A) prepubertal children.
B) women of reproductive age.
C) females at any age.
D) people in their teens to early twenties.

Answer 48

D) people in their teens to early twenties.

Reason: Most clinically apparent mononucleosis infections occur in individuals 10 to 30 years old, with a peak rate in those ages 15 to 19 years old.

Question 49

Which of the following is not a risk factor for malignant melanoma?

A) Hispanic ethnicity
B) Multiple pigmented nevi
C) Severe childhood sunburn
D) Family history

Answer 49

A) Hispanic ethnicity

Reason: Risk factors for malignant carcinoma include history of changing mole, family and/or personal history of melanoma, history of nonmelanoma skin cancer, atypical nevus syndrome, fair complexion, and tendency to sunburn.

Question 50

Which of the following, if left untreated, may progress to squamous cell carcinoma?

A) Keratosis pilaris
B) Seborrheic keratosis
C) Actinic keratosis
D) Lichen planus

Answer 50

C) Actinic keratosis

Reason: Sixty percent of squamous cell carcinomas occur at the site of previous actinic keratosis.

Question 51

The mechanism of action for the drug ezetimibe used in combination with a moderate-intensity statin for treatment of dyslipidemia in some individuals is:

A) binding cholesterol bile acids to increase excretion.
B) decreasing synthesis of LDL.
C) increasing synthesis of HDL.
D) inhibiting cholesterol absorption.

Answer 51

D) inhibiting cholesterol absorption.

Reason: Ezetimibe is a drug considered for use in combination with a moderate-intensity statin for individuals with dyslipidemia who need but cannot tolerate high-intensity statins. This drug works by inhibiting cholesterol absorption.

Question 52

The most common type of anxiety disorder is:

A) generalized anxiety disorder.
B) specific phobia.
C) panic disorder.
D) post-traumatic stress disorder.

Answer 52

B) specific phobia.

Reason: Anxiety is one of the most prevalent psychiatric disorders. Specific phobia is the most common type (25%), followed by social phobia (13%), PTSD (12% in women), general anxiety disorder (5%), and panic disorder (3.5%).

Question 53

Risk factors for SLE include all of the following except:

A) female gender.
B) reproductive age group.
C) first-degree relative with SLE.
D) Caucasian race.

Answer 53

D) Caucasian race.

Reason: Risk factors for SLE include being of African American or Hispanic descent or having a first-degree relative with SLE.

Question 54

A patient presents with moderate scratchy sensation in her right eye and a watery discharge that started about 24 hours ago. She states she is just getting over a cold. Appropriate treatment would include:

A) antibiotics.
B) comfort measures only.
C) mast cell stabilizer.
D) topical antihistamine.

Answer 54

B) comfort measures only.

Reason: Viral conjunctivitis usually has an acute onset, mild symptoms in one or both eyes, and a watery discharge. It is may be associated with an upper respiratory infection and is self-limited. Cold compresses and liquid tears may offer relief of symptoms.

Question 55

A 35-year-old overweight female presents with intermittent heartburn for several months. The use of Tums antacids provides temporary relief. During the past week, she has been awakened during the night with a burning sensation in her chest. She is not taking any other medications and has no major health problems. What additional information would support a diagnosis of GERD as the cause of her symptoms?

A) She has occasional nausea and vomiting.
B) She often notes coughing during the night and a bad taste in her mouth.
C) The pain is usually relieved by eating.
D) Constipation has been a chronic problem and she uses laxatives twice a week.

Answer 55

B) She often notes coughing during the night and a bad taste in her mouth.

Reason: Acid regurgitation with GERD is most common when reclining, straining, bending, or stooping. This can cause coughing and a bad taste in the mouth.

Question 56

Osteoarthritis may be distinguished from RA by:

A) asymmetry of joint involvement.
B) erythema of affected joints.
C) constant pain not affected by rest.
D) presence of systemic symptoms.

Answer 56

A) asymmetry of joint involvement.

Reason: Symptoms are often asymmetrical with osteoarthritis. Pain is aggravated by joint use and subsides with rest. Physical findings for the affected joints may include decreased range of motion, crepitus with movement, minimal local warmth without erythema, and enlargement of distal and proximal interphalangeal joints.

Question 57

An example of secondary prevention is providing:

A) immunizations.
B) health promotion counseling to reduce risk factors for disease.
C) health care that focuses on restoring optimal function following diagnosis of disease.
D) screening tests for early detection of disease states.

Answer 57

D) screening tests for early detection of disease states.

Reason: Secondary prevention is the delivery of healthcare services focused on early detection of disease states as well as interventions that limit severity and morbidity (e.g., identification of risk factors, screening tests, counseling/education).

Question 58

An adult with a blood pressure (BP) of 136/84 and a calculated 10-year risk of atherosclerotic cardiovascular disease less than 10% should be:

A) advised this is within normal limits and to have BP checked annually.
B) advised on lifestyle modifications and return to have BP checked in 3 to 6 months.
C) started on one anti-hypertensive medication and return to have BP checked in 1 month.
D) started on two anti-hypertensive medications from different classes and return to have BP checked in 1 month.

Answer 58

B) advised on lifestyle modifications and return to have BP checked in 3 to 6 months.

Reason: An adult with a BP of 136/84 would be classified as having Stage I hypertension (SBP 130–139 and/or DBP 80–9). If this individual has a calculated 10-year risk of atherosclerotic cardiovascular disease less than 10%, lifestyle modifications are recommended as first line therapy with a recheck of BP in 3 to 6 months.

Question 59

Which one of the following is considered to have a positive PPD reaction?

A) A 35-year-old healthy individual with a tuberculin reaction of 5 mm who has been in close contact with a TB-infected person
B) A 45-year-old individual who was recently released from one year of incarceration with a tuberculin reaction of 5 mm
C) A 28-year-old individual who has no risk factors with a tuberculin reaction of 10 mm
D) A 40-year-old individual with a tuberculin reaction of 5 mm and who has recently immigrated from a country with high TB prevalence

Answer 59

A) A 35-year-old healthy individual with a tuberculin reaction of 5 mm who has been in close contact with a TB-infected person

Reason: A 5-mm or greater skin reaction on the PPD test is considered positive in individuals who are HIV positive, immunocompromised, with abnormal chest radiograph findings consistent with healed TB lesions, or in recent close contact with a TB-infected person.

Question 60

A client who has been experiencing fatigue, insomnia, difficulty concentrating, and feelings of worthlessness for the past 2 weeks would meet the DSM-5 criteria for a major depressive disorder if she also has:

A) loss of interest in her usual activities.
B) psychomotor retardation.
C) psychosomatic complaints.
D) suicidal ideation.

Answer 60

A) loss of interest in her usual activities.

Reason: Loss of interest in usual activities and/or sad or depressed mood most of the day, every day, are required for diagnosis of major depressive disorder, along with a complex of symptoms that may include fatigue, insomnia, difficulty concentrating, feelings of worthlessness, and others.

Question 61

A patient with a history of radioactive iodine treatment for Graves’ disease presents with fatigue, weight gain, and dry skin. You would expect this patient to have which one of the following laboratory findings?

A) Low T3, low TSH, high total T4
B) Low TSH, high total T4, normal free T4
C) High TSH, low free T4
D) High TSH, high free T4

Answer 61

C) High TSH, low free T4

Reason: Radioactive iodine treatment for Graves’ disease usually results in long-term hypothyroidism; this outcome occurs in 70% of patients at 10 years.

Question 62

Which one of the following is no longer a criterion for a diagnosis of anorexia nervosa according to the DSM-5 criteria?

A) Amenorrhea
B) Disturbed body image
C) Intense fear of gaining weight
D) Significantly low body weight

Answer 62

A) Amenorrhea

Reason: DSM-5 criteria for the diagnosis of anorexia nervosa include restriction of intake relative to requirements leading to significantly low body weight in the context of age, gender, and physical health; intense fear of gaining weight and/or persistent behavior that interferes with weight gain, even though the patient is at a significantly low body weight; and disturbed body image.

Question 63

Fibromyalgia most commonly presents with which one of the following signs and symptoms?

A) Abrupt onset of proximal muscle weakness
B) Widespread musculoskeletal pain and tender points
C) Effusion of involved joints with mild local warmth
D) Subcutaneous nodules

Answer 63

B) Widespread musculoskeletal pain and tender points

Reason: Fibromyalgia is a syndrome characterized by chronic fatigue and by generalized, widespread musculoskeletal pain and stiffness associated with the finding of characteristic tender points of pain on physical examination.

Question 64

Management of constipation should include:

A) routine use of stool softeners.
B) bulk-forming agents for acute constipation.
C) hyperosmolar laxatives (sorbitol) as initial treatment for chronic constipation.
D) saline laxatives (milk of magnesia) for acute constipation.

Answer 64

D) saline laxatives (milk of magnesia) for acute constipation.

Reason: Saline laxatives draw water into the intestinal lumen, causing fecal mass to soften and swell; swelling stretches the intestinal lumen and simulates peristalsis.

Question 65

Acute otitis media is characterized by all of the following physical examination findings except:

A) distorted light reflex.
B) obscured bony landmarks.
C) erythema of the ear canal.
D) postauricular lymphadenopathy.

Answer 65

C) erythema of the ear canal.

Reason: Common physical examination findings with otitis media include a full or bulging tympanic membrane with absent or obscured landmarks, distorted light reflex, and postauricular or cervical lymphadenopathy.

Question 66

The leading killer of women in the United States is:

A) coronary heart disease.
B) lung cancer.
C) ovarian cancer.
D) violence.

Answer 66

A) coronary heart disease.

Reason: Coronary heart disease is the cause of death for one out of every three women each year.

Question 67

Which one of the following statements is correct concerning BMD testing?

A) Test results are most predictive of bone fracture when done on an annual basis.
B) The T-score compares the BMD of the client with that of an age-matched normal adult.
C) BMD T-scores should be combined with bone X-ray to confirm osteoporosis.
D) Treatment decisions based on T-scores may vary according to risk factors.

Answer 67

D) Treatment decisions based on T-scores may vary according to risk factors.

Reason: Pharmacologic treatment is considered for postmenopausal women presenting with any of the following criteria: hip or vertebral fracture; T-score of 2.5 or less at the femoral neck or spine after appropriate evaluation to exclude secondary causes; T-score between 1.0 and 2.5 at femoral neck or spine and 10-year probability of hip fracture of 3% or greater; or a 10-year probability of major osteoporotic-related fracture of 20% or greater based on U.S.-adapted WHO algorithm.

Question 68

Risk of vertical transmission of the HIV virus has been reduced by:

A) artificial rupture of membranes at 38 weeks’ gestation.
B) antiretroviral treatment of infants.
C) stopping maternal therapy in pregnancy so as to reduce CD4+ counts.
D) antiretroviral therapy during pregnancy.

Answer 68

D) antiretroviral therapy during pregnancy.

The risk of vertical transmission of the HIV virus from an HIV-positive mother to her infant may be reduced to less than 1% if the mother receives multiagent antiretroviral therapy and has an undetectable viral load at delivery.

Question 69

A 35-year-old female was diagnosed with Hashimoto’s thyroiditis and placed on 0.1 mg of levothyroxine. After 1 week of treatment, the patient states that she still feels fatigued. How would you manage this patient?

A) Increase the dose of levothyroxine to 0.125 mg.
B) Schedule an appointment this week to have a TSH drawn.
C) Add propranolol to the regimen.
D) No change in levothyroxine is indicated at this time.

Answer 69

D) No change in levothyroxine is indicated at this time.

Levothyroxine has a half-life of 6 days and achieves a steady state slowly. Adjust the dose every 6 weeks until TSH normalizes.

Question 70

Severe exacerbations in an individual with intermittent (step 1) asthma are appropriately treated with:

A) mast-cell stabilizers.
B) short-acting inhaled β2 agonists.
C) systemic corticosteroids.
D) theophylline.

Answer 70

C) systemic corticosteroids.

Severe exacerbations (peak flow < 60%) of asthma may require the use of a short course of oral steroids for 5 to 10 days.

Question 71

Among the following causes of viral hepatitis, which is most likely to lead to chronic infection and is the most common reason for liver transplantation?

A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D

Answer 71

C) Hepatitis C

As many as 80% of patients with hepatitis C will develop chronic hepatitis; 20% to 30% eventually develop cirrhosis or hepatocellular carcinoma.

Question 72

Which one of the following is not a finding in asthma?

A) Shortened expiratory phase
B) Wheezing
C) Tachypnea and/or dyspnea
D) Diminished lung sounds

Answer 72

A) Shortened expiratory phase

Physical respiratory findings in asthma include hyperresonance with percussion, wheezing, prolonged expiratory phase, and diminished breath sounds; tachypnea; and dyspnea.

Question 73

The American College of Rheumatology (2010) classification criteria for a diagnosis of RA include:

A) fever.
B) elevated erythrocyte sedimentation rate.
C) joint erosion on radiography.
D) symmetrical joint involvement.

Answer 73

B) elevated erythrocyte sedimentation rate.

The 2010 American College of Rheumatology classification criteria for diagnosis of RA involves a score-based algorithm that includes joint involvement (stiffness, swelling), serology (RF, anti-citrullinated protein antibody), acute-phase reactants (C-reactive protein, erythrocyte sedimentation rate), and duration of symptoms.

Question 74

All of the following are known teratogens except:

A) alcohol.
B) methotrexate.
C) opioids.
D) statins.

Answer 74

C) opioids.

Question 75

Peptic ulcer disease associated with presence of H. pylori can be diagnosed by:

A) visualization of H. pylori on Gram-stained preparation.
B) negative urea breath analysis.
C) negative urease assay via endoscopy.
D) serology positive for H. pylori antibodies.

Answer 75

D) serology positive for H. pylori antibodies.

A serologic ELISA test detects IgG antibodies, indicating current or past infection with H. pylori. It may or may not revert to negative after treatment. A positive urea breath test indicates the presence of active H. pylori infection.

Question 76

Which one of the following is an expected finding in tinea unguium?

A) Hair loss in affected areas
B) Negative KOH slide preparation
C) Yellowish, thickened nails
D) Crusted ulcerations

Answer 76

C) Yellowish, thickened nails

Tinea unguium is characterized by toenails being more frequently involved than fingernails and nails that are yellowish/thickened.

Question 77

A 20-year-old female presents with complaint of itching, and a red eye with a sticky, yellow discharge that started in one eye yesterday afternoon and this morning is in both eyes. She has no fever or other symptoms. The most likely diagnosis is:

A) allergic conjunctivitis.
B) bacterial conjunctivitis.
C) chemical exposure conjunctivitis.
D) viral conjunctivitis.

Answer 77

B) bacterial conjunctivitis.

Bacterial conjunctivitis has an acute onset with itchy sensation/discomfort and mucopurulent discharge beginning in one eye and spreading to the other eye.

Question 78

Using the CURB-65 criteria, a 65-year-old female with community-acquired pneumonia should be hospitalized if she develops:

A) blood pressure greater than 140/90 mm Hg.
B) confusion or disorientation.
C) dyspnea on exertion.
D) pleuritic chest pain.

Answer 78

B) confusion or disorientation.

CURB-65 criteria include confusion, uremia (BUN > 19 mg/dL), respiratory rate greater than 30 breaths per minute, blood pressure < 90 mm Hg systolic or < 60 mm Hg diastolic, and age 65 or older. If an individual meets two or more of the five CURB-65 criteria for community-acquired pneumonia, the patient should be hospitalized for treatment.

Question 79

Appendicitis typically presents with:

A) high fever as the initial symptom.
B) pain beginning in the RLQ.
C) diarrhea as the initial symptom.
D) pain in the periumbilical area followed by localization to the RLQ.

Answer 79

D) pain in the periumbilical area followed by localization to the RLQ.

Pain is the initial symptom in appendicitis, beginning in the epigastrium or periumbilical area and localizing to the RLQ after several hours.

Question 80

Which one of the following drugs decreases hepatic glucose production?

A) Biguanides (metformin)
B) Insulin
C) Meglitinides (repaglinide)
D) Sulfonylureas (glyburide, glipizide)

Answer 80

A) Biguanides (metformin)

Metformin, a biguanide, is an oral hypoglycemic used in the treatment of type 2 diabetes. It works by decreasing hepatic glucose production and intestinal absorption of glucose and by increasing peripheral glucose uptake and utilization

Question 81

Which of the following is not a recommended treatment for superficial thrombophlebitis?

A) Compression with an ace wrap
B) Elevation of affected limb
C) Heparin
D) NSAIDs

Answer 81

C) Heparin

Question 82

Antibiotic treatment should be initiated for the patient with sinusitis who has:

A) increased pain when he or she bends over or with sudden head movement.
B) symptoms present for 10 or more days without clinical improvement.
C) symptoms that started within the first week of onset of an upper respiratory infection.
D) yellow to green nasal discharge.

Answer 82

B) symptoms present for 10 or more days without clinical improvement.

Antibiotic treatment for acute sinusitis should be initiated if signs and symptoms are present for 10 or more days after the onset of upper respiratory symptoms or if symptoms first improve and then worsen again within 10 days.

Question 83

One of the most significant laboratory tests for evaluating an individual for chronic or heavy alcohol use is a(n):

A) ALP.
B) BUN.
C) CBC.
D) GGT.

Answer 83

D) GGT.

An elevated GGT level may indicate heavy or chronic alcohol use.

Question 84

A 28-year-old female presents with complaints of low back pain after helping a friend move 2 days ago. She denies any radiation of the pain, numbness, or tingling in the lower extremities or problems with elimination. On physical exam, mild paravertebral muscle spasm is noted with decreased range of motion of the spine. There are no focal neurologic findings. Appropriate management would include:

A) radiograph of the lumbosacral spine.
B) bed rest for 3 to 4 days.
C) NSAIDs.
D) referral to a neurologist.

Answer 84

C) NSAIDs.

Lower back pain is located in the back, buttocks, or one or both thighs. Pain is usually aggravated by standing/flexion and relieved with rest/reclining. Increased pain occurs with flexion and negative SLR, with a normal neurologic exam. A radiograph of the lumbosacral spine or a referral to the neurologist is not necessary at this time. Bed rest is not recommended for treatment of lower back pain. NSAIDs would be an appropriate management for this patient.

Question 85

A 45-year-old patient presents with a complaint of lower abdominal pain with urinary urgency and frequency for the past 3 months. The pain is worse during sexual intercourse and relieved somewhat with urination. Physical examination reveals suprapubic tenderness as well as tenderness along the anterior vaginal wall and urethra. The remainder of the exam is normal. What diagnosis best fits these findings?

A) Chronic urinary tract infection
B) Interstitial cystitis/painful bladder syndrome
C) Pelvic inflammatory disease
D) Pyelonephritis

Answer 85

B) Interstitial cystitis/painful bladder syndrome

Interstitial cystitis/painful bladder syndrome is defined as an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder. It is associated with lower urinary tract symptoms greater than 6 weeks’ duration with absence of infection. Th individual may have lower abdominal pain that becomes worse during sexual intercourse and is relieved somewhat with urination. Physical examination findings may include suprapubic tenderness as well as tenderness along the anterior vaginal wall and urethra.

Question 86

A model that can be used by clinicians who are not sex therapists to address sexual concerns and make appropriate referrals is the:

A) Basson nonlinear model.
B) Cisgender model.
C) Masters and Johnson linear model.
D) PLISSIT model.

Answer 86

D) PLISSIT model.

The clinician who is not a sex therapist can use the PLISSIT model to address sexual concerns and make appropriate referrals. The PLISSIT model includes permission giving, limited information, and specific suggestions provided by the clinician and referral for more intensive therapy if needed.

Question 87

A 21-year-old female presents with symptoms suggestive of infectious mononucleosis. Which one of the following does not support the diagnosis?

A) Pharyngitis
B) Positive monospot/heterophile antibody test
C) CBC with atypical lymphocytes
D) Cough

Answer 87

D) Cough

The classic triad of symptoms for mononucleosis is fever, sore throat, and swollen lymph nodes (particularly the anterior and posterior cervical chain). A monospot/heterophile antibody test will usually be positive within 1 to 2 weeks after onset of symptoms. The CBC will show lymphocytic leukocytosis, with 10% of cells being atypical.

Question 88

A 24-year-old female with asthma classified as mild persistent is considering pregnancy. She currently uses an albuterol metered-dose inhaler and the inhaled corticosteroid budesonide. Advice concerning her asthma and pregnancy should include which one of the following?

A) Exacerbations during pregnancy are common but will not harm the fetus/infant.
B) It is safer to be treated for asthma during pregnancy than to have symptoms and exacerbations.
C) Oral corticosteroids should be initiated prior to conception so that asthma is well controlled in early pregnancy.
D) The medications she is currently using are contraindicated during pregnancy.

Answer 88

B) It is safer to be treated for asthma during pregnancy than to have symptoms and exacerbations.

Asthma exacerbations during pregnancy increase the risk for perinatal mortality, preterm birth, and low-birth-weight infants. First-line treatment during pregnancy includes the short-acting inhaled β2 agonist albuterol and the inhaled corticosteroid budesonide.

Question 89

The most important point to stress with female patients using isotretinoin for acne is:

A) the possibility of hematologic disturbances.
B) the rare occurrence of pseudotumor cerebri.
C) the necessity for highly effective contraception.
D) avoiding alcohol while on this drug.

Answer 89

C) the necessity for highly effective contraception.

Isotretinoin is a known teratogen and is contraindicated for use during pregnancy or if the patient could become pregnant, and it should not be used in pregnancy because of its detrimental effects to the fetus.

Question 90

Screening for which one of the following types of hepatitis is recommended for all individuals born between 1945 and 1965?

A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D

Answer 90

C) Hepatitis C

The CDC and USPSTF recommend screening all individuals born between 1945 and 1965 one time if they have no other risk factors. Screen others based on risk factors—current injection or intranasal drug use, blood transfusion prior to 1992, long-term hemodialysis, born to mother with HCV infection, receipt of an unregulated tattoo, other percutaneous exposures, HIV infection.

Question 91

Prophylaxis for recurrent urinary tract infection/cystitis may include:

A) oral estrogen therapy for vaginal atrophy/genital syndrome of menopause.
B) regular use of barrier contraceptive methods or spermicide.
C) single-dose nitrofurantoin after sexual intercourse.
D) 6-month prophylaxis regimen with oral doxycycline.

Answer 91

C) single-dose nitrofurantoin after sexual intercourse.

Individuals who experience symptoms of recurrent urinary tract infection/cystitis after sexual intercourse may benefit from a prophylactic regimen of single-dose nitrofurantoin after sex. Vaginal (but not oral) estrogen therapy may be considered for postmenopausal individuals with vaginal atrophy/genital syndrome of menopause. Spermicides and diaphragms should be avoided.

Question 92

A 44-year-old female presents with type 2 diabetes and hyperlipidemia. Which of the following should be your main treatment goal?

A) HDL > 40 mg/dL
B) LDL cholesterol < 100 mg/dL
C) Total cholesterol < 200 mg/dL
D) Triglycerides < 250 mg/dL

Answer 92

B) LDL cholesterol < 100 mg/dL

Treatment goals for hyperlipidemia are based on risk factors. Diabetes is considered a CHD risk equivalent. The treatment goal for an individual who has hyperlipidemia and clinically manifested CHD or a CHD risk equivalent is an LDL-C of less than 100 mg/dL.

Question 93

Patients with acute cholecystitis should be advised:

A) to undertake strict weight-reduction diets if they are obese to prevent recurrences.
B) that recurrences are uncommon except in the elderly.
C) that hospital admission and cholecystectomy are the recommended treatment.
D) that lithotripsy is a highly successful treatment done in the outpatient setting.

Answer 93

C) that hospital admission and cholecystectomy are the recommended treatment.

Question 94

African American women are at increased risk for:

A) systemic lupus erythematosus.
B) skin cancer.
C) iron-deficiency anemia.
D) tinea corporis.

Answer 94

A) systemic lupus erythematosus.

The prevalence of SLE is much higher in African American women (1 in 250) and Hispanic women (100 in 100,000) than in Caucasian women (12 to 39 in 100,000).

Question 95

The laboratory diagnosis of diabetes mellitus can be determined by:

A) fasting plasma glucose ≥ 126 mg/dL.
B) a 2-hour postprandial glucose ≥ 126 mg/dL.
C) HbA1c > 5.5%.
D) random glucose ≥ 150 mg/dL.

Answer 95

A) fasting plasma glucose ≥ 126 mg/dL.

The criteria for diagnosis of diabetes include any of the following: fasting plasma glucose ≥ 126 mg/dL, 2-hour postprandial glucose ≥ 200 mg/dL, HbA1c ≥ 6.5%, or random glucose ≥ 200 mg/dL with classic symptoms of hyperglycemia or hyperglycemic crisis.

Question 96

A 20-year-old female presents with two annular lesions with a scaly border and central clearing on her trunk. The lesions have been present for 1 week and are mildly pruritic. What is the most likely diagnosis?

A) Psoriasis
B) Pityriasis rosea
C) Scabies
D) Tinea corporis

Answer 96

D) Tinea corporis

The classic presentation of tinea is a lesion with a central clearing surrounded by an advancing, red, scaly, elevated border. If the tinea is found on the body, it is classified as tinea corporis.

Question 97

Which of the following statements about genetic carrier screening is correct?

A) All genetic carrier screening decisions should be based on family history, ethnicity, or history of child with a congenital anomaly.
B) All women considering pregnancy should be offered genetic carrier screening for cystic fibrosis and spinal muscular atrophy.
C) Decisions regarding genetic carrier screening for thalassemia are best based on the woman’s race and ethnicity.
D) There is no benefit to screening the woman’s reproductive partner in determining risk of having an affected child.

Answer 97

B) All women considering pregnancy should be offered genetic carrier screening for cystic fibrosis and spinal muscular atrophy.

Additional genetic carrier screening decisions may be based on family history (maternal and paternal), ethnicity, history of child with a congenital anomaly, or CBC results suggesting a potential hemoglobinopathy. If a woman is found to be a carrier for a specific condition, her reproductive partner should be offered screening to determine risk of having an affected child.

Question 98

Otitis media is suspected when deep ear pain develops concurrent with or following:

A) airplane travel.
B) an asthma attack.
C) an upper respiratory infection.
D) persistent headache.

Answer 98

C) an upper respiratory infection.

Eustachian tube dysfunction secondary to URI (often viral) or allergies causes edema and congestion that impedes flow of middle ear secretions; accumulation of secretions promotes growth of pathogens.

Question 99

Which one of the following statements concerning rape is true?

A) All U.S. states have now established the same legal definition for rape.
B) The majority of rapes are committed by acquaintances of the victim.
C) The most common emotional response of the victim in the acute phase is anger.
D) The clinician is responsible for determining whether a rape has actually occurred.

Answer 99

B) The majority of rapes are committed by acquaintances of the victim.

The majority of rapes are perpetuated by an acquaintance rather than a stranger. Rape is a legal term whose definition may vary in different states, but typically includes the use of force, threat, or coercion and lack of consent by the victim in relation to sexual intercourse. The initial response of the victim/survivor may range from being calm to anxious to angry.

Question 100

A 27-year-old female presents with moderate sore throat, runny nose, cough, and general malaise for the past 2 days. Physical examination reveals temperature of 99.8°F, mild pharyngeal erythema, and no exudates. Appropriate management includes:

A) CBC with differential.
B) rapid strep antigen test.
C) saline gargles.
D) antibiotic treatment.

Answer 100

C) saline gargles.

Symptomatic relief measures are appropriate for this individual. Rapid streptococcal antigen test is recommended for an adult with pharyngitis who meets two or more of the following criteria: fever, lack of cough, tonsillar exudates, tender anterior cervical adenopathy.

Question 101

Approximately 10% of all individuals infected with hepatitis B virus become chronic carriers of the disease, a state putting them at risk for:

A) hepatocellular carcinoma.
B) mononucleosis.
C) gallbladder disease.
D) chronic immunocompromised status.

Answer 101

A) hepatocellular carcinoma.

As many as 10% of hepatitis B–infected adults and 90% of those infected as neonates become chronic carriers, with an increased risk of cirrhosis and hepatocellular carcinoma.

Question 102

Appropriate initial management for an otherwise healthy 52-year-old female with viral community-acquired pneumonia would include:

A) comfort measures with antibiotics if symptoms persist more than 5 days.
B) ordering a sputum culture before any antibiotic treatment.
C) treatment with azithromycin.
D) treatment with levofloxacin.

Answer 102

C) treatment with azithromycin.

Recommended first-line treatment of community-acquired pneumonia, whether viral or bacterial, is empiric antimicrobial therapy with an advanced-generation macrolide such as azithromycin. If the patient has risk factors for DRSP, the recommended antibiotic is a respiratory fluoroquinolone.

Question 103

Your patient is experiencing three to four migraine headaches per month. You decide to begin prophylactic medication. Which of the following is recommended for migraine headache prophylaxis?

A) Ergotamine
B) Propranolol (beta blocker)
C) Sumatriptan
D) An SSRI

Answer 103

B) Propranolol (beta blocker)

For patients who experience more than two severe headaches per month, who need acute treatment medication more than two times per week, or who are unable to tolerate abortive agents, consider prophylactic therapy: beta blockers such as propranolol/timolol, calcium channel blockers, or antiepileptic agents.

Question 104

A 34-year-old female presents with a 2-month history of a nonproductive cough associated with shortness of breath. She complains of fatigue and has noted an intermittent fever for the past 6 weeks. Significant cervical, inguinal, and axillary lymphadenopathy is noted. Her HIV test is positive. Chest X-ray shows a bilateral infiltrate, and she is diagnosed with PCP. HIV infection produces a spectrum of disease. This patient’s symptoms place her in which stage of HIV infection?

A) Acute HIV infection
B) Asymptomatic infection
C) Early symptomatic infection
D) AIDS

Answer 104

D) AIDS

PCP (pneumocystitis pneumonia) is an opportunistic infection that rarely occurs in healthy people. Most opportunistic infections occur in HIV-infected individuals with a CD4+ count less than 200 cells/mm3. PCP is a major AIDS-defining diagnosis.

Question 105

Which of the following test results would be expected with primary hyperthyroidism?

A) Low serum TSH and elevated free T4
B) Low serum TSH and low free T4
C) High serum TSH and elevated free T4
D) High serum TSH and low free T4

Answer 105

A) Low serum TSH and elevated free T4

Low TSH is a result of excess circulation of thyroid hormone (T4, T3) with hyperthyroidism.

Question 106

The most likely diagnosis for physical examination findings that include presence of lesions located on the elbows, knees, and scalp that have well-defined borders, an erythematous base, and silvery scales is:

A) contact dermatitis.
B) psoriasis.
C) scabies.
D) seborrheic keratosis.

Answer 106

B) psoriasis.

Question 107

A client tells you that she has experienced chest tightness, difficulty breathing, and dizziness whenever she rides on the city bus. She has been trying to find other transportation because she is very fearful about these symptoms recurring. Her symptoms best fit the description of:

A) acute stress disorder.
B) panic disorder with agoraphobia.
C) obsessive–compulsive disorder.
D) social phobia.

Answer 107

B) panic disorder with agoraphobia.

Agoraphobia is an anxiety disorder that includes avoidance of places or situations in which leaving suddenly may be difficult in the event that the individual has a panic attack. The recurrence of these panic attacks and fear related to their possible occurrence are considered panic disorder.

Question 108

A microcytic anemia with a low serum ferritin is likely secondary to:

A) anemia of chronic disease.
B) iron deficiency.
C) hypersplenism.
D) thalassemia minor.

Answer 108

B) iron deficiency.

Diagnostic findings for iron-deficiency anemia include hypochromic microcytic RBCs, MCV less than 80 fL, increased RDW, a low serum ferritin less than 10 mg/L, and decreased reticulocyte count.

Question 109

Contraceptive counseling for a 24-year-old female with diabetes who has no complications or other health problems should include which one of the following?

A) Combination hormonal contraceptives are contraindicated.
B) Progestin-only methods are a better choice than are those containing estrogen.
C) She can use any of the long-acting reversible contraceptives.
D) She should complete her childbearing by age 30 and consider sterilization.

Answer 109

C) She can use any of the long-acting reversible contraceptives.

Women with uncomplicated diabetes of less than 20 years’ duration can use any of the available contraceptive methods, including long-acting reversible contraceptives such as intrauterine contraception, progestin-only injections, and progestin-only implants. Combination hormonal contraceptives are also acceptable choices.

Question 110

Most gallstones are composed of:

A) precipitated bile salts.
B) precipitated calcium salts.
C) cholesterol.
D) pigments.

Answer 110

C) cholesterol.

Approximately 85% to 95% of gallstones are composed primarily of cholesterol.

Question 111

Long-term use of corticosteroids may be a secondary cause of:

A) asthma.
B) dyslipidemia.
C) iron-deficiency anemia.
D) osteoarthritis.

Answer 111

B) dyslipidemia.

Secondary causes of dyslipidemia include obesity; endocrine and metabolic disorders; obstructive liver disease; renal disorders; and some medications that include corticosteroids, thiazide diuretics, and beta blockers.

Question 112

Client instructions for taking alendronate should include which one of the following?

A) Take the medication with breakfast.
B) Take the medication at bedtime.
C) Take the medication on an empty stomach.
D) Take the medication with an antacid.

Answer 112

C) Take the medication on an empty stomach.

Client instructions for taking alendronate include the following: take the medication with 8 oz of water in the morning at least 30 minutes before any beverage, food, or medication, and avoid lying down for at least 30 minutes and until intake of the first food of the day.

Question 113

A 26-year-old female presents with complaint of watery diarrhea and abdominal cramping for the past 2 days that started a few days after she returned from a trip to Mexico. She has not noted any blood in her stools and has no fever. Her physical examination reveals hyperactive bowel sounds and mild, diffuse abdominal tenderness. Initial management for this patient should include:

A) instructions to take bismuth subsalicylate for 24 to 48 hours.
B) instructions to maintain fluid intake and limit the use of antidiarrheal agents.
C) prescribing metronidazole and ciprofloxacin for 5 days.
D) stool evaluation for bacterial pathogens, ova and parasites, and occult blood.

Answer 113

B) instructions to maintain fluid intake and limit the use of antidiarrheal agents.

The most common causative agent in traveler’s diarrhea is E. coli. If the patient does not have bloody stools or a fever, and symptoms are self-limiting, no stool evaluation or antibiotic treatment is needed.

Question 114

For the client described in question 18, isoniazid prophylaxis would be recommended if her PPD was greater than or equal to:

A) 5 mm.
B) 10 mm.
C) 15 mm.
D) 20 mm.

Answer 114

A) 5 mm.

A 5-mm or greater skin reaction on the PPD test is considered positive in individuals who are HIV positive, immunocompromised, with abnormal chest radiograph findings consistent with healed TB lesions, or in recent close contact with a TB-infected person.

Question 115

The recommended initial test for DVT in a symptomatic patient is:

A) plasma d-dimer.
B) contrast venography.
C) antithrombin III.
D) duplex ultrasound.

Answer 115

D) duplex ultrasound.

Duplex ultrasound has good sensitivity and specificity for diagnosis of a patient who has an intermediate to high probability of DVT. A negative test, however, does not rule out DVT in the symptomatic patient, so other follow-up tests are needed.

Question 116

A 21-year-old female complains of intermittent abdominal pain, bloating, and loose stools three to four times per month for the past 3 months. Which of the following additional findings would lead you toward a diagnosis of irritable bowel syndrome?

A) Abdominal pain is relieved with defecation.
B) Antacids relieve the pain.
C) She is awakened at night by the need to defecate.
D) She has noted a small amount of bright red blood in the loose stools.

Answer 116

A) Abdominal pain is relieved with defecation.

Abdominal pain and bloating are often relieved at least temporarily with defecation in patients with IBS. IBS is not characterized by symptoms that awaken the patient at night or by blood in the stools.

Question 117

The frequency of sickle cell crises may be reduced by:

A) activity restrictions.
B) oxygen therapy.
C) aggressive treatment of infections.
D) a high-protein diet.

Answer 117

C) aggressive treatment of infections.

Precipitating factors for vaso-occlusive crises include infection, physical or emotional stress, blood loss, pregnancy, surgery, and high altitudes. Aggressive treatment of infections may prevent a crisis for the patient with sickle cell disease.

Question 118

A systolic heart murmur present in an asymptomatic pregnant woman is likely:

A) due to valvular disease.
B) associated with history of rheumatic fever.
C) a physiologic (innocent) murmur.
D) to intensify with a Valsalva maneuver.

Answer 118

C) a physiologic (innocent) murmur.

Pregnant women may have grade 1 or 2 systolic murmurs due to physiologic increased cardiac output.

Question 119

Naloxone is a(n):

A) alcohol antagonist that creates a toxic response when individual consumes alcohol.
B) long-acting opioid agonist used to help prevent relapse in individuals with either alcohol or opioid use disorder.
C) opioid antagonist used to reverse the physical effects of opioid overdose.
D) partial opioid receptor agonist used in medication assisted treatment for opioid use disorder.

Answer 119

C) opioid antagonist used to reverse the physical effects of opioid overdose.

Naloxone is an opioid antagonist used to reverse the physical effects of an opioid overdose. It reverses depression of the CNS and respiratory system. It has with no potential for physical or psychological dependence.

Question 120

Major side effects of selective serotonin reuptake inhibitors include:

A) anticholinergic effects.
B) nausea.
C) orthostatic hypotension.
D) urinary retention.

Answer 120

B) nausea.

Side effects of SSRIs include anxiety, insomnia/hypersomnia, headache, nausea, anorexia, and sexual dysfunction.

Question 121

Two months after being raped, a client tells you she cannot concentrate on her schoolwork and is having nightmares about the experience. These symptoms indicate that she:

A) is still in the acute phase of rape trauma syndrome.
B) is going through normal reorganization following a rape.
C) is experiencing post-traumatic stress disorder.
D) now has a generalized anxiety disorder.

Answer 121

C) is experiencing post-traumatic stress disorder.

PTSD occurs in 30% to 65% of sexual assault survivors. PTSD is persistent anxiety lasting more than 1 month following an extremely traumatic event. Inability to concentrate and nightmares are characteristic of PTSD.

Question 122

A 46-year-old female presents with complaints of worsening low back pain after lifting a heavy object on the previous day. She has a history of intermittent low back pain in the last year, but she notes that the pain is now radiating down her right leg. She does not have any complaints of trouble with urination or bowel movements. On exam, you note a decreased range of motion of the spine in all planes. Straight leg raising at 35 degrees is positive on the right side. The Achilles tendon reflex on the right side is diminished compared to the left side, with decreased sensation over the right lateral foot. The most likely etiology of this patient’s symptoms is:

A) rupture of the Achilles tendon.
B) cauda equina syndrome.
C) herniated disc involving the L5 root.
D) herniated disc involving the S1 root.

Answer 122

D) herniated disc involving the S1 root.

A herniated disc is characterized by radicular pain; paresthesias may occur in the distribution of the involved nerve root. The most common disc ruptures involve the L5 or S1 nerve roots. An affected S1 root/L5–S1 disc involves pain in the buttocks, lateral leg, and malleolus and numbness in lateral foot and posterior calf.

Question 123

Macrocytic anemias include:

A) anemia of chronic disease.
B) vitamin B12–deficiency anemia.
C) iron-deficiency anemia.
D) sickle cell anemia.

Answer 123

B) vitamin B12–deficiency anemia.

Macrocytic anemia (MCV > 100 fL) is found in people with vitamin B12 deficiency, folate deficiency, liver disease, and hypothyroidism.

Question 124

Which one of the following medications is not recommended for ongoing treatment of generalized anxiety?

A) Alpraxolam (Xanax)
B) Buspirone (Buspar)
C) Duloxetine (Cymbalta)
D) Paroxetine (Paxil)

Answer 124

A) Alpraxolam (Xanax)

Alpraxolam (Xanax) is a benzodiazepine that should be used only for short-term management of generalized anxiety if needed for severe impairment until acceptable reduction of symptoms is achieved with an appropriate non-benzodiazepine medication, which may include selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, or buspirone, and/or cognitive-behavioral therapy. Benzodiazepines have a high dependence and abuse potential.

Question 125

A 20-year-old sexually active female presents at the office for an initial visit. Which one of the following screening tests/procedures should be provided?

A) Cervical cancer screening
B) Chlamydia test
C) Clinical breast examination
D) Hepatitis C test

Answer 125

B) Chlamydia test

Routine annual screening for chlamydia and gonorrhea is recommended for sexually active women age ≤ 25 years and in women > 25 years with risk factors (e.g., new sex partner, more than one sex partner, sex partner with concurrent partners, exchanging sex for money or drugs).

Question 126

A patient presents with complaint of extremely itchy, dry areas of skin on her wrists, hands, and knees. Physical examination reveals erythematous, dry, scaly, excoriated patches of skin with lichenification in these areas. The most likely diagnosis is:

A) contact dermatitis.
B) eczema.
C) psoriasis.
D) tinea.

Answer 126

B) eczema.

Symptoms of eczema include extremely itchy, dry patches of skin commonly on the face, wrists, hands, arms, knees, and genitals. Physical examination findings include erythematous, dry, scaly, excoriated patches of skin with lichenification in these areas.

Question 127

Which one of the following most likely suggests a secondary cause of hypertension?

A) Body mass index greater than 30
B) Abdominal bruit
C) Total cholesterol greater than 280 mg/dL
D) Enlarged spleen

Answer 127

B) Abdominal bruit

Secondary hypertension may be the result of renal artery stenosis. An abdominal bruit may indicate renal artery stenosis.

Question 128

When using a three-dose regimen, the second and third doses of the HPV vaccination should be given:

A) 1 month and 3 months after the initial dose.
B) 1 month and 6 months after the initial dose.
C) 2 months and 6 months after the initial dose.
D) 3 months and 12 months after the initial dose.

Answer 128

C) 2 months and 6 months after the initial dose.

The recommended schedule for the three-dose series HPV vaccination is initial dose, second dose 2 months after the initial dose, and third dose 6 months after the initial dose.

Question 129

A 21-year-old client comes to the clinic with complaint of amenorrhea. She also complains of feeling cold all the time. Physical examination reveals an underweight female with heart rate of 58 beats per minute and blood pressure 96/52 mm Hg. A pregnancy test is negative. Which of the following additional findings would contribute to a diagnosis of anorexia nervosa?

A) Currently on probation for shoplifting
B) Fine body hair on extremities
C) Migraine headaches
D) Swollen parotid glands

Answer 129

B) Fine body hair on extremities

Physical examination findings with anorexia nervosa include emaciation, dry skin, fine body hair (lanugo), muscle wasting, peripheral edema, bradycardia, arrhythmias, hypotension, delayed sexual maturation, and stress fractures.

Question 130

Which one of the following is not an anticipated symptom of active TB infection?

A) Tachycardia
B) Chest pain
C) Weight loss
D) Night sweats

Answer 130

A) Tachycardia

Individuals with active TB may have generalized symptoms of night sweats, fever, malaise, weakness, anorexia and weight loss, and pulmonary symptoms of productive cough, hemoptysis, chest pain, and dyspnea.

Question 131

Virchow’s triad defines the clinical origin of most venous thrombi and includes all of the following factors except:

A) stasis.
B) endothelial damage.
C) deposition of cholesterol plaques.
D) hypercoagulability.

Answer 131

C) deposition of cholesterol plaques.

The origin of most venous thrombi lies in Virchow’s triad—endothelial damage, stasis, and hypercoagulability.

Question 132

An important principle of antiretroviral therapy is that:

A) response to drug therapy is monitored with a p24 antigen/antibody test.
B) monotherapy is recommended as the initial treatment.
C) response to drug therapy is monitored by HIV RNA levels.
D) therapy should be started when symptoms first appear.

Answer 132

C) response to drug therapy is monitored by HIV RNA levels.

HIV RNA levels are useful for predicting progression of disease by indicating viral load and are used to monitor antiretroviral therapy.

Question 133

A 50-year-old female patient presents with a complaint of severe pain that started in her upper mid-abdomen and is now worse in the RUQ of her abdomen. She has also had nausea and vomiting. On deep palpation of her RUQ, she momentarily holds her breath on inspiration. You suspect:

A) appendicitis.
B) acute cholecystitis.
C) pancreatitis.
D) peptic ulcer disease.

Answer 133

B) acute cholecystitis.

Symptoms of acute cholecystitis include pain that starts in the epigastrium and then moves to the RUQ, accompanied with nausea and vomiting. The patient with acute cholecystitis has a stop in inspiratory effort because of the sharp increase in pain (Murphy’s sign) when the RUQ is palpated.

Question 134

Common physical findings with allergic rhinitis include:

A) facial tenderness.
B) inflamed nasal mucosa.
C) nasal crease.
D) purulent nasal discharge.

Answer 134

C) nasal crease.

A common physical finding with perennial allergic rhinitis is a horizontal crease along the lower bridge of the nose from the patient pushing the nose upward and backward because of itching and nasal discharge.

Question 135

Important nonpharmacologic treatments for acute low back pain do not include:

A) continuation of daily activities.
B) heat application.
C) strength-building exercises.
D) bed rest.

Answer 135

D) bed rest.

Nonpharmacologic interventions for managing lower back pain include continuation of daily activities rather than bed rest, in addition to local application of heat, warm baths, a physical therapy program to improve strength and conditioning, and low-stress aerobic exercise—walking, biking, swimming.