Quiz #3 Flashcards
(33 cards)
You are approached by 47 year old Emma who is very concerned about osteoporosis. Her dad’s side of the family has women who have experienced serious cases of the condition. Her mom’s side has no notable history with this condition. Now that Emma is getting close to the age of menopause, she wants to know how likely it is that she will experience effects of osteoporosis. She is especially interested in how she compares to others her own age. Which dual-energy xray absorptiometry score is most relevant in this case?
a) Z score
b) T score
c) D score
d) C score
Ans: Z score
T scores compare the patient to the population mean
With Z scores, your bone mineral density is compared to that of a typical individual whose age is matched to yours.
A college athlete comes to clinic complaining of malaise and a cough. His physical findings include a fever, and a chest film reveals lung consolidation. You note that he has no other previous health conditions. According to the latest guidelines of the IDSA and the ATS, which treatment is best for this patient?
a) Cefotaxime
b) Levofloxacin
c) Moxifloxacin
d) Azithromycin
Ans: D Azithromycin (macrolide)
Resp fluoros are not indicated in this case
Cefotaxime is a third generation cephalosporin and works against S. pneumoniae but not against H. Flu and M. Catarrhalis
Which of the following genetic syndromes is associated with congenital cardiac defects?
a) Tay-Sach’s Disease
b) Klinefelter’s syndrome
c) Turner’s syndrome
d) DiGeorge Syndrome
Ans: D Not sure this is right since:
DiGeorge Syndrome: aortic arch anomalies
Turner Syndrome: Coarctation of the aorta and Bicuspid aortic valves
Gayle who is 50, comes to clinic and complains of “twitches” that occur in her right shoulder. You administer an electromyography test and determine that these findings occur as a result of lower motor neuron dysfunction. Which of the following is the most likely diagnosis?
a) Nystagmus
b) Clonus
c) Tremors
d) Fasciculations
Ans: D Fasciculations
Fasciculations are small, localized involuntary muscle twitches
Nystagmus is the eyes
Clonus are continuous succession of seizure like twitches
Tremors occur as rhythmic oscillations not twitches
Which of the following is NOT considered by Native Americans to be an “Indian Problem” treatable with “Indian Medicine”?
a) Mental illness
b) Cancer
c) Pain
d) Alcoholism
Ans: B Cancer
Cancer is considered to be a White Man’s disease.
Mental health, alcoholism, and pain are all considered to be naturally indian disorders and are treatable with Indian Medicine
You are a nurse practitioner assessing the neurological system of a patient. Which of the following is the best question to ask in order to test the patient’s declarative memory?
a) What did you have for breakfast this morning?
b) Can you repeat the words: rose, hose, nose, and clothes?
c) Can you repeat the words: brown, chair, textbook, and tomato”
d) How old were you when you got your first job?
Ans: C
Can you repeat the words: brown, chair, textbook, and tomato”
Declarative is the patient’s ability to use memory to learn new information.
A and D deal with long and short term memory-episodic memory
B words rhyme so they are not diverse
After giving birth to Sarah, 28 year old Samantha and her husband leave the hospital after one day. When should she come back so that Tabitha can have her first well-child check?
a) 3-5 days
b) 4-6 days
c) 2-3 days
d) 1-2 days
Ans: A 3-5 days
Bright futures states that if an infant is discharged from the hospital before 48 hours, he/she should be seen in clinic within 3-5 days
Kerrie is looking to start a new birth control regimen after not using any for several years. She avoided birth control because of her somewhat high sensitivity toward estrogen. Her history also indicates that she sometimes has bouts of iron deficiency anemia. Which of the following is best as a recommendation for her?
a) Ortho-Evra
b) NuvaRing
c) Depo-Provera
d) IUD
Ans: C Depo provera
The advantage of Depo is prolonged amenorrhea
Estrogen based choices include Ortho Eva and the Nuva ring which trigger the intolerance
the IUD can lead to excess bleeding so that would not be a good choice with intermittent hx of Iron deficiency anemia
Cimetidine, and OTC agent that complicates polypharmacy, inhibits what enzyme in the liver, prolonging the effects of other drugs in the body?
a) Glucose oxidase
b) Cytochrome P450
c) Cox-1
d) Lactate dehydrogenase
Ans: B Cytochrome P450
There are three general strategies when interviewing an adolescent. Which of the following is NOT one of those strategies?
a) DRUGSS format
b) SAFETEENS format
c) PACES format
d) HEADSS format
Ans: A DRUGSS IS INVENTED
These are strategies for interviewing teens
HEADSS: Home environment, Employment and education, activities, drugs, social sexuality
PACES: Parents and peers, accident: alcohol/drugs, Cigarettes, emotional issues, school/sexuality
SAFETEENS: Sexuality, Accident/abuse, firearms/homicides,Emotions/toxins, environment, exercise, nutrition and shots/immuniz
You are assessing a 2 month old girl for developmental warning signs. By what age should she pick up a toy, according to normal developmental guidelines?
a) 6 months
b) 3 months
c) 5 months
d) 4 months
Ans: A 6 months
It is a dev warning sign if an infant cannot pick up a toy or try to pick up a toy by 6 months. While a child may be able to pick up a toy before the age of 6 months, it is not considered a warning sign until 6 months
a 51 year old man comes to clinic complaining of inflammation of his penile head. Upon assessment, you find that the glans is covered in a rash and is releasing a malodorous discharge. He tells you that the affected area is very painful. Which of the following medications would be best to prescribe for him?
a) Griseofulvin
b) Metronidazole
c) Ceftriaxone
d) Miconazole
Ans: D Miconazole
Candida balanitis: a fungal infection of the penile head.
Miconazole is the topical antifungal used to treat this problem. It seems like it could be GC but there is no discharge and the patient has no other symptoms.
Griseofulvin is for Tinea Capitus
Metronidazole is an antibiotic for Rosacea, UTI and other bact infections
Ceftriaxone is for GC
Alison, 25, checked into your hospital 2 weeks ago as an inpatient. When you make your rounds, she complains about a painful redness on her skin that seems to have spread overnight. She is shivering and states the she feels cold, although the infected skin is actually rather warm to the touch. You suspect cellulitis which you know may be caused by one of a few organisms. Which of the following is the leading cause of cellulitis in the inpatient setting?
a) E. coli
b) S. aureus
c) Staphylococcus
d) S. pyogenes
Ans: A
E. Coli: Inpatient cellulitis is most often a gram neg organism E. coli.
S. aureus that can cause inpatient cellulitis though less common than E. coli
S. pyogenes is the leading cause of OUTpatient cellulitis
Staphlococcus is just too general a reference
Be careful with these questions….when there are 3 Staphs and one is so general, that is a hint!
You are checking on a 6 year old whom you saw last month for strep throat. Since you know that rheumatic fever can follow strep throat by approximately 20 days, you wanted to make sure he has not developed this secondary condition. Which of the following is a major clinical manifestation of rheumatic fever?
a) Polyarthritis
b) Inflammatory changes in the oral cavity
c) Inflammatory changes of the lips
d) Polymorphous rash
Ans: A polyarthritis
Polyarthritis, a form of arthritis, is a major clinical manifestation of Rheumatic Fever. The affected joints will change every 1-2 days, and it is the large joints that are usually affected.
A polymorphous rash and inflam changes in both the lips and oral cavity are diagnostic of Kawasaki Disease which causes another cardiac defects: Coronary vasculitis, myocarditis, Mitral regurg, and dysrhythmias
You have been treating Edwina, 68, for a long-term fever. Since this is a prolonged presentation, you screen for infection. All of the following would indicate infections except:
a) 2 or more measurements of oral temperature equal or greater than 99F (37.2)
b) Rectal Temp equal to 99F (37.5)
c) Increase in temp of equal to or greater than 2F (1.1C) from baseline
d) Single measurement of temp equal or greater than 100F (37.8C)
Ans: B
A rectal temp equal to or greater than 99.5 F (37.5C) NOT 99F (37.2 C) indicates infection.
All of the other values are indicators of infection in the elder
A mom and her 13 year old daughter come to clinic reporting that the daughter complains of painful menstrual cramping and back pain requiring her to miss school several days per month. You suspect a diagnosis of Dysmenorrhea. Which of the following is NOT an example of supportive treatment of this diagnosis?
a) Heat application
b) High iron diet
c) Psychological counseling
d) Ibuprofen
Ans: B High iron diet
Support measures include psych support, heat, and OTC NSAIDs (for prostaglandin support)
Which of the following components of Continuous Quality Improvement monitors the numbers of qualified staff, equipment, and resources?
a) Appropriateness
b) Processes
c) Establishments
d) Structures
Ans: D
In the system of Continuous Quality Improvement, structures include the resources, equipment, and the size and qualifications of staff.
Processes of care include assessment, planning, performing treatments and management of complications.
Establishments are the businesses or institutions where CQI are implemented
Max, age 2 months, is brought to clinic for a checkup. His mom tells the NP that she has noticed that Max has a seemingly permanent head tilt, and he seems cross eyed. You suspect the child may have strabismus. Which of the following, if present, would indicate another possible problem?
a) Squinting
b) Head shaking
c) Face turning
d) Decreased visual acuity
Ans: B
Head shaking
Head shaking is NOT a sign associated with strabismus. All the other choices are findings of patients with suspected strabismus. In addition, exotropia, hyper or hypotropia, and an unequal Hirschberg pupillary reflex also may present
Which of the following would not be true about a genetic disorder?
a) Only 30-35% of genetic disorders are diagnosed in the neonatal period
b) Major malformations occur in approximately 2% of live births
c) About 80% are identified before the age of 6 months
d) Of the major malformations, 80% are associated with a genetic cause and an increased risk of recurrence
Ans: a
False: That only 30-35% of genetic disorders are diagnosed in the neonatal period.
In fact, genetic disorders are diagnosed at 40-45% in the neonatal period. All the other statements are true
Mary comes to your facility and asks for privacy. the 24 year old says that there is a fishy smelling gray discharge from her vagina. Of the following, which is the most likely diagnosis?
a) Candida
b) GC
c) Trich
d) BV
Ans: D
Bacterial Vaginosis presents with a fishy odor.
Trich is “frothy” Yellow-green
Candida is white curd-like
GC is green gook but does not reflect fishy
Shannon , 34, is in for diagnostic tests for Multiple sclerosis. Before you initiate assessment, you engage in a brief conversation concerning her disorder and the lab exams that surround it. Of the following statements, which is incorrect regarding lab diagnosis of MS?
a) An edrophonium test can be administered as a differential diagnostic
b) Lab diagnostics often find an increased number of lymphocytes in the circulating blood
c) Slightly elevated protein can be found in the CSF
d) Lab diagnostics can never be definitive for MS.
Ans: A
It is false that the edrophonium test can be administered as a differential diagnostic
Edrophonium is used as a differential diagnostic between MG and a cholinergic crisis, and thus is irrelevant for MS.
For MS labs, you find an increase in lymphs in the blood and elevated protein in the CSF however lab diagnostics can never be definitive for MS
A newborn delivered via caesarean section at 38 weeks gestation without complications is in the nursery for initial assessment. If the child physical measurements are all average, which of the following measurements should you most expect?
a) Wt. 3 kg; Head circ 33 cm; length 51 cm
b) Wt 2.8 kg; Head circ 30 cm; length 50 cm
c) Weight 1.8 kg; Head circ 33 cm; Length 52 cm
d) Weight 4 kg; Head circ 36 cm; Length 51 cm
Ans: A
Wt. 3 kg; Head circ 33 cm; length 51 cm
Average measurements for a term baby are
Weight 3.1 Kg
Head circ: 33-35 cm
Length: 51 cm
An 18 year old female comes to the office 2 weeks before leaving for college. She is anxious but also excited to live in the dorms. She however had an active TB infection and needs to begin treatment NOW. You tell her that if the condition proves susceptible to her medication regimen, the initial course of the medication could last for:
a) 9 months
b) 6 months
c) 2 months
d) 1 month
Ans: C
the INITIAL part of the med regimen of RIPE lasts for 2 months
After 2 months, the med regimen is reduced to only INH and rifampin for the next 4 months….this is the latter part of treatment.
Patients with HIV should be treated for 9 months
Maggie, 2 months old, is due to receive the polio vaccine. Which of the following statements is true regarding polio vaccine administration to the patient?
a) The oral polio vaccine should be given on the normal vaccination schedule
b) The final dose of the inactivated polio vaccine would typically be given when the patient is 6-10 years old
c) The oral vaccine should be given when Maggie is 6 years old
d) The inactivated polio vaccine must be given when Maggie is 6 years of age
Ans: D
The inactivated polio vaccine must be given when Maggie is 6 years old
The inactivated Polio vac should be administered in a series of 4 doses at 2, 4, and 6 months with the final dose at 6 years. The oral dose is discouraged and is only an option for the 3rd and 4th doses.
It is not recommended that Maggie receive her final polio at age 10
