weekly quizzes Flashcards
A 50-year-old patient presents with acute onset sore throat. On physical examination, palatal petechiae are detected. Assume a pretest probability for infectious mononucleosis of 1% and that palatal petechiae has a likelihood ratio of 5 for detecting infectious mononucleosis. Assume also that you set a testing threshold of 10% for this condition. What action is now most appropriate?
Question 1 Answer
a.
Rule out infectious mononucleosis
b.
Treat infectious mononucleosis
c.
Consider infectious mononucleosis an active alternative and order heterophile antibody testing
d.
Consider infectious mononucleosis an active alternative and order EBV viral capsid antigen (VCA) testing
???? chat gpt and me say consider c
What is the main reason that a naturopathic doctor avoid examination with a tongue depressor in a patient in whom they suspect epiglottitis?
Question 2 Answer
a.
It is not worth the time when urgent referral is needed
b.
The posterior pharynx can only be visualized in about 20% of cases and the diagnostic yield is therefore low
c.
The patient is likely to be in distress already and this examination is uncomfortable
d.
It may cause spasm and airway obstruction
d.
It may cause spasm and airway obstruction
What is the best approximation of the frequency of strep among children ages 5-15 with sore throat?
Question 3 Answer
a.
30%
b.
80%
c.
50%
d.
5%
a.
30%
In addition to acute onset of fever with severe sore throat and a toxic appearance, what should naturopathic doctor ask about in assessing whether their patient has epiglottitis?
Question 4 Answer
a.
Dyspepsia
b.
Dizziness
c.
Diarrhea
d.
Difficulty swallowing
d.
Difficulty swallowing
An 11-year-old patient presents with acute onset sore throat. The have no cough.
On physical examination, you note that they have a fever and that the anterior cervical lymph nodes are enlarged and tender. The oropharyngeal exam reveals tonsillar exudates.
What condition is most likely?
Question 5 Answer
a.
Streptococcal pharyngitis
b.
A coronavirus
c.
A rhinovirus
d.
Mononucleosis
a.
Streptococcal pharyngitis
What otoscopic finding argues most strongly in favor of acute otitis media?
Question 1 Answer
a.
Normal tympanic membrane mobility on pneumatic otoscopy
b.
Cloudy tympanic membrane
c.
Bulging tympanic membrane
d.
Distinctly red tympanic membrane
c.
Bulging tympanic membrane
A patient is experiencing left-sided hearing loss and otalgia. Whisper test at the left ear is positive, whereas there is no impairment at the right ear. The Weber test shows lateralization to the left ear. The Rinne test shows AC > BC in the right ear and BC > AC in the left ear.
What type of hearing loss is most suggested by these findings?
Question 2 Answer
a.
Left-sided sensorineural hearing loss
b.
Presbycusis
c.
Left-sided conductive hearing loss
d.
Otosclerosis
c.
Left-sided conductive hearing loss
A naturopathic doctor is considering influenza as a patient’s diagnosis. Which clinical finding, if present, should most increase a naturopathic doctor’s suspicion of this condition?
Question 3 Answer
a.
Myalgias
b.
Chills
c.
Cough
d.
Sore throat
a.
Myalgias
A 12-year-old patient presents with acute onset sore throat and cough. On physical examination, you note an oral temperature of 37.3°C (99.1°F). Posterior cervical lymph nodes are tender but anterior cervical lymph nodes are neither tender nor enlarged. The oropharyngeal exam reveals no tonsillar exudate or swelling.
What is this patient’s modified Centor score?
Question 4 Answer
a.
2 points
b.
4 points
c.
1 point
d.
3 points
c.
1 point
What findings on the Weber and Rinne tests would suggest right-sided conductive hearing loss?
Question 5 Answer
a.
Weber test lateralization to the right ear and Rinne test demonstrating AC>BC in the right ear and BC>AC in the left ear
b.
Weber test lateralizing to the left ear and Rinne test demonstrating AC>BC in the left ear and BC>AC in the right ear
c.
Weber test lateralizing to the right ear and Rinne test demonstrating AC>BC in the left ear and BC>AC in the right ear
d.
Weber test lateralizing to the left ear and Rinne test demonstrating AC>BC in the right ear and BC>AC in the left ear
c.
Weber test lateralizing to the right ear and Rinne test demonstrating AC>BC in the left ear and BC>AC in the right ear
A naturopathic doctor is inspecting a nevus on a patient’s arm and taking the patient’s history regarding the nevus. What should they pay particular attention to during this process?
Question 1 Answer
a.
Whether there is itching of the lesion and whether it looks like other nevi in the vicinity
b.
Whether there is asymmetry, border irregularity, a diameter of more than 6mm, whether the lesion has grown over time, and whether there are multiple colors within the lesion
c.
The patient’s history of sunburning, whether they have fair skin, and their dietary history to determine whether insufficient antioxidant consumption has led to immunocompromise
d.
Whether the lesion has evolved over time, whether there is variegated elevation, the depth of the lesion and whether its borders are surrounded by satellite lesions
b.
Whether there is asymmetry, border irregularity, a diameter of more than 6mm, whether the lesion has grown over time, and whether there are multiple colors within the lesion
On examining a rash, a naturopathic doctor observes a 1.5cm palpable, solid lesion. How should this be identified?
Question 2 Answer
a.
Papule
b.
Pustule
c.
Plaque
d.
Patch
c.
Plaque
What type of global reaction pattern best characterizes plaque psoriasis?
Question 3 Answer
a.
Papulosquamous
b.
Purpura and petechiae
c.
Folliculopapular
d.
Dermal
a.
Papulosquamous
A student is examining a patient’s rash. They note lichenification, that it is papulosquamous, and that it is localized. What have they missed?
Question 4 Answer
a.
Use of 365 nm ultraviolet long-wave light
b.
Determination of the global reaction pattern
c.
Description of the rash as inflammatory
d.
Identification of the primary lesion
d.
Identification of the primary lesion
What method would a naturopathic doctor use to best enhance the contrast between a circumscribed hypopigmented or hyperpigmented lesions and the surrounding skin
Question 5 Answer
a.
Wood lamp
b.
Dermoscopy
c.
Subdued lighting
d.
Diascopy
c.
Subdued lighting
Which finding(s) on physical examination would be most suggestive of osteoarthritis?
Question 1 Answer
a.
Ulnar deviation at the metacarpophalangeal joint
b.
Hypertrophic changes at distal interphalangeal joints
c.
Flexion at the proximal interphalangeal joint and hyperextension at the distal interphalangeal joint
d.
Flexion at the metacarpophalangeal joint, extension of the proximal interphalangeal joint, and flexion of the distal interphalangeal joint
b.
Hypertrophic changes at distal interphalangeal joints
In what context should infectious arthritis be most strongly considered by a naturopathic doctor?
Question 2 Answer
a.
Adults with knee pain that starts after trauma and which is present regardless of activity, whether or not effusion is detected
b.
Whenever effusion is detected on physical examination, regardless of trauma history
c.
When there is pain localized to the medial or lateral knee with no effusion
d.
Adults with knee pain unrelated to trauma or activity, where effusion is detected
d.
Adults with knee pain unrelated to trauma or activity, where effusion is detected
A 66-year-old patient complains of gradual onset right-sided pain in her hand that is made worse with movement. She denies morning stiffness. Physical examination of the hand reveals joint swelling and tenderness. What is the most likely condition?
Question 3 Answer
a.
Septic arthritis
b.
Osteoarthritis
c.
Rheumatoid arthritis
d.
Gout
b.
Osteoarthritis
A 35-year-old patient complains of unilateral knee pain which started suddenly 6 days ago after a soccer game. The pain is worse with activity. On physical examination of the knee, there is swelling and tenderness but no warmth or redness.
The naturopathic doctor first considers whether the condition causing this join pain is traumatic and whether it is inflammatory. What is most likely?
Question 4 Answer
a.
Non-traumatic inflammatory
b.
Non-traumatic and non-inflammatory
c.
Traumatic and inflammatory
d.
Traumatic and non-inflammatory
d.
Traumatic and non-inflammatory
A patient with joint pain undergoes joint aspiration and monosodium urate crystals are discovered. What diagnosis is most likely?
Question 5 Answer
a.
Osteoarthritis
b.
Psoriatic arthritis
c.
Rheumatoid arthritis
d.
Gout
d.
Gout
What finding would most indicate immediate referral in the context of acute low back pain?
Question 1 Answer
a.
Lower limb muscle weakness
b.
Decreased sensation in the lower limb which has not resolved after 2 weeks
c.
New onset sexual dysfunction
d.
Pain which radiates down the leg
c.
New onset sexual dysfunction
A 85-year-old woman presents to your office with low back pain. She has a history of osteoporosis.
What further workup is most indicated for this patient?
Question 2 Answer
a.
MRI
b.
Laboratory investigation for malignancy
c.
ESR and/or CRP
d.
Plain radiograph (x-ray)
d.
Plain radiograph (x-ray)
A patient with acute low back pain is also experiencing pain that radiates down to the lateral aspect of their foot and heel, along with a decreased sensation in the outer foot and weakness when trying to stand on their tiptoes. Which spinal level is most likely involved in this radiculopathy?
Question 3 Answer
a.
L4
b.
L3
c.
S1
d.
L5
c.
S1
Which of the following physical exams, if positive, provides the most evidence for detecting an L5 radiculopathy?
Question 4 Answer
a.
Weak ankle dorsiflexion
b.
Weak hallux (big toe) extension
c.
Asymmetric medial hamstring reflex
d.
Sensory loss down the lateral leg into the foot
c.
Asymmetric medial hamstring reflex
A patient presents to their naturopathic doctor’s office with acute low back pain that radiates into their left leg. The patient notes that the pain radiates down the back of their lower leg and into the foot.
On physical exam the naturopathic doctor notes the following:
Reduced sensation on the lateral side of the left foot and ankle
Weakened plantar flexion on the left side
Achilles (ankle) reflex diminished on the left side
What nerve root is most likely involved?
Question 5 Answer
a.
S1
b.
L3
c.
L4
d.
L5
a.
S1
