Exam 4

Question 1

1. Question: A 75 y/o male c/o worsening, right shoulder pain x 4 months. He states that he has tried OTC Tylenol, but it doesn’t seem to help very much. What is a possible differential diagnosis?
   a. Dislocation
   b. Fracture
   c. Osteoarthritis
   d. Given his age, more than likely a fall

Answer 1

Answer: C
Rationale for why the answer is correct: Pt is passed the acute pain phase. Osteoarthritis is a chronic cause for pain
Site for question/rationale: shoulder pain handout page 2

Question 2

2. Question: Your patient with chronic right shoulder pain, will need labs ordered to further help diagnosis. Which lab would be appropriate to order?
   a. Chem 20
   b. Lab cannot help diagnosis this problem
   c. CBC & sed rate
   d. A1C, TSH, UA

Answer 2

Answer: C
Rationale for why the answer is correct: CBC will help check for infection and Sed rate helps to check for inflammation. Both of these findings could be the reason for the chronic shoulder pain
Site for question/rationale: shoulder pain handout page 5

Question 3

3. Question: A 25 y/o male, a daily runner, c/o left knee pain that appears to have gotten worse lately, especially when he has to walk down his apartment stairs. He has a positive J-sign. What is a J-sign?
   a. J-sign is when the knee is swollen & warm
   b. J-sign is when the patella increases in size when the leg is extended
   c. J-sign is when the patella jumps laterally when the leg is fully extended
   d. J-sign is when the patella jumps laterally when the leg is bent

Answer 3

Answer: C
Rationale for why the answer is correct: This is the correct answer for J-sign
Site for question/rationale: knee pain handout page 2

Question 4

4. Question: An 18 y/o female, recent college student, is brought into the ED for c/o nuchal rigidity, temp 99, and slightly confused. What work up will need to be ordered for this pt?
   a. CBC, blood culture only
   b. CBC, blood culture, lumbar puncture
   c. CBC, blood culture, CMP, MRI
   d. No test needed as this is more than likely a virus caused by her being in the dorms

Answer 4

Answer: B
Rationale for why the answer is correct: Checking for elevated WBC and a lumbar puncture is crucial for establishing the diagnosis of bacterial meningitis, so need to examine CSF
Site for question/rationale: neuro ppt. handout, page 4

Question 5

5. Question: A caretaker expresses that her 85 y/o grandfather seemed normal yesterday, but today he seems slightly incorherent, unfocused on his usual daily activities, and seems to be unaware of anything. It appeared that he had gotten better around lunch time, but around 2pm, he became incoherent again. What is the likely diagnosis for this patient?
   a. This is typical behavior for someone this age
   b. Definitely Alzheimer’s
   c. Delirium
   d. Insomnia- make sure pt is getting adequate rest

Answer 5

Answer: C
Rationale for why the answer is correct: Pt developed symptoms in a short period and symptoms fluctuated throughout the day, this is delirium
Site for question/rationale: Dr. Vandergriff, neuro part 1, Time 5:44

Question 6

6. Question: You are teaching a family member about Parkinson’s disease. Which statement would mean that more teaching is needed?
   a. The disease is a progressive neurodegenerative disease
   b. If I notice any shuffling, short stepped gait, must notify the provider right away
   c. It is normal for him to have a stooped posture
   d. It is normal for his handwriting to keep getting smaller and smaller

Answer 6

Answer: B
Rationale for why the answer is correct: This is a normal magnification of Parkinson’s. Will not have to notify the provider right away
Site: Dr. Vandergriff, neuro part 2

Question 7

7. Question: What is the most accurate predictor of kidney disease?
   a. BUN/Creatinine
   b. Glomerular filtration rate
   c. There is no lab test that can predict kidney disease
   d. Chem 20

Answer 7

Answer: B
Rationale for why the answer is correct: GFR helps to predict kidney disease and is the most accurate
Site for question/rationale: renal diagnosis handout, Dr. Seth, page 3

Question 8

8. Question: Which lab is used to adjust drug dosages?
   a. GFR
   b. BUN
   c. Creatinine Clearance
   d. CMP

Answer 8

Answer: C
Rationale for why the answer is correct: This is the correct lab use to adjust drug dosages, as it shows that the kidneys are able to clear drugs through the kidney. Certain drugs should not be given or should be adjusted, if pt has kidney damage.
Site for question/rationale: Dr. Seth, renal diagnosis handout, page 4

Question 9

9. Question: What should be done prior to ordering a CT scan w/contrast for a patient?
   a. Check CBC
   b. Nothing need to be done, just send the patient to radiology
   c. Check kidney function, creatinine
   d. Check sodium/potassium level

Answer 9

Answer: c
Rationale for why the answer is correct: Dye can damage the kidney further if pt has kidney failure already
Site for question/rationale: Dr. Seth, renal diagnosis handout, page 5

Question 10

10. Question: What causes the urinalysis PH to rise if is left setting?
    a. Due to blood, calcium, sodium in the urine
    b. Due to patient being overhydrated
    c. Due to something patient ate prior to urinating
    d. Due to ammonia in the urine breaking down

Answer 10

Answer: D
Rationale for why the answer is correct: This is what causes the urine to breakdown, should place in the refrigerator to slow this process down
Site for question/rationale: urinalysis handout page 2, Dr. Seth

Question 11

1. Question: The NEUXUS and CCS guidelines have the same sensitivity for evaluating trauma patients’ need for radiography.
   A. True
   B. False

Answer 11

Answer: A
Rationale for why the answer is correct: The present study showed that the two guidelines have the same sensitivity for dealing with trauma patients and evaluating their need for radiography.
Site for question/rationale: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214507/

Question 12

2.	Question: What does the Kehr’s sign indicate? 
A.	Liver injury
B.	Spleen injury
C.	Left shoulder injury
D.	Right shoulder injury

Answer 12

Answer: B
Rationale for why the answer is correct: A spleen injury will radiate directly to the left shoulder.
Site for question/rationale: Dr. Shelly Seth “Shoulder Pain” presentation (timestamp 14:00)

Question 13

3.	Question: Which one of these is NOT an inflammatory arthritis? 
A.	Osteoarthritis
B.	Rheumatoid arthritis 
C.	Psoriatic arthritis 
D.	Undifferentiated arthritis

Answer 13

Answer: A
Rationale for why the answer is correct: Inflammatory arthritis includes rheumatoid arthritis, gout, systemic lupus erythematosus (SLE), psoriatic arthritis, undifferentiated arthritis
Site for question/rationale: Hand Pain and Swelling presentation by Dr. Shelly Seth (time 1:00)

Question 14

4.	Question: A patient is brought in my ambulance after a car accident and you assess his mental status right away. He only opens his eyes in response to pain, he is making sounds that can’t be comprehended, and he is withdrawing to pain. What Glasgow Coma score would this patient receive?
A.	5
B.	7
C.	11
D.	8

Answer 14

Answer: D
Rationale for why the answer is correct: There are 3 categories in which a patient is scored. This particular patient receives a score of 8 based on his s/s
Site for question/rationale: Dr. Kent Vandergriff’s Neuro handout, slide 3

Question 15

5.	Question: What labs are appropriate to order for a patient who presents with confusion and delirium without a known cause? (check all that apply)
A.	CMP
B.	Urine culture
C.	Glucose
D.	PT, PTT

Answer 15

Answer: A, B, C
Rationale for why the answer is correct: Serum electrolytes, creatinine, glucose, calcium, complete blood count, urinalysis, urine drug screen, and urine culture are reasonable for most patients when a cause is not immediately obvious.
Site for question/rationale: Dr. Kent Vandergriff’s Neuro handout, “labs” slide

Question 16

6. Question: What are the classic triad of symptoms for acute bacterial meningitis?
   A. Hypothermia, nuchal rigidity, confusion
   B. Fever, nuchal rigidity, change in mental status
   C. Change in mental status, nuchal rigidity, shivering
   D. Fever, nuchal rigidity, hypertension

Answer 16

Answer: B
Rationale for why the answer is correct: The classic triad of acute bacterial meningitis consists of: Fever (Most common usually > 38ºC, nuchal rigidity (stiff neck), change in mental status, small percentage may have hypothermia. (Rarely patients have a normal temperature)
Site for question/rationale: Dr. Kent Vandergriff’s Neuro handout

Question 17

7.	Question: What is the most accurate predictor of kidney disease?
A.	Glomerular Filtration Rate
B.	Creatinine
C.	BUN
D.	None of the above

Answer 17

Answer: A
Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease. It usually done by a nephrologist
Site for question/rationale: Renal Testing for Diagnosis presentation by Dr. Shelly Seth

Question 18

8.	Question: What are two contraindications for a kidney biopsy?
A.	Uncontrolled hypertension
B.	Single kidney 
C.	Recent surgery
D.	Pt greater than >75 years old

Answer 18

Answer: A, B
Rationale for why the answer is correct: Contraindications include: sepsis, uncontrolled HTN, hemorrhagic diathesis, parenchymal infection or malignancy, solitary or horseshoe kidney (unless it is transplanted), uncooperative patient
Site for question/rationale: Renal Testing for Diagnosis presentation by Dr. Shelly Seth

Question 19

9. Question: The collection of the 24-hour urine starts with the patient voiding (completely emptying bladder) and discarding the first urine passed in the morning.
   A. True
   B. False

Answer 19

Answer: A
Rationale for why the answer is correct: The 24-hour urine sample starts after the initial void because that is urine that was formed overnight.
Site for question/rationale: https://www.labcorp.com/resource/urine-specimens

Question 20

10.	Question: What GFR level signifies kidney failure? 
A.	30-40
B.	<15
C.	20-25
D.	<22

Answer 20

Answer: B
Kidney damage with normal kidney function GFR >90
Kidney damage with mild loss of kidney fx 60-89
Mild to moderate kidney dysfunction 45-59
Moderate to severe kidney dysfunction 30-44
Severe kidney dysfunction 15-29
Kidney failure <15
Site for question/rationale:
https://www.kidney.org/atoz/content/gfr

Question 21

1.	A 35-year-old female presents to your office complaining of clumsiness, burning and prickling sensation in right hand. She has a positive Tinel test, what is her likely her diagnosis?
A.	Osteoporosis
B.	Reiter’s Disease
C.	Carpel Tunnel Syndrome
D.	Fifth’s Disease

Answer 21

Answer: C
A Tinel test is used to help diagnose carpel tunnel syndrome by tapping the affected nerve that will produce a tingling sensation in hand. Although osteoporosis can affect the wrist it is normally diagnosed in older female adults past menopause. Reiter’s disease affects the joints, eyes and urethra of males 20-40 years old. Fifth’s disease is normally found in children.
Site for question/rationale: Hand Swelling and Pain handouts by Dr. Shelly Seth

Question 22

2. A 68-year-old male presents to the clinic complaining of pain, paresthesia and swelling to left hip. He has a history HTN and left hip replacement 6 months ago, what diagnostics might the APRN consider when determining a diagnosis?
   A. Arthrocentesis
   B. CT of the hip
   C. Jobes Test
   D. Anti-citrullinated protein antibody test

Answer 22

Answer: B
Rationale for why the answer is correct: Acceptable diagnostics for hip pain include plain x-ray 3 view, CT scan, and MRI. Arthrocentesis of an artificial joint should only be done by Ortho. Jobes test refers to shoulder ROM and the anti-citrullinated is specific to rheumatoid arthritis
Site for question/rationale: Hip pain handouts by Dr. Shelly Seth slide 7 - 9

Question 23

3. Which of the following is NOT low back pain clinical pearl:
   A. Loss of bowel or bladder
   B. Radiating pain into the leg along a dermatome
   C. Morning stiffness lasting more than 60 minutes
   D. Back pain with history of cancer

Answer 23

Answer: C
Rationale for why the answer is correct: Loss of bowel or bladder indicates cauda equina syndrome, which is an emergency. Radiating pain into the leg along a dermatome indicates a ruptured disc. Back pain with a history of cancer needs to be ruled out for metastatic disease. Morning stiffness greater than 60 minutes relates to rheumatoid arthritis.
Site for question/rationale: My back hurts handouts by Dr. Shelly Seth slide 3

Question 24

4. The classic triage of acute bacterial meningitis symptoms consist of which of the following (select all that apply)?
   A. Change in mental status
   B. Fever greater than 38 °C
   C. Altered lachrymal and salivary gland secretion
   D. Nuchal rigidity

Answer 24

Answer: A, B, D
Rationale for why the answer is correct: Altered lacrimal and salivary gland secretions is a clinical feature of Bell’s palsy, all other presenting symptoms are the classic triad of acute bacterial meningitis.
Site for question/rationale: Neuro handouts slide 11

Question 25

``` 5. A 21-year-old female presents to the clinic with a sudden onset of facial drooping on her left side of face and excessive drooling. She has a history of herpes simplex, asthma and just received her flu vaccine, which of the following is your probable diagnoses? A. Bell's palsy B. Bacterial meningitis C. Guillain-Barré D. Parkinson's ```

Answer 25

Answer: A Rationale for why the answer is correct: Clinical features of Bell's palsy are altered lacrimal and salivary gland secretion, sudden onset of unilateral facial paralysis, inability to close affected eye, disappearance of nasolabial fold, and altered taste to two thirds of tongue. Herpes simplex virus activation is the likely cause of Bell's palsy in most cases. Site for question/rationale: Neuro handouts slide 13-14

Question 26

6. A 52-year-old male comes into the clinic complaining of a sudden “thunderclap” headache. He also has a history of hypertension and diabetes, what is the next step by the APRN? A. Order a MRI of the head B. Order serologic testing for Lyme disease C. Order a lumbar puncture to rule out bacterial meningitis D. Send immediately to emergency room

Answer 26

Answer: D Rationale for why the answer is correct: A sudden onset of a “thunderclap” headache or the “worst headache of my life” may signal a subarachnoid hemorrhage. Patients must be referred to the emergency room as soon as possible for evaluation due to a high mortality rate. Site for question/rationale: Neuro handouts slides 29 - 30, and slides 45-47

Question 27

``` 7. A 73-year-old male presents to the clinic with nausea, vomiting, and flank pain. The patient has a history of chronic kidney disease, hypertension, and peptic ulcer disease. The APRN would like to prescribe a renal dose of antibiotic, which laboratory value is most important? A. Glomerular filtration rate B. Serum creatinine C. BUN D. Creatinine clearance ```

Answer 27

Answer: D Rationale for why the answer is correct: Creatinine clearance is measurement used to adjust drug dosages. Site for question/rationale: Renal testing for diagnoses handout by Dr. Shelly Seth slide 12

Question 28

``` 8. A 73-year-old male presents to the clinic with nausea, vomiting, and flank pain the patient has a history of chronic kidney disease, hypertension, and peptic ulcer disease. The APRN would like to order diagnostics to rule out kidney stones, which is most appropriate test for this patient? A. CT with contrast B. MRA with contrast C. Renal biopsy D. Renal ultrasound ```

Answer 28

Answer: D Rationale for why the answer is correct: Since this patient has chronic kidney disease it is best to avoid contrast for diagnostic testing to avoid complications. A renal ultrasound can be used at the bedside and no contrast is needed, it also can identify hydronephrosis, urine flow, differentiate cyst from masses, and stones. Site for question/rationale: Renal testing for diagnoses handout by Dr. Shelley Seth slide 14 -22

Question 29

9. A 40-year-old woman presents to the clinic with urinary frequency and discomfort. The APRN orders a microscopic urinalysis that reveals hematuria, pyuria, and bacterial casts, what is the next appropriate action? A. Have the patient return to clinic in 1 week for repeat urinalysis B. Treat patient for acute pyelonephritis C. Repeat urinalysis to rule out contamination D. Refer to nephrologist

Answer 29

Answer: B Rationale for why the answer is correct: Based on the bacterial cast present and microscopic urinalysis and patient's symptoms, this is an indication of acute pyelonephritis. A microscopic urinalysis is more accurate compared to a UA dipstick, which may have false positives. Site for question/rationale: Urinalysis handouts by Dr. Shelly Seth slides 4, 11, 12, 14, 15

Question 30

``` 10. A 55-year-old man presents to the clinic with a productive cough, fever, and shortness of breath. He has a history of hypertension, diabetes, and he is a smoker. He has been seen in the clinic several times and has been prescribed antibiotics; the APRN would like to order additional diagnostics, which is the most appropriate? A. Lumbar puncture B. Gram stain, C&S of sputum C. Urinalysis D. Gram stain, CNS of pleural fluid ```

Answer 30

Answer: B Rationale for why the answer is correct: It is possible that the patient is being prescribed antibiotics that are not sensitive to particular bacteria. The Gram stain should be order when infection is suspected, unknown origin of fever, and fluid accumulation in wrong place. The culture and sensitivity will give antibiotic specifics. Site for question/rationale: Fluid analysis handouts by Dr. Shelley Seth slides 3- 8

Question 31

``` 1. Question: A patient is coming in with a chief complaint of “Shoulder Pain.” After gathering their HPI and performing a PE, you diagnose them with arthritis. As a NP you know that the most common place to develop arthritis is in what articular surface? A. Sternoclavicular B. Acromioclavicular C. Glenohumeral D. Scapulothoracic ```

Answer 31

Answer: C Rationale for why the answer is correct: The most common place to develop arthritis of the shoulder and the most problematic area is the Glenohumeral. Site for question/rationale: Shoulder Pain presentation by Dr. Shelly Seth, 3:45. (In Red font)

Question 32

``` 2. Question: Morning stiffness lasting more than __ minutes indicates an inflammatory process. A. 30 minutes B. 60 minutes C. 90 minutes D. 20 minutes ```

Answer 32

Answer: B Rationale for why the answer is correct: CLINICAL PEARL: Morning stiffness lasting more than 60 minutes indicates an inflammatory process. Site for question/rationale: Hand Pain and Swelling presentation by Dr. Shelly Seth, 2:00.

Question 33

``` 3. Question: When a patient presents with a chief complaint of “Hip Pain.” The most important diagnostic tests to Rule Out infection include all EXCEPT: A. Sed Rate B. CBC C. CRP D. CMP ```

Answer 33

Answer: D Rationale for why the answer is correct: A Sed rate, CBC, and CRP are all labs that could indicate Infection or Inflammation. Site for question/rationale: Hip Pain presentation by Dr. Shelly Seth, 8:20.

Question 34

``` 4. Question: Clinicians must be aware that delirium can still occur at normal therapeutic levels with which drugs? A. Digoxin B. Lithium C. Quinidine D. All of the Above ```

Answer 34

Answer: D Rationale for why the answer is correct: Digoxin, Lithium, and Quinidine can all cause delirium even at therapeutic drug levels. Site for question/rationale: Neurology Presentation 1 by Dr. Kent Vandergriff, 7:15.

Question 35

``` 5. Question: The Classic Triad of Acute Bacterial Meningitis consists of all of the following EXCEPT: A. Elevated WBC B. Fever C. Stiff Neck D. Change in Mental Status ```

Answer 35

Answer: A Rationale for why the answer is correct: The Classic Triad of Acute Bacterial Meningitis includes Fever >38°C, Nuchal Rigidity (Stiff Neck), Changes in Mental Status, and occasionally Hypothermia (Rarely patients have a normal temperature). Site for question/rationale: Neurology Presentation 1 by Dr. Kent Vandergriff, 9:05.

Question 36

``` 6. Question: A 62-year-old patient presents to the ED with a sudden onset of a severe headache. The patient describes it as “the worst headache they have ever had.” The Nurse practitioner should automatically suspect that this is a: A. Migraine Headache B. Tension Headache C. Thunderclap Headache D. Cluster Headache ```

Answer 36

Answer: C Rationale for why the answer is correct: A sudden onset of a severe headache is known as a Thunderclap Headache and the patient usually describes it as “the worst headache they have ever had in their life.” It should be considered a subarachnoid hemorrhage until proven otherwise. Site for question/rationale: Neurology Presentation 2 by Dr. Kent Vandergriff, 3:30.

Question 37

``` 7. Question: Which test is the most accurate predictor of kidney disease? A. GFR B. BUN C. Serum Creatinine D. Urinalysis ```

Answer 37

Answer: A Rationale for why the answer is correct: The most accurate predictor of kidney disease is GRF. The GFR on lab reports is an “estimated” result. To do the test, a patient is given a marker that will clear through the glomerular filtration system and be measured. This is normally done by a nephrologist.

Question 38

``` 8. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 7:05. Question: When adjusting a medication dose, you should consider which lab? A. GFR B. Creatine Clearance C. BUN D. 24-hour urine protein ```

Answer 38

Answer: B Rationale for why the answer is correct: Creatinine Clearance is measurement used to adjust drug dosages. (RED FONT) Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 14:34.

Question 39

``` 9. Question: Your patient presents to the clinic with elevated blood pressures at 36 weeks gestation. What lab work would you expect to order on the patient suspected to have preeclampsia? A. BUN B. Creatine Clearance C. GFR D. 24-hour urine protein ```

Answer 39

Answer: D Rationale for why the answer is correct: Preeclampsia is an indication to order a 24-hour urine. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 16:18.

Question 40

``` 10. Question: All of the following tests would be appropriate to diagnose a kidney stone EXCEPT: A. CT with contrast B. CT without contrast C. Renal US D. KUB ```

Answer 40

Answer: A Rationale for why the answer is correct: CT scan stone protocol is that NO contrast be used. The calcium alone will show up. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, 19:50.

Question 41

1. Question: Which is not part of the four muscles of the rotator cuff? a. Supraspinatus b. Subscapularis c. Tres minor d. Glenohumeral

Answer 41

Answer: D- glenohumeral Rationale for why the answer is correct: Supraspinatus, Subscapularis, Tres minor, and Infraspinatus are the four muscles of the rotator cuff. Site for question/rationale: “CC: My shoulder hurts” by Dr. Shelly Seth Pg.3

Question 42

2. Question: What is not an example of chronic shoulder pain? a. Peripheral nerve entrapment b. Rotator cuff injury c. Osteoarthritis d. Adhesive capsulitis

Answer 42

Answer: A- Peripheral nerve entrapment Rationale for why the answer is correct: Peripheral nerve entrapment is an example of referred shoulder pain that is distal to the spinal column. Site for question/rationale: “CC: My shoulder hurts” by Dr. Shelly Seth Pg. 2

Question 43

3. Question: Which of these clinical pearls is most accurate? a. RA is not symmetrical, and OA is symmetrical b. OA is always symmetrical c. OA is usually not symmetrical, and RA is symmetrical d. RA is always symmetrical

Answer 43

Answer: C- OA is usually not symmetrical, and RA is symmetrical Rationale for why the answer is correct: RA is rheumatoid arthritis from inflammatory arthritis that is symmetrical, and OA is osteoarthritis from degenerative arthritis that is usually not symmetrical. Site for question/rationale: “CC: My hand hurts” by Dr. Shelly Seth Pg. 1

Question 44

4. Question: What part of the body does bacterial meningitis infect? a. The pia and the CSF in the subarachnoid space. b. The arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles. c. The dura mater and the CSF in both the subarachnoid space and the cerebral ventricles. d. The dura mater and the CSF in the cerebral ventricles.

Answer 44

Answer: B- the arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles. Rationale for why the answer is correct: - Bacterial meningitis infects the arachnoid mater and the CSF in both the subarachnoid space and the cerebral ventricles. Site for question/rationale: Top 10 Neuro Diagnosis in Acute & Primary Care Presentation PowerPoint Pg. 4

Question 45

5. Question: Which is not a presenting symptom of bacterial meningitis? a. Fever >100.4f b. Diplopia c. Hypothermia d. Nuchal rigidity

Answer 45

Answer: B- diplopia Rationale for why the answer is correct: Fever above 100.4f, hypothermia, and nuchal rigidity are all symptoms of bacterial meningitis. Rarely patient’s have a normal temperature with bacterial meningitis. Site for question/rationale: Top 10 Neuro Diagnosis in Acute & Primary Care Presentation PowerPoint Pg. 4

Question 46

6. Question: What is most likely the cause of Bell’s Palsy in most cases? a. Herpes simplex virus activation b. Viral meningitis c. Intracranial bleeding d. Syphilis exposure at birth

Answer 46

Answer: A- herpes simplex virus activation Rationale for why the answer is correct: Herpes simplex virus activation is the likely cause of Bell’s palsy in most cases. Site for question/rationale: Top 10 Neuro Diagnosis in Acute & Primary Care Presentation PowerPoint Pg. 5

Question 47

7. Question: What is the most accurate predictor of kidney disease? a. BUN b. Creatinine c. CMP d. GFR

Answer 47

Answer: D- GFR Rationale for why the answer is correct: GFR is the most accurate predictor of kidney disease. Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 3

Question 48

8. Question: A GFR should be considered with all the following except: a. Extremes of age and body size b. Severe malnutrition or obesity c. Athlete exercising 5x days/week d. Pregnancy

Answer 48

Answer: C- athlete exercising 5x days/week Rationale for why the answer is correct: Extremes of age and body size, severe malnutrition, pregnancy, and many more should all be considered for a GFR. Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 3

Question 49

9. Question: What is the measurement used to adjust drug doses? a. Creatinine clearance b. CMP c. Peak & trough levels d. A1C

Answer 49

Answer: A- creatinine clearance Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug doses. Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 4

Question 50

10. Question: What are contraindications to ordering a CT scan with dye? a. Patient taking metformin b. Renal disease c. Multiple myeloma d. All of the above

Answer 50

Answer: D- all of the above Rationale for why the answer is correct: Elevated creatinine, taking metformin, dehydration, allergies to dye, history of renal disease, and multiple myeloma are all contraindications for ordering and administering dye for a CT scan. Site for question/rationale: Renal testing for diagnosis presentation notes Pg. 6

Question 51

1. Question: A healthy 26-year-old comes into the clinic with complaint of knee pain. She states that the pain is right behind her kneecap and intensifies when walking downstairs. She is an avid runner who just finished up her 3rd marathon last month. You exam her and the J-sign is positive upon assessment. Which of the following is the most likely diagnosis? a. Pattellofemoral Pain Syndrome b. Patellar Tendinitis c. Prepatella Brusitis d. Osgood-Schlatters disease

Answer 51

Answer: A: Patellofemoral Pain Syndrome Rationale for why the answer is correct: Patellofemoral pain syndrome is the most common cause of anterior knee pain and occurs in 16-25% of injuries in runners. It is pain behind or around the patella aggravated by weight-bearing activities. The pain is worsened with activities such as squatting or descending stairs. Site for question/rationale: Dr. Shelly Seth “Knee Pain” presentation on slide 9 at minute 7

Question 52

2. Question: According to the NEXUS (National emergency x-radiography utilization study) a trauma patient must meet all of the follow criteria to not be required cervical spine imaging EXCEPT: a. Not intoxicated b. Alert and stable c. Only one distracting injury d. No midline spinal tenderness

Answer 52

Answer: C: Only one distracting injury Rationale for why the answer is correct: According to NEXUS trauma patients who do not require cervical spine imaging require ALL of the follow: alert and stable, No focal neurologic deficit, No altered LOC, not intoxicated, no midline spinal tenderness, and NO distracting injury

Question 53

3. Question: Your patient comes in with the complaint of back pain. You have him raise his leg and note pain at approximately 40 degrees. You determine that this means the test is positive and he may have a herniated disk. Which of the following is the test that you just performed? a. Hawkins Kennedy Test b. Straight Leg Raise c. Jerk Test d. Posterior impingement sign

Answer 53

Answer: B: Straight Leg Raise (SLR) – This is the most common test is the SLR during a physical exam for the complain of back pain. It is a positive test for a possible herniated disk. The remaining tests are Shoulder specialty tests. Rationale for why the answer is correct: Site for question/rationale: Min 8:15

Question 54

4. Question: Which of the following is not part of the acronym SNOOP for red flags with headaches? a. S: Systemic symptoms b. N: Neurologic symptoms c. O: Onset is new or sudden d. P: Prodrome or Aura

Answer 54

Answer: D: Prodrome or Aura Rationale for why the answer is correct: SNOOP stands for Systemic symptoms, Neurologic symptoms, Onset is new or sudden, Other associated conditions or features, Previous headache history Site for question/rationale: Dr. Kent Vandergriff’s lecture on “Top 10 Neuro Diagnosis in Acute and Primary Care” Slide 28-29

Question 55

5. Question: A 65 year old presents with stopped posture, shuffling gait, hypophonia, bradykinesia, and tremors. Based on these presenting symptoms what would be your leading diagnosis? a. Parkinson’s Disease b. Guillain Barre Syndome c. Bell’s Palsy d. Multiple Sclerosis

Answer 55

Answer: A: Parkinson’s Disease Rationale for why the answer is correct: Clinical assessment of the signs and symptoms associated with Parkinson’s disease are tremor, bradykinesia, rigidity, postural instability. There clinical manifestations are related to craniofacial, visual, musculoskeletal, and gait. The mean age of dx is 70.5 y/o, uncommon in less than 40 y/o, and incidence increases with > 60y/o. Site for question/rationale: Dr. Kent Vandergriff’s lecture on “Top 10 Neuro Diagnosis in Acute and Primary Care” Slide 32-35

Question 56

6. Question: A patient comes in with a complaint of the “worst headache of my life”. She states that it started about 3 hours ago and will not go away or decrease in severity even with OTC medication taken 2 hours ago. Based on the patient’s complaint you need to evaluate for a Subarachnoid Hemorrhage (SAH). Which of following is the gold standard to identify and treat diagnosis? a. Head CT b. Lumbar Puncture c. 4 Vessel cerebral angiogram d. MRI

Answer 56

Answer: C: Formal 4 cerebral angiogram Rationale for why the answer is correct: the Formal 4 cerebral angiogram is gold standard and utilized to identify and coil aneurysm. CT is good for diagnosis in >90% of cases if within 24 hours. LP is mandatory if there is suspicion of SAH despite a normal CT Site for question/rationale: Dr. Kent Vandergriff’s lecture on “Top 10 Neuro Diagnosis in Acute and Primary Care” Slide 41

Question 57

7. Question: Which of the follow labs are measured to adjust drug dosages? a. Cystatin C b. BUN c. Creatinine Clearance d. GFR

Answer 57

Answer: C: Creatinine clearance Rationale for why the answer is correct: Creatinine clearance is the correct measurement for adjusting drug dosages. Though the other labs are used for kidneys they are not specifically used to change your medication dosages. Site for question/rationale: “Diagnosing Renal Problems: Diagnostic Tests for Renal Diseases” By Dr. Shelly Seth at min 11:20 - 14:30- and slide 10 & 12

Question 58

``` 8. Question: Your patient comes in with a suspected UTI. You duo a UA and note the following. What differential diagnosis would you be most suspicious of? • Nitrites: Positive • RBCs < 2RBCs/hpf • Casts – Many WBC casts • Yeast: None a. Pyelonephritis b. Glomerulonephritis c. Tubular necrosis d. Tamm-Horsfall mucoprotein ```

Answer 58

Answer: B: pyelonephritis Rationale for why the answer is correct: WBC cases come from the kidney tubule and reflect pyelonephritis. Whereas Tamm-Horsfall mucoprotein is an incidental finding of hyaline casts, RBC casts indicate glomerulonephritis, and epithelial casts tubular necrosis. Site for question/rationale: “Urinalysis” by Dr. Shelly Seth slide 15 at approx. min 14

Question 59

9. Question: Which of the following is not included in the patient’s instructions for collecting 24-hour urine specimen? a. Upon rising the first morning, urinate emptying your bladder completely into specimen container and note exact time and print it on the container label b. Refrigerate the collected urine between all voidings and keep it in a cool place c. Collect all urine voided for 24 hours after the first void in the container provided by the physician. All urine passed during the 24-hour time period (day or night) must be saved. Urine passed during bowel movements also collected. d. Take the 24-hour specimen to the physician’s office or laboratory as soon as possible, placing it in a portable cooler or insulated bag to maintain cool temperature in transit.

Answer 59

Answer: A: Upon rising the first morning, urinate emptying your bladder completely into specimen container and note exact time and print it on the container label. Rationale for why the answer is correct: According to lapcorp, the patient instructions is to urinate their first morning urine into the toilet, and then begin the 24 hour collect post 1st morning void. Site for question/rationale: Urine Specimens | Labcorp. (2021). Labcorp. https://www.labcorp.com/resource/urine-specimens

Question 60

10. Question: The patient has a GFR of 20. What stage of chronic kidney disease would this place them in? a. Stage 1 b. Stage 2 c. Stage 4 d. Stage 5

Answer 60

Answer: C: Stage 4 Rationale for why the answer is correct: Stage 4 indicates severe loss of kidney function. The GFR for stage 4 is 29 to 15. Site for question/rationale: Estimated Glomerular Filtration Rate (eGFR). (2020, September 14). National Kidney Foundation. https://www.kidney.org/atoz/content/gfr

Question 61

``` 1. Question: A 9-year-old boy presents to the clinic after soccer practice and he complains of pain to his left shoulder. He has a positive Kehr’s sign. What is your leading diagnosis? A. Rotator cuff injury B. Impingement syndrome C. Spleen laceration D. Shoulder fracture ```

Answer 61

Answer: C Rationale for why the answer is correct: A positive Kehr’s sign is indicative of a spleen laceration. Site for question/rationale: “My Shoulder Hurts” presentation by Dr. Seth, minute 3:20

Question 62

``` 2. Question: A patient presents to the clinic with hand pain, conjunctivitis, urethral discharge and urethritis. What is your leading diagnosis for this patient? A. Reiter’s disease B. Lyme Disease C. Uveitis, temporal arteries D. None of the above ```

Answer 62

Answer: A Rationale for why the answer is correct: Patient’s with Reiter’s disease present with hand pain, conjunctivitis, urethral discharge and urethritis. Site for question/rationale: “My hand hurts” presentation by Dr. Seth minute 8:20

Question 63

3. Question: _______ is symmetrical and __________ is usually not symmetrical. A. Osteoarthritis and Rheumatoid arthritis B. Rheumatoid arthritis and Osteoarthritis C. Rheumatoid arthritis and Psoriatic arthritis D. Psoriatic arthritis and Osteoarthritis

Answer 63

Answer: B Rationale for why the answer is correct: A clinical pearl to remember is that RA is symmetrical and OA is usually not symmetrical. In addition, the metacarpal joints and wrists are painful in RA while the distal interphalangeal and proximal interphalangeal joints are painful in OA. Site for question/rationale: “My hand hurts” presentation by Dr. Seth minute 2:11

Question 64

``` 4. Question: A patient comes into the ER via ambulance and they are unresponsive. What is their Glasgow coma scale score? A. 0 B. 3 C. 15 D. 5 ```

Answer 64

Answer: B Rationale for why the answer is correct: The Glasgow coma scale ranges from 3-15 it measures 3 different areas (Eye opening, Best verbal response and Best motor response). An unresponsive patient would be scored a 3 according to the Glasgow coma scale Site for question/rationale: “Top Ten neuro diagnosis in acute and primary care part one” presentation by Dr. Vandergriff minute 2:45

Question 65

``` 5. Question: You suspect a patient has acute bacterial meningitis. Which of the following signs would this patient have? A. Fever greater than 38 degrees C B. Nuchal rigidity (stiff neck) C. Change in mental status D. All of the above ```

Answer 65

Answer: D. Rationale for why the answer is correct: The classic triad of acute bacterial meningitis consists of Fever greater than 38 degrees C, Nuchal rigidity (stiff neck) and change in mental status Rarely do patients present with a normal temperature. Site for question/rationale: “Top Ten neuro diagnosis in acute and primary care part one” presentation by Dr. Vandergriff minute 9:20

Question 66

6. Question: Which of the following would be the classic triad for a patient with normal pressure hydrocephalus? A. Psychosis, gait disturbance and urinary incontinence B. Dementia, headaches and gait disturbances C. Dementia, gait disturbance and urinary incontinence D. Headaches, gait disturbance and dementia.

Answer 66

Answer: C. Rationale for why the answer is correct: The classic triad presentation for NPH-normal pressure hydrocephalus would be Dementia, gait disturbance and urinary incontinence Site for question/rationale: “Top Ten neuro diagnosis in acute and primary care part two” presentation by Dr. Vandergriff minute 15:45

Question 67

``` 7. Question: Which lab value must you look at to adjust drug dosages? A. Creatine Clearance B. BUN C. Estimated GFR D. BMP ```

Answer 67

Answer: A Rationale for why the answer is correct: Creatine clearance is the measurement used to adjust drug dosages. Site for question/rationale: “Renal testing for diagnosis” presentation by Dr. Seth minute 14:35

Question 68

``` 8. Question: Which test is the most accurate predictor of kidney disease? A. BUN B. Glomerular filtration rate C. Serum Creatine D. Urinalysis ```

Answer 68

Answer: B Rationale for why the answer is correct: The Glomerular filtration rate is the most accurate predictor of kidney disease; this test is usually ordered by a nephrologist and it is done with a 24-hour urine. Site for question/rationale: “Renal testing for diagnosis” presentation by Dr. Seth minute 7:30

Question 69

9. Question: A which of the following are true about (gadolinium contrast)? a. It can cause nephrogenic systemic fibrosis and renal failure b. Do not use with patients in acute kidney injury c. If used on patients on dialysis, they must immediately dialyze after the test d. All of the above is true.

Answer 69

Answer: D Rationale for why the answer is correct: All of the above was true regarding the use of gadolinium contrast It can cause nephrogenic systemic fibrosis and renal failure, do not use with patients in acute kidney injury and If used on patients on dialysis, they must immediately dialyze after the test. A nephrologist MUST be involved as well and they will be the ones ordering this Site for question/rationale: “Renal testing for diagnosis” presentation by Dr. Seth minute 24:05

Question 70

10. Question: What is the normal urinalysis pH range? a. 7.35-7.45 b. 4.5-8.0 c. 1.0-4.5 d. 8.0-14

Answer 70

Answer: B Rationale for why the answer is correct: the normal range of urinalysis pH range is 4.5-8.0. acidity/alkalosis corresponds with metabolic state of patient. Site for question/rationale:” Urinalysis” presentation by Dr. Seth slide 2

Question 71

1. Question: Shoulder pain can be. a. Atrinsic b. Extrinsic c. Intrinsic d. All the above

Answer 71

Answer: C Rationale for why the answer is correct: The intrinsic qualities of something have to do with its nature. Site for question/rationale: DR. Seth Shoulder pain handout.

Question 72

2. Question: Patient comes into office with complains of hand pain, states he was on vacation in Indiana on a hunting trip. There was a lot of forest and it was very moist. Other complaints by patient involve neurological concerns and a large red wheel or annular red plaque on left leg. What does this patient present with. a. Reiter’s disease b. SLE c. Lyme disease d. Stephen Johnson’s Syndrome

Answer 72

Answer: C Rationale for why the answer is correct: Lyme disease presents with neurological concerns, and large red annular plaque where tick bite was observed. Site for question/rationale: DR. Seth Hand pain and swelling PP

Question 73

3. Question: Patient presents to clinic complaining of nausea, vomiting, fever, some weight loss and fatigue. Upon assessment a large macular “Butterfly Rash” is noticed on the patients face. As a practitioner the first disease process that comes to mind is. a. Lyme disease b. Reiter’s disease c. Rheumatoid arthritis d. Systemic Lupus Erythematous

Answer 73

Answer: D Rationale for why the answer is correct: Systemic Lupus presents with the classic “Butterfly Rash.” Site for question/rationale: Dr. Seth Hand and swelling PP

Question 74

4. Question: Patient presents to clinic with acute peripheral facial palsy of unknown cause. Eyebrow sagging, mouth drooping. Stroke is ruled out for this patient. As a provider you know that this presentation is classic for. a. Guillain Barre Syndrome b. Meningitis c. Bell’s Palsy d. Multiple Sclerosis

Answer 74

Answer: C Rationale for why the answer is correct: Classic presentation of Bell’s Palsy is facial paralysis, drooping mouth, sagging eyebrow, usually diagnosed upon ruling out stroke. Site for question/rationale: Neuro PP Bell’s Palsy

Question 75

5. Question: What is the mnemonic that is used for the presence of serious underlying disorders that can cause acute or subacute HA. a. FAST b. SNOOP c. SMART d. BEFAST

Answer 75

Answer: B Rationale for why the answer is correct: This widely used Mnemonic of SNOOP helps detect causes of secondary headache with significant morbidity and mortality. Site for question/rationale: Neuro PP Handout

Question 76

6. Question: A 25- year- old present to the clinic with neurological deficits that mimic Parkinson’s disease. As a provider you know that Parkinson’s is usually uncommon in people under the age of. a. 25 b. 30 c. 40 d. 75

Answer 76

Answer: C Rationale for why the answer is correct: According to the power-point progressive neurodegenerative disease Parkinson disease is uncommon in people younger than 40. Incidence of the disease increases rapidly over 60 years, with a mean age at diagnosis of 70.5 Site for question/rationale: Neuro PP

Question 77

7. Question: What labs are usually drawn for initial Kidney testing. a. UA, Serum Creatinine, BUN, GFR. b. UA, Creatinine serum, BNP, MCV c. CBC, CMP, BNP, UA d. Urinalysis, Creatinine Clearance, Complete metabolic panel, Glomerular filtration rate.

Answer 77

Answer: A Rationale for why the answer is correct: According to power point the basic labs for kidney testing are UA, Serum Creatinine, BUN, GFR. These simple blood tests and urine tests can help identify problems with the kidneys. Site for question/rationale: Renal Testing for Diagnosis PP

Question 78

8. Question: What is the normal PH of a urinalysis? a. 8.35-8.45 b. 4.5 – 8 c. 3.5-5 d. 6

Answer 78

Answer: B Rationale for why the answer is correct: Many factors affect urine PH, environment, heat, cold. Site for question/rationale: Urinalysis PP Dr. Seth.

Question 79

9. Question: Which lab is the most accurate predictor of Kidney Disease? a. GFR b. Serum Creatinine c. BUN d. 24 hr urine collection.

Answer 79

Answer: A Rationale for why the answer is correct: GFR is a test used to check how well the kidneys are functioning. It estimates how much blood passes through the glomeruli each minute. Site for question/rationale: Renal Testing for Diagnosis PP. Dr. Seth.

Question 80

10. Question: Which lab is used primarily to adjust drug dosages. a. Blood, Urea, Nitrogen b. LFTs c. Creatinine clearance d. Nitrates

Answer 80

Answer: C Rationale for why the answer is correct: The amount of blood the kidneys can make creatinine free each minute. The waste product from normal wear and tear of your muscles which passes through the kidneys. This process helps doctors understand how well the kidney is functioning and can help them adjust medication for those who are at risk for inadequate functioning of the renal system. Site for question/rationale: Renal Testing for Diagnosis PP. Dr. Seth.

Question 81

``` 1. Question: A 1-year-old patient arrives to the ED with limited range of motion of the left arm and pain with movement. After further investigation mom reports the patient’s big sister was pulling her around the house by both arms when the patient started screaming and refused to move her left arm. Which is the most likely diagnosis given symptoms and mechanism of injury? Answer: A. Rotator Cuff Injury B. Supracondylar Fracture C. Nurse Maid’s Elbow D. Impingement Syndrome ```

Answer 81

Rationale for why the answer is correct: Nurse Maids elbow occurs in children from 6 months to 5 years and is a very common diagnosis. It occurs with pulling or swinging motions and involves the subluxation of the radial head. It can easily be put back with a simple hyper pronation and supination movement. Analgesics can be given to reduce inflammation and help with pain. Site for question/rationale: Found in the Nurse Maid’s Elbow presentation power point in Canvas under Module 7 slide #1.

Question 82

``` 2. Question: What are the most appropriate and least invasive tests to order and perform on a patient you suspect to have osteonecrosis of the hip? Answer: A. Arthrocentesis, US, CBC, CRP B. Xray, CBC, CRP, Sed Rate C. CT, CRP, Sed Rate D. MRI, CBC, CRP ```

Answer 82

Rationale for why the answer is correct: A plain view Xray of the hip joint is the best radiological test to perform that is the least invasive mechanism to diagnose osteonecrosis of the hip. In addition, a CBC, CRP, and Sed Rate should be drawn to evaluate for infection and inflammation. Site for question/rationale: Found on slides #7/8 on the Hip Pain Handout found under Module 7 in canvas.

Question 83

3. Question: Which symptoms are the most indicative of a diagnosis of Systemic Lupus Erythematosus (SLE)? Answer: A. Hand pain, fever, fatigue, and a malar rash B. Symmetrical hand pain, fever, fatigue, and chest pain C. Hand pain, conjunctivitis, and urethral discharge D. Hand pain, annular red plaque, and neurological changes/issues

Answer 83

Rationale for why the answer is correct: A malar rash is a tell-tale sign of SLE in combination with the other preceding symptoms this diagnosis can be likely believed. Other symptoms of SLE include weight loss, chest pain, nausea, vomiting, diarrhea, personality changes, and a photosensitive rash. The other answers indicate either RA, Reiter’s Disease, or Lyme’s disease. Site for question/rationale: Found in the Hand Swelling and Pain Handout on power point slide #9 from Module 7.

Question 84

``` 4. Question: A 30-year-old male presents with progressive muscle weakness that occurred symmetrically and absent deep tendon reflexes. What is your leading differential diagnosis? Answer: A. Parkinson’s Disease B. Stroke C. Subarachnoid Hemorrhage D. Guillain Barre Syndrome ```

Answer 84

Rationale for why the answer is correct: Guillain Barre Syndrome is an acute immune-mediated polyneuropathy are classified under GBS. A heterogenous condition with several variant forms that presents with as a monophasic paralyzing illness provoked by a preceding infection. Clinical manifestations include a progressive and symmetric muscle weakness and absent of decreased deep tendon reflexes. Usually starts from the most distal part of the body and works in an upward fashion resulting in respiratory muscle weakness and ventilator support. Site for question/rationale: Found in the Neuro power point under Module 7 slide # 20.

Question 85

``` 5. Question: What diagnostic tests are important in the diagnosis of Bacterial Meningitis? Answer: A. CBC, Blood cultures, and LP B. CBC, Sed Rate, CRP, and CT C. CBC, CMP, and CT D. CBC, Sed Rate, CT, and LP ```

Answer 85

Rationale for why the answer is correct: Bacterial Meningitis is an inflammatory disease of the leptomeninges and is defined by an abnormal number of WBC’s in the CSF. The symptoms present with fever, nuchal rigidity, and change in mental status. The workup includes CBC, Blood Cultures, Lumbar Puncture, and possible CT if mass or high ICP is suspected. Site for question/rationale: Found in the Neuro power point under Module 7 slide #9.

Question 86

6. Question: What are clinical manifestations and features found in a patient with Bell’s Palsy? Answer: A. Masked facial expression, eyelid apraxia, hypophonia B. Unliteral facial paralysis, inability to close eye, disappearance of nasolabial fold C. Sudden headache described as the worst headache of their life, photophobia, blurred vision D. Numbness of face, difficulty speaking, blurred vision

Answer 86

Rationale for why the answer is correct: Bells Palsy is known as acute peripheral facial palsy with unknown cause. Clinical manifestations of Bells Palsy include sudden onset, usually within hours, of unilateral facial paralysis, eyebrow sagging, mouth drooping, inability to close eyelid, disappearance of nasolabial fold, altered secretion of lacrimal and salivary glands, and loss of taste on anterior 2/3 of the tongue. Site for question/rationale: Found in the Neuro power point under Module 7 slide #10.

Question 87

7. Question: What are some differential diagnoses that are found in a patient with exudative fluid? Answer: A. CHF, Cirrhosis, Hypoalbuminemia B. Peritoneal dialysis, Pericarditis, Malignancy C. Nephrotic causes, PE D. Pneumonia, PE, Pancreatitis

Answer 87

Rationale for why the answer is correct: Exudative fluid is usually secreted from inflamed tissue and contain cells or cellular substances. An exudative effusion needs analysis and treatment. Some causes include pneumonia, malignancy, PE, pancreatitis, recent GI surgery, and trauma. Site for question/rationale: Found in the Fluid Analysis power point under Module 8 slide # 27.

Question 88

``` 8. Question: What are some differential diagnoses associated with blood in the urine? Answer: A. UTI B. Kidney stone C. Proteinuria D. Tumor ```

Answer 88

Rationale for why the answer is correct: When RBC’s are found in a urinalysis there are numerous diagnoses that require a follow up. These diagnoses include kidney stone, damage to the kidney, and bladder cancer. Site for question/rationale: Found in the Fluid Analysis power point under Module 8 page 5.

Question 89

9. Question: Which question regarding history is the most appropriate and pertinent question a provider should ask when evaluating and assessing a patient for a urinary tract infection? Answer: A. “Do you have hematuria, polyuria, urgency, or any flank pain?” B. “Do you have any history of kidney disease?” C. “Have you ever had any recent resting with dye? D. “Have you ever been diagnosed edema, hypertension, or diabetes?”

Answer 89

Rationale for why the answer is correct: When evaluating for a UTI the most appropriate question for a provider to ask is regarding any blood, pain, increased frequency/urgency/polyuria and or any flank pain. The other answers are important secondary questions to evaluate PMH and any previously diagnosed cardiovascular/renal problems. Site for question/rationale: Found in the Renal Diagnosis power point under Module 8 page #1.

Question 90

``` 10. Question: What test is the most accurate predictor of Kidney Disease? Answer: A. Creatinine Clearance B. Glomerular Filtration Rate C. 24 Hour Urine D. Renal Ultrasound ```

Answer 90

Rationale for why the answer is correct: Glomerular Filtration Rate is the most accurate predictor of kidney disease. This test is done by a nephrologist and is usually an estimated amount. The patient is given a marker that will clear through the glomerular system and measured. The GFR should be considered with extremes of ages, and body size, malnutrition or obesity, musculoskeletal disease, vegetarian diet, rapidly changing kidney function, and or pregnancy. Site for question/rationale: Found in the Renal Diagnosis power point under Module 8 page #3.

Question 91

1. Question: Referred left shoulder pain caused by diaphragmatic irritation secondary to a ruptured spleen is called? a. Kerr’s sign b. Murphy’s point tenderness c. Kernig’s sign d. McBurney’s point tenderness

Answer 91

Answer: A Rationale for why the answer is correct: Kerr’s sign occurs when free blood in the abdomen irritates the diaphragm which causes nerve pain that refers to the left shoulder. Site for question/rationale: Dr. Seth’s lecture “Shoulder Pain Diagnostics” (3:15)

Question 92

2. Question: After performing a physical exam on a patient who complains of shoulder pain. The provider decides to perform a single AP shoulder X-Ray. This is appropriate because? a. A one-view film will show anything that could be wrong b. The provider is trying to be cost effective therefore a one-view is acceptable c. There were not obvious signs of injury on the physical exam d. This is not appropriate. At least 2 views need to be performed.

Answer 92

Answer: D Rationale for why the answer is correct: Performing a single view on an X-ray is not comprehensive enough to show the provider possible injury in the shoulder. The provider needs to visualize the shoulder from a minimum of 2 views. Site for question/rationale: “Shoulder series” (15:30)

Question 93

3. Question: A common difference when diagnosing rheumatoid arthritis (RA) versus osteoarthritis (OA) is? a. RA pain is usually in either the left OR right wrist b. RA is caused by overworked/overused joints c. RA is usually symmetrical, OA is usually asymmetrical d. Only a few highly specialized providers can distinguish and diagnose RA/OA

Answer 93

Answer: C Rationale for why the answer is correct: RA is a systemic process and affects joints on both sides of the body. OA is typically caused by an overused joint (the right hand in right-handed people) and common on one side of the body. Site for question/rationale: Dr. Seth’s lecture “Hand Pain and Swelling Diagnostics” (2:45)

Question 94

4. Question: Parkinson’s disease is a diagnosis typically based on what clinical symptoms? a. Headache, younger than 40 y/o, and progressive muscle paralysis b. Erect posture, increased coordination, and exophthalmos c. Tremors, stooped posture, shuffling gait, bradykinesia d. Muscle weakness that starts in the legs and progresses towards the head

Answer 94

Answer: C Rationale for why the answer is correct: Parkinson’s is a progressive disease characterized by tremors, bradykinesia, rigidity, shuffling gait, and postural instability. This is a diagnosis made by the clinician based on manifestations. Site for question/rationale: Dr. Vandergriff’s lecture “Neuro Part II” (7:00)

Question 95

5. Question: Symptomatic seizures are those that occur…? a. Unrelated to a medical condition b. Over a lifetime and will require lifelong treatment c. In front of a medical professional witness d. In the setting of an acute medical condition such as hypoglycemia or hyponatremia. Low risk for lifelong seizures.

Answer 95

Answer: D Rationale for why the answer is correct: Symptomatic seizures are related to an acute medical condition that causes a seizure such as electrolyte imbalance, traumatic brain injury, or meningitis. Site for question/rationale: Dr. Vandergriff’s lecture “Neuro Part II” (8:00)

Question 96

6. Question: An APRN suspects a patient is suffering from a subarachnoid hemorrhage. The non-contrast CT results are normal. What is the APRN’s next diagnostic study to verify his suspicion? a. Lumbar puncture b. Contrast CT c. Cranial Ultrasound d. Test for nuchal rigidity

Answer 96

Answer: A Rationale for why the answer is correct: LP is mandatory in suspected SAH with normal head CT. Findings of LP will be xanthocromia, elevated RBC, and opening pressure Site for question/rationale: Dr. Vandergriff’s lecture “Neuro Part II” (14:05)

Question 97

7. Question: Regarding renal testing, what is a serum test that changes quickly with dehydration and illness that is used to calculate medication dosages? a. GFR b. BUN c. BNP d. Creatine

Answer 97

Answer: D Rationale for why the answer is correct: Creatine is a useful serum lab test that is used to calculate renal function and adjust medication regiments. Unlike GFR, it is easy to test and changes quickly with disturbances in the body. Site for question/rationale: Dr. Seth’s lecture “Diagnosing Renal Problems” (12:00)

Question 98

8. Question: In order to differentiate between a renal cyst and a renal mass, a good test to order is? a. KUB b. CT scan c. Ultra Sound d. 24-hour urine

Answer 98

Answer: C Rationale for why the answer is correct: Question: A renal US is a way to avoid contrast and is able to differentiate between renal cysts and masses. This allows the provider to determine the next course of treatment based on findings. Site for question/rationale: Dr Seth’s lecture “Diagnosis Renal Problems” (16:45)

Question 99

9. Question: Nitrates, leukocytes, WBCs, WBC casts, and bacteria are all elements of a urinalysis reviewed by the APRN to determine if a patient has what condition? a. Pyelonephritis b. Dehydration c. Bladder cancer d. Urinary tract infection

Answer 99

Answer: D Rationale for why the answer is correct: The items listed are primarily what ab APRN will review when diagnosis a UTI. These elements will show an increase in number compared to a “normal” urinalysis. Site for question/rationale: Dr. Seth’s lecture “Diagnostics Urinalysis” (1:25)

Question 100

10. Question: The lab test that determines a patient’s kidney function and helps the APRN determine the stage of kidney disease is? a. eGFR b. Creatine c. BUN d. Sodium and potassium

Answer 100

Answer: A Rationale for why the answer is correct: eGFR >90 reveals 90+ percent of the patient’s kidney function remails. <90 begins to show a decline in function and can be interpreted as a percent of kidney function. Site for question/rationale: (Estimated Glomerular Filtration Rate (EGFR), 2020)

Question 101

1. Question: A patient is being seen following a motor vehicle collision and reports left shoulder pain despite no discernible acute fracture. The pain is not worsened during manipulation of the shoulder. What does this most likely indicate? a. Glenohumeral strain b. Neural impingement c. Positive Jobes test d. Positive Kehr's sign

Answer 101

Answer: d) Positive Kehr's sign Rationale for why the answer is correct: Following a traumatic event (e.g., motor vehicle collision), patients may experience blunt abdominal trauma resulting in splenic laceration. The hallmark sign for splenic laceration is a positive Kehr's Sign where the patient reports referred left shoulder pain. Site for question/rationale: Module 7: Musculoskeletal, Seth, Shoulder pain diagnostics. Time mark at 13:30, slide 14.

Question 102

2. Question: A patient is being seen by the APRN for reports of back pain. What patient data requires emergent intervention? a. Difficulty with hand movements b. History of prostate cancer c. Recent onset of incontinence d. Radiating leg pain

Answer 102

Answer: c) Recent onset of incontinence Rationale for why the answer is correct: A patient reporting lower back pain with new onset of loss in bowel or bladder function is suggestive of Cauda Equina syndrome. Cauda Equina syndrome is an emergency and requires a prompt MRI and admission to the hospital for higher level of care. While lower back pain in addition to history of prostate cancer may be suggestive of metastatic cancer and necessitates further testing, it does not require emergent intervention. Difficulty with hand movement in association with back pain may indicate a possible pinched nerve, whereas radiating leg pain may indicate a ruptured disc; both of which are not the medical priority. Site for question/rationale: Module 7: Musculoskeletal, Seth, Back pain diagnostics. Time mark at 03:04, slide 3.

Question 103

3. Question: A patient is being seen today for hand pain but shows no overt signs of dermatological symptoms or sensory loss. The patient's spouse says they have not been the same since their last hike. What diagnosis is most likely? a. Lyme disease b. Psoriatic arthritis c. Sjorgen's disease d. Temporal arteritis

Answer 103

Answer: a) Lyme disease Rationale for why the answer is correct: Lyme disease may cause hand pain and is commonly diagnosed by its hallmark annular red plaque. However, in instances when the plaque does fade, the APRN should be suspicious of Lyme disease in the presence of neurological alteration and recent history of travel to areas greatest at risk for ticks (e.g., wooded areas). Psoriatic arthritis is distinguished by plaques on the hand, Sjorgen's by dry mouth, and temporal arteritis by vision loss and eye pain. Site for question/rationale: Module 7, Seth, Hand pain and swelling diagnostics. Time mark at 09:18, slide 11.

Question 104

4. Question: A 65-year-old male is being seen today by the APRN. The APRN notices diminished neurological function. Which of the following clinical manifestations does not aid in diagnosing Parkinson's disorder? a. Ascending weakness b. Bradykinesia c. Postural instability d. Tremor

Answer 104

Answer: a) Ascending weakness Rationale for why the answer is correct: Parkinson's disease is a progressive neurodegenerative disease with increased incidence over the age of 60 years. Early diagnosis of Parkinson's disorder is influenced by presence of tremor, bradykinesia (i.e., slow movement), postural instability, and muscular rigidity. Ascending weakness is suggestive of Guillain Barre. Site for question/rationale: Module 7: Neuro, Vandergriff, Neuro Part II. Time mark at 06:41.

Question 105

5. Question: When interpreting the cerebrospinal fluid results following a lumbar puncture, which result would suggest bacterial meningitis? a. Glucose: 75 mg/dL b. Neutrophil percentage: 60% c. Protein: 32 mg/dL d. White blood cell count: 4,000/microL

Answer 105

Answer: d) White blood cell count: 4,000/microL Rationale for why the answer is correct: Bacterial meningitis can be diagnosed using a lumbar puncture. A white blood cell count of 1,000-5,000/microL, neutrophil percentage greater than 80%, protein count greater than 200 mg/dL, and/or a glucose of less than 40 mg/dL would be indicative of bacterial meningitis. Site for question/rationale: Module 7: Neuro, Vandergriff, Neuro Part I. Time mark at 10:07.

Question 106

6. Question: Which of the following assessment groupings collectively make up what is known as the classic triad of normal pressure hydrocephalus (NPH)? a. Bradykinesia, masked facial expression, shuffling gait b. Dementia, gait disturbance, urinary incontinence c. Fevering, nuchal rigidity, altered mental status d. Unilateral facial paralysis, loss of taste, altered lacrimal gland secretion

Answer 106

Answer: b) Dementia, gait disturbance, urinary incontinence Rationale for why the answer is correct: The classic triad of normal pressure hydrocephalus is dementia, gait disturbance, and urinary incontinence. Parkinson's disease may be identified by dementia, gait disturbance (e.g., shuffling gait), bradykinesia, rigidity, tremor, masklike expression, and postural instability. The classic triad of bacterial meningitis is fevering, nuchal rigidity, and altered mental status. Bell's palsy may be identified by unilateral facial paralysis, loss of taste on the anterior tongue, altered lacrimal and salivary gland secretion. Site for question/rationale: Module 7: Neuro, Vandergriff, Neuro Part II. Time mark at 15:25.

Question 107

7. Question: On interpretation of a patient's urinalysis, the APRN notes presence of RBC casts. What pathology is this most indicative of? a. Acute pyelonephritis b. Diabetes mellitus c. Glomerulonephritis d. Tubular necrosis

Answer 107

Answer: c) Glomerulonephritis Rationale for why the answer is correct: Presence of RBC casts indicates glomerulus or tubule bleeding within the kidneys, and is commonly caused by a recent streptococcal infection. Bacterial casts will be present during acute pyelonephritis, whereas tubular necrosis is associated with epithelial casts. Diabetes mellitus is more associated with glycosuria and proteinuria. Site for question/rationale: Module 8, Seth, Diagnostic Urinalysis. Time mark at 14:25, slide 15.

Question 108

8. Question: When analyzing the protein levels in a patient's urinalysis, the APRN correctly understands: a. Dipstick testing is not positive until 150 mg b. Over-hydration will increase protein levels c. Microalbuminuria is required when testing diabetic patients d. Radiocontrast may create a false negative

Answer 108

Answer: c) Microalbuminuria is required when testing diabetic patients Rationale for why the answer is correct: Diabetic patients will require a microalbuminuria in addition to the urinalysis for more accurate evaluation, as well as a serum creatinine and BUN. The APRN should also be mindful that over-hydration will decrease protein levels, and that dehydration, stress, radiocontrast, and exercise may create false positives. Additionally, dipstick testing does not indicate positivity until 300-500 mg/day. Site for question/rationale: Module 8, Seth, Diagnostic Urinalysis. Time mark at 05:55, slide 7.

Question 109

9. Question: When managing a patient with renal disease, the APRN correctly understands: a. ARBs should be selected in place of ACE inhibitors b. Creatinine clearance is used to adjust drug dosages c. Gadolinium contrast is safer than iodine contrast d. Serum creatinine is the best predictor for kidney disease

Answer 109

Answer: b) Creatinine clearance is used to adjust drug dosages Rationale for why the answer is correct: Creatinine clearance is the preferred measurement used when adjusting drug dosages. Patients with renal disease taking ACE inhibitors, ARBs, NSAIDs, and COX inhibitors should be cautioned due to potential renal injury. Further, gadolinium contrast should be avoided in acute kidney injury and may cause nephrogenic systemic fibrosis, as well as renal failure. Glomerular filtration rate is the best predictor for kidney disease.

Question 110

10. Question: An elderly patient is admitted to the ICU who is severely malnourished and shows signs of neglect. The APRN suspects the patient is at high risk for renal disease. In collaboration with a nephrologist, what diagnostic would the APRN anticipate to best predict renal disease? a. BUN b. Glomerular filtration rate c. Serum Creatinine d. Urinalysis

Answer 110

Answer: b) Glomerular filtration rate Rationale for why the answer is correct: Glomerular filtration rate is the most accurate predictor of renal disease and is commonly performed by a nephrologist. Patients with extremes in age or body size, and have extremes in nutrition (e.g., malnourished, obesity) should have a glomerular filtration rate performed. While a BUN, serum creatinine, and urinalysis will assist in determining renal status, the best predictor for renal disease is glomerular filtration rate. Site for question/rationale: Module 8, Seth, Diagnosing Renal Problems. Time mark at 07:00, slides 7-8.

Question 111

1. According to Nexus criteria which of the following scenarios would NOT require C-spine imaging (assume age is less than 65 years and remainder of history and physical exam findings are normal)? a. Midline tenderness at C3-4, alert and stable, ambulating with steady gate b. No altered level of consciousness, no focal neurologic deficits, no distracting injuries. c. Intoxicated, alert and stable, no midline spinal tenderness d. Alert and stable, no focal neurological deficits, complains of severe left femur pain

Answer 111

``` Answer: B. Rationale for why the answer is correct: According to Nexus criteria, Trauma patients who do not require cervical spine imaging require all of the following: • alert and stable • no focal neurologic deficit • no altered level of consciousness • not intoxicated • no midline spinal tenderness • no distracting injury Site for question/rationale: Ramos and Morgan, “NEXUS Criteria.” https://radiopaedia.org/articles/nexus-criteria?lang=us ```

Question 112

2. What condition is considered contraindication for performing joint arthrocentesis? a. Prepatellar Bursitis b. Concurrent cellulitis at the effusion site c. History of knee replacement d. History of Gout

Answer 112

Answer: B Rationale for why the answer is correct: Arthrocentesis at artificial joint sites can be performed but should be referred to Orthopedic Surgery. Joint aspiration is contraindicated where there is preexisting or suspect cellulitis. Site for question/rationale: Seth, “Knee Pain, 14:02.

Question 113

3. All of the following except this finding raises concern for lumbar disc herniation. a. Positive straight leg raise test b. Pain that radiates down one or both legs c. Radiculopathy (numbness or tingling down part of one or both legs). d. Skin discoloration

Answer 113

Answer: D Rationale for why the answer is correct: Disc herniation may present with any of the following: Abrupt or gradual pain, Pain with radiation, Numbness and tingling is a often, Changes to bowel or bladder function, Possible asymmetric Deep Tendon Reflexes, Abnormal or positive Straight Leg Raise rest. Site for question/rationale: Rhoads, “Low Back Pain,” p. 188.

Question 114

4. You are seeing a patient with complaint of “hand pain” who works as a software programmer. He describes pain and numbness in the thumb and second digit of the dominant hand. On exam you appreciate decreased grip strength in the affected hand. The patient also reports worsening symptoms at night. You suspect Carpal Tunnel Syndrome. What other diagnostics would you order? a. Ultrasound b. CT with contrast c. Both A&B d. Neither A nor B

Answer 114

Answer: A Rationale for why the answer is correct: “Routing use of MRI or CT has no role in the diagnosis of carpal tunnel syndrome…Ultrasound or MRI may be used to detect space-occupying lesions in and around the carpal tunnel.” Site for question/rationale: Clinical Key, “Carpal Tunnel Syndrome,” Imaging.

Question 115

5. What psychiatric disturbances are related to the treatment of Parkinson’s disease? a. Vivid dreams and nightmares, visual hallucinations, paranoid psychosis b. Hypomania, decreased libido, auditory hallucinations c. Auditory hallucinations, Agitation, Mania d. Suicidal ideation, depression, compulsive behaviors

Answer 115

Answer: A Rationale for why the answer is correct: Symptoms related to treatment of Parkinson’s disease include: • Vivid dreams and nightmares • Visual hallucinations with a clear sensorium • Hallucinations with confusion • Mania, impulse control disorders (e.g., hypersexuality, problem gambling), dopaminergic drug addiction • Paranoid psychosis Site for question/rationale: Clinical Key, “Parkinson’s Disease.”

Question 116

6. All patients presenting with symptoms of fever, altered level of consciousness, and a stiff neck must have which diagnostic test performed immediately? a. MR Brain with and without contrast b. CT of the cervical spine without contrast c. Lumbar Puncture d. EEG

Answer 116

Answer: C Rationale for why the answer is correct: Lumbar Puncture with CSF analysis and cultures are “crucial” diagnostic testing for suspected bacterial meningitis Site for question/rationale: Vandergriff, “Common Neuro Diagnosis in Acute & Primary Care, part 1,” 10:02.

Question 117

7. When a 24-hour urine collection is in process, the patient should keep the collected urine specimen: a. In any type of jar or container at room temperature b. In the provided container at room temperature c. In any type of jar or container in a cool place or refrigerated d. In the provided container in a cool place or refrigerated

Answer 117

Answer: D Rationale for why the answer is correct: Patients are instructed to refrigerate collected urine or keep it in a cool place in the container provided. The container may contain a preservative. Site for question/rationale: Labcorp, “Routine 24-hour Urine collection.”

Question 118

8. Nitrites found in urinalysis are indicative of what condition? a. Bacteria in urine b. Kidney Stone c. Dehydration d. Pregnancy

Answer 118

Answer: A Rationale for why the answer is correct: Nitrites are secreted by bacteria found in urine if bacteria are present (typically Gram-negative bacteria) Site for question/rationale: Seth, “Urinalysis,” 9:46.

Question 119

9. When considering estimates of creatinine clearance in morbidly obese patients which scenario is most likely to provide precise and accurate estimates: a. Lean Body Weight estimate based on Total Body Weight and Body Mass Index, incorporated into the Cockroft -Gault equation b. Modification of Diet in Renal Disease and Ideal Body Weight in the Cockcroft-Gault equation c. Salazar-Corcoran equation and use of Total Body Weight or Adjusted Body Weight d. All of the above

Answer 119

Answer: A Rationale for why the answer is correct: Demirovic, Pai and Pai concluded the following in their study. “Use of MDRD4 and IBW in the Cockcroft-Gault equation underestimated CL(cr), while the Salazar-Corcoran equation and use of TBW or ABW in the Cockcroft-Gault equation overestimated this value. Substitution of fat-free weight or LBW in the Cockcroft-Gault equation provided unbiased estimates of CL(cr).” Site for question/rationale: Demirovic, Pai and Pai, “Estimation of Creatinine Clearance in Morbidly Obese Patients.”

Question 120

10. Which of the following applies to the utilizing renal ultrasound? a. Cannot differentiate cysts from masses b. Cannot identify stones c. Uses contrast d. None of the above

Answer 120

Answer: D Rationale for why the answer is correct: Renal ultrasound can be used to identify hydronephrosis, urine flow, differentiate masses from cysts, identify renal, and does not use contrast. Site for question/rationale: Seth, “Diagnosing Renal Problems”, starting at 16:31.

Question 121

``` 1. Question: Referred shoulder pain is commonly NOT from which of the following areas of the body? A. Neck B. Chest C. Abdomen D. Foot ```

Answer 121

Answer: Foot Rationale for why the answer is correct: The most common areas of referred shoulder pain are the neck, chest, and abdomen, seen in cases where the shoulder pain is not intrinsic. Neck-think neural impingement at the level of the cervical spine. Chest-think peripheral nerve entrapment distally to the spinal column. Abdomen-think diaphragmatic irritation, seen in spleen laceration, perforated viscous (gas), infection, ruptured ectopic pregnancy. Site for question/rationale: Dr. Shelly Seth’s “Shoulder Pain” voice thread presentation at time stamp 1:11 and 2:07

Question 122

2. Question: Upon your assessment, which of the following findings would lead you to suspect rheumatoid arthritis as opposed to osteoarthritis? A. Distal interphalangeal joint pain B. Metacarpal joint and wrist pain bilaterally C. Proximal interphalangeal joint pain D. Pain that is attributed to the right shoulder from a history of softball participation

Answer 122

Answer: Metacarpal joint and wrist pain bilaterally Rationale for why the answer is correct: Metacarpal joints and wrist are more painful in RA and it is usually symmetrical. In OA, the distal interphalangeal and proximal interphalangeal joints are more painful and it is usually not symmetrical. OA pain can also be attributed to sports participation or the overuse of a joint. Site for question/rationale: Dr. Shelly Seth’s “Hand Pain and Swelling” voice thread presentation

Question 123

3. Question: Which of the following is an important question to ask the patient if he/she complains of hip pain, and your assessment reveals an elevated temperature, chills, and recent fevers? A. Do you have anyone else your household with hip pain? B. Have you been exercising on a stationary bike? C. Have you noticed any recent weight gain? D. Do you have an artificial hip?

Answer 123

Answer: Do you have an artificial hip? Rationale for why the answer is correct: In an infection, it is common for bacteria to seed themselves into the artificial joint, often leading to removal of that infected joint and antibiotic treatment for ~6 weeks. Site for question/rationale: Dr. Shelly Seth’s “Hip Pain” voice thread presentation at time stamp 3:40

Question 124

``` 4. Question: Your patient with knee pain tells you he has a history of a knee replacement 2 years prior. What diagnostic tool will you NOT use for this patient? A. CT B. XR C. MRI D. Ultrasound ```

Answer 124

Answer: MRI Rationale for why the answer is correct: MRI cannot be used when there is any hardware or metal in the body, like from a previous knee replacement. An ultrasound, XR, or CT scan would not be contraindicated diagnostics secondary to a patient’s history of knee replacement. Site for question/rationale: Dr. Shelly Seth’s “Knee Pain” voice thread presentation at time stamp 13:00 (Also known as “I think I need a cane and a handicapped parking sticker”)

Question 125

``` 5. Question: What GCS score would you give to a patient who opens his eyes only to pain, is confused when responding to questions, and localizes to pain? A. 4 B. 9 C. 11 D. 15 ```

Answer 125

Answer: 11 Rationale for why the answer is correct: This patient assessment correlates to a GCS of 11 with eye opening = 2, best verbal response = 4, and best motor response = 5. Site for question/rationale: Dr. Kent Vandergriff’s “Neurology 1 presentation” voice thread at time stamp 2:10

Question 126

``` 6. Question: A pneumonic used to help the clinician remember the red flags for the presence of serious underlying disorders that can cause acute or subacute headaches is ¬¬________? A. PQRST B. SNOOP C. CAGE D. OLDCARTS ```

Answer 126

Answer: SNOOP Rationale for why the answer is correct: SNOOP stands for systemic symptoms, neurologic symptoms, onset is new, other associated conditions/features, and previous headache history. Site for question/rationale: Dr. Kent Vandergriff’s “Neurology 2 presentation” voice thread at time stamp 2:00

Question 127

``` 7. Question: Accurate diagnosis of Parkinson’s disease is facilitated by the clinician’s early recognition of its characteristic signs and associated symptoms, that do NOT include: _____? A. Tremors B. Seizures C. Bradykinesia D. Postural instability ```

Answer 127

Answer: Seizures Rationale for why the answer is correct: Parkinson’s disease is facilitated by the clinician’s early recognition of its characteristic signs and associated symptoms including tremor, bradykinesia (slow movement), rigidity, and postural instability. Site for question/rationale: Dr. Kent Vandergriff’s “Neurology 2 presentation” voice thread at time stamp 6:50

Question 128

``` 8. Question: Which lab value is the most accurate predictor of renal disease? A. GFR B. Cr C. K D. BUN ```

Answer 128

Answer: GFR Rationale for why the answer is correct: Glomerular filtration rate is the most accurate predictor of kidney disease. Usually done by a nephrologist, the patient is given a marker that will clear through the glomerular system, and a measurement of clearance is taken. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” voice thread presentation at time stamp 7:01

Question 129

``` 9. Question: You are checking a patient’s home medication list before ordering a CT scan and decide to stop which of the medications below, as it is nephrotoxic? A. Vitamin D B. Metformin C. ASA 81mg D. Lisinopril ```

Answer 129

Answer: Metformin Rationale for why the answer is correct: Metformin is nephrotoxic, in that if the kidneys are not functioning as they should filtering the metformin, this medication can build up to toxic levels. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” voice thread presentation at time stamp 20:45

Question 130

``` 10. Question: Relative and absolute contraindications for a kidney biopsy include all of the following except _______? A. sepsis B. uncontrolled HTN C. age > 75 years D. uncooperative patient ```

Answer 130

Answer: age > 75 years Rationale for why the answer is correct: Renal biopsy contraindications include: sepsis, uncontrolled HTN, hemorrhagic diathesis, parenchymal infection/malignancy, solitary kidney, and an uncooperative patient. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” voice thread presentation at time stamp 29:00

Question 131

1. A 16-year-old patient comes into the clinic complaining of anterior knee pain. She reports she’s currently in track in school and has noticed her knee usually hurts when she’s walking down the stairs. You perform an examination on her and note she has a positive J sign. This may be indicative of: a. Prepatellar bursitis b. Patellofemoral pain syndrome c. Patellar tendinitis d. Osgood Schlatter’s

Answer 131

Answer: B. Patellofemoral pain syndrome Rationale for why the answer is correct: Classic presentation of patellofemoral pain syndrome is pain in the anterior knee when squatting or descending stairs. The J sign is when the patella jumps laterally when the leg is fully extended. Site for question/rationale: Shelly Seth, Knee Pain Diagnostics presentation, 6:57 – 8:04

Question 132

2. The ____________ (fill in the blank) joint in the shoulder joint is the one most affected by conditions such as arthritis. a. Supraspinatus b. Acromioclavicular c. Glenohumeral d. Infraspinatus

Answer 132

Answer: C. Glenohumeral Rationale for why the answer is correct: The glenohumeral joint is the joint most affected by conditions such as arthritis. Site for question/rationale: Shelly Seth, Shoulder Pain Diagnostics lecture, 3:33 – 3:45.

Question 133

3. When differentiating between rheumatoid arthritis (RA) and osteoarthritis (OA), all of the following are true except: a. The metacarpal joints are painful in RA b. The distal and proximal interphalangeal joints are painful in OA c. RA is usually unilateral d. OA is usually due to wear and tear

Answer 133

Answer: C. RA is usually unilateral Rationale for why the answer is correct: Clinical pearls include: metacarpal joints are painful in RA. The distal and proximal interphalangeal joints are painful in OA, RA is symmetrical, and OA is not, OA is usually due to wear and tear. Site for question/rationale: Shelly Seth, Hand pain and swelling lecture, 1:54 – 3:13.

Question 134

``` 4. A 20-year-old male presents to the clinic complaining of headache, fatigue, generalized malaise for 3 days. Upon assessment, you note: GCS 13 HR: 115 BP: 126/78 RR: 23 O2 sat: 99% Temp: 38.6 Your differentials for this patient should include: a. Subarachnoid hemorrhage b. Bell’s palsy c. Bacterial meningitis d. Guillain-Barre syndrome ```

Answer 134

Answer: c. Bacterial meningitis Rationale for why the answer is correct: Bacterial meningitis presenting symptoms classic triad include: fever >38, nuchal rigidity, and change in mental status. The above patient currently presents w/ 2 of the 3 symptoms in the classic triad. The other 3 diagnoses do not fit the presenting symptoms. Site for question/rationale: Kent Vandergriff, Neuro lecture, Part 1, 9:09 – 9:45.

Question 135

5. A 38-year-old female presents to the clinic with sudden onset paralysis to the right side of her face. She has no past medical history. Upon assessment you note she has right eyebrow sagging, a right flattened nasolabial fold, drooping right side of her mouth, a fever blister to her left upper lip and an absent blink reflex to her right eye. She has no other focal neurologic deficits. Which of the following statements are correct? a. You need to go to the emergency room as soon as possible b. We need to schedule a stat CTA of your head c. We are going to start you on anti-thrombolytic therapy d. You can expect recovery within 6 months

Answer 135

Answer: D. you can expect recovery within 6 months Rationale for why the answer is correct: Bell’s palsy is a clinical syndrome characterized by sudden onset unilateral facial paralysis. Although idiopathic, herpes simplex activation is likely a cause. Clinical manifestations include, sudden onset unilateral facial paralysis, eyebrow sagging, flattened nasolabial fold, inability to close eye, +/- loss of taste to the anterior 2/3 of tongue, and altered secretion of lacrimal and salivary glands. Patients usually have a recovery to some degree within 6 months. Site for question/rationale: Kent Vandergriff, Neuro lecture, Part 1, 10:50 – 12:57.

Question 136

6. All of the following clinical manifestations are true of Parkinson’s disease except: a. Craniofacial abnormalities such as a masked facial expression b. Musculoskeletal abnormalities such as a shuffling gait and stooped posture c. Nonmotor cognitive disorders such as psychosis and sleep disturbances d. Craniofacial abnormalities such as a unilateral facial droop

Answer 136

Answer: d. Craniofacial abnormalities such as a unilateral facial droop Rationale for why the answer is correct: Clinical manifestations of Parkinson’s disease include: 1. craniofacial abnormalities such as a masked facial expression, hypophonia, 2. Visual (hypometric saccades, eyelid opening, apraxia), 3. Musculoskeletal abnormalities such as micrographia, stooped posture shuffling gait, short-stepped gait, freezing and 4. Nonmotor cognitive dysfunction such as psychosis, mood disorders, sleep disturbances, fatigue, autonomic disturbances, olfactory, pain and sensory disturbances and dermatologic (seborrhea). Site for question/rationale: Kent Vandergriff, Common neuro diagnoses in acute and primary care, Part 2, 5:33 - 6:33.

Question 137

7. A 68-year-old male presents to the clinic complaining of pruritus, n/v, and swelling to bilateral ankles. You are reviewing his labs and note he has an acute kidney injury. Which of the following concerns you the most? a. He takes 800mg of Ibuprofen for his chronic low back pain every 8 hours b. He takes Tums for his reflux three times a day c. He takes a One a day Men’s multivitamin daily d. He takes 0.4mg Tamsulosin daily

Answer 137

Answer: a. He takes 800mg of Ibuprofen for his chronic low back pain every 8 hours Rationale for why the answer is correct: A patient showing signs and symptoms of renal impairment should have a complete historical evaluation to include, medications. Medications that should be stopped in a patient showing signs of renal impairment include NSAIDs, COX inhibitors, ACE inhibitors and ARBs. Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 2:25 – 2:50

Question 138

8. You are going to prescribe an antibiotic for a patient that has renal failure. In order to estimate the correct dosage for the patient, you must look at the: a. BUN b. Creatinine c. GFR d. Creatinine clearance

Answer 138

Answer: d. creatinine clearance Rationale for why the answer is correct: Creatinine clearance is used to adjust drug dosages. Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 12:54 – 14:42.

Question 139

9. A patient with a history of HTN, DM, HLD, ESRD, with HD on MWF requires an emergent heart cath. Upon reviewing his chart, you: a. Should ensure the patient has Lasix ordered b. Ensure nephrology is consulted c. Should ensure the patient has 0.9% NS + 20 KCL running at 100cc/hr d. Should ensure the patient eats before the procedure

Answer 139

Answer: B. Ensure nephrology is consulted Rationale for why the answer is correct: A patient receiving a heart catheterization is going to be receiving contrast. You want to ensure nephrology is consulted for stat HD post procedure. Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 24:35 – 25:30.

Question 140

10. The following are all indications for a renal biopsy, except a. Nephrotic syndrome with no current explanation b. Transplant rejection with no current explanation c. Solitary kidney with no current explanation d. Persistent proteinuria with no current explanation

Answer 140

Answer: c. Solitary kidney Rationale for why the answer is correct: Contraindications for a renal biopsy include: sepsis, uncontrolled hypertension, hemorrhagic diathesis, parenchymal infection or malignancy, solitary or horseshoe kidney unless transplanted or uncooperative patient. Site for question/rationale: Shelly Seth, Diagnosing Renal Problems lecture, 28:25 – 29:20.

Question 141

1. Question: Jerome, your 16-year-old male patient, is in your office complaining of shoulder pain. During the history portion of your assessment you discover he is the star quarterback at Small Town High School and he got sacked multiple times during the game on Friday night. Nothing in your assessment is abnormal. Which of the following could explain his shoulder pain? a. Kerr’s sign, signifying a splenic laceration b. A malar rash that looks like a “butterfly” c. He has undiscovered ankle fracture d. Murphy’s Sign is positive

Answer 141

Answer: A Rationale for why the answer is correct: With this specific patient a lacerated/injured spleen is most likely, so he would have a positive Kerr’s sign. Site for question/rationale: Shelly Seth’s My Shoulder Hurts Presentation, slide 14.

Question 142

2. Question: Which of the following is a differentiating characteristic between Rheumatoid Arthritis and Osteoarthritis? a. RA is a symmetrical joint pain, redness, and inflammatory process; it occurs in the morning. b. RA is due to overuse and is usually unilateral c. OA is a symmetrical joint pain, redness, and inflammatory process; it occurs in the morning. d. OA is due to overuse and is usually symmetrical, involving joints on both right and left side of body

Answer 142

Answer: A Rationale for why the answer is correct: It is the only answer choice where each statement is correctly matched with the disease process. Site for question/rationale: Shelly Seth’s My Hands Hurt Presentation, slide 3.

Question 143

3. Question: A patient comes into your clinic with complaints of back pain. Upon further questioning, he reluctantly admits loss of bowel and bladder control. What would be your next intervention? a. Obtain a multiple view X-ray b. CT scan c. Stool and urine cultures, UA, BMP d. Call and ambulance

Answer 143

Answer: D Rationale for why the answer is correct: This patient is exhibiting signs of cauda equine syndrome. It is a medical emergency. Site for question/rationale: Shelly Seth’s My Back Hurts Presentation, slide 3.

Question 144

4. Question: As you are rounding on your patients, you note Mr. White to open his eyes spontaneously, respond verbally to your questions in an appropriate and oriented manner, and obey commands. Which of the following is most correct? a. Mr. Smith is a 3 on the Glasgow Coma Score which means he is appropriate and non-comatose. No intervention needed. b. Mr. Smith is a 3 on the Glasgow Coma Score which means he is severely comatose and needs to be intubated immediately. c. Mr. Smith is 15 on the Glasgow Coma Score which means he is appropriate and non-comatose. No intervention needed. d. Mr. Smith is a 15 on the Glasgow Coma Score which means he is severely comatose and needs to be intubated immediately.

Answer 144

Answer: C Rationale for why the answer is correct: Glasgow Coma Score ranges from 3-15; lower numbers are associated with being more comatose; intubation is needed for a score less than 8. Mr. Jones is optimally performing in each GCS category, so his score is a 3. Site for question/rationale: Module 7, Mr. Vandergriff’s Neuro lecture, slide 3.

Question 145

5. Question: Jane, an otherwise healthy 40-year-old female, is in the ER with complaints of a “really high” fever, stiff neck, and, per her husband, a change in mental status. What labs would you consider ordering? a. LP, cultures, CBC b. X-ray, PT/PTT/INR c. LP, Ultrasound, glucose d. UA, CBC, BMP

Answer 145

Answer: A Rationale for why the answer is correct: This patient is presenting with signs of meningitis. The listed labs will rule in/confirm this diagnosis. Site for question/rationale: Module 7, Mr. Vandergriff’s Neuro lecture, slides 11 & 12.

Question 146

6. Question: Which of the following could be indicative of an emergent diagnosis manifesting as a headache? a. A headache that is sudden in onset, a “thunderclap headache” or “the worst headache of my life” b. A headache that occurs on someone < 50 years old c. A headache that presents in an otherwise healthy individual d. A headache in a patient who maintains baseline neuro exam

Answer 146

Answer: A Rationale for why the answer is correct: Headaches with these types of characteristics can indicate a more serious etiology like subarachnoid hemorrhage. Site for question/rationale: Module 7, Mr. Vandergriff’s Neuro lecture, slides 27 & 30.

Question 147

7. Question: Which of the following labs indicates the need to adjust a drug dosage? a. Elevated BUN/CRE b. Decreased LFT’s c. Decreased Creatinine Clearance d. Hyperkalemia

Answer 147

Answer: C Rationale for why the answer is correct: A decreased creatinine clearance is indicative of kidney disease. Many drugs are excreted renally, so a decreased clearance would let the provider know that drug dose may need to be changed to decrease nephrotoxicity and further kidney damage.

Question 148

8. Question: What should be considered before ordering a CT with contrast? a. Creatinine, level of hydration b. IV access, patient preference c. 24-hour urine results, CBC d. UA & culture and sensitivity results

Answer 148

Answer: A Rationale for why the answer is correct: These indicators can help the practitioner decide how well the kidneys will filter out the contrast, and the risk of complication. Site for question/rationale: Module 8, Shelly Seth’s Renal Testing for Diagnosis Presentation, slide 17.

Question 149

9. Question: Which of the following patients cannot get a renal biopsy? a. Marcy, a 20-year-old in renal failure, who is in the ICU due to sepsis. b. George, a 75-year-old, who is otherwise healthy c. Sally, a 50-year-old, who has a history of UTI’s d. Harold, a 100-year-old who was born with a horseshoe kidney. He is here for his annual nephrologist appointment s/p transplant 50 years ago.

Answer 149

Answer: D Rationale for why the answer is correct: Harold is the only patient who has a contraindication to renal biopsy. Site for question/rationale: Module 8, Shelly Seth’s Renal Testing for Diagnosis Presentation, slide 23.

Question 150

10. Question: When reviewing your morning labs on Aurora, who currently has a UTI, what would you expect to see on her UA? a. + Nitrites, Bacteria > 100,000, WBC casts b. pH > 10, ketones, nitrites + c. RBC’s, WBC casts, Glucose > 200 d. Bilirubin +, Bacteria > 100,000, WBC casts

Answer 150

Answer: A Rationale for why the answer is correct: these elements will be present on a patient with a UTI Site for question/rationale: Module 8, Shelly Seth’s Urinalysis Presentation, slide 3.

Question 151

1. Question: What is NOT true about the NEXUS criteria? A. Is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging. B. Has a 99.6% sensitivity for ruling out cervical spine injury in the original study validating the criteria C. It may not be reliable with patients over the age of 65 D. Trauma patients who meet the criteria of being alert and stable do not require cervical spine imaging.

Answer 151

Answer: D Rationale for why the answer is correct: Trauma patients who do not require cervical spine imaging require ALL of the following: Alert and stable, no focal neurologic deficit, no altered level of consciousness, not intoxicated, no midline spinal tenderness, no distracting injury. Site for question/rationale: Nexus criteria

Question 152

``` 2. Question Which of the following should NOT be considered in acute shoulder pain (less than two weeks)? A. Trauma B. Rotator Cuff Injury C. Fractures D. Dislocations ```

Answer 152

Answer: B Rationale for why the answer is correct: Rotator cuff injury, impingement syndrome, adhesive capsulitis, and osteoarthritis are all part of chronic should pain. Site for question/rationale: Shoulder pain handout slide 4-5

Question 153

3. Question: Why would the APRN order a CT scan with contrast of the hip for a patient with hip pain? A. To look at vessels and blood flow B. To measure bone density C. To assess fractures D. A CT scan with contrast of the hip is never ordered

Answer 153

Answer: A Rationale for why the answer is correct: A CT scan with contrast is used for better definition. The contrast is used to look at the vessels and blood flow. A DEXA scan is used to measure bone density and fractures can be seen with plain Xray (3 views). Site for question/rationale: Hip pain handout slide 7

Question 154

``` 4. Question: If a patient has a Glasgow Coma Scale of less than 8, the APRN can expect the patient to be: A. Alert and oriented B. Intubated C. Referred to psych ward D. Stable and being discharged home ```

Answer 154

Answer: B Rationale for why the answer is correct: The Glasgow Coma Scale assess eye opening, best verbal response, and best motor response. The total score can range from 3-15. Someone who is completely unresponsive would score a 3, less than 8 the patient should be intubated. Site for question/rationale: Neurology presentation part 1 3:38

Question 155

5. Question: SNOOP is a reminder of danger signs (red flags) for the presence of serious underlying disorders that can cause acute or subacute headaches. What does the S in SNOOP stand for? A. Sundowning, Stressors, Somatic complaints B. Social Anxiety, Suffering, Stress C. Systemic symptoms: illness, fever, weight loss, cancer, pregnancy, immunocompromised D. Sunlight, Slow reflexes, Seizures

Answer 155

Answer: C Rationale for why the answer is correct: S stands for systemic symptoms, illness, fever, weight loss, cancer, pregnancy, immunocompromised. N stands for neurologic symptoms or abnormal signs, confusion, impaired alertness or consciousness, papilledema, focal neurologic symptoms, meningism, seizures. O stands for Onset is new (especially over 50) or sudden (thunderclap). O stands for Other conditions such as illicit drugs, toxic exposure, HA awakens from sleep, worse with Valsalva maneuvers, precipitated by cough, exertion, or sexual activity. P stands for Previous HA history with HA progression or change in attack frequency, severe clinical features. Site for question/rationale: Neurology presentation part 2, 2:17

Question 156

``` 6. Question: What is NOT a Non-Motor cognitive dysfunction of Parkinson’s disease? A. Mood disorders B. Fatigue C. Olfactory dysfunction D. Shuffling gait ```

Answer 156

Answer: D Rationale for why the answer is correct: Non-Motor cognitive dysfunctions are included in ABC. Shuffling gait is a motor symptom. Site for question/rationale: Neurology presentation part 2 6:10

Question 157

``` 7. Question: What medications are significant for a patient with renal problems? Select ALL A. Tylenol and NSAIDS B. ACE inhibitors and ARB’s C. COX inhibitors and Tylenol D. COX inhibitors and NSAIDS ```

Answer 157

Answer: B and C Rationale for why the answer is correct: Medications that are significant for a patient with renal problems include NSAIDS, COX inhibitors, ACE inhibitors, and ARB’s. If you see a patient with renal problems or acute kidney injury on any of these medications, you will stop them automatically. Site for question/rationale: Diagnosing Renal Problems presentation 2:30

Question 158

``` 8. Question: What initial labs will the APRN order for the patient with renal problems? Select all A. Urinalysis and serum Creatinine B. 24-hour urine collection and BUN C. BUN and GFR D. Culture and Susceptibility ```

Answer 158

Answer: A and C Rationale for why the answer is correct: The initial labs for the patient with renal problems include urinalysis, serum creatinine, BUN, GFR Site for question/rationale: Diagnosing Renal Problems presentation 6:31

Question 159

``` 9. Question: What lab is the most accurate predictor of Kidney Disease? A. BUN B. Serum Creatinine C. 24-hour urine collection D. GFR ```

Answer 159

Answer: D Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease and is usually done by a nephrologist. Site for question/rationale: Diagnosing Renal Problems presentation 7:08

Question 160

``` 10. Question: All of the following are part of the top three culture and sensitivity fluid analysis for a patient with a fever of unknown origin, Except? A. Sputum B. Lumbar puncture CSF C. Blood D. Urine ```

Answer 160

Answer: B Rationale for why the answer is correct: The top three culture and sensitivity fluid analysis for a patient with a fever of unknown origin include sputum, blood, and urine. Site for question/rationale: Fluid Analysis presentation 0:51

Question 161

1. Question: How is the Hawkins-Kennedy test performed? a) internal rotation with the shoulder flexed to 90° b) shoulder abducted and extended 90° c) arm internally rotated across patients back d) arms at sides and elbows flexed at 90°

Answer 161

Answer: a) internal rotation with the shoulder flexed to 90° Rationale for why the answer is correct: Hawkins-kennedy test is performed by internal rotation with the shoulder flexed to 90°. It tests for rotator cuff impingement. Site for question/rationale: Shoulder special tests 0:42

Question 162

2. Question: A previously healthy 48-year-old woman presents to the clinic with right shoulder pain for the past 2 months. The pain is worse in the morning, but improves by noon. During this time, she has also had bilateral wrist pain and occasional hip pain. She is not on any prescribed medications, but takes acetaminophen and ibuprofen in alternating doses with minimal relief. She has a sedentary lifestyle. Which of the following most strongly indicates serologic testing for rheumatoid arthritis in this patient? a) Failure to respond to analgesics b) Female c) Multiple joint pain for 2 months d) Sedentary lifestyle

Answer 162

Answer: c) Multiple joint pain for 2 months Rationale for why the answer is correct: RA is a systemic disease and involves numerous joints. Clinical guidelines state a minimum of 5 joint involvement before diagnosis can be made. Site for question/rationale: Hand Pain and swelling lecture 16:57

Question 163

3. Question: Which of the following is the most appropriate step in management of a patient with a clinical diagnosis of carpal tunnel syndrome that has caused no sensory deficits and has not disrupted sleep or daily function? a) Intravenous steroids b) Splinting c) Opiates d) Open surgery

Answer 163

Answer: b) splinting Rationale for why the answer is correct: Splinting allows the compressed nerve to rest and heal due to restrictive motion. Site for question/rationale: Hand pain and swelling lecture 19:04

Question 164

4. Question: A 56-year-old man presents to your clinic with a difficulty maintaining his balance and posture. He does not have any medical conditions. A physical examination reveals a tremor in his hands. He walks with a stooped posture. Which is most likely the diagnosis? a) Parkinson’s b) Multiple Sclerosis c) Epilepsy d) Low back pain

Answer 164

Answer: a) Parkinson’s Rationale for why the answer is correct: Symptoms of parkinson’s include difficulty balancing, stooped posture and tremors, Site for question/rationale: Neurological part 2 5:32

Question 165

5. Question: Which of the following differentiates meningitis from other types of CNS infections? a) Headache b) Altered mental status c) Fever d) Neck stiffness

Answer 165

Answer: d) Neck Stiffness Rationale for why the answer is correct: Neck stiffness is a classic symptom of meningitis. Site for question/rationale: Neurology part 1 9:20

Question 166

6. Question: A 55-year-old male is brought to the ER. His wife says that they were doing their morning exercise routine when he suddenly started acting strange. Upon questioning, the patient says that he does not know where he is located. A physical examination reveals chewing movements. What is the most likely diagnosis? a) Seizures b) Head trauma c) Dementia d) Parkinson’s

Answer 166

Answer: a) seizures Rationale for why the answer is correct: Seizures are sudden changes in behavior. Site for question/rationale: Neurology part 2 7:10

Question 167

7. Question: 65 year old male presents to the clinic with “the worst headache of my life”. The Nurse Practitioner knows that a thunderclap headache is suggestive of… a) Migraine b) Subarachnoid hemorrhage c) Tension headache d) Meningitis

Answer 167

Answer: b) Subarachnoid hemorrhage Rationale for why the answer is correct: Thunderclap headaches are typically associated with subarachnoid hemorrhage. Site for question/rationale: Neurology part 2 3:29

Question 168

8. Question: Which of the following can accurately measure creatinine clearance? a) Arterial blood sample b) 24 hour urine sample c) 22 hour urine sample d) Venous blood sample

Answer 168

Answer: b) 24 hour urine sample Rationale for why the answer is correct: 24 hour urine gives a more complete picture than just the spot test. Site for question/rationale: Renal Diagnostics Slide 13

Question 169

9. Question: 35 year old female has elevated nitrates on her UA. What causes an elevation in nitrates? a) Protein b) Glucose c) Gram negative bacteria d) Yeast

Answer 169

Answer: c) Gram negative bacteria Rationale for why the answer is correct: UTI caused by Gram negative bacteria can be detected on a UA due to the secretion of nitrates by the bacteria. Site for question/rationale: Urinalysis slide 11

Question 170

10. Question: What is NOT a possible cause of pyuria? a) Tumor b) Stones c) Infection d) Overactive bladder

Answer 170

Answer: d) Overactive bladder Rationale for why the answer is correct: Overactive bladder in the urine do not cause pyuria. Site for question/rationale: Urinalysis slide 14

Question 171

``` 1. Question: The NEXUS criteria have a sensitivity of 99.6% of ruling out? A. Pregnancy B. Cervical spine injury C. Pneumonia D. Hip fracture ```

Answer 171

Answer: B. Cervical spine injury Rationale for why the answer is correct: National Emergency X-Radiography Utilization Study (NEXUS) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging; this criteria has a 99.6% sensitivity of ruling out cervical spine injury. Site for question/rationale: NEXUS criteria article by Dr. Joao Ramos and Dr. Matt A. Morgan et al.; under the musculoskeletal module.

Question 172

2. Question: In the Canadian C-spine Rules, what is considered a high-risk factor that requires cervical spine imaging? A. The patient is 60 years of age. B. The patient fell from an elevation of 1 foot. C. The patient is complaining of paresthesia to the bilateral upper extremities. D. The patient is 18 years old in an MVA going approximately 30 mph with minor impact to the rear end.

Answer 172

Answer: C. The patient is complaining of paresthesia to the bilateral upper extremities. Rationale for why the answer is correct: High-risk factors include age greater than 65, paresthesia in extremities, or a dangerous mechanism. A dangerous mechanism is considered a fall from an elevation greater than 3 feet or five stairs, axial load to the head, high-speed motor vehicle collision (e.g.,>100 km/hr. or 60 mph, rollover, ejection), bicycle collision, or motorized recreational vehicles. Site for question/rationale: Canadian C-spine rules article by Dr. Joao Ramos and Dr. Matt A. Morgan et al.; under the musculoskeletal module.

Question 173

``` 3. Question: What type of joint is the glenohumeral joint? A. Synovial joint B. Hinge joint C. Condyloid joint D. Ball-and-socket joint ```

Answer 173

Answer: D. Ball-and-socket joint. Rationale for why the answer is correct: The glenohumeral joint is a ball-and-socket joint that you will have the most arthritis problems. Site for question/rationale: Shoulder Pain presentation by Dr. Shelly Seth at timestamp 3:40-3:50 and 5:35-5:45.

Question 174

4. Question: A 45-year-old female presents to the Emergency Department with a fever of 39.0 Celsius, a stiff neck, and episodes of confusion that started two days ago. What examination/testing would you consider performing? A. Serologic testing for Lyme Disease B. Lumbar puncture for bacterial meningitis C. No testing is required. D. The patient’s symptoms will disappear after controlling fever with Tylenol only.

Answer 174

Answer: Lumbar puncture for bacterial meningitis. Rationale for why the answer is correct: The classic triad for acute bacterial meningitis consists of fever greater than 38 degrees Celsius, nuchal rigidity (stiff neck), change in mental status, and a small percentage have hypothermia. A lumbar puncture is an examination of cerebrospinal fluid (CSF), which is crucial for establishing bacterial meningitis diagnosis. Site for question/rationale: Neurology 1 presentation by Dr. Kent Vandergriff at timestamp 9:15-10:08.

Question 175

``` 5. Question: What is the likely cause of Bell’s palsy? A. Herpes simplex virus activation B. Hepatitis C C. Chlamydia trachomatis D. Staphylococcus aureus ```

Answer 175

Answer: A. Herpes simplex virus activation. Rationale for why the answer is correct: Bell’s palsy and idiopathic facial paralysis are no longer considered synonymous, as HSV activation can most likely cause Bell’s palsy. Site for question/rationale: Neurology 1 presentation by Dr. Kent Vandergriff at timestamp 11:04-11:23.

Question 176

``` 6. Question: A 30-year-old male presents to the Emergency Department complaining of progressive muscle weakness causing difficulty walking. During your history-taking, he states that he had the flu last week, and now this week, he has developed muscle weakness. What would you most likely suspect? A. Tension headache B. Parkinson’s disease C. Guillain-Barre syndrome D. Hemorrhagic stroke ```

Answer 176

Answer: C. Guillain-Barre syndrome. Rationale for why the answer is correct: Guillain-Barre syndrome most often presents as an acute monophasic paralyzing illness provoked by a preceding illness. Site for question/rationale: Neurology 1 presentation by Dr. Kent Vandergriff at timestamp 15:20-15:54.

Question 177

7. Question: When do you order a culture and sensitivity? A. Fever of unknown origin B. Chest pain with exertion C. After you have started the antibiotic for seven days D. None of the above.

Answer 177

Answer: A. Fever of unknown origin. Rationale for why the answer is correct: Culture and sensitivity should be ordered when an infection is suspected, there is a fever of unknown origin or fluid in the wrong place. Site for question/rationale: Fluid Analysis presentation by Dr. Shelly Seth at timestamp 1:05-

Question 178

``` 8. Question: At what stage is it considered kidney failure, and what is the percentage? A. Stage 1; 50 % B. Stage 5; less than 15% C. Stage 4; 29 to 15% D. D. Stage 5; 45% ```

Answer 178

Answer: B. Stage 5; less than 15% Rationale for why the answer is correct: As kidney disease worsens, the GFR percentage decreases. Stage 5 is considered kidney failure, and it is a GFR of less than 15%. Site for question/rationale: Found in the article Estimated Glomerular Filtration Rate (eGFR) (2021), by the National Kidney Foundation; in the module under renal.

Question 179

``` 9. Question: What can affect the urinalysis? A. Hot baths B. Cold showers C. Food, medications, and dehydration D. Washing your hands ```

Answer 179

Answer: C. Food, medications, and dehydration. Rationale for why the answer is correct: Urinalysis can be affected by food, medications, dehydration, fluid overload, or urine sitting out greater than an hour. Site for question/rationale: Urinalysis presentation by Dr. Shelly Seth at timestamp 2:33-3:33.

Question 180

``` 10. Question: When diagnosing a urinary tract infection which markers do you look at? A. Nitrites-positive B. Bacteria >100K C. Leukocyte esterase- small D. All the above. ```

Answer 180

Answer: D. All the above Rationale for why the answer is correct: When diagnosing a urinary tract infection, the markers you need to look at are nitrites, WBC, leukocytes esterase, casts, and bacteria in a urinary analysis. Site for question/rationale: Urinalysis presentation by Dr. Shelly Seth at timestamp 1:15-1:25.

Question 181

1. A38 yo female presents with complaints of hand. During your ROS you find that she has been experiencing fever, abdominal pain, fatigue, and recent weight loss. On exam you note thinning hair and a malar rash. What is the most likely differential for this patient? a. Osteoarthritis b. Rheumatoid Arthritis c. Lyme disease d. Systemic Lupus Erythematosus (SLE)

Answer 181

Answer: d. Systemic Lupus Erythematosus (SLE) Rationale for why the answer is correct: The signs of SLE are fever, weight loss, fatigue, hair loss, chest pain, abdominal pain- n/v/d, personality change, malar rash, and photosensitive rashes. Site for question/rationale: Cc: My hands hurt – Dr. Seth; Slide 9, video 6:46

Question 182

2. Which of the following is NOT a criterion for forgoing c-spine imaging according to the NEXUS rules? a. alert and stable b. no focal neurologic deficit c. no altered level of consciousness d. not intoxicated e. < 65 years old f. no midline spinal tenderness

Answer 182

Answer: e. < 65 years old Rationale for why the answer is correct: Age is not one of the criteria for the NEXUS c-spine rules although they state that ≥ 65 yo the criteria may not be reliable. Site for question/rationale: NEXUS criteria webpage

Question 183

3. Which of the following are possible differentials of medial knee pain? Select all that apply. a. Iliotibial band syndrome b. Medial meniscus injury c. Baker’s cyst d. MCL injury e. Bursitis

Answer 183

Answer: b., d, & e. Rationale for why the answer is correct: Medial meniscus injury, MCL injury, Bursitis are all medial differentials. Iliotibial band syndrome is a lateral knee differential. Baker’s cyst is a posterior differential. Site for question/rationale: cc: I think I need a cane….and a handicapped parking sticker. – Dr. Seth slide 14; video 10:54

Question 184

4. A 38 yo presents with altered mental status. Family states they found the patient confused and repeating words that make no sense. During your exam you note that the patient opens her eyes and moves her extremities spontaneously but keeps saying words that make no sense to the context. You can understand the words; they just do not fit with what is going on. What score would you give for the Glasgow coma scale? a. 15 (4/5/6) b. 13 (4/3/6) c. 12 (3/4/5) d. 11 (4/3/4)

Answer 184

Answer: b. 13 (4/3/6) Rationale for why the answer is correct: The Glasgow coma scale calculation begins with eye opening so that is the first score and since she opens her eyes spontaneously, she gets a 4. The second score is voice with a total of 5 points possible. She says understandable but inappropriate words, so she gets a score of 3. The last score is motor function with a possible score of 6. She moves extremities spontaneously, so she gets a 6. Added up the total score is 13 and they are displayed as E/V/M so 4/3/6. Site for question/rationale: Neurology 1 presentation – Dr. Vandergriff; slide 3: video 1:51

Question 185

5. Your patient is a 28 yo male presenting with c/o headache, a stiff neck, and confusion. You suspect bacterial meningitis and begin the workup. You perform an LP and examine the CSF. Which of the following is indicative of bacterial meningitis? a. neutrophils 30%, protein 60 mg/dL, glucose 72 mg/dL b. neutrophils 60%, protein 110 mg/dL, glucose 54 mg/dL c. neutrophils 84%, protein 226 mg/dL, glucose 32 mg/dL d. none of the above

Answer 185

Answer: c. neutrophils 84%, protein 226 mg/dL, glucose 32 mg/dL Rationale for why the answer is correct: When looking at CSF in bacterial meningitis, the neutrophils most often are >80%, protein is >200 mg/dL, and glucose <40 mg/dL Site for question/rationale: Neurology 1 presentation – Dr. Vandergriff; slide 12: video 9:52

Question 186

6. Which of the following is an acronym used when assessing for “red flags” in headaches? a. SNOOP b. TCLAP c. PONS d. None of the above

Answer 186

Answer: a. SNOOP Rationale for why the answer is correct: Red flags in headaches are Systemic symptoms, Neurological symptoms, New or sudden Onset, Other associated symptoms (trauma, drug use, toxins, awakens from sleep, worse with Valsalva, precipitated by exertion, cough, or sex, and Previous headache hx with change in frequency, severity, or change in clinical features. Site for question/rationale: Neurology 2 presentation – Dr. Vandergriff; slides 28-29: video 2 1:54

Question 187

7. A 68 yo male presents with c/o headache for the past 2 hours that he describes as “the worst headache I’ve ever had” and had a sudden onset. He has a history of atrial fibrillation and CAD. He has nausea and vomited once. The family said he fainted for approximately 1 minute. His v/s are as follows: HR-78 IR, RR-18, B/P-179/102, SpO2- 92% RA, Temp- 98.2 F. Which of the following is the most likely differential for this patient? a. Meningitis b. Subarachnoid hemorrhage c. Migraine d. Cluster headache

Answer 187

Answer: b. Subarachnoid hemorrhage Rationale for why the answer is correct: A subarachnoid hemorrhage presents as the worst headache ever with sudden onset. This patient has a history of A-fib so is probably on blood thinners which put them at risk for SAH. Site for question/rationale: Neurology 2 presentation – Dr. Vandergriff; slides 45-46: video 2 12:45

Question 188

8. Which of the following tests is the most accurate predictor of kidney disease? a. Serum creatinine b. Blood Urea Nitrogen (BUN) c. Bun/creatinine ratio d. Glomerular filtration rate (GFR)

Answer 188

Answer: d. Glomerular filtration rate (GFR) Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease but it is not used as much as the other tests because of its complexity. To perform an accurate GFR a “marker” is injected into the patient and usually performed in sequence with a 24-hour urine. Site for question/rationale: Diagnosing Renal Problems – Dr. Seth; Slide 8. Video 7:00

Question 189

9. You are collecting a 24-hour urine on a patient to determine if there is damage to his kidney. Which of the following education is incorrect? a. Begin urine collection in the morning and discard the first voiding at the beginning of the collection. b. Do not collect urine during a bowel movement. c. Maintain your normal amount of fluids during the collection period. d. On the second morning of collection, void at the same time as the previous morning and add this void to the collection, ending the 24-hour collection.

Answer 189

Answer: b. Do not collect urine during a bowel movement. Rationale for why the answer is correct: Urine is collected even during bowel movements. Collection is initiated in the morning with the first voiding discarded and every voiding following collected. The second morning the patient should void at the same time as the previous morning which ends collection. Changes in fluid intake may affect the collection volume and skew the results. Site for question/rationale: Lab Corps 24-hour urine collection and results website

Question 190

10. You have a culture and sensitivity report on a patient you are treating. Which of the following interpretations on the culture and sensitivity report would tell you that the antibiotic you are considering is a good choice? a. S b. R c. I d. All the above

Answer 190

Answer: a. S Rationale for why the answer is correct: S on the interpretations section of the C&S report indicates that the organism is sensitive/susceptible to that antibiotic, meaning the antibiotic will work. R means the organism is resistant to the antibiotic and it will not work. I means this antibiotic may work with higher doses or may not work and would most likely be a last resort choice. There are other considerations to choosing the right antibiotic of course, such as route, cost, and minimum inhibitory concentration. Site for question/rationale: Fluid Analysis lecture – Dr. Seth; Slide 8, video 9:06

Question 191

1. Question: Which of the following associated with back pain indicate Cauda Equina Syndrome? a) Radiating pain into leg b) History of cancer c) Numbness and tingling d) Loss of bowel or bladder control

Answer 191

Answer: Loss of bowel or bladder control Rationale for why the answer is correct: If they have back pain along with trouble going to the bathroom, this is an emergency (Cauda Equina Syndrome) depending on the severity you will either admit the to the hospital or get an MRI, they may end up having bowel or bladder loss for life. Site for question/rationale: Low back pain lecture Minute 3:10

Question 192

2. Question After how many weeks would you consider low back pain to be chronic? a) >6-9 weeks b) 2 weeks c) 4 weeks d) 1 week

Answer 192

Answer: >6-9 weeks Rationale for why the answer is correct: >6-9 weeks equals chronic pain Site for question/rationale: Low back pain lecture Minute 5:30

Question 193

3. Question: What are important questions to ask when patient has back pain to check if patient has an infection going on? a) Instrumentation, temperature, chills b) Hobbies c) Sports d) Previous injury

Answer 193

Answer: Instrumentation, temperature, chills Rationale for why the answer is correct: It is really important to know if patient is having temperature or chills as well as knowing if they have had instrumentation and previous surgeries to know if they have an infection going on. Site for question/rationale: Low back pain lecture Minute 6:25

Question 194

4. Question: Which of the following is not a cause of delirium and confusion? a) Substance intoxication b) Withdrawal c) Medication side effect d)

Answer 194

Answer: Rationale for why the answer is correct: delirium and confusion is a syndrome cause by a medical condition, substance intoxication, withdrawal, or medication side effect. Site for question/rationale: Neuro lecture Part 1 Minute 4:50

Question 195

5. Question: Which of the following labs would you NOT order for a patient with delirium/confusion? a) Serum Electrolytes b) CBC c) Urine drug screen d) TSH

Answer 195

Answer: TSH Rationale for why the answer is correct: reasonable labs to look at in the patient with delirium/confusion when a cause is not immediately obvious are serum electrolytes, creatinine, glucose, calcium, CBC, UA, urine drug screen, urine culture Site for question/rationale: Neuro lecture Part 1 Minute 6:44

Question 196

6. Question: Which of the following is not 1 of the parts of the meninges? a) Pia b) Arachnoid c) Dura maters d) hypothalamus

Answer 196

Answer: Hypothalamus Rationale for why the answer is correct: the meninges consist of 3 parts: the pia, arachnoid, and dura maters (PAD) Site for question/rationale: Neuro lecture Part 1 Minute 8:30

Question 197

7. Question: In which of the following scenarios would you consider running a GFR? a) Severe malnutrition or obesity b) Disease of skeletal muscle c) Vegetarian diet d) All of the above

Answer 197

Answer: All of the above Rationale for why the answer is correct: GFR should be considered doing when seeing anybody that has kidney disease and is being seen by nephrologist, Extremes of age and body size (child with renal problem), very obese or malnourished, disease of the skeletal muscle, paraplegia/quadriplegia, strict vegetarian diet can cause problems, rapidly changing kidney function, and pregnancy. Site for question/rationale: Diagnosing renal problems lecture minute 8:00

Question 198

8. Question: Which lab measurement is used to adjust drug dosages? a) Creatinine clearance b) BUN c) GFR d) CBC

Answer 198

Answer: Creatinine Clearance Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug dosages. Site for question/rationale: Diagnosing renal problems lecture minute14:30

Question 199

9. Question: For which of the following would you NOT do a 24 hour urine test? a) For hematuria with recurrent kidney stones b) Children, when they have their first kidney stone c) Abdominal pain d) Pheochromocytoma

Answer 199

Answer: Abdominal pain Rationale for why the answer is correct: it is done for hematuria with recurrent kidney stones, in children that have their first kidney stone because they should not be having kidney stones, for uncontrolled HTN to diagnose pheochromocytoma, preeclampsia, kidney disease and multiple myeloma, these are some of the reasons why you would do a 24 hours urine. Site for question/rationale: Diagnosing renal problems lecture minute 14:45

Question 200

10. Question: Which of the following would you be able to observe when doing a KUB? a) Stones b) Neoplasms c) Air d) All of the above

Answer 200

Answer: All of the above Rationale for why the answer is correct: when doing a KUB these are some of the things that it can look at stones, neoplasms, tumors, any disease process that causes a buildup of calcium, air which you should not have in the kidney. Also, soft tissue changes, you can look at it and see if the renal outline is not very sharp you would need to determine if it is an infection, inflammation, tumor. Site for question/rationale: Diagnosing renal problems lecture minute 18:58

Question 201

1. Which is correct regarding Nexus vs CCR rules? a. Nexus is reliable for people over 65 years old. b. Nexus has high and low risk criteria c. CCR has slightly higher specificity d. Nexus has slightly higher specificity

Answer 201

Answer: D Rationale for why the answer is correct: Both have same sensitivity, Nexus has slightly higher specificity. CCR has high and low risk criteria. Nexus is NOT reliable for people over 65 years old. Site for question/rationale: Article comparing Nexus vs CCR, conclusion paragraph Ala, A., Shams Vahdati, S., Ghaffarzad, A., Mousavi, H., & Mirza-Aghazadeh-Attari, M. (2018). National emergency X-radiography utilization study guidelines versus Canadian C-Spine guidelines on trauma patients, a prospective analytical study. PloS one, 13(11), e0206283. doi:10.1371/journal.pone.0206283

Question 202

2. What sign would be most pertinent to know if a patient came in with L shoulder pain? a. Tinel sign b. Kehr’s sign c. Sperling’s sign d. Phalen sign

Answer 202

Answer: B Rationale for why the answer is correct: A + Kehr’s sign is indicative of splenic injury and is specific to L shoulder pain. Site for question/rationale: “My shoulder hurts” PowerPoint, slide 14

Question 203

3. Which is INCORRECT about RA? a. It is symmetrical b. It involves the metacarpal and wrist joints c. It involves the DIP and PIP joints d. Stiffness lasts more than 60 minutes in the morning

Answer 203

Answer: C Rationale for why the answer is correct: RA is symmetrical because it is systemic, inflammatory process. Stiffness lasts more than 60 minutes in the morning due to the disease process being inflammatory. It involves the metacarpal and wrist joints. OA involves the DIP and PIP joints, is asymmetrical due to being a wear and tear disease process. Site for question/rationale: “My hands hurt” PowerPoint, slide 3

Question 204

4. Which is true regarding Bell’s Palsy? a. Loss of taste is a clinical symptom b. It is also called idiopathic facial paralysis c. Onset is 2-4 days d. Labs confirm diagnosis

Answer 204

Answer: A Rationale for why the answer is correct: Loss of taste of the anterior tongue, acute facial paralysis, acute onset of 1-2 days, altered lacrimal/salivary glands are all CLINICAL diagnosis. Bell’s Palsy and idiopathic facial paralysis are not the same as Bell’s Palsy is likely from HSV Site for question/rationale: Common Neuro Diagnosis in Acute & Primary Care Part 1 PowerPoint, slide 14

Question 205

5. A 20-year-old female presents to the emergency room with weakness in her legs that started a couple days ago. She is now starting to have facial numbness. After reviewing her chart, you see she was seen for a GI virus 2 weeks ago. What is your next step? a. Obtain an MRI b. No tests needed as pt is experiencing Guillain Barre Syndrome c. Obtain an LP d. Obtain a CT

Answer 205

Answer: C Rationale for why the answer is correct: An LP is absolutely necessary in all suspected GB patients. Initial dx is based on clinical symptoms, but an LP and electrodiagnostic studies are useful in confirming dx. An MRI and CT are not indicated. Site for question/rationale: Common Neuro Diagnosis in Acute & Primary Care Part 1 PowerPoint, slide 21-24

Question 206

6. Which patient in the emergency room needs to be seen first as high priority in regard to headaches? a. A 22-year-old college student with hx of migraines that says, “This just won’t go away” b. A 52-year-old male that woke up in the middle of the night with a headache that says, “I’ve never had a headache before, this feels terrible” c. A 45-year-old female with sensitivity to light that says, “I just need help; I can’t even go to work today” d. An 18-year-old male that says, “This headache just started today, and my mom told me to come get looked at. It’s a 4/10”

Answer 206

Answer: B Rationale for why the answer is correct: Red flags for headaches: “SNOOP” Systemic s/s, neuro s/s, onset is new (esp. for >50 years old), suddenly like a thunderclap, trauma, drug use, awakens from sleep, precipitated by cough, sex, exertion, or change in attack frequency/severity/features. Site for question/rationale: Common Neuro Diagnosis in Acute & Primary Care Part 2 PowerPoint, slide 4-7

Question 207

7. Which statement is true regarding GFR and creatinine? a. Creatinine is most accurate predictor of kidney disease b. GFR is most accurate predictor of kidney disease c. GFR should not be done on extremely old or young pts as it’s too dangerous d. GFR and creatinine clearance are the same thing

Answer 207

Answer: B Rationale for why the answer is correct: GFR is the most accurate predictor of kidney disease. It should be considered on extremely old and young pts, malnourished or obese, vegetarian diets, skeletal diseases, preeclampsia, etc. Site for question/rationale: Renal Testing for Diagnosis PowerPoint, slide 12 and 13

Question 208

8. Which statement is TRUE regarding creatinine clearance? a. There is only 1 calculation to estimate CL(cr) b. GFR, not CL(cr), is used to adjust drug dosages c. You can accurately estimate creatinine clearance in morbidly obese pts d. You cannot accurately estimate creatinine clearance in morbidly obese pts

Answer 208

Answer: C Rationale for why the answer is correct: “An lean body weight, based on true body weight and BMI, incorporated into the Cockcroft-Gault equations provided an unbiased, relatively precise, accurate, and clinically practical estimate of the 24 hr measured CL(cr) in morbidly obese pts” Site for question/rationale: Article estimating crea cl in morbidly obese pts, conclusion paragraph

Question 209

9. Which would NOT be an indication for a 24 hr urine collection? a. Preeclampsia b. Uncontrolled HTN c. Child with 1st time kidney stone d. 1st time kidney stone

Answer 209

Answer: D Rationale for why the answer is correct: Recurrent kidney stones or CHILDREN with 1st time kidney stones would indicate the need for a 24 hr urine collection, as well as preeclampsia, uncontrolled HTN, kidney disease, multiple myeloma and hematuria. Site for question/rationale: Renal Testing for Diagnosis PowerPoint, slide 12

Question 210

10. Which result is most pertinent to follow up in a UA? a. + RBC b. + glucose c. + protein d. High specific gravity

Answer 210

Answer: A Rationale for why the answer is correct: UA should not have RBCs and require follow up because it could be due to kidney damage or stone or bladder cancer. The other results could be positive due to stress, exercise, hydration status, contrast, etc. and are less pertinent. Site for question/rationale: Urinalysis PowerPoint, slide 15

Question 211

1. Question: Trauma patients who do not require cervical spine imaging require all of the following EXCEPT: a. Alert and Stable b. No focal neurological deficit c. No altered level of consciousness d. A midline spinal tenderness

Answer 211

Answer: D Rationale for why the answer is correct: Trauma patients who do not require cervical spine imaging require all of the following: alert and stable, no focal neurological deficit, no altered level of consciousness, not intoxicated, no midline spinal tenderness, no distracting injury. Site for question/rationale: https://radiopaedia.org/articles/nexus-criteria?lang=us page 1

Question 212

2. Question: A patient comes into the clinic and is complaining of shoulder pain that started 1.5 weeks ago. What differential diagnosis would you consider? a. Trauma b. Fracture c. Dislocation d. All the above

Answer 212

Answer: D Rationale for why the answer is correct: Acute pain is considered less than 2 weeks and you should consider trauma, fractures, dislocations, and falls. Site for question/rationale: Shoulder Pain Presentation by Dr. Shelly Seth @ 1:27 and Shoulder Pain Handout page 2 slide 3.

Question 213

3. Question: A patient comes in to the clinic to establish care. She states she has a history of inflammatory arthritis. What would you expect to see as a possible diagnosis for this patient? a. Osteoarthritis (OA) b. Gout c. Lyme Disease d. Carpal Tunnel Syndrome

Answer 213

Answer: B Rationale for why the answer is correct: Types of Inflammatory Arthritis are rheumatoid arthritis (RA), Systemic Lupus, psoriatic arthritis, erythematosus (SLE), Gout, Undifferentiated Arthritis. Site for question/rationale: My Hands Hurt presentation by Dr. Shelly Seth @ 1:26 and My hand hurts handouts p. 1 slide 2

Question 214

4. Question: The Glasgow Coma Scale focuses on 3 areas which are: a. Eye Opening, Best Motor Response, Level of Consciousness b. Best Language response, Best Motor Response, Eye Opening c. Eye Opening, Best Verbal Response, Best Motor Response d. Best Focus Response, Best Motor Response, Best Facial Response

Answer 214

Answer: C Rationale for why the answer is correct: The Glasgow Coma scale focus on of Eye Opening, best Verbal Response, Best Verbal Response Site for question/rationale: Neurology 1 presentation by Kent Vandergriff @3:17 and Neurology Handouts p.1 slide 3

Question 215

5. Question: A patient comes into the clinic and after your assessment you are considering a diagnosis of delirium. What labs would you order to help aid in your differential diagnosis? a. Blood gas b. Serum Electrolytes c. Ammonia d. All the above

Answer 215

Answer: D Rationale for why the answer is correct: Labs for delirium: Serum Electrolytes, creatinine, glucose, calcium, CBC, urinalysis, UDS, Urine culture, Drug levels of current drugs, blood gas, liver function tests, ammonia, thyroid function and vitamin B12 levels Site for question/rationale: Neurology 1 presentation by Kent Vandergriff @6:36 and Neurology Handouts p.3 slides 8 & 9

Question 216

6. Question: A patient comes in presenting with signs and symptoms of bacterial meningitis. You know that bacterial meningitis reflects infection of the a. Arachnoid mater and the CSF in both subarachnoid space and cerebral ventricles b. The pia c. Dura mater and the CSF in the pia d. None of the above

Answer 216

Answer: A Rationale for why the answer is correct: Bacterial meningitis reflects infection of the Arachnoid mater and the CSF in both subarachnoid space and cerebral ventricles Site for question/rationale: Neurology 1 presentation by Kent Vandergriff @9:00 and Neurology Handouts p.4 slide 10

Question 217

7. Question: A patient comes into the clinic and tells you that he has a suddenly in last 8 hours developed facial paralysis on one side of his face, he cannot close his eye on the affected side, and he feels like he has lost taste. You also notice the disappearance of the nasolabial fold. What differential diagnosis would you suspect? a. Bell’s Palsy b. Stroke c. Guillain Barre d. Parkinson’s

Answer 217

Answer: A Rationale for why the answer is correct: Clinical Features of Bell’s Palsy is Sudden (hours) unilateral facial paralysis, eyebrow sagging, mouth drooping, inability to close eye, disappearance of nasolabial fold, +/- loss of taste of anterior 2/3 of tongue and altered secretion lacrimal & salivary gland. Site for question/rationale: Neurology 1 presentation by Kent Vandergriff @11:56 and Neurology Handouts p.5 slide 13

Question 218

8. Question: If you are adjusting drug dosages for certain medications that affect kidney function. What measurement would you use? a. BUN b. Creatinine Clearance c. Glomerular Filtration Rate (GFR) d. Urinalysis

Answer 218

Answer: B Rationale for why the answer is correct: Creatinine Clearance is the measurement used to adjust drug dosages. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth at 13:47 and Renal Diagnosing Handouts p. 4 slide 12.

Question 219

9. Question: When would you order a 24-hour urine? a. A patient has hematuria and recurrent kidney stones b. A patient has been experiencing a backache c. A patient has liver disease d. A patient has controlled hypertension

Answer 219

Answer: A Rationale for why the answer is correct: A 24-hour urine should be done when a spot test won’t tell the whole story, hematuria/recurrent kidney stones, children that are experiencing their first kidney stone, pheochromocytoma, pre-eclampsia, kidney disease, and multiple myeloma Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth at 16:25 and Renal Diagnosing Handouts p. 5 slide 13.

Question 220

10. Question: A neonate has a differential diagnosis of hydronephrosis. What would be ordered to be performed at bedside? a. CT Scan b. Renal Ultrasound c. Excretory urography d. KUB

Answer 220

Answer: B Rationale for why the answer is correct: A renal ultrasound can be used at bedside, it avoids the use of contrast. Renal Ultrasounds can be used for hydronephrosis, urine flow, differentiates cortex and medulla, differentiates cysts from masses, and stones. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth at 17:16 and Renal Diagnosing Handouts p. 5 slide 14.

Question 221

1. Question: When assessing range of motion, it is important to assess which of the following? a. Passive ROM only b. Active ROM only c. Active ROM and then Passive ROM d. Passive ROM and then Active ROM

Answer 221

Answer: C Rationale for why the answer is correct: When assessing ROM start with active where the patient does the work and then following with passive ROM in which you as the provider do the work. Site for question/rationale: Shoulder presentation, 12:12

Question 222

2. Question: A patient presents with hand pain, fever, weight loss, chest pain, and a rash. Which of the following would be your primary differential? a. Rheumatoid Arthritis b. Systemic Lupus Erythematosous c. Reiter Disease d. Osteoarthritis

Answer 222

Answer: B Rationale for why the answer is correct: This would be narrowed down to RA and Lupus but the rash points to Lupus. Site for question/rationale: Hand presentation, 7:58

Question 223

3. Question: When sending labs for a patient complaining of hip or knee pain, you would order all of the following EXCPET: a. CMP b. CBC c. Sed Rate d. CRP

Answer 223

Answer: A Rationale for why the answer is correct: Lab diagnostics for hip and knee pain include CBC, Sed Rate and CRP in order to check for infection and inflammation. Site for question/rationale: Hip presentation, 8:40

Question 224

4. Question: You would like to perform an arthrocentesis on your patient with knee pain. What would be a contraindication for this procedure? a. Pain b. Cellulitis c. Decrease ROM d. Fluid removal

Answer 224

Answer: B Rationale for why the answer is correct: Never perform a joint aspiration through cellulitis or infection. Site for question/rationale: Knee presentation, 13:58

Question 225

5. Question: A patient presents to the ED with altered mental status. Last known normal was 3 hours ago. What order set would you use for this patient? a. CMP, CBC, UDS, ABG, CT head b. CMP, CBC, blood culture, lumbar puncture c. CMP, CBC, Head CT d. CMP, liver function, UDS

Answer 225

Answer: A Rationale for why the answer is correct: A patient presenting with altered mental status should have a differential of stroke and should be ruled out. Site for question/rationale: Neuro part 1, 8:00

Question 226

6. Question: A lumbar puncture is obtained for a patient with suspicion of Guillain Barre. What results of the LP would you expect to see? a. Normal CSF protein and WBC b. Increase CSF protein and increase WBC c. Decrease CSF protein and decrease WBC d. Increase CSF protein and normal WBC

Answer 226

Answer: D Rationale for why the answer is correct: Lp results for a patient with Guillain barre shows and increase in protein with a normal WBC. Site for question/rationale: Neuro part 1, 19:14

Question 227

7. Question: When assessing the history of a headache, using the acronym SNOOP, what would you be looking for as the provider? a. Systemic symptoms, neuro symptoms, onset, other symptoms, previous headache b. Systemic symptoms, neuro symptoms, onset, order of symptom onset, previous headache c. Signs and symptoms, neuro symptoms, onset, order of symptom onset, previous headache d. Signs and symptoms, neuro symptoms, onset, other symptoms, previous headache

Answer 227

Answer: A Rationale for why the answer is correct: SNOOP stands for answer A Site for question/rationale: Neuro part 2, 2:11

Question 228

8. Question: You are looking at the results from a urinalysis, what are the most important indicators of a urinary tract infection? a. pH, leucocytes, and bacteria b. pH, WBC, and bacteria c. Nitrites, leucocytes, casts and bacteria d. Nitrite, ketones, casts, and bacteria

Answer 228

Answer: C Rationale for why the answer is correct: When interpreting the results of a UA look at nitrites, leukocytes, WBC, casts, and bacteria to diagnose a UTI. Site for question/rationale: Urinalysis, 1:31

Question 229

9. Question: You are suspecting your patient has a kidney stone. What type of imaging order would be placed to diagnosis a kidney stone? a. Renal ultrasound b. MRI/MRA c. CT scan with contrast d. CT scan without contrast

Answer 229

Answer: D Rationale for why the answer is correct: Any patient with suspected kidney injury should not receive IV contrast as is it processed through the kidney. Kindey stones tend to have enough calcium that they show up well on a CT scan. Site for question/rationale: Renal testing, 20:40

Question 230

10. Question: Which of the following is a false statement? a. The glomerular filtration is the most accurate predictor or kidney disease. b. A serum creatinine is a quick and easy way to diagnose dehydration and kidney injury. c. Creatinine Clearance is the measurement used to adjust drug dosing. d. BUN levels are used to change medication dosing.

Answer 230

Answer: D Rationale for why the answer is correct: Creatinine clearance is used to adjust drug dosing. Not BUN. Site for question/rationale: Renal testing, 10:30

Question 231

``` 1. Question: What is the purpose of striking the heel with fist during a rapid musculoskeletal trauma evaluation? Select all that apply. A) To assess for tibia fracture B) To assess for hip instability C) To assess for fracture of the ankle D) To assess for calcaneus fracture ```

Answer 231

Answer: B & D Rationale for why the answer is correct: Striking the heel with fist during a rapid musculoskeletal evaluation is to assess for possible calcaneus fracture, which is a commonly missed bony abnormality in the trauma patient. This will also send a compressive force up to hip to assess for hip instability. Tibia fracture might be assessed by running hand down tibia since bone is very superficial as well as compressing tibia and fibula together. Fracture of the ankle joint might be assessed through palpation or squeezing foot together. Site for question/rationale: Brief Exam for Skeletal Injures DeGowins Diagnostic Examination Marker 5:41-6:00

Question 232

``` 2. Question: A 46-year-old marathon runner presents to clinic with knee pain. The APRN is suspicious for patellofemoral pain syndrome. Which is NOT a classical finding in this syndrome? A) Anterior knee pain B) Positive J-sign C) Positive Lachman test D) Pain worsened with going downstairs ```

Answer 232

Answer: C Rationale for why the answer is correct: Patellofemoral pain syndrome is a common overuse disorder characterized by anterior knee pain, positive J sign (when patella moves laterally with fully extended leg), pain worsened with weight bearing activities, and pain is typically elicited with descending stairs. A positive Lachman test would be indicative of an ACL tear. Site for question/rationale: Knee Pain Lecture by Dr. Shelly Seth Marker 7:00-8:06

Question 233

3. Question: The APRN is reviewing which lab results to order for a patient suspected of having rheumatoid arthritis. Which of the following lab results would be the most specific to RA if positive in this patient? A) positive rheumatoid factor B) positive Anti-citrullinated protein antibody test C) positive antinuclear antibodies (ANA) D) positive C-reactive protein

Answer 233

Answer: B Rationale for why the answer is correct: All of these lab values could be ordered for a patient suspected of having RA and each may be positive, but Anti-citrullinated protein antibody test is the most specific for RA. C-reactive protein is a nonspecific marker for inflammation. ANA antibodies can be elevated in SLE and RA. Rheumatoid factor is typically positive but can be present in other diseases. Site for question/rationale: Dr. Shelly Seth Hand Pain and Swelling Lecture Marker 13:16-14:53

Question 234

``` 4. Question: A patient presents to the ER with bilateral lower extremity weakness. Upon further investigation, the APRN finds that the patient had a viral gastrointestinal illness a week prior. The patient states the illness has been getting progressively worse with weakness moving up his body in almost a systemic fashion. The APRN is correct to order which test first to confirm her hypothesis of Guillain Barre syndrome? A) EEG B) MRI brain C) CTA chest D) Lumbar Puncture ```

Answer 234

Answer: D Rationale for why the answer is correct: A lumbar puncture should be performed on all patients to rule in/out GBS. An LP will show an increased CSF protein count. The CTA is the test of choice for pulmonary embolism. A CTA would be useful to look at the vessels if an abnormality was suspected. An EEG would be a test of choice to determine seizure activity. A brain MRI would be useful to get a better visual of the vessels within the brain if a stroke was suspected. Additional testing for GBS may include IgG antibody testing to GQ1b antibodies and electrodiagnostic studies. Site for question/rationale: Dr. Kent Vandergriff Lecture Neurology Part 1 Marker 15:10-19:26

Question 235

5. Question: A patient has been in the ICU for 14 days with complications related to urosepsis. The patient is agitated quite often during the night, yet during the day remains lethargic. The APRN is concerned for delirium. What would not be an appropriate next step to take? A) Order a long acting benzodiazepine to help alleviate patient anxiety at night B) Order an ABG to determine the patient does not have an acid-base imbalance that could better explain the symptoms C) Order electrolyte panel to rule out electrolyte abnormalities as the cause for the change in mood D) Perform a thorough history and physical to determine patient’s baseline cognitive function

Answer 235

Answer: A Rationale for why the answer is correct: When assessing a patient for possible delirium, we want to first rule out any other causes for the change in behavior. An electrolyte panel and ABG would be appropriate tests to order during that time. A thorough history and physical can help the provider rule out preexisting neurological disorder or disease that could better explain the patient’s symptoms. A long acting benzodiazepine would not be first line therapy for this patient as it does not help identify the cause for the patient’s symptoms. Site for question/rationale: Dr. Kent Vandergriff Neurology Presentation Part 1 Marker 4:47-8:10

Question 236

6. Question: A 23 year old presents with “throbbing” like headache. She states that she gets these headaches consistently during finals week. The patient asks what imaging will be needed to aide in her diagnosis. Based on the signs and symptoms, the APRN is correct in stating which of the following? A) The patient likely needs a CT scan B) The patient does not need imaging, but may need a lumbar puncture C) The patient does not need imaging D) The patient meets criteria for an MRI

Answer 236

Answer: C Rationale for why the answer is correct: The patient’s history and symptoms are most consistent with a tension style headache. The patient meets no qualifiers for emergent headaches as the headache did not come on suddenly, she has no PMH, age<50 years old, no neurological symptoms, no abrupt onset, and severity is similar to headaches she has had in the past. Site for question/rationale: Dr. Kent Vandergriff Lecture Neurology Part 2 1:16-1:55

Question 237

7. Question: A patient presents to the ER with fever of unknown origin and headache 10/10. A lumbar tap is scheduled to aide in diagnosis. Which of the following statements made by the wife demonstrates accurate knowledge on the use of the CT scan before lumbar puncture? A) a CT is used to help confirm anatomy of the lumbar spine B) a CT is used to confirm to rule out any abnormality that may put the patient at risk for elevated ICP C) a CT scan is used to measure the amount of fluid available for lumbar puncture D) a CT scan can help prevent unnecessary testing by ruling out viral meningitis

Answer 237

Answer: B Rationale for why the answer is correct: a CT scan aids in ruling out any abnormality that may place the patient at risk for an acute raise in ICP, which can lead to brain herniation if CSF is drained too quickly. A CT scan cannot rule out viral meningitis. A CT scan before lumbar puncture does show anatomy of the lumbar spine but that’s not why it is used before puncture. Site for question/rationale: Dr. Shelly Seth Fluid Analysis Lecture Marker 20:12-20:52, 23:48-24:20

Question 238

``` 8. Question: A 67-year-old female with a BUN 67 and Creatinine of 1.45 is to receive vancomycin maintenance dose. The APRN knows that vancomycin is adjusted based on? A) Creatinine B) Age C) BUN D) None of these ```

Answer 238

Answer: D Rationale for why the answer is correct: Drug doses are adjusted based on creatinine clearance. Drug doses are not adjusted based on creatinine alone, age, or BUN. Site for question/rationale: Dr. Shelly Seth Diagnosing Renal Problems Lecture Marker 13:39-14:43

Question 239

9. Question: A 19-year-old female presents to clinic for routine history and physical. Labs, urinalysis, and GYN exam are performed. The patient looks at her results in her patient portal and sees that her urine was positive for glucose. The patient asks her APRN during her follow up what this means. The APRN is correct in stating that... A) Glucose in urine is normal in females B) Glucose in the urine is normal C) Glucose in the urine is not normal D) Glucose in the urine is normal in men

Answer 239

Answer: C Rationale for why the answer is correct: Glucose in the urine is abnormal but can be present in certain disease processes such as diabetes, multiple myeloma, and Fanconi’s syndrome. Glucose in urine does not depend on sex. Site for question/rationale: Dr. Shelly Seth Urinalysis Lecture Marker 7:44-8:25

Question 240

10. Question: A 38-year-old female presents to the urology office to pick up a 24-hour urine collection container for measurement of urine catecholamines. The ARPN knows she provided clear instructions when the patients state which of the following? A) “I will start the sample as soon as I wake up.” B) “I will store the collection container in room temperature.” C) “I should take the 24-hour collection to the lab within 1 week” D) “I will stop the urine collection with the first void of the following morning”

Answer 240

Answer: D Rationale for why the answer is correct: The 24-hour urine collection begins with discarding the first morning urine and then collecting all urine from the remainder of that day. The 24-hour urine collection ends with the first void of the following morning. The 24-hour urine collection container should be kept in a cool place or refrigerated. Site for question/rationale: Lab Corp 24-hour Urine Collection reading

Question 241

1. Question: A 56-year-old female comes into the clinic with a chief complaint of right shoulder pain. On physical examination, her pain is unaffected by active or passive range of motion. As the provider you suspect her shoulder pain is referred. Which of the following are causes of referred shoulder pain? (Select all that apply) a. Cervical spine neural Impingement b. Peripheral nerve Entrapment c. Diaphragmatic irritation

Answer 241

Answer: A, B, C Rationale for why the answer is correct: Cervical spine impingement, peripheral nerve entrapment, and diaphragmatic irritation are causes of referred shoulder pain. Site for question/rationale: Shoulder Pain Diagnostics by Dr Shelly Seth (03:21)

Question 242

2. Question: When completing basic physical exams, which of the following should you complete first? a. Passive Range of Motion b. Extension c. Flexion d. Active Range of Motion

Answer 242

Answer: Active Range of Motion Rationale for why the answer is correct: Active range of motion should always be assessed first so that the patient’s willingness to move may be observed as well as any limitations identified. Site for question/rationale: Shoulder Basic Physical Examination Presentation Texas Tech University (01:52)

Question 243

3. Question: True or False: A bulge in the inguinal area can assist in ruling out hip injury.

Answer 243

Answer: False Rationale for why the answer is correct: Bulge and pain in the inguinal area can be indicative of hip injury. Site for question/rationale: Hip Pain Diagnostics by Dr Shelly Seth (05:15)

Question 244

4. Question: A patient comes into the ER via ambulance status post MVC. The patient’s eyes open in response to pain, is verbally speaking with incomprehensible sounds , and is withdrawing to pain. Which of the following best describes the patient’s Glasgow Coma Score (GCS)? a. 15 b. 3 c. 0 d. 8

Answer 244

Answer: D (8) Rationale for why the answer is correct: the GCS score for ‘responsive to pain’ is 2, the GCS score for ‘incomprehensible sounds’ is 2 , and the GCS score for ‘withdrawal to pain’ is 4; total score is 8. Site for question/rationale: Neuro Part I Presentation by Dr Kent Vandergriff (03:35)

Question 245

5. Question: A patient is brought in by family due to decreasing mentation. As you evaluate the patient, you suspect delirium. The family tells you that the patient has a history of bipolar disorder and high blood pressure. Which of the following medications can cause delirium at therapeutic levels? a. Lithium b. Metoprolol c. Vitamin C d. Tylenol

Answer 245

Answer: Lithium Rationale for why the answer is correct: Delirium can occur with “therapeutic” levels of several agents like digoxin, lithium, or quinidine. Site for question/rationale: Neuro Part I Presentation by Dr Kent Vandergriff (07:20)

Question 246

6. Question: Which of the following acronyms is helpful in identifying key red flags in a patient complaining of head pain? a. SNOOP b. CAGE c. SPIN d. NIHSS

Answer 246

Answer: SNOOP Rationale for why the answer is correct: SNOOP is a helpful acronym to identify red flags in headaches/ migraines; S-systemic symptoms, N-neurologic symptoms, O-onset, O- other associated conditions, P- previous headaches. Site for question/rationale: Neuro Part II Presentation by Dr Kent Vandergriff (02:40)

Question 247

7. Question: Prior to ordering a CT scan with contrast, which lab should be reviewed? a. LFT b. Creatinine c. Blood Glucose d. D-dimer

Answer 247

Answer: Creatinine Rationale for why the answer is correct: Creatinine should be checked before a clinician even orders a CT with contrast; if the patient receives contrast when their serum creatinine levels are elevated further kidney damage will ensue. Site for question/rationale: Renal Testing for Diagnosis by Shelly Seth (20:40)

Question 248

8. Question: Mrs. Jones, a 58-year-old female, is admitted to the hospital for AKI. Which of the following medications should be stopped immediately to prevent further kidney damage? (Select all that apply) a. Ibuprofen b. Lisinopril c. Losartan d. Tylenol

Answer 248

Answer: A, B, C Rationale for why the answer is correct: Medications that should not be used in patients with kidney disfunction include: NSAIDS (Ibuprofen), ACE Inhibitors (Lisinopril), ARB’s (Losartan), and COX inhibitors. Site for question/rationale: Renal Testing for Diagnosis by Shelly Seth (2:39)

Question 249

9. Question: A 27-year-old male patient comes into the clinic with a chief complaint of R flank pain for the last 2 hours. The patient states the pain is 9 out of 10 on the pain scale, has his hand on his right flank, is not wanting to move, and is positive for CVA tenderness on physical exam. Which of the following should be included in the NP’s differentials list? a. Kidney Stone b. STI c. Gastritis d. Migraine

Answer 249

Answer: Kidney stone Rationale for why the answer is correct: Severe flank pain and CVA tenderness are common in patients with kidney stones. Site for question/rationale: Renal Testing for Diagnosis by Shelly Seth (4:35)

Question 250

10. Question: Which of the following is used to adjust drug dosages? a. BUN b. Creatinine Clearance c. Antinuclear Antibodies d. Serum Blood Glucose

Answer 250

Answer: Creatinine Clearance Rationale for why the answer is correct: Creatinine clearance is a measurement used to adjust drug dosages. Site for question/rationale: Renal Testing for Diagnosis by Shelly Seth (14:40)

Question 251

1. Question: Which of the following would indicate a trauma patient does require cervical spine imaging? a. Alert and Stable b. Midline Spinal Tenderness c. No distracting injury d. No focal neurological deficit

Answer 251

Answer: B. Midline Spinal Tenderness Rationale for why the answer is correct: Criteria that exclude trauma patients from C-spine imaging include alert and stable, no focal neurologic deficit, no altered level of consciousness, not intoxicated, no midline spinal tenderness, and no distracting injury. Site for question/rationale: NEXUS criteria found at https://radiopaedia.org/articles/nexus-criteria?lang=us

Question 252

2. Question: Which is not a cause of referred shoulder pain? a. Neural impingement b. Diaphragmatic irritation c. Peripheral nerve entrapment d. Trauma

Answer 252

Answer: D. Trauma Rationale for why the answer is correct: Trauma to the shoulder would not be considered referred pain. Site for question/rationale: Shoulder Pain Presentation by Shelly Seth, time 2:17.

Question 253

3. Question: A 53 year old man presents to the clinic with lower back pain for 4 weeks. He has pain when raising his straight legs greater than 30 degrees while laying flat. What is the most likely diagnosis? a. Herniated Disk b. Lumbar strain c. Cauda Equina d. Osteoarthritis

Answer 253

Answer: A. Herniated Disk Rationale for why the answer is correct: Straight leg raise is the most common test to assess for a herniated disk. Site for question/rationale: Back Pain Presentation by Dr. Shelly Seth, time 8:23.

Question 254

4. Question: Where is the infection in Bacterial Meningitis? a. Dura Matter b. Arachnoid matter c. Pia matter d. Brain stem

Answer 254

Answer: B. Arachnoid matter Rationale for why the answer is correct: “Bacterial meningitis reflects infection of the arachnoid matter and the CSF in both the subarachnoid space and the cerebral ventricles.” Site for question/rationale: Neurology 1 Presentation by Dr. Kent Vandergriff, time 9:00.

Question 255

5. Question: What is NOT part of the classic triad of Bacterial Meningitis? a. Fever (>38 degrees Celsius) b. Nuchal rigidity c. Tinnitus d. Change in mental status

Answer 255

Answer: C. Tinnitus Rationale for why the answer is correct: The classic triad of symptoms for bacterial meningitis include fever, nuchal rigidity, and change in mental status. Site for question/rationale: Neurology 1 Presentation by Dr. Kent Vandergriff, time 9:18.

Question 256

6. Question: A 47 year old male presents with a headache described as the “worst headache of my life.” What test diagnoses more than 90% of cases with subarachnoid hemorrhage? a. Brain XR b. US of head c. Non-contrast head CT d. Angiography

Answer 256

Answer: C. Non-contrast head CT Rationale for why the answer is correct: Non-contrast head CT reveals the diagnosis of more than 90% of cases of Subarachnoid Hemorrhage. Site for question/rationale: Neurology Presentation 2 by Dr. Kent Vandergriff, time 13:51.

Question 257

7. Question: In a patient suspected of having AKI what home medications would not need to be discontinued? a. Ibuprofen b. Celeberex c. Captopril d. Metoprolol

Answer 257

Answer: D. Metoprolol Rationale for why the answer is correct: In patients with suspected AKI, NSAIDS (ibuprofen), COX inhibitors (Celebrex), ACE inhibitors (Captopril), and ARBs. Beta blockers (metoprolol) are not on the list. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Shelly Seth, time 2:38.

Question 258

8. Question: What renal lab value is used to adjust drug dosage? a. Creatinine clearance b. BUN c. Estimated GFR d. Urine pH

Answer 258

Answer: A. Creatinine clearance Rationale for why the answer is correct: Creatinine clearance is measurement used to adjust drug dosage. Site for question/rationale: Diagnosing renal problems presentation by Dr. Shelly Seth, time 14:43.

Question 259

9. Question: Renal ultrasound can be used to visualize all the following except: a. Hydronephrosis b. Differentiate cysts from masses c. Observe urine flow d. Renal blood flow

Answer 259

Answer: D. Renal blood flow Rationale for why the answer is correct: All other answers are correct. Site for question/rationale: Diagnosing renal problems presentation by Dr. Shelly Seth, time 18:03.

Question 260

10. Question: When would a kidney biopsy be inappropriate? a. Nephrotic syndrome b. Hematuria c. Transplant rejection d. Uncomplicated UTI

Answer 260

Answer: D. Uncomplicated UTI Rationale for why the answer is correct: Biopsies are appropriate in AKI with no explanation, Nephrotic Syndrome, Persistent proteinuria, Hematuria, confirming other disease, transplant rejection. Site for question/rationale: Diagnosing Renal Problems Presentation by Dr. Shelly Seth, time 28:41.

Question 261

1. Question: A 32-year male who plays tackle football with his friends on weekends comes into the clinic with a chief complaint of shoulder pain. While doing your assessment the patient does not experience pain during ROM testing however has a positive Spurling Test. The Nurse Practioner knows that this indicates which of the following? a. Referred pain indicating spleen laceration b. Referred pain indicating Cervical spine radiculopathy c. Referred pain indicating perforated viscous d. Chronic shoulder pain

Answer 261

Answer: Referred pain indicating Cervical spine radiculopathy Rationale for why the answer is correct: Spurling test is used to help diagnose pain that stems from the cervical spine Site for question/rationale: Shoulder Pain Diagnostics Presentation by Dr. Seth @2:

Question 262

2. Question: A 27 year old very active female with a PMH of shoulder surgery, presents with anterior knee pain. During your interview she states she runs frequent marathons on weekends, upon examination she has a positive J-sign. Which of the following would be the best leading diagnosis? a. Osgood-Schlatters disease b. Patellar tendinitis c. Patellofemoral Syndrome d. Osteoarthritis

Answer 262

Answer: Patellofemoral syndrome Rationale for why the answer is correct: PFS is the most commons form of anterior knee injury for runners and positive J-sign is noted during physical examination

Question 263

3. Question: The Nurse Practioner is seeing a patient in which they suspect a possible PCL injury. Which of the following tests would be performed to rule in this diagnosis? a. Lachman test b. Drawer test c. Varus sress test d. McSchlatter test

Answer 263

Answer: Drawer test Rationale for why the answer is correct: Excessive posterior displacement of the tibia when performing this test indicates a possible injury to the PCL, excessive anterior displacement would indicate ACL injury Site for question/rationale: Knee Pain Diagnostics by Dr Seth @12:15

Question 264

4. Question: A wife brings her husband into the patient presents to ER with recent onset of high fever, complaints of stiff neck and the wife states the patient has been confused over the last day or two. You suspect meningitis which of the following would be appropriate to order to confirm this diagnosis? (select all that apply) a. Lumbar puncture b. Blood cultures c. CBC d. None of the above

Answer 264

Answer: A, B, C Rationale for why the answer is correct: CBC, BC and a lumbar puncture is especially crucial when diagnosing bacterial meningitis Site for question/rationale: Neuro presentation part I by Dr Vandergriff @10:18

Question 265

5. Question: The Meninges consist of three parts, Pia, Arachnoid and dura maters. The Nurse practioner knows that that Bacterial meningitis is an infection of which part of the Meninges? a. Pia and CSF b. CSF and Dura Maters c. Arachnoid mater and CSF d. CSF only

Answer 265

Answer: Arachnoid mater and CSF Rationale for why the answer is correct: Bacterial meningitis is an infection of the CSF in both the subarachnoid space and the cerebral ventricles including the arachnoid mater Site for question/rationale: Neuro presentation part I by Dr Vandergriff @8:47

Question 266

6. Question: A 54 year old patient with a past medical history of hypertension presents with complaints of headache they describe as the worse headache they have had rating a 10/10 pain, it woke them up from their sleep and couldn’t go back to sleep so their spouse drove them to the ER. The Nurse Practioner wants to order some imaging for this patient, which would be the MOST preferred imaging exam for a headache? a. CT b. Ultrasound c. MRI d. AP and Lateral views

Answer 266

Answer: MRI Rationale for why the answer is correct: MRI of the head is the preferred imaging for headache to rule out subarachnoid hemorrhage Site for question/rationale: Neuro presentation part II by Dr Vandergriff @3:42

Question 267

7. Question: The Nurse Practioner is seeing a new patient with CKD, when deciding how to dose the medications the Nurse Practioner knows to use which of the following lab values to properly renal dose the medication? a. GFR b. BUN c. Creatine clearance d. Potassium

Answer 267

Answer: Creatine Rationale for why the answer is correct: Creatine clearance changes quickly with illness or hydration status Site for question/rationale: Diagnosing Renal Problems presentation by Dr Seth @ 14:44

Question 268

8. Question: A. 42 year old male presents with complaints of fever, chills, frequent painful urination and pain in lower back 8/10 rating. You suspect pyelonephritis, which of the following lab results from a urinalysis would confirm your diagnosis? a. WBC casts b. RBC casts c. Bacterial Casts d. Hyaline Casts

Answer 268

Answer: WBC casts and Bacterial casts Rationale for why the answer is correct: WBC casts. Come from the kidney tubules and can indicate pyelonephritis, Bacterial casts usually indicate acute pyelonephritis Site for question/rationale: Urinalysis Presentation by Dr Seth @13:47

Question 269

9. Question: The Nurse Practioner is rounding on a patient in the ICU, upon reviewing the culture and sensitivity report they note the following: Ampicillin=I, Unasyn=S, Augmentin=R, Vancomycin=I. Which of the following would the Nurse Practioner prescribe? a. Ampicillin b. Unasyn c. Augmentin d. Vancomycin

Answer 269

Answer: Unasyn Rationale for why the answer is correct: Based on the C&S results showing that the microbe shows susceptibility to Unasyn the Nurse Practioner should prescribe Unasyn. Site for question/rationale: Fluid analysis diagnostics presentation by Dr Seth @8:06

Question 270

10. Question: Which of the following studies would be contraindicated in a patient with severely elevated creatine clearance and takes metformin daily? a. MRI w/o contrast b. KUB c. MRU d. CT w/ contrast

Answer 270

Answer: CT w/ contrast Rationale for why the answer is correct: Contrast can further reduce the blood flow to the kidneys causing contrast nephropathy Site for question/rationale: Diagnosing Renal Problems presentation Dr Seth @ 20:33

Question 271

1. Question: Marge, a 67-year-old female, comes into your emergency department status post fall. She states she was working on her garden and tripped over the water hose. She denies taking any blood thinners. Her chief complaint is right wrist pain; however, she also states she hit her head but denies loss of consciousness. What would be the appropriate decision for the APRN to make regarding cervical spine imaging? Answer: A) No imaging is required B) No imaging is required as long at the patient can rotate her neck 45 degrees C) No imaging is required because the patient denies neck pain D) C-spine imaging is recommended for this patient

Answer 271

``` D2. Question: Ayden, an 18-year-old male, presents to your clinic today for worsening pain in his hands over the past week. He denies any injury or fever. He states he noticed a target shaped rash on his shin while he was on a mission trip in Ecuador but did not think anything of it because they had been hiking through rugged terrain. What is your leading diagnosis for Ayden? Answer: A) Fifth disease B) Carpal tunnel C) Wrist sprain D) Lyme Disease ```

Question 272

``` 2. Question: Ayden, an 18-year-old male, presents to your clinic today for worsening pain in his hands over the past week. He denies any injury or fever. He states he noticed a target shaped rash on his shin while he was on a mission trip in Ecuador but did not think anything of it because they had been hiking through rugged terrain. What is your leading diagnosis for Ayden? Answer: A) Fifth disease B) Carpal tunnel C) Wrist sprain D) Lyme Disease ```

Answer 272

D Rationale for why the answer is correct: An annular target shaped plaque, hand pain, and neurologic issues are cardinal signs of Lyme disease. Fifth disease is common in younger pediatric patients and has a characteristic “slapped cheek” rash appearance. Carpal tunnel can be found in this population related to repetitive use of electronics, but the patient does not report any associated symptoms such as paresthesia or weakness. The patient could have experienced a wrist sprain unknowingly while hiking through rugged terrain, but there is no associated swelling or erythema and symptoms have been worsening over the past week instead of getting better. Site for question/rationale: Dr. Shelly Seth’s presentation over hand pain slides 11-12 timestamp 8:50.

Question 273

``` 3. Question: An APRN student is discussing with their preceptor common knee injuries and specific tests to assess for each injury, which of the following injuries is incorrectly matched with the corresponding test? A) B) McMurray test- meniscus C) Lachman test- ACL D) Drawer test- ACL or PCL ```

Answer 273

C Rationale for why the answer is correct: A Lachman test is used to assess for an ACL injury. The other options are correctly paired tests to injuries. Site for question/rationale: Dr. Shelly Seth’s presentation over knee injuries slide #16 timestamp 11:51.

Question 274

``` 4. Question: You are the APRN working in a community ER. An 8-year-old patient presents with 3 days of fever, lethargy, GCS 14, and nuchal rigidity. Which of the following diagnosis is at the top of your differential? Answer: A) Strep throat B) Mononucleosis C) Bacterial meningitis D) UTI ```

Answer 274

Rationale for why the answer is correct: Bacterial meningitis often presents as fever, altered mental status, and nuchal rigidity. Strep throat and mono can cause neck pain and tenderness but should not cause altered mental status. UTI can cause altered mental status in the older adult but is less common in pediatrics. Site for question/rationale: Dr. Kent Vandergriff’s presentation part 1, slide# 10 timestamp 9:13.

Question 275

5. Question: Which of the following statements is not true regarding seizures? Answer: A) Symptomatic seizures carry a high risk of developing epilepsy in the future B) Unprovoked seizures are a seizure of unknown etiology C) Testing includes lab, UA, UDS, ECG, EEG, MRI, CT, and/or LP D) The first step in diagnosis is determining if the event was a seizure or not

Answer 275

A Rationale for why the answer is correct: Symptomatic seizures carry a low risk for developing epilepsy in the future. The patient might experience seizures during the acute phase of illness; however, they typically resolve with the illness. The other three statements are correct statements. Site for question/rationale: Dr. Kent Vandergriff’s presentation part 2 slides 25-27 timestamp 7:04.

Question 276

6. Question: The criteria for diagnosing multiple sclerosis include all of the following except? Answer: A) Serum testing for MS antibodies B) Finding evidence of damage to at least two areas of the CNS including the brain, spinal cord, or optic nerves C) Finding evidence that damage to CNS has occurred at different points in time D) Ruling out all other possible diagnosis

Answer 276

A Rationale for why the answer is correct: There is no specific physical finding or lab test that can confirm MS at this time. The physician instead must determine if the patient meets diagnostic criteria. The Revised McDonald Criteria recommends an MRI and CSF analysis to assist in diagnosis. Site for question/rationale: https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-MS Link provided in Neuro module about MS

Question 277

7. Question: An APRN student doing clinicals notices that their patient needs a dosage change on one of their mediations. Which statement by the APRN would indicate an understanding of dose adjustments? Answer: a) “I will just call pharmacy to have them adjust the dose for me” b) “I will adjust the dose based on the patient’s GFR” c) “I will adjust the dose based on the patient’s creatinine clearance” d) “I will adjust the dose by half and see how the patient does”

Answer 277

Rationale for why the answer is correct: Dosage adjustments should be made according to the creatinine clearance. GFR is an accurate measure of kidney function but is not used for dose adjustments. The APRN should not depend on pharmacy to do their dose adjustments, it is not within their scope to prescribe and pharmacy might not always be available. Adjusting by half without any clinical reasoning would be poor practice by the APRN. Site for question/rationale: Dr. Shelly Seth’s presentation over renal testing slide #12, timestamp 14:33.

Question 278

8. Question: You are the APRN working in a rural clinic seeing a new patient for the first time today to establish care. The patient is a 40-year-old woman who has previously been healthy but states she has noticed some swelling in her legs and her blood pressure was elevated in clinic today at 146/90. You decide to order renal function tests and discover her GFR is 46. What is your next step? Answer: A) Have the patient follow up in 6 months to reassess B) Send the patient to the ED for emergent dialysis C) Refer the patient to a nephrologist D) Tell the patient to drink more fluids because they are probably dehydrated

Answer 278

Rationale for why the answer is correct: A GFR of 46 indicates mild to moderate loss of kidney function. Waiting 6 months would not be advisable as kidney function will likely continue to decrease without intervention. The patient still has functioning kidneys to emergent dialysis is not warranted at this time. Dehydration can cause acute changes in kidney function however this patient is already having mild to moderate loss of kidney function and needs to be worked up further by a specialist. Site for question/rationale: https://www.kidney.org/atoz/content/gfr Resource posted in the renal module

Question 279

9. Question: You are the APRN working in a pediatric urgent care clinic. You are taking care of Alyssa a 6-year-old female presenting with frequent UTI. Her mother states that they have been instructed multiple times to follow up with the patient’s pediatrician but have not done so yet. You order a UA and note leukocytes, nitrites, and a large amount of glucose. What do you plan to do next? Answer: A) Check a POC glucose B) Send the patient to the emergency department C) Order antibiotics and discharge the patient D) Tell the patient there is nothing more you can do for them until they see the PCP

Answer 279

Rationale for why the answer is correct: Glucose in the urine is often associated with diabetes. Bacteria love glucose and this could likely be the cause for recurrent UTI. The APRN should check a POC capillary glucose to confirm their suspicion. It would not be prudent to send the patient to the ED without performing a POC glucose. It would not be best practice to send the patient home on antibiotics without addressing a high urine glucose. It is unethical for the APRN to deny care to a patient. Site for question/rationale: Dr. Shelly Seth’s presentation over UA slide #9, timestamp 7:51.

Question 280

10. Question: Which of the following is not a characteristic of a CSF analysis of a patient with acute bacterial meningitis? Answer: A) Increased opening pressure B) >80% polymorphonuclear neutrophil (PNM) C) Glucose increased D) Protein increased

Answer 280

Rationale for why the answer is correct: Glucose will be decreased in acute bacterial meningitis. Bacteria use the glucose as fuel causing the level to decrease. All of the other findings are expected findings for this diagnosis. Site for question/rationale: Dr. Shelly Seth’s presentation over fluid analysis slide #22, timestamp 25:15.

Question 281

1. Question: According to NEXUS criteria, trauma patients who do not require cervical spine imaging require all of the following except: a. Alert and stable b. No focal neurologic deficit c. Altered level of consciousness d. No intoxication

Answer 281

Answer: c. altered level of consciousness Rationale for why the answer is correct: trauma patient who do not require cervical spine imaging require all of the following: Alert and stable No focal neurologic deficit No altered level of consciousness No intoxication No midline spinal tenderness No distracting injury Site for question/rationale: NEXUS criteria by Dr. Joao Ramos and Dr. Matt A Morgan et al.

Question 282

2. Question: According to Canadian c-spine rules, all of the following risk factors in a trauma patient require cervical spine imaging except: a. Paresthesias in extremities b. High-speed motor vehicle collision of 75 mph c. Delayed onset of neck pain and patient cannot rotate the neck 45 degrees d. Absence of midline C-spine tenderness and patient can rotate the neck 45 degrees

Answer 282

Answer: d. Absence of midline C-spine tenderness and patient can rotate the neck 45 degrees Rationale for why the answer is correct: Low-risk factors are: simple rear-end motor vehicle collision excluding being hit by a high-speed vehicle, a large vehicle, or rollover Sitting position in emergency department Ambulatory at any time since the injury Delayed onset of neck pain Absence of midline C-spine tenderness If the patient meets the criteria for a low-risk injury and can rotate the neck 45 degrees then no cervical spine imaging is required, however, if the patient meets the criteria for a low-risk injury and cannot rotate the neck 45 degrees, then cervical spine imaging is warranted Site for question/rationale: Canadian C-spine rules by Dr. Joao Ramos and Dr. Matt A. Morgat et al.

Question 283

3. Question: A patient presents to the ED complaining of sudden onset of left shoulder pain following a motor vehicle collision. Which of the following tests should take priority in assessing this patient’s pain? a. Jobe’s test b. CT of the abdomen c. Empty can test d. Lidocaine injection test

Answer 283

Answer: b. CT of the abdomen Rationale for why the answer is correct: CT scan of the abdomen can assess for spleen injury which can cause referred left shoulder pain. Site for question/rationale: Dr. Shelly Seth’s Shoulder Pain presentation 14:28 minutes

Question 284

4. Question: What test should be considered for a patient experiencing reduced ability to direct, focus, sustain, or shift attention? a. Urinalysis and urine culture b. CBC c. Drug levels d. All of the above

Answer 284

Answer: d. all of the above Rationale for why the answer is correct: serum electrolytes, creatinine, glucose, calcium, cbc, ua, urine drug screen, urine culture, drug levels, blood gas, liver function tests, ammonia, thyroid function tests, and vitamin B12 levels are all labs that should be considered when diagnosing delirium and confusion. Site for question/rationale: Dr. Kent Vandergriff’s neuro diagnosis presentation part I 6:40 minutes

Question 285

5. Question: Which of the following type of headaches is considered emergent and should warrant further investigation? a. Headache precipitated by coughing b. A newly pregnant woman complaining of a headache c. A 55 year old patient complaining of a new headache d. A 35 year old patient complaining of headache with light sensitivity and nausea

Answer 285

Answer: c. A 55 year old patient complaining of a new headache Rationale for why the answer is correct: Risk factors likely to have serious underlying cause include greater than 50 years of age with a new or unusual headache Site for question/rationale: Dr. Kent Vandergriff’s neuro diagnosis presentation part II 4:00 minutes

Question 286

6. Question: Which of the following tests should be performed for a patient presenting to the ED with a sudden severe thunderclap headache? a. CT of the head b. Lumbar puncture c. Formal 4 vessel cerebral angiogram d. All of the above

Answer 286

Answer: d. All of the above Rationale for why the answer is correct: Non-contrast head CT reveals diagnosis of SAH in more than 90% of cases; Lumbar puncture is mandatory if there is a suspicion of SAH despite a normal head CT; Formal 4 vessel cerebral angiogram is the gold standard and utilized to identify and coil aneurysm Site for question/rationale: Dr. Kent Vandergriff’s neuro diagnosis presentation part II 13:48 mintues

Question 287

7. Question: Which of the following lab values are used to adjust drug dosages? a. Urinalysis b. GFR c. Creatinine clearance d. BUN

Answer 287

Answer: c. Creatinine clearance Rationale for why the answer is correct: Creatinine clearance is used to evaluate renal function vs. GFR because GFR is usually an estimate so creatinine clearance can therefore determine kidney drug elimination and predict an optimal dose for a patient. Site for question/rationale: Dr. Shelly Seth’s Diagnosing renal problems presentation 14:40 minutes

Question 288

8. Question: Which type of testing is more accurate in diagnosing a kidney cyst vs a kidney mass? a. 24 hour urine b. Renal ultrasound c. KUB d. CT scan

Answer 288

Answer: b. Renal ultrasound Rationale for why the answer is correct: Renal ultrasounds can help differentiate between kidney cysts vs masses, is readily available and does not use contrast which is an advantage for renal patients Site for question/rationale: Dr. Shelly Seth’s Diagnosis renal problems presentation 16:44 minutes

Question 289

9. Question: When ordering a CT scan with contrast for renal patients, what precautions should be done? a. Check creatinine levels b. Discontinue any nephrotoxic drugs c. Ensure adequate hydration and assess patient’s ability to tolerate contrast based on their kidney function d. All of the above

Answer 289

Answer: d. All of the above Rationale for why the answer is correct: Scans without contrast are better options for patient with renal issues, however, if contrast is necessary, assessing for adequate kidney function is necessary prior to instilling dye or contrast to avoid contrast nephropathy. Site for question/rationale: Dr. Shelly Seth’s Diagnosing renal problems presentation 20:30 minutes

Question 290

10. Question: All of the following conditions are contraindications for a biopsy except: a. Sepsis b. Transplant rejection c. Uncontrolled hypertension d. Hemorrhagic diathesis

Answer 290

Answer: b. Transplant rejection Rationale for why the answer is correct: contraindications for biopsies include sepsis, uncontrolled hypertension, hemorrhagic diathesis, parenchymal infection, malignancy, solitary or horseshoe kidney unless it is transplanted, uncooperative patient Site for question/rationale: Dr. Shelly Seth’s Diagnosis renal problems presentation 28:51 minutes

Question 291

1. A positive Kehr’s sign would be indicative of what type of shoulder pain? a) Chronic shoulder pain: rotator cuff injury b) Chronic shoulder pain: osteoarthritis c) Referred shoulder pain: peripheral nerve entrapment. d) Referred shoulder pain: spleen laceration.

Answer 291

Answer: D) Referred pain: spleen laceration. Rationale for why the answer is correct: Kehr’s sign is a referred pain in the left shoulder blade secondary to spleen injury/ bleeding. Peripheral nerve entrapment would not cause Kehr’s sign nor would chronic pain. Site for question/rationale: “My shoulder hurts” lecture, Dr. Shelly Seth, audio clip 3:20/ 17:03; 14:32/ 17:03.

Question 292

2. The most accurate way to diagnose Rheumatoid Arthritis is____________? a) A serum Rheumatoid Factor b) A serum Anti-citrullinated protein antibody test c) A score of 6 or more on the ACRC RA guidelines d) A serum CRP

Answer 292

Answer: c) A score of 6 or more on the ACRC RA guidelines. Rationale for why the answer is correct: The ACRC RA guidelines are the most accurate way to diagnose RA. The guidelines incorporate the whole patient picture as serum diagnostics alone can often be low or negative, but the patient could still have the disease. Site for question/rationale: “My hands hurt” lecture; Dr. Shelly Seth; Audio clip 16:52/ 20:53.

Question 293

3. What question during your history/ PE would lead you toward a DDx of hip fracture? a) Have you noticed a shortening of either leg since the injury? b) Does the pain get worse when you rest? c) Do you have lymph node swelling? d) Do you have any artificial joints?

Answer 293

Answer: a) Have you noticed a shortening of either leg since the injury? Rationale for why the answer is correct: Presence of a change in length after injury in indicative of hip fracture. B would not narrow down to a hip fracture. C & D are questions to rule in/out infection. Site for question/rationale: “I’m having trouble walking- my hip hurts” lecture, Dr. Shelly Seth; Audio clip 4:47/ 12:02.

Question 294

4. When assessing knee pain, a positive J-sign would indicate what? a) Inability to fully extend leg. b) Inability to flex leg. c) Patellar movement laterally when leg fully extended. d) Redness and erythema to back of knee.

Answer 294

Answer: c) patellar movement laterally when leg fully extended. Rationale for why answer is correct: Positive J sign is when the patella jumps laterally when the leg is fully extended. Present in patellofemoral pain syndrome. Site for question/ rationale: “I think I need a cane… and a handicapped parking sticker” lecture, Dr. Shelly Seth, Audio clip 7:49/ 17:21.

Question 295

5. A 40-year-old male patient presenting with temp of 102.5 F, neck pain/ stiffness and confusion would need to be worked up for the MNM DDx of: a) Osteoarthritis b) Bacterial Meningitis c) Hyponatremia d) CVA

Answer 295

Answer: b) Bacterial Meningitis Rationale for why the answer is correct: The classic triad of Bacterial Meningitis is fever >38.1, nuchal rigidity and a change in mental status. Failure to treat could be fatal. The other DDx are possible but BM most likely. Site for question/rationale: “Top 10 Neuro Diagnosis in Acute & Primary Care” lecture, Dr. Kent Vandergriff, Audio Clip 1: 9:49/ 20:30.

Question 296

6. What is the preferred imaging exam for a patient who chief complaint is headache and diagnostic information is needed? a) MRI head b) CT head c) CTA d) XRAY head & neck (at least 3 views)

Answer 296

Answer: a) MRI head Rationale for why the answer is correct: MRI head is the preferred imaging exam for HA. Site for question/rationale: “Top 10 Neuro Diagnosis in Acute & Primary Care” lecture, Dr. Kent Vandergriff, Audio Clip 2: 4:41/22:59.

Question 297

7. The 50-year-old male patient presenting to the ER assisted by wife complaining of unilateral weakness, difficulty with speech and facial drooping needs a STAT _________? a) Head CT without contrast b) Head CT with contrast c) MRI with contrast d) MRI without contrast

Answer 297

Answer: a) head CT without contrast Rationale for why the answer is correct: A head CT without contrast will differentiate between a embolic and hemorrhagic stoke and eval for POC. Time is particularly important. Do this quick! Site for question/rationale: “Top 10 Neuro Diagnosis in Acute & Primary Care” lecture, Dr. Kent Vandergriff, Audio Clip 2: 11:06/22:59.

Question 298

8. What diagnostic measurement is used to adjust drug dosing in renal insufficiency? a) GFR b) Serum creatinine c) Creatinine Clearance d) Renal US

Answer 298

Answer: c) Creatinine clearance Rationale for why the answer is correct: Renal dosing is dependent on patient creatinine clearance. Site for question/rationale: “Renal Testing for Diagnosis” Lecture, Dr. Shelly Seth, Audio Clip 14:45/ 29:52.

Question 299

9. 60-year-old female presents to the clinic with recurrent UTI and r/o pyelonephritis for the third time in four months. Diagnostics have been inconclusive to date and the provider considers ordering a CT with contrast. What would be an absolute contraindication of CT later today with contrast? a) History of DM, Type 2 b) She took her medications this morning as prescribed: Levothyroxine and Metformin. c) She has a temperature of 100.6 F. d) Her husband had a reaction to oral contrast last year.

Answer 299

Answer: b) She took her medications this morning as prescribed: Levothyroxine and Metformin. Rationale for why the answer is correct: Metformin administration is an absolute contraindication for administering contrast. The other answers would cause the provider pause and particularly the DM, type 2. However, if the diabetes is well controlled and kidney function intact would not be an absolute contraindication. Site for question/rationale: “Renal Testing for Diagnosis” Lecture, Dr. Shelly Seth, Audio clip 21:33/ 29:51.

Question 300

10. Transudative fluid causes may be all the following except: a) CHF fluid b) Pneumonia fluid c) Cirrhosis fluid d) Peritoneal dialysis fluid

Answer 300

Answer: b) Pneumonia Fluids Rationale for why the answer is correct: Pneumonia fluid is considered exudative and needs analysis and treatment; it is from inflamed tissue. Site for question/rationale: “Fluid analysis diagnostics” Lecture, Dr. Shelly Seth, Audio clip 31:25/ 39:38.

Question 301

1. When evaluating a patient for a suspected shoulder injury, what is the minimum number of views that should be used on a shoulder series x-ray? a. 4 b. 3 c. 2 d. 1

Answer 301

Answer: C Rationale for why the answer is correct: A shoulder series should consist of two views minimum. Site for question/rationale: Shoulder Pain presentation by Dr. Shelly Seth; minute 15:08.

Question 302

2. Select all that apply: Which of the following are characteristic of rheumatoid arthritis involvement in the hands? a. Symmetrical hand pain b. Asymmetrical hand pain c. Metacarpal joints and wrist involvement d. Distal interphalangeal and proximal interphalangeal joint involvement

Answer 302

Answer: A, C Rationale for why the answer is correct: Rheumatoid arthritis normally affects joints bilaterally (symmetrical) and commonly affects the metacarpal joints and wrists. Osteoarthritis normally affects unilateral joints (asymmetrical) and the DIP/PIP joints of the hand. Site for question/rationale: Hand Pain and Swelling presentation by Dr. Shelly Seth; minute 3:08.

Question 303

3. A 78-year-old female patient presents to the clinic after a fall reporting severe pain to the left lower extremity. You notice that her left leg is shorter than her right leg. Which differential diagnosis would be considered first? a. Osteonecrosis b. Osteoarthritis c. Hip fracture d. Hip labral tear

Answer 303

Answer: C Rationale for why the answer is correct: Shortening of the affected leg and/or rotation are indicative of a hip fracture. Site for question/rationale: Hip Pain presentation by Dr. Shelly Seth; minute 4:54.

Question 304

4. Which of the following diagnostic exams is best for guiding acute treatment in a patient who has had a stroke? a. MRI b. CTA c. Noncontrast CT d. Chest x-ray

Answer 304

Answer: C Rationale for why the answer is correct: A noncontrast CT scan is the best for guiding acute therapy since time is of the essence in stroke treatment. Site for question/rationale: Neuro presentation part 2; minute 11:24.

Question 305

5. Which of the following presentations is NOT a red flag in a patient who arrives to the clinic with a chief complaint of “headache”? a. Altered level of consciousness b. Papilledema c. Sudden onset d. History of similar headaches

Answer 305

Answer: D Rationale for why the answer is correct: Patients with a history of headaches that are similar and have not changed in severity or clinical presentation do not present with a “red flag”. If the headaches were progressing/changing in frequency, severity, or clinical features, then this would be a red flag. Site for question/rationale: Neuro presentation part 1; minute 2:17.

Question 306

6. How often is it recommended for diabetic patients to be screened for peripheral neuropathy? a. When clinical symptoms appear b. Annually c. Biannually d. At every check-up

Answer 306

Answer: B Rationale for why the answer is correct: Diabetic patients should be screened at time of diagnosis and every year thereafter for peripheral neuropathy and diabetic foot ulcers. Site for question/rationale: Peripheral neuropathy: A practical approach (Clinical Key - Watson & Dyck)

Question 307

7. Which of the following is not an initial diagnostic lab that you would order for a patient who presents with a suspected renal disorder? a. Serum creatinine b. BUN c. TSH d. GFR

Answer 307

Answer: C Rationale for why the answer is correct: The glomerular filtration rate, serum creatinine, BUN, and urinalysis are all considered initial lab tests when working up a patient with suspected renal disease. Site for question/rationale: Diagnosing Renal Problems by Dr. Shelly Seth; minute 6:39.

Question 308

8. For which of these patients would you not consider ordering a GFR? a. A 10-year-old child who has been vomiting for the past two days b. A 3-year-old child with an abnormally elevated creatinine c. A pregnant woman with suspected kidney dysfunction d. A 19-year-old who has adhered to a vegetarian diet for the last 6 years

Answer 308

Answer: A Rationale for why the answer is correct: A GFR should be considered in patients who have preexisting kidney disease, severe obesity/malnutrition, vegetarian diet, disease of skeletal muscle, paraplegia/quadriplegia, rapidly changing kidney function, pregnancy, and extremes of age/body size. Site for question/rationale: Diagnosing Renal Problems by Dr. Shelly Seth; minute 10:41.

Question 309

9. Which diagnostic is a measurement used to adjust medication dosage? a. GFR b. BUN c. Creatinine clearance d. UA

Answer 309

Answer: C Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug dosages. Site for question/rationale: Diagnosing Renal Problems by Dr. Shelly Seth; minute 14:36.

Question 310

10. Which of the following can differentiate a cyst from a mass upon interpretation? a. KUB b. Excretory urography c. Retrograde pyelography d. Renal US

Answer 310

Answer: D Rationale for why the answer is correct: A renal ultrasound can differentiate cysts from masses, show stones and calcifications, and differentiate the cortex from the medulla. Site for question/rationale: Diagnosing Renal Problems by Dr. Shelly Seth; minute 18:36.

Question 311

1. Question: Trauma patients who do not require cervical spine imaging require all of the following EXCEPT: a. Alert and stable b. Not intoxicated c. Altered level of consciousness d. No distracting injury

Answer 311

Answer: C Rationale for why the answer is correct: Trauma patients who do not require cervical spine imaging need to be alert and stable, have no focal neurologic deficit, no altered level of consciousness, not intoxicated, no midline spinal tenderness, and no distracting injury present. Site for question/rationale: Nexus Rules Presentation

Question 312

2. Question: A 46-year-old patient presents to clinic complaining of right-hand pain that has been going on for about 4 weeks. Upon examination, the distal interphalangeal and proximal interphalangeal joints are painful to palpation. What would be considered your leading differential diagnosis? a. Rheumatoid Arthritis b. Osteoarthritis c. Gout d. Carpel Tunnel Syndrome

Answer 312

Answer: B Rationale for why the answer is correct: The distal interphalangeal and proximal interphalangeal joints are painful in osteoarthritis and osteoarthritis is usually not symmetrical. Site for question/rationale: Hand Pain and Swelling Handout

Question 313

3. Question: A 35-year-old patient presents to clinic complaining of anterior knee pain when running and walking up stairs. Upon examination, patient has a positive J-sign. What would be your leading diagnosis? a. Patellofemoral pain syndrome b. Prepatellar bursitis c. PCL tear d. Patellar tendinitis

Answer 313

Answer: A Rationale for why the answer is correct: Classic presentation is pain in anterior knee worsened with activities such as squatting or descending stairs and a positive J-sign. Site for question/rationale: Knee Pain Handout

Question 314

4. Question: Which of the following symptoms is NOT considered a danger sign or “red flag” for the presence of a serious underlying disorder regarding headaches? a. Impaired alertness or consciousness b. A headache precipitated by sexual activity c. Head trauma d. Slow, progressive onset

Answer 314

Answer: D Rationale for why the answer is correct: Systemic symptoms (fever, weight loss, immunocompromised), neurologic symptoms (confusion, impaired alertness or consciousness), sudden onset, other associated conditions (head trauma, drug use, precipitation by a cough, exertion, or sexual activity), and a previous headache history with a change a change in attack frequency are all danger signs or “red flags” that should not be overlooked when assessing headaches. Site for question/rationale: Neuro Handout Page 10 Snooping Slides

Question 315

5. Question: A 72-year-old patient presents to clinic with hand tremors, a shuffling gait, stooped posture, slow movements, and fatigue. What would be your leading differential diagnosis? a. Multiple Sclerosis b. Parkinson’s Disease c. Guillian-Barre Syndrome d. Alzheimer’s Disease

Answer 315

Answer: B Rationale for why the answer is correct: An accurate diagnosis of Parkinson’s rests on the clinician’s ability to recognize its characteristic signs and associated symptoms, especially early: tremor, bradykinesia, rigidity, and postural instability. Site for question/rationale: Neuro Handout Page 12 Diagnosing Slide on Parkinson’s

Question 316

6. Question: A 37-year-old patient presents to clinic with complaints of a fever, stiff neck, and has a change in mental status. A diagnosis of bacterial meningitis is made. Which of the following diagnostic tests would NOT be part of the work up? a. Blood Cultures b. Lumbar Puncture c. Brain MRI d. CBC

Answer 316

Answer: C Rationale for why the answer is correct: A work-up for bacterial meningitis includes a CBC, blood cultures, lumbar puncture, and a head CT if ICP is suspected. Site for question/rationale: Neuro Handout Page 4 Work Up Slide on Bacterial Meningitis

Question 317

7. Question: When collecting a random urine specimen for a routine analysis, what is considered the best time to provide the urine specimen? a. Before bed b. First thing in the morning c. Second void of the day d. After lunch

Answer 317

Answer: B Rationale for why the answer is correct: The first urine voided in the morning is preferred because it has a more uniform volume and concentration and a lower pH, which helps preserve the formed elements. Site for question/rationale: Lab Corps 24-hour urine collection and results article

Question 318

8. Question: When evaluating the severity of kidney disease, which of the following diagnostic tests would be the best indicator? a. Glomerular Filtration Fate b. Urinalysis c. Serum Creatinine Clearance d. BUN

Answer 318

Answer: A Rationale for why the answer is correct: Glomerular filtration rate is considered the most accurate predictor of kidney disease. Site for question/rationale: Renal Diagnosis Handout Page 3 Glomerular Filtration Rate

Question 319

9. Question: Which lab test is the considered the best measurement used to adjust drug dosages? a. BUN b. Glomerular filtration rate c. Urinalysis d. Serum Creatinine Clearance

Answer 319

Answer: D Rationale for why the answer is correct: Creatinine Clearance is the measurement used to adjust drug dosages. Site for question/rationale: Renal Diagnosing Handout Page 4 Slide 3

Question 320

10. Question: Which of the following is NOT considered a variation in testing regarding a urinalysis? a. Dehydration or fluid overload can give false results b. Food can alter results c. Urine can become more alkalotic with setting out for more than 1 hour d. Medications can affect urinalysis

Answer 320

Answer: C Rationale for why the answer is correct: Variations in urinalysis testing include: urine can become more acidic with setting out for more than 1 hour, dehydration or fluid overload can give false results, and food and medications can affect the urinalysis. Site for question/rationale: Urinalysis Handout Page 2 Slide 1

Question 321

``` 1. Question: According to the NEXUS criteria trauma patients who do not require cervical spine imagining require which of the following: A. Alert and stable B. No focal neurologic defect C. No altered LOC D. All of the above ```

Answer 321

Answer: D. All of the above Rationale for why the answer is correct: Trauma patients who do not require cervical spine imaging require all of the following: alert and stable, no focal neurologic deficit, no altered level of consciousness, not intoxicated, no midline spinal tenderness, and no distracting injury Site for question/rationale: Nexus criteria link

Question 322

2. Question: How do you assess internal rotation of the shoulder? A. by having the patient reach behind the back and touch their shoulder B. by having the patient stretch their arm out to their side C. by bending their arm at the elbow D. by putting their hand on their hip

Answer 322

Answer: A. by having the patient reach behind the back and touch their shoulder Rationale for why the answer is correct: internal rotation of the shoulder is tested by having the patient reach behind the back and touch the inferior aspect of the opposite scapula. Site for question/rationale: Shoulder basic physical exam video at 2:56

Question 323

``` 3. Question: Which of the of the following symptoms described by the patient would indicate a diagnosis of rheumatoid arthritis: A. Malar rash on the face B. Symmetrical hand pain C. Asymmetrical hand pain D. Conjunctivitis ```

Answer 323

Answer: B. Symmetrical hand pain Rationale for why the answer is correct: Symmetrical pain is consistent with RA. Malar rash is consistent with SLE, asymmetrical hand pain is consistent with OA, and conjunctivitis is consistent with Reiter’s disease. Site for question/rationale: Hand pain and swelling diagnostics at 8:27

Question 324

``` 4. Question: An inflammatory disease of the leptomeninges (tissues surrounding the brain and spinal cord) and is defined by an abnormal number of white blood cells in the CSF is: A. Delirium B. Bacterial meningitis C. Bell’s palsy D. Guillain Barre ```

Answer 324

Answer: B. Bacterial meningitis Rationale for why the answer is correct: Delirium is caused by a medical condition, substance intoxication, withdrawal, or medication side effect. Bacterial meningitis is an inflammatory disease of the leptomeninges (tissues surrounding the brain and spinal cord) and is defined by an abnormal number of white blood cells in the CSF. Bell’s palsy is acute peripheral facial palsy of unknown cause. Guillain Barre is an acute immune mediated polyneuropathy that present as an acute monophasic paralyzing illness provide by a preceding infection. Site for question/rationale: Neuro ppt. handouts

Question 325

``` 5. Question: Which of the following are part of the acronym for SNOOP: A. systemic symptoms B. neurologic symptoms C. previous headache history D. all of the above ```

Answer 325

Answer: D. all of the above Rationale for why the answer is correct: SNOOP is a reminder of the red flags of headaches it stands for: systemic symptoms, neurologic symptoms, onset, other associated conditions, and previous headache history Site for question/rationale: Neuro ppt. handouts

Question 326

6. Question: The incidence of Parkinson’s disease is: A. Common in people younger than 40 years old B. Common in people age 50 and older C. The incidence of disease increases rapidly over 60 years, with a mean age at diagnosis of 70.5 years D. The incidence of disease increases rapidly over 70 years, with a mean age at diagnosis of 80.5 years

Answer 326

Answer: C. The incidence of disease increases rapidly over 60 years, with a mean age at diagnosis of 70.5 years Rationale for why the answer is correct: Parkinson’s disease is uncommon in people younger than 40 and the incidence of Parkinson’s disease increases rapidly over 60 years, with a mean age at diagnosis of 70.5 years. Site for question/rationale: Neuro ppt. handouts

Question 327

``` 7. Question: Which of the following is the measurement used to calculate drug dosing for patients which chronic renal disease? A. BUN B. GFR C. Creatinine clearance D. Chloride ```

Answer 327

Answer: C. Creatinine clearance Rationale for why the answer is correct: The renal dosing of medication is based on the Creatinine clearance not BUN, GFR, or chloride. Site for question/rationale: Renal diagnosis handout ppt

Question 328

``` 8. Question: Which of the following can be detected on a renal ultrasound? A. Cyst B. Tumors C. Hydronephrosis D. All of the above ```

Answer 328

Answer: D. all of the above Rationale for why the answer is correct: Renal ultrasound can show hydronephrosis, urine flow, differentiate between cortex and medulla, differentiate between a cyst and a mass, and stones. Site for question/rationale: Renal diagnosis handout ppt

Question 329

``` 9. Question: Which of the following diagnostics would you want to avoid in a patient with chronic kidney failure: A. CT with contrast B. Renal ultrasound C. KUB D. CT scan stone protocol ```

Answer 329

Answer: A. CT with contrast Rationale for why the answer is correct: In the patient with chronic kidney failure the kidneys are not able to filter out wastes, toxins, and drugs efficiently therefore it would be contraindicated to order a CT with contrast. Site for question/rationale: diagnosing renal problems presentation 20:06

Question 330

10. Question: Which of the following would the clinician need to order a culture and sensitivity? A. Fever of known origin B. When infection is not suspected C. Clinicians always need to order culture and sensitivity on every wound D. Fever of unknown origin

Answer 330

Answer: D. Fever of unknow origin Rationale for why the answer is correct: A clinician needs to order a culture and sensitivity when infection is suspected, fever of unknown origin, and when fluid is in the wrong place. Site for question/rationale: Fluid analysis handout ppt

Question 331

1. Question: Shoulder pain less than 2 weeks is considered Acute Pain. Which of the following injuries is NOT considered acute pain? a. Fracture b. Rotator Cuff Tear c. Dislocation d. Fall

Answer 331

Answer: b: Rotator Cuff Tear Rationale for why the answer is correct: Rotator Cuff Tear is considered to be chronic pain, while trauma, fractures, dislocations, and falls are acute pain. Site for question/rationale: Shoulder pain presentation by Dr. Seth at minute 1:17.

Question 332

2. Question: Using the American College of Rheumatology Classification for Rheumatoid Arthritis, what is the minimum number of points out of 10 do you need to determine patient has RA? a. 4 out of 10 b. 5 out of 10 c. 6 out of 10 d. 7 out of 10

Answer 332

Answer: c. 6 out of 10 Rationale for why the answer is correct: According to the guidelines set by the American College of Rheumatology, 6 out of the 10 possible points is needed to determine if the patient has RA.

Question 333

3. Question: An adolescent patient comes into the clinic complaining of knee pain that is aggravated walking downstairs. What is the most likely cause of this knee pain? a. Osgood-Schlatter disease b. Patellar tendonitis c. Patellofemoral Pain Syndrome d. Prepatellar bursitis

Answer 333

Answer: c. Patellofemoral Pain Syndrome Rationale for why the answer is correct: Patellofemoral Pain Syndrome is the most common cause of anterior knee pain and is aggravated by weight bearing exercises like running, descending downstairs, and squatting. Site for question/rationale: “I think I need a cane…and a handicapped parking sticker” presentation at minute 7:40.

Question 334

4. Question: A 76-year-old patient is brought in by EMS to your ER with c/c of fall from standing, upon arrival, you perform a neuro exam on patient. The patient does open his eyes when asked to, uses inappropriate words, and can localize his pain. From this information, what is his Glasgow Coma Scale? a. 10 b. 11 c. 9 d. 12

Answer 334

Answer: b. 11 Rationale for why the answer is correct: Since the patient can open his eyes when spoken to, he gets a 3, since he uses inappropriate words when trying to speak, he gets a 3, and since he can localize pain but not follow commands, he gets a 5.

Question 335

5. Question: A young patient presents to your clinic complaining of a fever and stiff neck. He states that he is a college student and was studying one could not remember where he put his textbook. He states that he has had a slight temperature for the past week that has been getting worse in addition to having a stiff neck. What procedure is priority in this patient? a. CT scan of head and neck b. X-ray of neck c. Flexeril and acetaminophen d. Lumbar puncture

Answer 335

Answer: d. Lumbar puncture Rationale for why the answer is correct: Examination of the spinal fluid for bacteria is necessary for the diagnoses of meningitis. To obtain the sample, a lumbar puncture is performed. Site for question/rationale: Neurology 1 presentation at minute 9:57.

Question 336

6. Question: What is thought to be the cause of Bell’s palsy? a. Staphylococcal infection b. Gonorrhea c. Herpes simplex virus d. Transient ischemic attack

Answer 336

Answer: c. Herpes simplex virus Rationale for why the answer is correct: With Bell’s Palsy, HSV is the mostly likely cause, however, there are many causes of facial paralysis, and a thorough examination is necessary. Site for question/rationale: Neurology 1 presentation at minute 11:06.

Question 337

7. Question: A patient comes into your clinic complain of blood in his urine and increased urgency. You ask him what medications he is currently taking. Which of the following meds that he is on would you stop immediately until further workup can be performed? a. Metoprolol b. Albuterol c. Lisinopril d. Prednisone

Answer 337

Answer: c. Lisinopril Rationale for why the answer is correct: The following medications should be immediately stopped if patient is suspected of having renal disease. NSAIDS, COX inhibitors, ACE inhibitors, and ARBs. Lisinopril is an ACE inhibitor, which can lower the blood pressure that can lead to renal failure. Site for question/rationale: Renal Testing for Diagnoses power point slide 3.

Question 338

8. Question: A patient has proteinuria and hematuria that can not be explained. A biopsy is order for the patient. Which of the following is not a contraindication for a biopsy of the kidney? a. Sepsis b. Pt has only one kidney c. Nephrotic Syndrome d. Parenchymal infection

Answer 338

Answer: C. Nephrotic Syndrome Rationale for why the answer is correct: Nephrotic syndrome that is unexplained is a indication to perform a biopsy while the other conditions are contraindications. Site for question/rationale: Renal Testing for Diagnoses power point slide 20.

Question 339

9. Question: When diagnosing a urinary tract infection a urinalysis is performed. Which of the findings below is not indicative of a UTI? a. Positive Nitrites b. Protein > 150 mg/dl c. WBC casts present d. Presence of Leukocyte Esterase

Answer 339

Answer: b. Protein >150mg/dl Rationale for why the answer is correct: Positive nitrites, positive for leukocyte esterase, presence of more than 2-5 WBCs/hpf, presence of WBC casts, and positive for bacteria. Site for question/rationale: Urinalysis presentation at minute 1:30.

Question 340

10. Question: Which of the following criteria is not necessary to order a culture and sensitivity on a patient? a. Fluid in the wrong place b. Severe pain c. Fever of unknown origin d. Infection is suspected

Answer 340

Answer: b. severe edema present Rationale for why the answer is correct: Severe edema is not part of the criteria for ordering a culture and sensitivity on a body fluid. Severe pain needs to be investigated but no C/S unless one of the other criteria are present. Site for question/rationale: Fluid analysis voice thread at minute 1:10.

Question 341

1. Question: You are using the Canadian C-Spine rules to determine if a trauma patient needs imaging. You find the patient to be at low risk. Which of the findings on physical exam would determine the patient needs imaging for c-spine despite being low risk? A. Patient has mild bruising on chest and abdomen from seatbelt B. Patient cannot rotate neck 45 degrees C. Patient has pain in back D. Patient walks into the exam room.

Answer 341

Answer: B. Patient cannot rotate neck 45 Degrees. Rationale for why the answer is correct: Not being able to rotate your neck 45 degrees may be a sign of a cervical injury and warrants imaging to rule out cervical damage. Mild bruising is not indication for imaging. Back pain does not warrant cervical imaging in a low-risk patient. Ambulation makes the patient in the low-risk category and does not necessitate imaging. Site for question/rationale: Musculoskeletal section, Canadian C-Spine handout. Pg 1. (Ramos and Morgan. 2021)

Question 342

2. Question: You are seeing a patient with a chief complaint of left shoulder pain due do a bicycle accident. On exam, you complete ROM on the patient and no increase of pain or decrease in range of motion is noted. You have a positive Kehr’s sign. The provider knows this is indicative of injury to what area? A. Rotator Cuff injury B. Fractured clavicle C. Ruptured Spleen D. Pneumothorax

Answer 342

Answer: C. Ruptured Spleen Rationale for why the answer is correct: Kehr’s sign is acute left shoulder pain due to blood or irritants in the peritoneal cavity when a person is lying down with the legs elevate. It is a classic sign of a ruptured spleen. Kehr’s sign does not indicate injury to the rotator cuff, a fractured clavicle, or a pneumothorax. Site for question/rationale: Dr. Shelly Seth, Should Pain presentation. Time Stamp 14:00

Question 343

3. Question: A patient presents with the chief complaint of back pain with radiation to the leg. The ACNP identifies that the pain travels down a dermatome. The ACNP knows that this is consistent with what type of pain? A. Ruptured Disc B. Osteoarthritis C. Muscular inflammation D. Spinal Infection

Answer 343

Answer: A. Ruptured Disc Rationale for why the answer is correct: A pain that presents with back pain and radiates to the leg along a dermatome, is consistent with a ruptured disc pressing on the nerve. Site for question/rationale: Dr. Shelly Seth, Low Back Pain Presentation. Timestamp 2:20

Question 344

4. Question: The ACNP is performing a physical exam on a patient with a knee injury sustained during a football game. The NP knows that which of the following positive tests is consistent with an ACL or MCL injury A. McMurry Test B. Apley’s Test C. Ballottement Sign D. Drawer Test

Answer 344

Answer: D. Drawer Test Rationale for why the answer is correct: A positive drawer test can indicate a ruptured ACL or MCL. The McMurry test and the Apley’s test are used to test the meniscus. The Ballottement sign indicates fluid around the patella. Site for question/rationale: Dr. Shelly Seth, Knee Pain Presentation. Time Stamp 12:15

Question 345

5. Question: A patient presents with a chief complaint of “the worst headache of my life.” What is the lead must not miss diagnosis the practitioner must rule out? A. Migraine Headache B. Subarachnoid hemorrhage C. Cluster Headache D. Ischemic Stroke

Answer 345

Answer: B. Subarachnoid Hemorrhage Rationale for why the answer is correct: A complaint of the worst headache of my life should indicate that there is an increased intracranial pressure. The most urgent diagnosis that must be ruled out in this scenario is a subarachnoid bleed. A migraine and cluster headache are not life threatening. Although an ischemic stroke requires further examination and fast intervention, it is not usually described as the worst headache ever.

Question 346

6. Question: A patient is brought to the ED with slurred speech, right sided facial droop, and limb ataxia. The ACNP knows that before administering a TPA/TNK what diagnostic test must be complete to rule out a hemorrhagic stroke? A. X-ray B. MRI C. CT scan without contrast D. EEG

Answer 346

Answer: C. CT Scan without contrast Rationale for why the answer is correct: In order to determine quickly if a patient has had an ischemic vs hemorrhagic stroke, a CT is the standard diagnostic imagining. An MRI may be useful but takes much longer and is not considered the standard. X-ray and EEG are not diagnostic in this scenario. Site for question/rationale: Neurology power point Handouts, Slide 14

Question 347

7. Question: The ACNP is examining a patient presenting with a fever, altered mental status, and nuchal rigidity during the physical exam. Which of the following diagnostics should the practitioner order to confirm bacterial meningitis? A. Lumbar puncture B. MRI C. Doll’s eyes test D. Caloric reflex test

Answer 347

Answer: A. Lumbar Puncture Rationale for why the answer is correct: Examination of the cerebrospinal fluid (CSF) is crucial for establishing the diagnosis of bacterial meningitis:1000 to 5000/microL (range of 10,000) with a percentage of neutrophils usually > than 80 percent, protein >200 mg/dL, and glucose. An MRI is not indicated for diagnosis due to its inability to distinguish between the bacterial and viral meningitis. Doll’s eyes and Caloric reflex are used to test brainstem function in comatose patients. Site for question/rationale: Neurology Power point Handouts. Slide 4

Question 348

8. Question: You suspect a patient has kidney disease. The practitioner knows that which of the following tests is the MOST accurate predictor of kidney disease? A. Glomerular filtration rate B. BUN C. Urine Glucose test D. CBC

Answer 348

Answer: A. Glomerular filtration rate Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease and is different than the EGFR seen in blood work which is estimating the GFR. In order to measure the GFR a marker is given to the patient and the time to clear it is measured in a 24 hour urine study. Urinalysis identifies presence of abnormalities such as excess amounts of protein, blood, pus, bacteria and sugar. BUN measures the protein breakdown from foods you eat and can help diagnose but isn’t as specific as GFR or Creatinine. CBC is not specific for the kidney but can help identify a systemic infection. Urine glucose may indicate diabetes but can also be caused by other factors and follow up is needed to confirm. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” lecture. Time stamp- 7:05

Question 349

9. Question: A practitioner is seeing a patient with CKD and is having to adjust medication dosages due to the impaired renal function. The practitioner knows which of the following measurements is used to calculate the adjusted medication dosage? A. Creatinine B. EGFR C. BUN D. Creatinine clearance

Answer 349

Answer: D. Creatinine clearance Rationale for why the answer is correct: The creatinine clearance is the measurement that is used to adjust dosage of medications in patients with renal disease. BUN, creatinine, and EFGR all measure kidney function but are not used to calculate medication dosages. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” Lecture. Time Stamp, 14:35

Question 350

10. Question: A patient presents to the clinic with complaints of flank pain and pain on urination. The practitioner orders a urinalysis. Which of the following results would be consistent with an acute pyelonephritis? A. Urine Glucose 150 B. RBC’s 2/hpf C. Positive Bacterial Casts D. PH of 5

Answer 350

Answer: C. Positive Bacterial Casts Rationale for why the answer is correct: Positive bacterial casts are an indication of an acute pyelonephritis. A glucose of 150 is high but is indicative of diabetes. Rbc of 2/hpf is considered normal and the PH of 5 is also within normal limits. Site for question/rationale: Dr. Shelly Seth’s Urinalysis Presentation. Time Stamp 14:55

Question 351

1. Question: A 65 year old male comes in with right shoulder pain. You know that which part of the shoulder is most susceptible to “wear and tear” arthritis? a. The acromioclavicular joint b. The glenohumeral joint c. The rotator cuff d. The clavicle

Answer 351

Answer: B Rationale for why the answer is correct: The glenohumeral joint is the joint where most of the osteoarthritis and rheumatoid arthritis is located and it is also where most of the “wear and tear” happens. Site for question/rationale: Dr. Shelly’s Seth video time stamp 5:45.

Question 352

2. Question: A 5 year old boy is brought in by his mother because he has not been feeling well. His mother tells you “He’s been so warm that his cheeks have just stayed red.” She also states that he has not wanted to play with his toy cars because he says his hands hurt. Which test would help determine if this is acute fifth’s disease? a. Parvovirus B-19 IgG b. Parvovirus B-19 IgM c. Parvovirus B-19 IgE d. CBC

Answer 352

Answer: B Rationale for why the answer is correct: To test for fifth’s disease, you would test for antibodies of parvovirus-19. You would want to test both Parvovirus-19 IgG and IgM, but the test that identifies this as an acute infection is the IgM (miserable). Site for question/rationale: Dr. Shelly Seth’s video presentation on hand pain, time stamp 16:40.

Question 353

3. Question: A 70 year old female is seeing the NP for left hip that started 2 days ago after a fall. During your physical exam, which hip test would help determine the presence of a fracture? a. A FADIR test b. A FABER test c. A Scour test d. A Fulcrum test

Answer 353

Answer: D Rationale for why the answer is correct: The Fulcrum test is used to determine the presence of a hip fracture. This is where you place an arm under the thigh on the affected side and push down on the knee of the same side to create a see-saw type movement on the hip joint. Site for question/rationale: Hip special tests video, time stamp 4:55.

Question 354

4. Question: Delirium can be caused by infection, abnormal electrolytes, intoxication or withdrawal and medications. Which of the following medications can cause delirium at even therapeutic levels? a. Digoxin b. Lithium c. Quinidine d. All of the above

Answer 354

Answer: D Rationale for why the answer is correct: Digoxin, lithium and quinidine can all cause delirium even at therapeutic levels. Site for question/rationale: Dr. Vandergriff’s Neuro Part I presentation, time stamp 7:15 and handouts slide 8.

Question 355

5. Question: An 18 year old female is brought to the clinic by her mother on a warm spring day. The mother states that she had been complaining about a headache after school, but she brought her in because the patient started acting odd, began shivering and “she doesn’t even want to move her head side to side because of the pain.” Her temp is 102 F. What should the NP do at this point? a. Do a rapid strep and flu test b. Perform a mini mental exam c. Immediately send patient to the ED. d. Perform a lumbar puncture in the office.

Answer 355

Answer: C Rationale for why the answer is correct: This patient is presenting with symptoms of bacterial meningitis and this is an emergency. Site for question/rationale: Dr. Vandergriff’s Neuro Part II video, time stamp 3: 47 and slide 30 on neuro handouts; Neuro Part 1 video, time stamp 9:40, slide 10 on handouts

Question 356

6. Question: When performing he Phalen test and Tinel sign, what disease/disorder are you testing for? a. Bell’s palsy b. Carpal tunnel syndrome c. Multiple sclerosis d. Parkinson’s disease

Answer 356

Answer: B Rationale for why the answer is correct: Phalen test and Tinel sign are both provocative tests used to diagnose carpal tunnel syndrome. They each test for parasthesias/pain in the median nerve distribution. Site for question/rationale: Clinical Key: Carpal Tunnel Syndrome-primary diagnostic tools.

Question 357

7. Question: All of the following are TRUE about a 24 hour urine collection EXCEPT: a. The collection of 24 hr urine starts with the first collection of urine. b. Urine passed during a bowel movement must also be collected. c. The urine must be refrigerated at 2C-8C temperature or in a cool place d. Normal (for patient) intake of fluids is desirable during the 24 hr urine collection.

Answer 357

Answer: A Rationale for why the answer is correct: The collection of the 24-hour urine starts with the patient voiding (completely emptying bladder) and discarding the first urine passed. Site for question/rationale: LabCorp article on 24 hour urine.

Question 358

8. Question: A patient’s urinalysis shows positive nitrites and leukocyte esterases. The NP wants to rule out pyelonephritis. Which of the following would the NP be looking for in the microanalysis? a. Epithelial casts b. Hyaline casts c. WBC casts d. Bacterial casts

Answer 358

Answer: C and D Rationale for why the answer is correct: WBC casts and bacterial casts are indicative of pyelonephritis. Site for question/rationale: Dr. Shelly Seth’s Urinalysis Video presentation time stamp 14:20, handouts slide 15.

Question 359

9. Question: Which measurement is used to adjust medication dosages for patients with renal problems? a. BUN b. GFR c. Creatinine clearance d. BUN/Creatinine ratio

Answer 359

Answer: C Rationale for why the answer is correct: All of the measurements listed can show how kidneys are doing. However, the creatinine clearance is the measurement you use to adjust dosages for patients with renal problems. Site for question/rationale: Dr. Shelly Seth’s video presentation Diagnosing Renal Problems, time stamp 14:40, slide 12

Question 360

10. Question: Which of the following are considerations that must be taken into account before ordering any imaging with IV contrast? a. History of diabetes b. Allergy to dye. c. History of multiple myeloma d. All of the above

Answer 360

Answer: D Rationale for why the answer is correct: All of the options are things that need to be considered before ordering any imaging with IV contrast. Site for question/rationale: Dr. Shelly Seth’s video presentation Diagnosing Renal Problems, time stamp: 21:50, handout slide 17.

Question 361

1. Question: A 43 year old male patient presents to the emergency department after a motor vehicle accident. The patient is placed on a cervical collar and backboard by EMS prior to arrival to the ED. Which of the following NEXUS criteria would disqualify the patient from cervical collar removal until a radiology study of the cervical spine was completed? a. The patient was ambulatory at the scene of the accident b. The patient’s breath smells of alcohol while speaking c. The patient is alert and oriented d. The patient’s blood pressure is slightly elevated

Answer 361

Answer: B Rationale for why the answer is correct: According to the NEXUS criteria, radiology study of the cervical spine is necessary if the patient is intoxicated, has an altered level of consciousness, has neurological deficits, has midline spinal tenderness, is not alert and stable, or has a distracting injury. Site for question/rationale: Radiopaedia link regarding NEXUS criteria on module: https://radiopaedia.org/articles/nexus-criteria?lang=us

Question 362

2. Question: Which of the following shoulder joints is most commonly affected when a patient presents with arthritic pain? a. Acromioclavicular b. Glenohumural c. Sternoclavicular d. Scapulothoracic

Answer 362

Answer: B Rationale for why the answer is correct: The glenohumural joint, or the ball-and-socket joint of the shoulder is the most common site of arthritic pain of the shoulder. Site for question/rationale: Shoulder pain diagnostics video @3:40, Dr. Shelly Seth

Question 363

3. Question: A patient who went camping one week prior presents to the clinic with complaints of pain to bilateral hands. On physical examination, the APRN notes an annular red plaque to the patient’s right lower thigh. Based on the history and physical exam findings, which differential should have the highest likelihood? a. Reuter’s disease b. Rheumatoid arthritis c. Systemic Lupus Erythematosus d. Lyme disease

Answer 363

Answer: D Rationale for why the answer is correct: Lyme disease is transmitted by ticks and an individual may come in contact with these during hiking, camping, or outdoor activities in some areas. Signs and symptoms include hand pain, an annular red plaque, and neurological issues. Site for question/rationale: Hand Pain and Swelling Diagnostics @ 9:00, Dr. Shelly Seth

Question 364

4. Question: When assessing a patient who was taken to the emergency department by his family due to an altered mental state, the APRN orders diagnostics and evaluates vital signs: i. WBC 9,000 ii. Hgb 14 iii. T 38.2, HR 115, RR, 21, BP 110/74, SpO2 97% When considering acute bacterial meningitis, which other sign or symptom would complete the “classic triad” commonly associated with this diagnosis? a. Headache b. RUQ abdominal pain c. Nuchal rigidity d. Cervical lymphadenopathy

Answer 364

Answer: C Rationale for why the answer is correct: Acute bacterial meningitis usually presents with a classic triad of symptoms, including fever (commonly over 38 degrees Celsius), nuchal rigidity, and changes in mental status. Site for question/rationale: Neuro Part I video @9:40, Dr. Kent Vandergriff

Question 365

5. Question: An APRN is evaluating a 45 year old male patient who presented to his PCP’s office with a continuous headache that has persisted for 3 months. The patient’s headache has not increased in severity but the dull quality has been occurring on a daily basis. Which of the following imaging exams should the APRN order for this chronic headache? a. Ultrasound b. Magnetic resonance imaging c. Computed tomography d. X-ray

Answer 365

Answer: B Rationale for why the answer is correct: Magnetic resonance imaging (MRI) of the head is the preferred imaging exam for headaches. Site for question/rationale: Neuro Part II video @ 4:15, Dr. Kent Vandergriff

Question 366

6. Question: A patient presents to the emergency department with complaints of sudden-onset occipital headache, emesis, and altered mental status. The APRN rapidly assesses the patient and includes a cardiovascular accident (CVA) in the differential list. Which of the following actions would the APRN prioritize? a. Ordering a CT of the head b. Ordering a thrombolytic infusion c. Referring the patient to a neurologist or neurosurgeon d. Ensuring the patient’s airway is secured

Answer 366

Answer: D Rationale for why the answer is correct: When a patient with a stroke presents to the APRN, it is imperative that the patient is medically stabilized first, which includes special attention to airway, breathing, and circulation. Site for question/rationale: Neuro Part II video @10:40, Dr. Kent Vandergriff

Question 367

7. Question: The APRN orders a urinalysis of a 24 hour collection for a 35 year old male patient who developed anasarca. Upon evaluation results, the APRN notes the protein in the 24 hour urine collection was 375 mg. Given this value, the APRN considers which of the following differential diagnoses as being likely? a. Urinary tract infection b. Tubular proteinuria c. Glomerular proteinuria d. Nephrotic syndrome

Answer 367

Answer: D Rationale for why the answer is correct: A urine protein value over 350mg in 24 hours is most likely indicative of nephrotic syndrome due to the large amount of protein spillage. Site for question/rationale: Diagnostics urinalysis video @7:00, Dr. Shelly Seth

Question 368

8. Question: Upon assessment of a urinalysis report, the APRN notes there is nitrites present in the urine. The APRN knows that: a. Nitrites are normally found in the urine b. Gram positive bacteria are the only organisms that secrete nitrites c. Gram negative bacteria are the only organisms that secrete nitrites d. This finding is indicative of a fungal infection

Answer 368

Answer: C Rationale for why the answer is correct: Nitrites in the urine are secreted by gram-negative bacteria. Site for question/rationale: Diagnostics Urinalysis video @9:30, Dr. Shelly Seth

Question 369

9. Question: The APRN is assessing a urine sample and notes it is positive for leukocyte esterase, however, the patient does not present any signs of dysuria, frequency, olioguria, nor hesitancy. When interpreting the results, the APRN considers: a. Positive leukocyte esterase must be a urinary tract infection b. Positive leukocyte esterase is a potential sign of bladder malignancy c. Leukocyte esterase may develop with lysed WBCs or with urine that has been set out too long d. Leukocyte esterase never contributes to the diagnosis of a urinary tract infection

Answer 369

Answer: C Rationale for why the answer is correct: Leukocyte esterase can be indicative of a urinary tract infection, however, due to it being falsely positive with urine that has been out for a long time, it is imperative that the clinical presentation and signs/symptoms are taken into consideration. Site for question/rationale: Diagnostics Urinalysis video @10:35, Dr. Shelly Seth

Question 370

10. Question: The APRN is aware that special attention should be placed to the following value when dosing prescribed patient medications: a. Creatinine clearance b. eGFR c. Urobilinogen d. WBC count

Answer 370

Answer: A Rationale for why the answer is correct: The creatinine clearance is the value used to dose medications. Site for question/rationale: Diagnosing renal problems video @ 14:35, Dr. Shelly Seth

Question 371

``` 1. Question: A 65-year-old female comes into your clinic and reports that she has early symptoms of rheumatoid arthritis. You what to conduct a focused assessment for which symptom. A. Limited motion of joints B. Deformed joints of the hands C. Early morning stiffness D. Rheumatoid nodules ```

Answer 371

Answer: C Rationale for why the answer is correct: Most patients with early symptoms of rheumatoid arthritis report early morning stiffness or stiffness after sitting still for a while. Site for question/rationale: Hand Swelling and Pain Handout p2.

Question 372

``` 2. Question: Which condition should the Nurse Practitioner assess when completing the history and physical examination of a patient diagnosed with osteoarthritis. A. Anemia B. Osteoporosis C. Weight loss D. Local joint pain ```

Answer 372

Answer: D Rationale for why the answer is correct: Osteoarthritis is a degenerative joint disease with local manifestations such as local joint pain. Site for question/rationale: Hand Swelling and Pain Handout p2.

Question 373

``` 3. Question: A physician suspects a patient may have rheumatoid arthritis due to the patient’s presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply: A. Rheumatoid factor B. Uric Acid Level C. Erythrocyte Sedimentation D. X-ray Imaging ```

Answer 373

Answer: A, C and D Rationale for why the answer is correct: These are diagnostic tests to help diagnose RA. Option B is used in gout. Site for question/rationale: Hand Swelling and Pain Handout p6.

Question 374

``` 4. Question: A patient with Parkinson’s Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. The NP will document the patient has: A. Akinesia B. Cogwheel rigidity C. Bradykinesia D. Flexor rigidity ```

Answer 374

Answer: C Rationale for why the answer is correct: Bradykinesia is one of the early signs of a movement disorder such as Parkinson's or parkinsonism. It is caused by reduced levels of dopamine in the brain and is often first noticed by family and friends. Site for question/rationale: Neuro PPT. Handout p12.

Question 375

``` 5. Question: Which is the initial sign of Parkinson’s diseases? A. Rigidity B. Tremor C. Bradykinesia D. Question: Bell Palsy Akinesia ```

Answer 375

Answer: B Rationale for why the answer is correct: The first sign of Parkinson’s disease is usually tremors. The patient commonly is the first to notice this sign because the tremors may be minimal at first. Site for question/rationale: Neuro PPT. Handout p12.

Question 376

``` 6. Question: Which is the initial sign of Bell’s Palsy? A. Tremor B. Lightheaded C. Idiopathic facial paralysis D. Stiffness ```

Answer 376

Answer: C Rationale for why the answer is correct: Increasing evidence implicates herpes simplex type I and herpes zoster virus reactivation from cranial-nerve ganglia. Site for question/rationale: Neuro PPT. Handout p5.

Question 377

7. Question: The physician orders a 24-hour urine collection on a patient with recurrent kidney stones. As the nurse you know that the specimen should be. A. Kept on ice or refrigerated B. Sent to the lab every 5 hours C. Kept at room temperature D. Kept at temperature between 96.5°F to 100° F

Answer 377

Answer: C Rationale for why the answer is correct: Site for question/rationale: 24-hour urine collection and results article

Question 378

8. Question: When a patient's urine dipstick test indicates a small amount of protein, the nurse's next action should be to. A. Ask the patient about any family history of chronic renal failure. B. Obtain a clean-catch urine for culture and sensitivity testing. C. Inquire about which medications the patient is currently taking D. Send a urine specimen to the laboratory to test for ketones.

Answer 378

Answer: C Rationale for why the answer is correct: Some medications may give false-positive readings. Site for question/rationale: Urinalysis Handout p2.

Question 379

9. Question: What is the main function when a physician orders a gram stain? A. To see if the virus is responsible for the symptoms B. To see what type of virus it is C. To find out what antibiotic to order D. To help narrow the decision until the culture comes back

Answer 379

Answer: D Rationale for why the answer is correct: A Gram stain is a test used to identify bacteria. It is one of the most common ways to quickly diagnose bacterial infection in the body. Site for question/rationale: Handout for Fluid analysis PPT p2

Question 380

``` 10. Question: A 51-year-old male comes into your clinic and you what to rule out Meningitis. At the hospital they need to perform a lumbar puncture but before the procedure they need to: A. Collect his urine B. Perform an MRI of his head C. Perform a CT of his head D. Do an EKG ```

Answer 380

Answer: B Rationale for why the answer is correct: A computed tomography (CT) scan of the head is frequently ordered by clinicians prior to performing a lumbar puncture (LP) to rule out an intracranial abnormality with elevated intracranial pressure that could potentially place the patient at risk for brain herniation. Site for question/rationale: Handout for Fluid analysis PPT p7.

Question 381

1. Question: Your 50-year-old male patient comes in to see you for a complaint of shoulder pain. You as the patient to perform ROM and he is unable to lift his arm above his shoulder. When you perform passive ROM, you are able to move his arm above his shoulder without resistance or pain. You know that this rules out a problem involving: a. A problem involving the bones of the shoulder b. A muscle or tendon problem c. A nerve problem d. A rotator cuff injury

Answer 381

Answer: a. a problem involving the bones of the shoulder Rationale for why the answer is correct: Active ROM would be limited if the shoulder mobility problem involved bones, muscles/tendons/ nerves or rotator cuff. If passive ROM is not limited when active ROM is limited then there is no problem with the structures of the shoulder bones. Site for question/rationale: Dr. Seth’s Shoulder pain presentation. Minute 12:00.

Question 382

2. Question: True or false: Hand pain/swelling is usually one-sided in rheumatoid arthritis and symmetrical in osteoarthritis.

Answer 382

Answer: False Rationale for why the answer is correct: Hand pain and swelling in osteoarthritis is usually one-sided. Hand pain and swelling in rheumatoid arthritis is symmetrical. Site for question/rationale: Dr. Seth’s hand pain/swelling presentation. Minute 2:50.

Question 383

3. Question: Which of following signs and symptoms would be indicative of a hip fracture? a. Paresthesia b. Erythema c. Swelling of entire leg d. Shortening of one leg and rotation

Answer 383

Answer: d. Shortening of one leg and rotation Rationale for why the answer is correct: Shortening of one leg and rotation are signs of a hip fracture. Erythema is a sign of infection. Paresthesia is a sign of a pinched nerve. Swelling of the entire leg with poor circulation is a sign of a systemic problem. Site for question/rationale: Dr. Seth’s Hip pain presentation. Minute 6:45.

Question 384

4. Question: You are seeing a 25-year-old patient with a chief complaint of knee pain. After further questioning you learn the patient is a runner and has been training for an upcoming race. What would you suspect to be your most likely differential diagnosis? a. Patellofemoral pain syndrome b. Prepatellar bursitis c. Baker’s cyst d. Lateral meniscus injury

Answer 384

Answer: a. patellofemoral pain syndrome Rationale for why the answer is correct: patellofemoral pain syndrome is a common injury in weight-bearing activities such as running and is the most common type of knee pain. Site for question/rationale: Dr. Seth’s Knee pain presentation.

Question 385

5. Question: You are working up a patient with suspected Guillain-Barre. You have performed a lumbar puncture and are waiting for the results. What do you expect to find on the results that will rule in Guillain-Barre? (select all that apply.) a. Increased CSF protein & Normal CSF WBC b. Decreased CSF protein & increased CSF WBC c. Increased CSF protein & decreased CSF WBC d. Normal CSF protein & increased CSF WBC

Answer 385

Answer: a. Increased CSF protein & Normal CSF WBC Rationale for why the answer is correct: The LP results in Guillain-Barre would show increased CSF protein and normal WBC. Site for question/rationale: Common neuro diagnoses presentation part 1. Minute 18:50.

Question 386

6. Question: When assessing your 60-year-old trauma patient, you note that the patient is awake and talking to you, is able to follow commands, but is only able to answer one orientation question correctly. Using the Glasgow Coma Scale, how would this patient score? a. GCS 3 b. GCS 14 c. GCS 15 d. GCS 11

Answer 386

Answer: b. GCS 14 Rationale for why the answer is correct: The patient scores a 4 for opening eyes, a 4 for being confused, and 6 for obeying commands. Site for question/rationale: Neuro presentation part I. Minute 3:20.

Question 387

7. Question: A 24-year-old female is present in the clinic today complaining of a headache. She has no past medical history but is 34 weeks pregnant with her second child. She is alert and oriented rates her pain a 4/10, the headache is located at the temple region bilaterally, and it is not relieved with Tylenol. What in her HPI would alert you to further investigate a headache in this patient? a. Nothing, this patient is presenting with non-emergent headache symptoms b. Pain 4/10 c. Not relieved with Tylenol d. Pregnancy

Answer 387

Answer: d. pregnancy Rationale for why the answer is correct: pregnancy is a headache ‘red flag’ for a serious underlying disorder. SNOOP reminds clinicians to look at systemic symptoms such as illness, fever, weight loss, cancer, pregnancy, and immunocompromised. Site for question/rationale: Neuro presentation part II. Minute 2:20.

Question 388

8. Question: Which of the following is correct for patient teaching regarding a 24-hr urine collection? a. The first void of the day at the start of your 24-hr urine collection should be added to the specimen collection b. The first void of the day at the end of your 24-hr urine collection should be discarded c. Collect all urine voided for 24-hrs, including urine passed with bowel movements d. The urine collected should be kept at room temperature

Answer 388

Answer: c. Collect all urine voided for 24-hrs, including urine passed with bowel movements Rationale for why the answer is correct: The first void of the day at the beginning of the 24-hour urine collection should be discarded. The first void of the day at the end of your 24-hr urine collection should be included and marks the end of the 24-hour collection. Collect all urine voided for 24-hours, including urine passed with bowel movements. Urine collected should be refrigerated.

Question 389

9. Question: True or false? To diagnose a kidney stone you must order a CT with contrast.

Answer 389

Answer: False Rationale for why the answer is correct: A CT scan stone protocol is without contrast. The kidney stone will show without contrast and is not required. Site for question/rationale: Diagnosing renal problems presentation. Minute 20:17.

Question 390

10. Question: Which of the following components of a Urinalysis would you use to diagnose a UTI? (Select all that apply. a. WBC b. Nitrites c. Glucose d. Bacteria e. Protein f. Casts

Answer 390

Answer: a, b, d, f Rationale for why the answer is correct: You would use the following components of a urinalysis to diagnose a UTI: Nitrites, leukocyte esterase, WBCs, Casts, Bacteria. Site for question/rationale: Urinalysis presentation. Minute 00:55.

Question 391

``` 1. Question: An 18 month old female patient is brought to the clinic by her parents. They express that the patient started crying and is no longer using her right arm after they were swinging her in between them by her hands. The parents deny any recent fever or a fall injury and the patient doesn't react when you are touching her arm. You recognize this as a “pulling” injury and immediately put which of the following as your top differential? A. Elbow facture B. Nursemaid elbow C. Septic elbow D. Shoulder fracture ```

Answer 391

Answer: A. Nursemaid elbow Rationale for why the answer is correct: Nursemaid elbow is a pulling injury in which the ligament that wraps around the radial head slips out of place. The patient didn't sustain a fall or have any recent fevers plus when touching the arm, the patient doesn't seem to have pain. By these factors, you can rule out fractures and a septic elbow. Site for question/rationale: PowerPoint and presentation by Dr. Mercedes Day

Question 392

``` 2. Question: A patient presents to the clinic complaining of shoulder pain that first started one week ago. You recognize this as acute pain. As an NP you know that which of the following injuries likely causes acute pain? A. Osteoarthritis B. Rotator cuff injury C. Impingement syndrome D. Fractures ```

Answer 392

Answer: D. Fractures Rationale for why the answer is correct: Osteoarthritis, rotator cuff injuries, and impingement syndrome all cause chronic pain. Fractures are a major cause of acute pain. Site for question/rationale: Dr. Shelly Seth’s PowerPoint presentation on shoulder pain

Question 393

``` 3. Question: A patient presents to you complaining of stiffness and pain in the joints of her wrists. After obtaining a thorough history, you examine her and notice that her pain is focused around her metacarpal joints and the pain is symmetrical on both signs. Which of the following is the likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Psoriatic arthritis D. Shingles ```

Answer 393

Answer: A. Rheumatoid Arthritis Rationale for why the answer is correct: Rheumatoid arthritis is systemic which is why the pain presents on both sides. Additionally, the metacarpal joints are the primary spot of pain in RA. Osteoarthritis is not symmetrical, is characterized by wear and tear, and the distal and proximal interphalangeal joins are painful in OA. Site for question/rationale: Dr. Shelley Seth’s PowerPoint presentation on hand pain and swelling diagnostics

Question 394

``` 4. Question: The Glascow Coma Scale criteria involves grading all of the following EXCEPT: A. Eye opening B. Best motor response C. Facial palsy D. Best verbal response ```

Answer 394

Answer: C. Facial palsy Rationale for why the answer is correct: The Glascow Coma Scale grades eye opening, motor response, and verbal response. Facial palsy is apart of the stroke scale and must be assessed if you suspect the patient may be suffering from a stroke. Site for question/rationale: Dr. Kent Vandergriff’s Neuro Part 1 PowerPoint presentation

Question 395

``` 5. Question: Which of the following is not a classic triad of acute bacterial meningitis? A. Painful rash B. Fever C. Change in mental status D. Nuchal rigidity ```

Answer 395

Answer: A. Painful rash Rationale for why the answer is correct: Meningitis is characterized by fever, change in mental status, and nuchal rigidity. A painful rash is not an expected finding with meningitis. Site for question/rationale: Dr. Kent Vandergriff’s Neuro Part 1 PowerPoint presentation

Question 396

6. Question: A patient presents to you with complaints of a headache. Which of the following would you consider a risk factor for an emergent cause of a headache? A. No abnormal neurologic findings B. History of a similar headache C. No high-risk comorbid conditions D. Headache awakens the patient from sleep

Answer 396

Answer: D. Headache awakens the patient from sleep Rationale for why the answer is correct: Non-emergent headaches typically have no abnormal neurologic findings while emergent headaches have abnormal neurologic findings. Additionally, the patient is at low risk of having an emergent headache if they've experienced a similar headache before and they have no high-risk comorbid conditions. As a provider, you would be concerned if a headache was so painful it was awakening the patient from sleep and consider emergent reasons for the headache. Site for question/rationale: Dr. Kent Vandergriff’s Neuro Part 2 PowerPoint presentation

Question 397

``` 7. Question: The NP wants to prescribe IV vancomycin to a patient with bacterial pneumonia. Which lab level do you expect to be monitored to adjust the drug dose and kidney function and response to the medication? A. ALT and AST B. Creatinine Clearance C. WBC count D. BNP ```

Answer 397

Answer: B. Creatinine Clearance Rationale for why the answer is correct: The Creatinine clearance lab shows how well the kidneys are filtering blood. When adjusting some medications; you need to determine the patient’s creatinine clearance as to not give larger doses than the kidneys can filter. ALT and AST are liver function tests. WBC doesn't address kidney well being and a BNP is a heart function lab. Site for question/rationale: Dr. Shelley Seth’s PowerPoint on Diagnosing Renal Problems

Question 398

``` 8. Question: You are assessing and taking a history on a patient in clinic. They informed you that they had to do a 24 hour urine collection last year. You know that all of the following are reasons to do a 24 urine collection EXCEPT: A. Preeclampsia B. Kidney Disease C. Persistent diarrhea D. Recurrent kidney stones and hematuria ```

Answer 398

Answer: C. Persistent diarrhea Rationale for why the answer is correct: Preeclampsia, Kidney disease and recurrent kidney stones and hematuria are good reasons to do a 24-urine collection. Persistent diarrhea would not be an indication to do a 24-hour urine as the problem and test are not related in any way. Site for question/rationale: Dr. Shelley Seth’s PowerPoint on Diagnosing Renal Problems

Question 399

``` 9. Question: You patient presents with abdominal and back pain that they rate a 10/10. They also complain of nausea and vomiting, hematuria, and pain during urination. On exam, you note the patient has CVA tenderness. You want to send the patient to get a CT scan to check for kidney stones. Which of the following would you be sure to check or verify before performing a CT with contrast (dye)? A. Creatinine B. Magnesium level C. ALT and AST D. Troponin ```

Answer 399

Answer: A. Creatinine Rationale for why the answer is correct: Creatinine is how the patient will clear the contrast from their system, therefore you need to know the patients creatinine before administering the dye. Magnesium level, ALT and AST, and troponin levels would not affect your ability to order a CT with contrast. Site for question/rationale: Dr. Shelley Seth’s PowerPoint on Diagnosing Renal Problems

Question 400

``` 10. Question: You have a patient that presents with urinary frequency and burning with urination. You do a urinalysis. What is one lab value on a UA you will look at to help you diagnose a urinary tract infection? A. Yeast B. Ketones C. pH D. WBCs ```

Answer 400

Answer: D. WBCs Rationale for why the answer is correct: High WBCs (leukocytes) in urine often indicate a UTI. Yeast, Ketones, and pH are not values of a urinalysis you will look at to help you diagnose a UTI. Site for question/rationale: Dr. Shelley Seth’s PowerPoint presentation on Urinalysis

Question 401

1. What does a positive Kehr’s sign tell you? a. Referred pain to the left shoulder likely indicating splenic injury b. Neural impingement at level of cervical spine c. Peripheral nerve entrapment distal to spinal column d. Anterior cruciate ligament instability

Answer 401

Answer: A. Rationale for why the answer is correct: this referred pain sign is often an indication that there is irritation in the peritoneum and usually with the spleen. Site for question/rationale: Shoulder pain diagnostics presentation, ~3:20.

Question 402

2. Which hand joints are painful in a classic presentation of rheumatoid arthritis? a. Metacarpal joints b. Distal interphalangeal joints c. Proximal interphalangeal joints d. Radiohumeral joint

Answer 402

Answer: A. Metacarpal joints Rationale for why the answer is correct: Metacarpal and wrist joints are more commonly painful in RA. DIP and PIP are more painful in OA. RA is usually symmetrical, while OA is not. Site for question/rationale:

Question 403

3. Your patient comes in complaining of low back pain and occasional inability to urinate or have a bowel movement. What is your next step? a. Refer patient to the ER b. Order spinal ultrasound c. Insert foley catheter d. Order 24-hour urine test

Answer 403

Answer: A. Refer patient to ER Rationale for why the answer is correct: Based on low back pain and change or loss in bowel or bladder function is possibly cauda equina syndrome, which is considered an emergency. Sending the patient to the ER is the safest course of action. Site for question/rationale: Back pain diagnostics presentation. ~2:05.

Question 404

4. Mrs. Smith (87 years old) presents to the ER, brought by her daughter from her nursing home. Her daughter states that, “she was just fine yesterday, and now she won’t talk to anyone, sleep, and doesn’t even recognize me!” Her physical exam is unremarkable, her only past medical history includes frequent UTIs, and only takes OTC Tylenol as needed for headaches. What is your initial differential diagnosis for this acute neurological change? a. Delirium b. Bacterial meningitis c. Stroke d. Bell’s Palsy

Answer 404

Answer: A. Delirium Rationale for why the answer is correct: Delirium is a syndrome caused by a medical condition, substance intoxication, withdrawal or medication side effect that causes acute neurological and behavioral changes over hours or days. Mrs. Smith’s is potentially caused by another UTI. Her physical exam does not contain classic signs/symptoms of any of the other disease processes. Site for question/rationale: Neuro presentation part 1. ~4:40.

Question 405

5. You suspect your patient has bacterial meningitis. What diagnostic will you NOT typically order? a. CBC b. Blood cultures c. Lumbar puncture d. Ultrasound of the spinal column

Answer 405

Answer: D. Ultrasound of the spinal column. Rationale for why the answer is correct: The other three answers are most appropriate for suspected bacterial meningitis. Site for question/rationale: Neuro presentation part 1. ~9:55

Question 406

6. Your patient presents with paralysis of the right side of his face that started this morning. Which virus is likely responsible for this? a. Epstein-Barr b. Herpes Simplex Virus c. Rhinovirus d. Human Immunodeficiency Virus

Answer 406

Answer: B. Herpes simplex virus Rationale for why the answer is correct: This is the most common cause of Bell’s Palsy. Site for question/rationale: Neuro Presentation 1, ~11:00.

Question 407

7. What is a common presenting statement for a patient with a subarachnoid hemorrhage? a. “Tylenol seemed to help quite a bit” b. “My neck hurts worse than my head” c. “This is the worst headache of my life” d. “My headache pain is a 3 out of 10”

Answer 407

Answer: C. This is the worst headache of my life Rationale: This statement is a common presenting statement made by 90% of patients and is due to the buildup of blood in the subarachnoid space. Site: Neuro presentation 2, ~13:20.

Question 408

8. You suspect your patient is having renal problems. Which part of the patient’s history and physical would NOT make you think renal problems? a. Complaints of weight gain b. Nuchal rigidity c. Unable to “think clearly” d. BP 189/102

Answer 408

Answer: B. Nuchal Rigidity Rationale for why the answer is correct: Nuchal rigidity is more indicative of meningitis than renal problems. All of the other s/s are common indicators of renal problems. Site for question/rationale: Diagnosing Renal Problems presentation, ~3:35.

Question 409

9. What lab is used to adjust medication dosages? a. GFR b. Serum creatinine c. BUN d. Creatinine clearance

Answer 409

Answer: D. Creatinine clearance Rationale for why the answer is correct: This is the correct lab to adjust medication dosages based on. The other answers are incorrect. Site for question/rationale: Diagnosing Renal Problems presentation, ~14:20.

Question 410

10. What does NOT happen when the urine for a urinalysis sits out > 1 hour? a. Urine gets more acidic b. Ketones form and bilirubin conjugates c. Casts dissolve d. Microorganisms grow

Answer 410

Answer: B. Rationale for why the answer is correct: Ketones and bilirubin actually decrease Site for question/rationale: Urinalysis voice thread. ~ 3:00.

Question 411

1. Question: Which of the following statements is false regarding the NEXUS and CCR guidelines? a. Both have the same sensitivity b. Most common cause of hospital emergency room visits is trauma related c. CCR performs better than NEXUS at ruling out which patients don’t need radiography d. NEXUS is a set of 6 criteria that a patient must meet to not have radiography

Answer 411

Answer: C) CCR performs better than NEXUS at ruling our which patients don’t need radiography Rationale for why the answer is correct: All statements are true except answer C. NEXUS guidelines are better at ruling out which patients need radiography. Site for question/rationale: See scholarly article comparing NEXUS and CCR

Question 412

2. Question: All of the following are considered acute causes of shoulder pain except? a. Trauma b. Rotator cuff injury c. Fall d. Dislocation

Answer 412

Answer: B) Rotator cuff injury Rationale for why the answer is correct: Acute differentials are: traumas, dislocations, falls, and fractures. Chronic causes are: rotator cuff injury, osteoarthritis, impingement syndrome, and adhesive capsulitis. Site for question/rationale: See should injury PPT minute 1:30

Question 413

3. Question: A 10 year old arrives to the clinic with complaints of fatigue, swollen joints, and a red rash on their cheek. Which diagnostic test would you most likely order? a. CBC b. ESR c. Lyme titer Western Blot d. Parovirus B19 IgG and IgM

Answer 413

Answer: D) Parovirus B19 IgG and IgM Rationale for why the answer is correct: Parovirus is most common in children, and usually presents with the iconic “slap cheek” rash on the face. It can also cause anemia and swollen or painful joints. ESR is nonspecific for the type of inflammatory process, the CBC could show the anemia but not specifically the process causing the anemia. Lyme disease presents with the target rash and red plaques. Site for question/rationale: See Hand pain and swelling diagnostics PPT minute 15:00

Question 414

4. Question: All of the following findings are consistent with bacterial meningitis except? a. Altered mental status b. Temperature of 101.7 c. Negative blood cultures d. CSF protein levels >220mg/dL

Answer 414

Answer: C) negative blood cultures Rationale for why the answer is correct: you would expect positive blood cultures, fever, altered mental status, CSF protein >200mg/dL. C is the answer before the cultures would be positive. Site for question/rationale: See Neuro PPT minute: 9:00

Question 415

5. Question: A 45 year old female arrives to the clinic with a history of headaches, drug use, hypothyroidism, and anemia. On examination she complaints of a headache typical of what she normally has, she’s afebrile, and her neurological exam is negative. Which of the following would be a part of the SNOOP acronym? a. Afebrile b. Hypothyroidism c. 45 years old d. History of drug use

Answer 415

Answer: D) history of drug use Rationale for why the answer is correct: High risk comorbidities (hypothyroidism is not), age <50, and afebrile are considered non-emergent criteria for headaches. However, history of drug use is considered a part of the SNOOP criteria under the letter “O” for “other associated conditions or features. Site for question/rationale: See Neuro2 PPT minute 3:0

Question 416

6. Question: All of the following are a part of the classic triad for normal pressure hydrocephalus except? a. Seizures b. Dementia c. Shuffled gait d. Urinary incontinence

Answer 416

Answer: A) seizures Rationale for why the answer is correct: the classic triad of symptoms for NPH include: dementia, gait disturbances, and urinary incontinence. Site for question/rationale: See Neuro2 PPT minute 15:00

Question 417

7. Question: _______ is used to adjust drug dosages. a. Serum creatinine b. BUN c. Glomerular filtration rate (GFR) d. Creatinine clearance

Answer 417

Answer: D) Creatinine clearance Rationale for why the answer is correct: All of the following make up the formulas for drug dosage. Creatinine clearance is what is used for drug dosing. Site for question/rationale: See Diagnosing Renal Problems PPT minute 14:40

Question 418

8. Question: What would you need to tell a patient before doing a 24 hour urine test? a. Drink extra fluids b. Discard the first void in the morning c. It’s ok to miss some of the urine during the 24 hours, as long as most of it is collected d. Discard the urine that occurred with a bowel movement

Answer 418

Answer: B) discard the first void in the morning Rationale for why the answer is correct: A patient shouldn’t change their fluid intake unless instructed by the provider. A patient does need to discard the first void in the morning. For collection, it is also important to collect all urine (besides first void) even during a bowel movement. Site for question/rationale: See 24 hour urine article

Question 419

9. Question: A patient presents with altered mental status. After you see this patient, you think of the differential diagnosis acute bacterial meningitis. Besides blood work, what would be the first priority to order for this patient? a. Lumbar puncture b. CT of the head c. MRI of the head d. EEG

Answer 419

Answer: B) CT of the head Rationale for why the answer is correct: if you are suspecting a patient to have bacterial meningitis, it’s important to do a CT scan first to rule out any other potential severe diagnoses, but also to check for the potential to have high opening pressures (high intracranial pressures). If a patient unknowingly has high opening pressures and a lumbar puncture is performed first, then the patient is at risk for having CSF leak at high pressures with the introduction of the needle and can cause the brain to herniate. Site for question/rationale: see fluid analysis ppt minute 24:00

Question 420

10. Question: Which of the following options would you be able to use the Light’s criteria with? a. BMP b. effusion LDH and CMP c. serum/effusion LDH d. Serum LDH and a CMP

Answer 420

Answer: C) serum/effusion LDH Rationale for why the answer is correct: In order to use the Light’s criteria to determine if fluid is exudative or transudative, you will need either a serum and effusion LDH (which does not come in a CMP), or a serum and effusion total protein (which is in the CMP). Site for question/rationale: fluid analysis PPT minute 33:00

Question 421

``` 1. Question: According to the NEXUS criteria, trauma patients who do not require cervical spine imaging require all of the following except: A. Alert and stable B. No focal neurologic deficit C. Age > 65 years D. No midline spinal tenderness ```

Answer 421

Answer: C. Age > 65 years Rationale for why the answer is correct: The NEXUS criteria may not be reliable with patient >65 years of age Site for question/rationale: Nexus Criteria article (Ramos & Morgan, n.d.)

Question 422

``` 2. Question: A patient presents to your clinic with the chief complaint of bilateral hand pain with morning stiffness that lasts more than 60 minutes. The following will be ranked highly on your list of differential diagnoses except: A. Osteoarthritis B. Systemic lupus erythematosus C. Rheumatoid arthritis D. Psoriatic arthritis ```

Answer 422

Answer: A. Osteoarthritis Rationale for why the answer is correct: Morning stiffness that lasts more than 60 minutes indicates an inflammatory process. Osteoarthritis is a degenerative type of arthritis. Site for question/rationale: “Cc: My Hand Hurts” Presentation, Dr. Seth, Slides 2-3

Question 423

3. Question: A 60-year-old man presents to the emergency department stating that he was in a “fender bender” 15 minutes ago. When obtaining his HPI from your seated patient, he states that he was rear-ended, going 30 mph on a residential street and that he drove himself to the ED. According to the Canadian C-spine rules, which should be your next step? A. Cervical spine imaging is indicated B. Ask the patient to rotate his neck 45⁰ C. Immobilize the neck D. Cervical spine imaging is not indicated

Answer 423

Answer: B. Ask the patient to rotate his neck 45⁰ Rationale for why the answer is correct: If the patient meets the criteria of a low-risk injury (simple rear-end motor vehicle collision, sitting position in the ED, ambulatory any time since the accident, delayed onset of neck pain, and absence of midline C-spine tenderness) then one should assess on physical exam whether the patient can rotate the neck 45°. Site for question/rationale: “Canadian C-Spine Rules” (Ramos & Morgan, n.d.)

Question 424

``` 4. Question: When ruling in/out a stroke, which other stroke mimics should you include in your list of differential diagnoses? (Select all that apply) A. Migraine B. Hyperglycemia C. Intracerebral hemorrhage D. Tumor ```

Answer 424

Answer: A., C., and D. Rationale for why the answer is correct: Stroke mimics include migraine, hypoglycemia, intracerebral hemorrhage, and tumor. Site for question/rationale: Stroke (Mirsen & Ayoub, 2019) ClinicalKey

Question 425

``` 5. Question: The following are risk factors for Bell palsy except: A. Adults age ≥ 50 years B. History of diabetes C. Pregnancy D. Children age ≤ 10 years ```

Answer 425

Answer: D. Children age ≤ 10 years Rationale for why the answer is correct: Bell palsy is very uncommon in children age ten years and younger. Site for question/rationale: Elsevier Point of Care: Bell Palsy, ClinicalKey

Question 426

``` 6. Question: Which of the following tests is considered the gold standard for diagnosing carpal tunnel syndrome? A. Tinel test B. Carpal tension test C. Phalen test D. None of the above ```

Answer 426

Answer: D. None of the above Rationale for why the answer is correct: None of the provocative tests have been established as a gold standard for diagnosing carpal tunnel syndrome. Site for question/rationale: Elsevier Point of Care: Carpal Tunnel Syndrome, ClinicalKey

Question 427

7. Question: When educating a patient about a routine 24-hour urine collection, one would include the following information except: A. Urine that is passed during a bowel movement should be discarded. B. The collection of the 24-hour urine starts with the patient voiding (completely emptying bladder) and discarding the first urine passed in the morning. C. Except for this first discarded urine, all of the urine passed during that day and night, up to and including the first voiding of the following day, must be collected. D. The entire specimen should be refrigerated at 2°C to 8°C during collection or kept in a cool place

Answer 427

Answer: A. Urine that is passed during a bowel movement should be discarded. Rationale for why the answer is correct: The only urine that should be discarded is the first urine passed in the morning on the first day. Site for question/rationale: LabCorp Routine 24-Hour Urine Collection

Question 428

``` 8. Question: Your 65-year-old diabetic patient has a GFR of 50. What is her stage of chronic kidney disease? A. Stage 5 B. Stage 4 C. Stage 3a D. Stage 3b ```

Answer 428

Answer: C. Stage 3a Rationale for why the answer is correct: A GFR in the range of 59-45 is considered Stage 3a of chronic kidney disease. Site for question/rationale: “Glomerular Filtration Rate” article

Question 429

``` 9. Question: Which lab test is the most accurate predictor of kidney disease? A. Urinalysis B. BUN C. GFR D. Creatinine clearance ```

Answer 429

Answer: C. GFR Rationale for why the answer is correct: The GFR is the most accurate predictor of kidney disease. Site for question/rationale: “Renal Testing for Diagnosis” lecture, Dr. Seth, Slide 8

Question 430

``` 10. Question: Which lab measurement is used to adjust drug dosage? A. Urinalysis B. BUN C. GFR D. Creatinine clearance ```

Answer 430

Answer: D. Creatinine clearance Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug dosage. Site for question/rationale: “Renal Testing for Diagnosis” lecture, Dr. Seth, Slide 12

Question 431

1. Question: Based on the Canadian C-spine rules, a patient does not require cervical spine imaging if they meet the requirement for a low risk injury and can turn their head how many degrees? A. 15 B. 30 C. 45 D. 90

Answer 431

Answer: C. Rationale for why the answer is correct: Rationale: A cervical spine image is required for all high risk factor injuries and low risk factor injuries in which the patient is unable to turn their head 45 degrees. Site for question/rationale: Canadian C-spine rules

Question 432

``` 2. Question: Which of the following indicates left shoulder pain and is a classic symptom of splenic injury? A. McBurney’s sign B. Kehr’s sign C. Rovsing’s sign D. Murphy’s sign ```

Answer 432

Answer: B. Rationale for why the answer is correct: Kehr’s sign is an acute pain in the left shoulder and is an acute sign of spleen injury. Site for question/rationale: Shoulder pain presentation by Dr. Seth (@13:40)

Question 433

``` 3. Question: Which of the following is the condition in which old bone is replaced by newer bone tissue that over time becomes more fragile and misshapen? A. Osteoporosis B. Rheumatoid arthritis C. Avascular necrosis D. Paget’s Disease ```

Answer 433

Answer: D. Rationale for why the answer is correct: In Paget’s disease, new bone tissue quickly replaces old bone tissue. Over time this bone may become more fragile and misshapen and cause injury. Site for question/rationale: Hip pain presentation by Dr. Seth (@3:00)

Question 434

4. Question: Which of the following statements is true? A. Morning stiffness lasting more than 60 minutes indicates an inflammatory process. B. Rheumatoid arthritis does not usually occur bilaterally. C. Osteoarthritis usually occurs symmetrically. D. None of the above

Answer 434

Answer: A. Rationale for why the answer is correct: Morning stiffness lasting more than 60 minutes indicates an inflammatory process. Rheumatoid arthritis usually occurs symmetrically, and osteoarthritis usually does not occur symmetrically. Site for question/rationale: Hand pain and swelling diagnostics presentation by Dr. Seth (@3:07)

Question 435

``` 5. Question: A patient presents to the clinic with a fever, nuchal rigidity, and his wife reports he has a change in mental status. What is the most likely differential diagnosis? A. Guillain-Barre syndrome B. Subarachnoid hemorrhage C. Bacterial Meningitis D. Bell’s Palsy ```

Answer 435

Answer: C. Rationale for why the answer is correct: The classic triad of acute bacterial meningitis consists of fever, nuchal rigidity and altered mental status. A small percentage of patients may present with hypothermia, and rarely patients have a normal temperature. Site for question/rationale: Neuro presentation Part 1 by Dr. Vandergriff (@9:17)

Question 436

``` 6. Question: Which diagnostic exam is the preferred testing for seizures? A. Electrocardiogram (EKG) B. Electroencephalogram (EEG) C. CT scan with and without contrast D. MRI with and without contrast ```

Answer 436

Answer: D. Rationale for why the answer is correct: EEG is done in emergent situations when sensorium is persistently impaired to make sure patient is not having subclinical seizures. CT scan may be done, but MRI with and without contrast is the preferred diagnostics for seizures. Lumbar puncture may be indicated if infectious process indicated in the differential diagnosis. Site for question/rationale: Neuro presentation part 2 by Dr. Vandergriff (@9:35)

Question 437

``` 7. Question: A patient presents to the clinic with bradykinesia, tremor, and also reports stiffness and unstable gait. Which is the most likely differential diagnosis? A. Parkinson’s Disease B. Multiple Sclerosis C. Normal Pressure Hydrocephalus D. Alzheimer’s Disease ```

Answer 437

Answer: A. Rationale for why the answer is correct: Tremor, bradykinesia, postural instability, and rigidity are characteristic signs that are associated with Parkinson’s disease (especially early). Site for question/rationale: Neuro presentation part 2 by Dr. Vandergriff (@6:55)

Question 438

``` 8. Question: Which test is the most accurate predictor of level of kidney function or stage of disease? A. Serum Creatinine B. GFR C. BUN D. MDRD ```

Answer 438

Answer: B. Rationale for why the answer is correct: Glomerular Filtration Rate is the most accurate predictor of kidney disease; a nephrologist usually does it. Serum Creatinine is easy to do and changes quickly with dehydration, illness, etc. Serum creatinine and BUN are directly related to excretory renal function. MDRD is the equation used to estimate creatinine clearance. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Seth (@ 7:12)

Question 439

9. Question: In acute contrast nephropathy, when do you expect to see the serum creatinine peak? A. Immediately (within an hour) B. 1-2 days C. 4-7 days D. Serum creatinine is not affected by contrast dye

Answer 439

Answer: C. Rationale for why the answer is correct: In contrast nephropathy, serum creatinine rises over the first 1-2 days, peaks at 4-7 days and then normalizes at 10-14 days. This is especially significant for patients with existing renal disease or diabetes. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Seth (@ 27:02)

Question 440

``` 10. Question: Which of the following require renal biopsy to assess for cause? A. Hematuria B. Nephrotic Syndrome C. Transplant rejection D. All of the above ```

Answer 440

Answer: D. Rationale for why the answer is correct: Renal biopsies are done to diagnose kidney disease, assess prognosis, monitor disease progress and response to treatment. It is also done to determine the cause of AKI, nephrotic syndrome, persistent proteinuria, hematuria, transplant rejection and to confirm another disease. Site for question/rationale: Diagnosing Renal Problems presentation by Dr. Seth (@ 28:25)

Question 441

1. Question: Ms. Jones presented to clinic with numbness and pain in their hand for 3 weeks now. She reported that is hurts more at night. She is an accountant and is constantly using a computer. Which hand pain related condition is most likely Ms. Jones’ diagnosis? a. Uveitis b. Lyme Disease c. Provirus d. Carpal Tunnel Syndrome

Answer 441

Answer: D Rationale for why the answer is correct: Ms. Jones’ HPI is consistent with Carpal Tunnel Syndrome. Her history included repetitive movements such as typing and using the computer all day. Site for question/rationale: Hand Pain and Swelling Video presentation 18:00

Question 442

2. Question: When ordering an Xray to examine the hip for fractures and joint problems, what is the minimum number of XRAY views to look at to help with the diagnosis? a. 1 b. 2 c. 3 d. 4

Answer 442

Answer: C Rationale for why the answer is correct: 3 views minimum to look for joints problems and fractures in the hip. Site for question/rationale: Hip Pain Diagnostics Video presentation 07:15

Question 443

3. Question: A patient presents with anterior knee pain worsened with squatting or descending stairs. This is a classic sign of what overuse related anterior knee pain injury? a. Osgood- Schlatter Disease b. Patellar Tendinitis c. Patellofemoral syndrome d. Osteoarthritis

Answer 443

Answer: C Rationale for why the answer is correct: Anterior knee pain which is worsened by squatting or going down the stairs is a classic presentation of Patellofemoral pain syndrome. Site for question/rationale: Knee pain Diagnostics Video 07:00

Question 444

4. Question: Which symptom is not one the classic triad symptoms for Bacterial Meningitis? a. Fever b. Stiff Neck c. Change in mental status. d. No WBC in CSF

Answer 444

Answer: D Rationale for why the answer is correct: A, B, & C are the classic triad symptoms for Bacterial Meningitis. There is an increase of WBC in the CSF with Bacterial Meningitis. Site for question/rationale: Neuro Part 1 Video 09:00

Question 445

5. Question: What diagnostic test is crucial for diagnosing bacterial Meningitis? a. CBC b. CT c. Blood Cultures d. Lumbar Puncture

Answer 445

Answer: D Rationale for why the answer is correct: All choices are tests used to help diagnose bacterial meningitis. Lumbar puncture is a crucial test to establish bacterial meningitis diagnosis. Site for question/rationale: Neuro Part 1 Video 10:00

Question 446

6. Question: Mr. Jones presented with a left sided paralysis that started 3 hours ago while eating lunch. On physical exam, he has sagging eyebrows, mouth drooping, and unable to close his left eye. What condition could Mr. Jones have? a. Bell’s Palsy b. Carpal Tunnel Syndrome c. Guillain Barre d. Delirium

Answer 446

Answer: A Rationale for why the answer is correct: Patient presented with signs and symptoms of Bell’s palsy. S&S include unilateral facial paralysis, sudden onset (hours), sagging eye brows, mouth drooping, and inability to close eyes. Site for question/rationale: Neuro Part 1 Video 11:00

Question 447

7. Question: Which Test is the most accurate predictor of Kidney Disease? a. BUN b. Creatinine c. GFR d. Urinalysis

Answer 447

Answer: C Rationale for why the answer is correct: GFR is a test done by nephrologists and not the “estimated” GFR from the blood test. The patient is given a marker that clears through the kidneys and measured.

Question 448

8. Question: What is the measurement used to adjust drug dosages? a. BUN b. GFR c. Estimated GFR d. Creatinine Clearance

Answer 448

Answer: D Rationale for why the answer is correct: Creatinine clearance is the measurement sed to adjust drug dosages. Site for question/rationale: Diagnosing Renal problems 14:30

Question 449

9. Question: What are important things to consider when treating renal patients? a. If they are taking nephrotoxic medications like metformin b. If they are allergic to contrast. c. If they are dehydrated d. All the above

Answer 449

Answer: D Rationale for why the answer is correct: All choices above are important things to remember when taking care of renal patients. Site for question/rationale: Diagnosing Renal problems 21:00

Question 450

10. Question: What is important to consider when a patient had a test with contrast? a. Increase fluids. b. Monitor renal function. c. Check medications for medications that would put the patient at a higher risk for kidney injury. d. All the above

Answer 450

Answer: D Rationale for why the answer is correct: All the choices above should be done to reduce of kidney injury specially in renal patients. Site for question/rationale: Diagnosing renal problems 26:00

Question 451

1. Question: Acute shoulder pain may be caused by which of the following? a. Osteoarthritis b. Rotator cuff injury c. Dislocation d. Adhesive capsulitis

Answer 451

Answer: Dislocation Rationale for why the answer is correct: Osteoarthritis, rotator cuff injury, and adhesive capsulitis are all causes of chronic shoulder pain (pain lasting >2 weeks). Site for question/rationale: Dr. Shelly Seth’s “My Shoulder Hurts” PowerPoint presentation, Time Mark 1:18 – 1:53

Question 452

2. Question: A patient presents to the clinic complaining of hand pain, irritated eyes, and burning pain upon urination. What is the provider’s most likely diagnosis? a. Lyme disease b. Reiter’s disease c. SLE d. Rheumatoid arthritis

Answer 452

Answer: Reiter’s disease Rationale for why the answer is correct: Reiter’s disease presents with hand pain, conjunctivitis, urethral discharge, and urethritis Site for question/rationale: Dr. Shelly Seth’s PowerPoint presentation “My Hands Hurt”, Time Mark 8:08-8:48

Question 453

3. Question: Rotation and shortening of the leg are classic symptoms of what musculoskeletal issue? a. Rheumatoid arthritis b. Osteoporosis c. GTPS d. Hip fracture

Answer 453

Answer: hip fracture Rationale for why the answer is correct: Rotation and shortening of the leg are classic signs of a hip fracture. Site for question/rationale: Dr. Shelly Seth’s “ I’m having trouble walking – my hip hurts” PowerPoint presentation, Time Mark 4:49-4:56

Question 454

4. Question: A person who responds to verbal commands, uses inappropriate words, and localizes pain has a Glasgow Coma Scale of what? a. 11 b. 9 c. 12 d. 16

Answer 454

Answer: 11 Rationale for why the answer is correct: Responds to verbal commands is 3, Inappropriate words is 3, and localizes pain is 5, making their GCS score 11 Site for question/rationale: Neurology Powerpoint Presentation, slide 3

Question 455

5. Question: What is the most likely cause of Bell’s Palsy? a. Nothing, it is idiopathic b. Herpes simplex virus c. Cerebral vascular accident d. Herpes zoster virus

Answer 455

Answer: Herpes simplex virus Rationale for why the answer is correct: Bell’s palsy is no longer considered synonymous with idiopathic facial paralysis, as it is caused by activation of herpes simplex virus Site for question/rationale: Neurology Powerpoint presentation, slide 13

Question 456

6. Question: What disease process involves progressive weakness and/or paralysis that begins in the legs, affects deep tendon reflexes, and may lead to respiratory muscle weakness requiring ventilator support? a. Parkinson’s disease b. Bacterial meningitis c. Guillain Barre d. Mononucleosis

Answer 456

Answer: Guillain Barre Rationale for why the answer is correct: Guillain Barre is a progressive paralyzing illness that can cause absent or depressed deep tendon reflexes, may be mild or severe and affects extremity, facial, respiratory, and bulbar muscles, and 30% of patients require ventilator support. Site for question/rationale: Dr. Vandergriff’s neurology lecture, Time Mark 15:08-16:40

Question 457

7. Question: An elderly patient presents to the clinic with a chief complaint of difficulty walking. Observing the patient, the provider notes a short-step, shuffling gate, stooped posture, and flat affect. What condition does the provider suspect the patient has? a. Cerebral vascular accident b. Guillain Barre c. Bell’s Palsy d. Parkinson’s disease

Answer 457

Answer: Parkinson’s disease Rationale for why the answer is correct: Parkinson’s disease is characterized by craniofacial changes such as masking and hypophonia, visual disturbances, musculoskeletal changes like stooped posture, and gate abnormalities such as shuffling, short-stepping, and freezing. Site for question/rationale: Dr. Vandergriff’s neurology lecture, Time Mark 5:32-6:07

Question 458

8. Question: What lab value is used to determine renal dosing of medications? a. GFR b. Creatinine clearance c. Serum creatinine d. BUN

Answer 458

Answer: creatinine clearance Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust medication dosing for renal patients. Site for question/rationale: Dr. Shelly Seth’s “Renal Testing For Diagnosis” lecture, Time Mark 14:34-14:42

Question 459

9. Question: What lab result is the most accurate predictor of kidney disease? a. Creatinine clearance b. GFR c. Serum creatinine d. BUN

Answer 459

Answer: GFR Rationale for why the answer is correct: GFR is the most accurate predictor of kidney disease Site for question/rationale: Dr. Shelly Seth’s “Renal Testing For Diagnosis” lecture, Time Mark 7:01-7:56

Question 460

10. Question: A young adult patient presents to the clinic with a chief complaint of kidney stones. This is their third kidney stone this year. What test is the provider most likely to order? a. KUB b. MRA c. 24 hour urine d. MRI without contrast

Answer 460

Answer: 24 hour urine Rationale for why the answer is correct: Recurrent kidney stones should have a 24 hour urine test to analyze why they are producing kidney stones to help prevent future sequelae. Site for question/rationale: Dr. Shelly Seth’s “Renal Testing For Diagnosis” lecture, Time Mark 14:45 – 15:37

Question 461

1. Question: When assessing a patient for shoulder pain, which should be included? A- sensation B- strength C- pulses D- all of the above

Answer 461

Answer: D Rationale for why the answer is correct: By checking sensation, strength, and pulses in the affected arm, the provider is assessing the nerve and blood flow involvement and can use the information to help rule in or out diagnoses. Site for question/rationale: Shelly Seth, shoulder lecture, 13 mins 20 secs

Question 462

2. Question: Which of the following are characteristics of systemic lupus? A- Hand pain B- Butterfly rash C- Personality changes D- All of the above

Answer 462

Answer: D Rationale for why the answer is correct: All of the following are characteristics of systemic lupus. Site for question/rationale: Shelly Seth, hand lecture, 7 mins 40 secs

Question 463

3. Question: A child comes in with hand pain and slapped cheek rash. What is your top diagnosis? A- Fifth’s disease B- Reiter’s disease C- Lyme disease D- Systemic lupus

Answer 463

Answer: A Rationale for why the answer is correct: A parent may bring the child in for hand pain because it is what the child will complain of. The slapped cheek rash is a classic characteristic for Fifth’s disease.

Question 464

4. Question: A patient comes in complaining of hand pain and when assessing you notice a target shaped rash on their arm. What should you test for and suspect? A- Reiter’s disease B- Lyme disease C- Fifth’s disease D- Systemic lupus

Answer 464

Answer: B Rationale for why the answer is correct: A target shaped rash is a classic sign for Lyme’s disease and should lead the provider to further test to confirm diagnosis. Site for question/rationale: Shelly Seth, hand lecture, 8 mins 50 secs

Question 465

5. Question: Where do symptoms of Guillen Barre usually start? A- Bilateral arms B- Bilateral legs C- One side of the body D- Eyes and mouth

Answer 465

Answer: B Rationale for why the answer is correct: Weakness usually begins in bilateral lower extremities and works its way up the body, possibly involving the chest and diaphragm which could lead to need for mechanical ventilation. Site for question/rationale: Kent Vandergriff, neuro part 1 lecture, 16 mins 35 secs

Question 466

6. Question: What is considered a warning sign or “red flag” characteristic of someone complaining of a headache? A- It started 3 weeks ago B- It came on like a thunderclap C- It makes me more tired D- It makes me sensitive to light

Answer 466

Answer: B Rationale for why the answer is correct: A complaint of ‘thunderclap’ headache is a sign of possible rupture and is considered a medical emergency. The other 3 choices are characteristics of migraines and cluster headaches.

Question 467

7. Question: Which tests are appropriate to order when diagnosing someone for a stroke? A- Liver function tests B- Toxicology screens C- ABG D- All of the above

Answer 467

Answer: D Rationale for why the answer is correct: All of the above should be ordered to help rule out hepatic encephalopathy, overdose, or hypoxia when diagnosing for a stroke. Site for question/rationale: Kent Vandergriff, neuro part 2, 12 mins 20 secs

Question 468

8. Question: Which of the following complaints would lead you to suspect renal issues? A- fatigue B- weight gain C- itching D- all of the above

Answer 468

Answer: D Rationale for why the answer is correct: All the above are systemic signs of renal failure and should be further assessed by the provider. Site for question/rationale: Shelly Seth, renal testing for diagnosis lecture, 3 mins 50 secs

Question 469

9. Question: What is the most accurate predictor of kidney disease? A- BUN B- creatinine C- GFR D- urinalysis

Answer 469

Answer: C Rationale for why the answer is correct: GFR is the most accurate predictor. The other 3 are indicators kidney function but are not the most accurate. Site for question/rationale: Shelly Seth, renal testing for diagnosis lecture, 7 mins

Question 470

10. Question: You suspect a patient with renal failure to have renal stones, what test do you order first? A- CT with contrast B- CT without contrast C- MRI without contrast D- MRI with contrast

Answer 470

Answer: B Rationale for why the answer is correct: Contrast should not be used on patients with renal failure because of the risk for further damage. A CT is appropriate because it is sufficient, shorter, and less expensive than an MRI and should be used first when diagnosing renal stones. Site for question/rationale: Shelly Seth, renal testing for diagnosis lecture, 20 mins

Question 471

1. Question: Mary is a 3-year-old female who comes to your clinic with her mother who says since this morning, Mary has been holding her left arm and has not been moving her arm. She says this morning her old sibling was swinging her around and then suddenly started crying in pain. Since then, she has not been wanting to play. You suspect Mary has a: a. Humeral fracture b. Humeral dislocation c. Radial head fracture d. Radial head subluxation

Answer 471

Answer: D Rationale for why the answer is correct: Subluxation of the radial head, also known as nursemaid elbow, is a pulling mechanism of the arm. There is no falls, injury, swelling, or any redness to the arm. Site for question/rationale: Day, M. (n.d.). Nurse Maid’s Elbow. Video presentation time 01:42.

Question 472

2. Question: John, a 65-year-old male presents to the clinic who reports that he has been having morning stiffness to his right hand for the past month and has been taking Tylenol with no relief. You know that this type of arthritis you mostly have pain in the DIP and PIP joints of the hand: a. Juvenile arthritis b. Rheumatoid arthritis c. Osteoarthritis d. Psoriatic arthritis

Answer 472

Answer: C Rationale for why the answer is correct: Osteoarthritis is usually not symmetrical, and mostly occurs in the dip and pip joints of the hands whereas rheumatoid arthritis affects the metacarpal joints and wrists are usually affected bilaterally. Site for question/rationale: Seth, S. (n.d.). My hand hurts. Video presentation time 00:55.

Question 473

3. Question: Howard, an 87-year-old male has worked as a gardener and roofer for over 60 years now and you suspect he has prepatellar bursitis. You know that this is a chronic trauma to what parts of the knee? a. Meniscus and IT band b. Patella and bursa c. Medial and anterior cruciate ligament d. Patella

Answer 473

Answer: B Rationale for why the answer is correct: Prepatellar bursitis is a chronic trauma of the patella and bursa, also known as housemaid’s knee. It affects anyone who has a long history of being on their knees a lot such as carpet layers, miner’s, roofer’s, and gardeners. Site for question/rationale: Seth, S. (n.d.). I think I need a cane….and a handicapped parking sticker. Video presentation time 08:47.

Question 474

4. Question: A 55-year-old male presents to the clinic with complaint of fever, chills, and redness with pain to his right hip. He reports that he had a hip replacement few months ago and was fine until he started having fever for the past 2 days. He has taken ibuprofen with mild relief, but has trouble walking and continues with pain. You have one of your differentials as: a. Hip dislocation b. Osteoarthritis c. Paget’s Disease d. Infection

Answer 474

Answer: D Rationale for why the answer is correct: Any artificial prosthesis anywhere in the body is a potential for infection which can seed into the joint. Infection causes systemic illness such as fever, tachycardia, or chills. Site for question/rationale: Seth, S. (n.d.). I’m having trouble-my hip hurts. Video presentation time 00:32.

Question 475

5. Question: A 56-year-old female comes to your clinic who reports one side of her face is sagging and just started about 4 hours ago. She is concerned about a possible stroke, but on her examination, you notice that she has full movements of her arms bilaterally and symmetrical, and she has trouble closing her left eye. This type of neurological condition has an unknown cause. Which condition do you suspect is high on your list? a. Intracranial hemorrhage b. Guillain Barre c. Bell’s palsy d. Aneurysms

Answer 475

Answer: C Rationale for why the answer is correct: Bell’s palsy is an acute peripheral facial palsy of unknown cause. It is believed that herpes simplex virus activation can be a likely cause of bell’s palsy in some cases. Site for question/rationale: Vandergriff, K. (n.d.). Neuro Part I. Video presentation time 10:51.

Question 476

6. Question: You know that bell’s palsy has different clinical features from stroke (CVA). Which is NOT a clinical feature. a. Sudden onset of unilateral facial paralysis b. Inability to close eye on affected side c. Disappearance of nasolabial fold d. Paralysis or loss of motor function to one side of body

Answer 476

Answer: D Rationale for why the answer is correct: Clinical features for Bell’s palsy include unilateral facial paralysis sudden, eyebrow sagging, mouth drooping, inability to close eye, disappearance of nasolabial fold, and loss of taste to anterior 2/3 of tongue. Site for question/rationale: Vandergriff, K. (n.d.). Neuro Part I. Video presentation time 11:28.

Question 477

7. Question: You have a 66-year-old male who has history of diabetes mellitus type 2 and hypertension. You notice on her lab work she is starting to develop kidney disease with her serum creatinine slightly elevated and her glomerular infiltration rate is slightly low. You need to put her on new medications, what type of measurement do you use to adjust drug dosages for patients with renal problems? a. Creatinine clearance b. GFR rate c. Blood urea nitrogen d. Urinalysis

Answer 477

Answer: A Rationale for why the answer is correct: Creatinine clearance is a measurement used to adjust drug dosage and you can use the Cockcroft-Gault formula to estimate creatinine clearance. Site for question/rationale: Seth, S. (n.d.). Renal testing for diagnosing. Video presentation time 02:14.

Question 478

8. Question: You have a patient who presents to your clinic with left flank pain and nausea with vomiting. You notice that the patient appears uncomfortable sitting in his chair and tells you that he has a history of kidney stones in past. You order which diagnostic testing to confirm your suspicion? a. CT pelvis with iv contrast b. CT with no contrast c. Chest radiograph d. Colonoscopy

Answer 478

Answer: B Rationale for why the answer is correct: To evaluate for kidney stones, you order a CT scan stone protocol which does not use IV contrast since calcium stones can easily be seen without contrast. Site for question/rationale: Seth, S. (n.d.). Renal testing for diagnosis. Video presentation time 19:55.

Question 479

9. Question: You order a biopsy to diagnose kidney disease of a patient. What is NOT considered a contraindication to perform a biopsy of the kidney? a. Sepsis b. Uncontrolled hypertension c. Malignancy d. Diabetes mellitus type 2

Answer 479

Answer: D Rationale for why the answer is correct: There are many contraindications for obtaining a kidney biopsy which is sepsis, uncontrolled HTN, hemorrhagic diathesis, parenchymal infections or malignancy, solitary or horseshoe kidney (unless transplanted), and uncooperative patient. Site for question/rationale: Seth, S. (n.d.). Renal testing for diagnosis. Video presentation time 28.

Question 480

10. Question: Margaret, a 65-year-old female comes to your clinic with dysuria which started about 2 days ago. You order a urinalysis which does not show infection. Which one of the markers do you look at to help diagnose cystitis? a. Ketones b. Nitrites c. Protein d. pH

Answer 480

Answer: B Rationale for why the answer is correct: There are about 5 markers you can use to help diagnose with urinary tract infections which is nitrites, leukocyte esterase, WBCs 15 with clumps, WBC casts, and bacteria. Site for question/rationale: Seth, S. (n.d.). Urinalysis. Video presentation time 00:47.

Question 481

1. The definition of acute shoulder pain is pain experienced for: a. <2 days b. <2 weeks c. <3 days d. <3 weeks

Answer 481

Answer: B <2 weeks Rationale for why the answer is correct: Shoulder pain experienced for less than 2 weeks is considered acute, and is commonly caused by blunt trauma, dislocations, fractures, or overuse. Site for question/rationale: Dr. Shelly Seth’s “Shoulder Pain” lecture, minute 1:28.

Question 482

2. A 16-year-old football player was brought to the ED after sustaining an injury during a football game. What positive finding on the physical exam would indicate a splenic laceration or rupture? a. Neer’s Test b. Murphy’s Sign c. Painful Arc Test d. Kehr’s Sign

Answer 482

Answer: D Kehr’s Sign Rationale for why the answer is correct: Kehr’s sign is an acute left shoulder pain associated with splenic injury or rupture. Site for question/rationale: Dr. Shelly Seth’s “Shoulder Pain” lecture, minute 13:45.

Question 483

3. An avid runner presents to your clinic today with pain to her right anterior knee. She states that she is having difficulty descending stairs or squatting to pick something up. Based on this information, what diagnosis should rank high on your differentials? a. Patellar tendinitis (tendinopathy) b. Patellofemoral pain syndrome c. Prepatellar bursitis d. Anterior cruciate ligament tear

Answer 483

Answer: B Patellofemoral pain syndrome Rationale for why the answer is correct: Patellofemoral pain syndrome is the most common cause of anterior knee pain, particularly in runners. The classic symptoms include anterior knee pain that is worsened while descending the stairs or squatting. Site for question/rationale: Dr. Shelly Seth’s “Knee Pain” lecture, minute 17:21.

Question 484

4. A Glasgow Coma Scale score < ____ is typically an indication for intubation. a. 8 b. 15 c. 11 d. 3

Answer 484

Answer: A 8 Rationale for why the answer is correct: A person with a GCS <8 should be intubated. Site for question/rationale: Dr. Kent Vandergriff’s “Neuro” lecture, minute 3:41.

Question 485

5. A 78-year-old female patient presents with sudden disorientation and inability to focus. Her family states that she was fine yesterday. Which of the following labs and/or drug levels would your order to narrow your diagnosis? Select all that apply: a. Glucose b. Urine culture c. Digoxin d. Quinidine

Answer 485

Answer: A Glucose, B Urine culture, C Digoxin, and D Quinidine Rationale for why the answer is correct: Hypoglycemia can present as stroke-like symptoms. UTIs and digoxin and quinidine even in therapeutic levels can induce delirium in a person. Site for question/rationale: Dr. Kent Vandergriff’s “Neuro” lecture, minute 7:23

Question 486

6. A patient comes in with sudden onset unilateral facial paralysis with an inability to close her right eye and decreased tear production to the affected eye. The activation of what virus is the most likely cause of this issue. a. HPV b. CMV c. HSV d. HIV

Answer 486

Answer: C HSV Rationale for why the answer is correct: Bell’s Palsy was once interchangeable with idiopathic facial paralysis, but they are no longer synonymous as the activation of the herpes simplex virus is the most likely cause of Bell’s Palsy. Site for question/rationale: Dr. Kent Vandergriff’s “Neuro” lecture, minute 11:19

Question 487

7. A 58-year-old diabetic patient presents to the clinic with complaints of fatigue, weight gain, pruritis, difficulty concentrating, and restless legs. What medication(s) on their medication list would you recommend discontinuing until you have run labs? Select all that apply: a. Digoxin b. Insulin c. Ibuprofen d. Lisinopril

Answer 487

Answer: C Ibuprofen and D Lisinopril Rationale for why the answer is correct: Medications like NSAIDs and ACE inhibitors can cause renal problems, therefore should be discontinued if renal symptoms arise. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” lecture, minute 4:06.

Question 488

8. A patient with an elevated serum creatinine in relation to dehydration from vomiting would be diagnosed as _________? a. Pre-renal b. Intrarenal c. Post-renal

Answer 488

Answer: A Pre-renal Rationale for why the answer is correct: Patients with acute kidney injury related to nausea/vomiting and/or volume depletion are diagnosed as having a pre-renal acute kidney injury. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” lecture, minute 12:42.

Question 489

9. A patient with an elevated serum creatinine in relation to BPH would be diagnosed as _________? a. Pre-renal b. Intrarenal c. Post-renal

Answer 489

Answer C Post-renal Rationale for why the answer is correct: Patients with acute kidney injury related to BPH, stone, or a blocked urethra/ureter are diagnosed as having a post-renal acute kidney injury because the blocking of the urine can also increase the serum creatinine levels. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” lecture, minute 12:47.

Question 490

10. When trying to determine if you need to adjust a drug’s dosage, you would use _______. a. BUN b. Glomerular Filtration Rate c. Creatinine d. Urinalysis

Answer 490

Answer: C Creatinine Rationale for why the answer is correct: If drug dosages need to be renally adjusted, creatinine clearance is the measurement that will help make that determination. Site for question/rationale: Dr. Shelly Seth’s “Diagnosing Renal Problems” lecture, minute 14:42.

Question 491

1. Question: There are four muscles, two anterior and two posterior, that make up the rotator cuff. What are these four muscles? A. Anterior: Deltoid, Teres major, Posterior: Deltoid, Teres minor B. Anterior: Supraspinatus, Subscapularis, Posterior: Infraspinatus, Teres minor C. Anterior: Supraspinatus, Subscapularis, Posterior: Erectorspinae, Rhomboid D. Anterior: Subscapularis, Sternocleidomastoid, Posterior: Infraspinatus, Rhomboid

Answer 491

Answer: B Rationale for why the answer is correct: Anatomy of the shoulder joint. Site for question/rationale: My Shoulder Hurts PPT, Shelly Seth. Slide #7

Question 492

``` 2. Question: A patients comes to the clinic with a chief complaint of knee pain. The patient reports they are an avid runner and has recently increased their running in preparation for a marathon. The pain is located around the patella and is generally worse after a long run. The APRN has the patient fully extend their leg and the patella jumps laterally indicating a positive J-sign. What is the most likely syndrome this patient is suffering? A. Osgood-Schlatters disease B. Osteoarthritis C. Prepatellar Bursitis D. Patellofemoral pain syndrome ```

Answer 492

Answer: D Rationale for why the answer is correct: Patellofemoral syndrome is common in 16-25% of runners, it is aggravated by weight bearing activities such as running, squatting, and stair climbing. This syndrome is the most common cause of anterior knee pain. Site for question/rationale: I think I need a cane….and a handicapped parking sticker PPT. Shelly Seth. Slide # 9.

Question 493

``` 3. Question: A patient with a history of lower back pain comes to the clinic as they are experiencing radiating pain into the leg along a dermatome. What is the most likely cause of this radiating pain in this patient? A. Sciatica B. Ruptured disk C. Cauda Equina syndrome D. Metastatic disease ```

Answer 493

Answer: B Rationale for why the answer is correct: Any radiating pain into the leg along a dermatome is indicative of a ruptured disk. Sharp shooting pain is more consistent with sciatica and loss of bowel or bladder function is consistent with Cauda Equina syndrome which is a medical emergency. Any back pain in a patient with a history of cancer, needs to have metastatic disease ruled out. Site for question/rationale: My back hurts PPT. Shelly Seth. Slide # 3.

Question 494

``` 4. Question: An older female patient presents with the chief complaint of pain in both of their wrists. After further assessment, the patient points to the metacarpal joints and explains it has recently started to become painful in this area too. The APRN asks the patient about morning stiffness and the patient explains how it takes at least an hour every day to stop feeling so stiff. What is the most likely cause of this patient’s complaints? A. Osteoarthritis B. Reiters Disease C. Rheumatoid Arthritis D. Lyme Disease ```

Answer 494

Answer: C Rationale for why the answer is correct: Any stiffness lasting greater than 60-minutes is indicative of an inflammatory process. Joint pain that is symmetrical is associated with Rheumatoid arthritis and non-symmetrical pain is associated with osteoarthritis. The patient complains of metacarpal and wrist pain, which are both locations associated with Rheumatoid arthritis. Site for question/rationale: My hands hurt PPT. Shelly Seth. Slide #3.

Question 495

``` 5. Question: What scale is used to determine a patient’s neurological state? A. Glasgow Coma Scale B. Edinburgh Scale C. Braden Scale D. Morse Scale ```

Answer 495

Answer: A Rationale for why the answer is correct: Edinburg is a Maternal depression scale, the Braden scale is used to determine skin integrity and the Morse scale is a Fall predicting scale. Site for question/rationale: Top 10 Neuro Diagnosis in Acute and Primary Care PPT. Slide #3.

Question 496

``` 6. Question: A patient presents with the following clinical features: eyebrow sagging, mouth drooping, altered secretion of the lacrimal and salivary glands and the disappearance of nasolabial folds. What is the most likely cause for these clinical features? A. Guillian Barre B. Bell’s Palsy C. Bacterial Meningitis D. Parkinson’s ```

Answer 496

Answer: B. Rationale for why the answer is correct: Bell’s Palsy is the acute peripheral facial palsy of unknown cause. The above, are common clinical features of Bell’s Palsy. Site for question/rationale: Top 10 Neuro Diagnosis in Acute and Primary Care PPT. Slide #14.

Question 497

``` 7. Question: What is the most frequent headache type? A. Episodic tension-type headache (TTH) B. Migraine C. Cluster headache D. Exertional ```

Answer 497

Answer: A. Rationale for why the answer is correct: The episodic tension-type headache is the most common headache type. Patients will describe it as a tight band around their head with an aching pressure, triggered by stress. Migraine is the most common diagnosis in patients presenting for medical attention. Site for question/rationale: Top 10 Neuro Diagnosis in Acute and Primary Care PPT. Slide #26.

Question 498

``` 8. Question: An APRN needs to adjust the drug dosage for a patient. What will the APRN review to make this drug dosage adjustment? A. Glomerular Filtration Rate B. Blood Urea Nitrogen (BUN) C. Urinalysis D. Creatinine Clearance. ```

Answer 498

Answer: D. Rationale for why the answer is correct: Creatinine clearance is the measurement used to adjust drug dosages. It is the Cockcroft-Gault formula that is used to estimate the creatine clearance. It is easy to do, and changes quickly with dehydration and illness for example, and allows for safe medication adjustments in patients. Site for question/rationale: Renal testing for diagnosis PPT. Shelly Seth. Slide #12.

Question 499

``` 9. Question: A patient with chronic kidney disease has a GFR of 43%. What stage of chronic kidney disease is this patient exhibiting? A. Stage 1. Normal. B. Stage 4. Severe. C. Stage 3b. Moderate to Severe. D. Stage 5. Kidney Failure. ```

Answer 499

Answer: C. Rationale for why the answer is correct: Site for question/rationale: Estimated Glomerular Filtration Rate (eGFR), National Kidney Foundation, Page 2.

Question 500

``` 10. Question: A parent brings their child in to the clinic with complaints of nausea, vomiting, intense pain in the lower back and flank area, accompanied by frequent, painful urination. The child is running fever and the parent reports the child has had frequent urinary tract infections, however the child has never had symptoms like this. What test will the APRN order for this child? A. Creatinine Clearance B. 24-Hour Urine C. Glomerular Filtration Rate D. Spot Check Urinalysis ```

Answer 500

Answer: B. Rationale for why the answer is correct: A 24-hour urine test is completed when a spot urine test does not tell the whole story. A 24-hour urine test is used for several conditions including multiple myeloma, kidney disease, preeclampsia, pheocytocytoma – for uncontrolled hypertension, hematuria/recurrent kidney stones and for children who have their first kidney stone. Site for question/rationale: Renal testing for diagnosis PPT. Shelly Seth. Slide #13.