exam one diagnostics Flashcards
(473 cards)
1
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Question: What is the first piece of information obtained for a patient seeking medical attention? a. Family history b. Symptoms c. Chief complaint d. allergies
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Answer: Chief complaint Rationale for why the answer is correct: Gives the provider a general idea of possible diagnosis Site for question/rationale: text book- Differential Diagnosis pg 1
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Question: How will the provider obtain more details after the general history is obtained? a. Ask more open-ended questions b. Use a directed history c. Have patient describe what they are feeling d. Just read previous notes from other providers
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Answer: Use a directed history Rationale for why the answer is correct: patient may not offer pertinent symptoms unless prompted Site for question/rationale: text book- Differential Diagnosis pg 1
3
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Question: When should diagnostic testing be ordered? a. Diagnostic tests are never needed b. Only if patient has good insurance c. With every problem that the patient has d. Only if necessary
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Answer: Only if necessary Rationale for why the answer is correct: Only if necessary to yield an impact on the diagnosis & ultimate treatment of the problem Site for question/rationale: Differential Diagnosis pg 2
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Question: What should the provider do with the patient’s symptoms? a. Nothing at all needs to be done b. Only document the symptoms the provider needs c. Make a list of patient’s symptoms & risk factors d. Order diagnostic test for each symptom
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Answer: Make a list of patient’s symptoms & risk factors Rationale for why the answer is correct: This would help with noting positive & negative associated symptoms & helps look for significant signs of illness Site for question/rationale: Differential Diagnosis pg 3
5
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Question: What is the treatment for hyponatremia? a. Correct less than 10mEq/L per 24 hours b. Correct 15mEq/L per 24 hours c. Correct 20 mEq/L per 24 hours d. Correct 25 mEq/L per 24 hours
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Answer: Correct less than 10mEq/L per 24 hours Rationale for why the answer is correct: There is a risk with correcting with > 12mEq/L per 24 hours- Central Potine Myelinolysis (permanent flaccid paralysis, dysphagia, death) Site for question/rationale: Labs- BMP handout
6
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Question: Why does the bilirubin level increase with renal failure? a. Due to too much sodium b. Due to the liver not filtering out the byproducts c. Due to the kidneys not filtering properly d. Due to not not drinking enough fluids
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Answer: Due to the kidneys not filtering properly Rationale for why the answer is correct: Because with renal failure, there is a problem with the kidneys filtering and working properly, therefore having a bilirubin increase Site: Lab- handout CMP/LFT
7
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Question: When should the provider order a colonoscopy for acute diverticulitis? a. Right away b. 4-6 weeks after resolution of symptoms c. In 12 months d. No colonoscopy necessary
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Answer: 4-6 weeks after resolution of symptoms Rationale for why the answer is correct: The pain is in pain & has tenderness. It is better to wait 4-6 weeks after healing Site for question/rationale: Abdominal PDF
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Question: What is the gold standard of diagnosis for intussusception? a. Abdominal xray b. Stool for occult blood c. Barium enema d. CBC, BMP
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Answer: Barium enema Rationale for why the answer is correct: Provider will see coiled spring appearance. May also reduce the intussusception Site for question/rationale: abdominal pdf
9
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Question: The patient presents to the clinic, c/o fishy odor, thing discharge, & vaginal itchiness. Which diagnosis should the provider suspect? a. Candidiasis b. Trichomomasis c. It is normal d. Bacterial vaginosis
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Answer: Bacterial vaginosis Rationale for why the answer is correct: These are symptoms of BV. It is not normal. With trichomomasis, the discharge is frothy. Candidiasis- no odor Site for question/rationale: Womens Health PDF
10
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Question: A 15-year-old male presents to the clinic with acute left testicle pain, nausea & vomiting. What should the provider recommend for testicular torsion? a. Apply an ice pack every 2-3 hours b. Refer to an urologist c. Refer to the ER d. Prescribe Ibuprofen and an antibiotic to decrease infection
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Answer: Refer to the ER Rationale for why the answer is correct: lack of blood flow to the affected testicle, intervention must take place in the first 4-6 hours to salvage the testicle from infarction Site for question/rationale: Male reproduction PDF & Advanced Health Assessment & Clinical Diagnosis in Primary care- author Dains p 250
11
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Question: You ask the patient what brings her in today for a visit and she states, “ My stomach has been hurting and I feel nauseous”. What section of the SOAP note would this piece of information pertain to? A) Subjective B) Objective C) Assessment D) Plan
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Answer: A Rationale for why the answer is correct: “My stomach has been hurting and I feel nauseous” is the patient’s chief complaint. Patient’s chief complaint is subjective information. Site for question/rationale: Shelly Seth’s SOAP note presentation (11:15).
12
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Question: Ms. Jennifer Wallace is a 5’3, 157pound, 17 year old female with a chief complaint of right upper quadrant abdominal pain, onset 2 days ago. She reports her pain as intermittent, dull, and achy. She states eating makes her pain worse and has no pain relief with Tylenol. Nausea and vomiting are associated symptoms, onset yesterday. She denies tobacco, alcohol, and illicit drug use. Which of the following does NOT belong in the HPI (History of Present Illness)? A) Chief complaint of right upper quadrant abdominal pain”. B) “She reports her pain as intermittent, dull, and achy”. C) “No pain relief from Tylenol”. D) “She denies tobacco, alcohol, and illicit drug use”.
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Answer: D Rationale for why the answer is correct: The HPI should consist of information on why the patient is seeking care. OLDCARTS, OPQRST, and SOCRATES information is placed here. The patient’s social history is relevant on why the patient is seeking care and therefore does not belong in the HPI. Site for question/rationale: Shelly Seth’s SOAP presentation (11:20-13:35)
13
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Question: Which of the following patients could be treated empirically? A) 25 year old female patient presents with suprapubic pain and urinary frequency. Treat empirically for UTI. B) 36 year old male patient presents with fever, chills, and nausea. Treat empirically for Influenza. C) 22 year old male patient presents with sore throat, swollen tonsils, low-grade fever, white patches on their tonsils, and sister recently had strep throat. Treat empirically for Strep throat. D) 19 year old female patient presents with dysuria and white vaginal discharge. Treat empirically for Chlamydia.
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Answer: C Rationale for why the answer is correct: C has a HIGH percent probability of the patient having Strep without even having to test them. Since the patient has at least 90% probability based on clinical presentation, there is no need to test and they can be treated empirically. All of the other patients require further assessment/laboratory data because they have a median probability of having the disease. Site for question/rationale: Amy Morre’s Basics of diagnostics presentation (15:00-15:45).
14
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Question: All of the following are true EXCEPT? A) If you’re ruling in a test, you want the specificity to be high. B) If you’re ruling out a test, you want the sensitivity to be high. C) Specificity indicates the likelihood of someone with a particular disease. D) Sensitivity indicates how soon the patient must be tested in order to get an accurate result.
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Answer: D Rationale for why the answer is correct: Sensitivity does not indicate how soon the patient must be tested to get accurate results. Sensitivity is how well the test can detect a certain disease. All of the other statements are true. Site for question/rationale: Amy Moore’s Basics of diagnostics presentation (17:23-17:40 & 18:38-19:35).
15
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Question: Which Leukocytes account for the largest percent of your WBC’s? A) Neutrophils B) Monocytes C) Lymphocytes D) Eosinophils
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Answer: A Rationale for why the answer is correct: Neutrophils (45%-65%). Monocytes (2%-8%). Lymphocytes (15%-40%). Eosinophils (0%-5%). Site for question/rationale: CBC handout/voice thread presentation. Slide 9 labeled “Leukocytes (WBC’s)
16
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Question: Which of the following is FALSE concerning Total Bilirubin? A) Must be > 2.5 to produce jaundice B) It is a by product of WBC’s destruction C) Elevated Direct (Conjugated) Total Bilirubin levels are likely related to gallbladder or pancreas problem. D) Elevated Indirect (unconjugated) Total Bilirubin levels are likely related to a liver problem.
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Answer: B Rationale for why the answer is correct: Total Bilirubin is a by-product of RBC’s. All of the other answer choices are true. Site for question/rationale: CMP handout/voice threat presentation. Slides 8&9 labeled “Total Bilirubin”
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- Question: Mr. Turner, a 23 year old male, presents with chief complaint of sudden onset right lower quadrant abdominal pain associated with nausea and vomiting. Exam reveals rebound tenderness and positive obturator sign. Which diagnostic testing is gold standard for this patient’s symptoms? a. CBC b. Urinalysis c. Abdominal CT D. Abdominal ultrasound
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Answer: D Rationale for why the answer is correct: The chief compliant, associated symptoms, and exam indicate the patient has appendicitis. We can do a CBC to look for elevated WBC (>20,000 can indicate perforated appendix). We can also do a urinalysis to look for hematuria and pyuria (not every patient will have this). An abdominal CT is considered gold standard diagnostic for acute appendicitis in adults. Abdominal ultrasound could be used in the pediatric population to decrease risk of radiation exposure but not considered gold standard. Site for question/rationale: Abdominal/lab tests presentation by Dr. Amy Moore. Slide 4 & 7 (9:15-10:40)
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Question: The American Academy of Gastroenterology has guidelines for pancreatitis diagnostics. Which of the following is NOT part of the diagnostic criteria for pancreatitis? a. Presence of abdominal pain b. Positive CT scan c. Elevated WBC higher than 16,000 d. Elevated serum lipase and/or serum amylase at least 3 times normal limits
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Answer: C Rationale for why the answer is correct: A,B, and D are all part of the guideline. Elevated WBC higher than 16,000 is part of Ranson’s criteria for severity of acute pancreatitis that must be present on admission. Elevated Amylase alone cannot be used reliably and Lipase is preferred. Amylase and Lipase will rise initially but can trend down pretty quickly. Remember, alcoholics and people with multiple episodes of pancreatitis may not produce Amylase/Lipase enzymes so those would not be reliable for diagnosis. Site for question/rationale: Abdominal/lab tests presentation by Dr. Amy Moore. Slide 11 (14:59-16:50)
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Question: Which of the following can NOT be diagnosed using a wet prep? a. Chlamydia b. Trichomoniasis c. Syphilis d. Bacterial vaginosis
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Answer: C Rationale for why the answer is correct: A RPR (rapid plasma regain) blood test can be drawn to tell you how likely it is your patient has syphilis. If RPR is positive, you can confirm the positive results with a VDRL blood test. All of the others answer choices; an APRN can gather a sample and look at the sample using an NaCl wet mount. Just remember to use sterile saline because the KOH wet prep will destroy all elements but fungal (Woman’s Health Overview Diagnostics powerpoint, slide 4. Site for question/rationale: STI diagnostics presentation (18:40 Chlamydia can use wet prep) (11:40 Trichomonas can use wet prep) (16:55 Syphilis uses RPR). Woman’s Health Overview Diagnostics powerpoint, slide 2: Assessing vaginitis via wet prep.
20
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Question: Which of the following is true? a. Mammograms should be performed every 1-2 years beginning from ages 40-50 and screening for breast cancer until the age of 75. b. Pap smears should start at age 21 and be performed every 5 years. c. A patient with no family history of colon cancer should get a colonoscopy at age 60. d. Adolescent women with a normal BMI don’t need their cholesterol levels checked until age 22.
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Answer: A Rationale for why the answer is correct: A is true. B is false because Pap smears should be performed every 3 years. C is false because the gold standard is a colonoscopy at age 50 for those without family history. D is false because women need their cholesterol levels checked once between ages 9-11 and again at ages 17-21. Cholesterol levels should be checked despite the patient’s BMI.
21
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Question: SOAP Notes include which sections: a. Severity, Objective, Analysis, Plan b. Severity, Onset, Aggravating/Alleviating factors, Palliation c. Subjective, Objective, Assessment, Plan d. Subjective, Onset, Analysis, Presentation
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Answer: Subjective, Objective, Assessment, Plan Rationale for why the answer is correct: SOAP notes is an acronym that is a form of documentation for healthcare professionals to follow in order to evaluate and record patient interactions during appointments in order to evaluate and determine the best treatment option that coincides with the appropriate information gathered throughout the visit. This acronym stands for Subjective, Objective, Assessment, and Plan. Site for question/rationale: SOAP Note Presentation Video by Shelly Seth in Module 1
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Question: When completing a patient’s history, the Review of Systems element is documented under which part of the SOAP note? a. Objective b. Plan c. Assessment d. Subjective
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Answer: Subjective Rationale for why the answer is correct: Subjective data includes anything from personal views or experiences. This section is composed of the chief complaint, history of present illness, medical/ surgical/ family/ social history, review of systems, current medications, and allergies. Site for question/rationale: SOAP Note Presentation Video by Shelly Seth in Module 1
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Question: Clinical Laboratory Improvement Amendments (CLIA) granted which tests as waived point of care tests? a. UA, urine pregnancy test, blood glucose, blood chemistry b. Hemoglobin, UA, wet prep, and semen analysis c. UA, blood chemistry, Fern test d. Pinworm exam, urine pregnancy test, hemoglobin
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Answer: UA, urine pregnancy test, blood glucose, blood chemistry Rationale for why the answer is correct: UA, urine pregnancy tests, blood glucose, and blood chemistry are waived diagnostic point of care tests that are regulated by the CLIA. The CLIA requires clinical labs to be certified by Medicare and Medicaid services in order to accept human samples. Site for question/rationale: Basics of Diagnostics Video Module 1
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Question: Which tests are examples of Provider-Performed Microscopy Procedures (PPM)? a. Wet mount, blood count, Fern test b. Wet mount, KOH prep, pinworm exam, semen analysis c. UA, KOH prep, Hemoglobin d. Chemistry, semen analysis, blood glucose
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Answer: Wet mount, KOH prep, pinworm exam, semen analysis Rationale for why the answer is correct: PPM’s are procedures that are performed under a microscope by a provider. All of the above listed tests are tests that are not waived or point of care testing under the CLIA. Site for question/rationale: Basics of Diagnostics Video Module 1
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Question: A patient arrives to the ED with nausea, vomiting, headache, and malaise. The patient rapidly declines and is now obtunded and seizing. Which diagnostic laboratory study should you order to determine the cause of the patient’s sudden neurological decline and what is your anticipated diagnosis? a. BMP- Hyponatremia b. BMP- Hyperkalemia c. CBC- Sepsis d. CBC- Anemia
Answer: BMP- Hyponatremia Rationale for why the answer is correct: Hyponatremia presents with neurological symptoms secondary to the formation of cerebral edema. When water enters the cells in the brain the cells begin to swell. Since the brain is encompassed in an enclosed skull it cannot expand leading to compression of the brain from cerebral edema resulting in a deterioration in neurological status. Site for question/rationale: BMP Video/Slides from Module 1: Slide #4
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Question: A patient presents to your office with complaints of heat intolerance, palpitations, fatigue, weakness, and hair loss. Throughout your assessment you determine the patient has lost weight, is tachycardic, with rapid, deep tendon reflexes. Which laboratory tests should the NP order? a. BMP, CBC b. CMP, CBC c. TSH, T4, T3 d. TSH, T4, T3, CBC, LFT’s
Answer: TSH, T4, T3, CBC, LFT’s Rationale for why the answer is correct: Thyroid hormone levels should be an anticipated order to determine or eliminate if the cause of the patient’s symptoms is related to the thyroid gland itself or if it they are secondary symptoms to a different diagnosis. CBC and LFT’s should also be added to the diagnostic tests to rule out other disorders like thyroid cancer, liver, gallbladder, or pancreatic changes. In addition, these levels should be obtained and monitored prior to starting any antithyroid medication. Site for question/rationale: Endocrine & Autoimmune Disorders Video/Slides Module 1: Slide #3 and 4
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Question: When examining the abdomen which technique should be employed first? a. Light Palpation b. Deep Palpation c. Inspection d. Auscultation
Answer: Inspection Rationale for why the answer is correct: Healthcare providers should lead with the least invasive technique and move towards to most invasive. Each body system should lead with inspection especially that of the abdomen. Auscultation, light palpation, deep palpation, and percussion should follow respectively. This allows the provider to slowly examine the abdomen in its entirety without causing extreme amounts of pain. This procedure should be completed with the patient lying supine. Site for question/rationale: Abdominal Test Video and Slides from Module 2: Slide #3
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Question: A 4-week-old infant comes into your clinic today due to increased projectile vomiting and an inability to hold feeds down. After evaluation you noticed the infant has lost weight, has an olive shaped mass in the RUQ during palpation, and has a sunken fontanel. Which diagnostic procedures should the NP order? a. CMP, US, and upper GI Series b. Barium enema, abdominal x-rays, and BMP c. LFT’s, CBC, upper GI series d. US, LFT’s, BMP, and abdominal CT
Answer: CMP, US, and upper GI Series Rationale for why the answer is correct: These symptoms correlate to pyloric stenosis. The provider should order an upper GI series to evaluate for any abdominal abnormalities or a thin, elongated pyloric canal or “string sign”. A pyloric US is the definitive diagnostic test to diagnose pyloric stenosis. Lastly, a CMP should be drawn to evaluate for electrolyte imbalances from the babies consistent vomiting. Site for question/rationale: Abdominal Test Video and Slides Module 2: Slide #14
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Question: A 65-year-old male has an appointment to see you after suffering from urinary hesitancy and urgency with occasional nocturia for the past 4 months. Upon assessment you notice a firm, smooth, symmetrical enlarged prostate. Which laboratory tests should the NP order to help her come to a diagnosis? a. UA, prostatic US, gram stain, fractional urine exam b. UA, prostatic US, postvoid residual, PSA, CT, and needle biopsy c. Prostatic US, PSA, CBC d. Syphilis serology, prostatic US, UA/Culture, needle biopsy
Answer: UA, prostatic US, postvoid residual, PSA, CT, needle biopsy Rationale for why the answer is correct: The patient’s symptoms represent what one would see on an exam of a male with BPH. Prostatic US, CT, and needle biopsy are the definitive diagnostic measures to determine if the patient has BPH or prostate cancer. UA can assess for infection, specific gravity, dehydration, glucose which all help eliminate differential diagnoses for this patient. If there is a residual amount left in the bladder after voiding this can indicate an enlarged prostate. A PSA level that is elevated indicates BPH while one that is lower can indicate prostate cancer. Site for question/rationale: Men’s Reproductive Health/Test Video and Slides Module 2: Slide #2
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Question: A 21-year-old sexually active female presents to your office for her first PAP Smear. The patient doesn’t have any symptoms but states she has multiple sexual partners. The provider visualizes warts and the patient’s PAP came back abnormal. Which diagnostic tests can the provider anticipate? a. Nothing at this time. b. Colposcopy and biopsy c. CBC, US, Biopsy d. Cervicectomy
Answer: Colposcopy and biopsy Rationale for why the answer is correct: After visual inspection of the cervix and the presence of warts the provider should anticipate to send the female patient for a colposcopy and biopsy to determine the presence and type of HVP. The biopsy should be sent to rule out oncogenic
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Question: Where in the SOAP note would you document your course of treatment? A. Subjective B. Objective C. Assessment D. Plan
Answer: D. Plan Rationale for why the answer is correct: The course of treatment that you identify and make a plan for should be documented in the plan section of the SOAP note. It is the last part of the note and will serve as a guide for what treatment the patient will need. Site for question/rationale: SOAP note presentation by Shelly Seth (~23:50 in video)
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Question: A 43-year-old male comes into the clinic complaining of abdominal pain for the last 2 weeks. Where would you document this in the SOAP note? A. Subjective B. Objective C. Assessment D. Plan
Answer: A. Subjective Rationale for why the answer is correct: The chief complaint which is what the patient tells you why he/she is there to see you. Subjective information is whatever the patient tells you, not what you can observe. Site for question/rationale: SOAP Note Presentation by Dr. Mello, Dr. Moore, and Dr. Hilliard (at 1 minute in video)
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Question: What tools can we use to help guide our decision on whether or not our diagnosis is probable before ordering diagnostic tests? Check all that apply A. Direct studies of disease probability B. Validated clinical prediction rules C. Prevalence of the disease in the population D. Clinical experience and judgement
Answer: A, B, D Rationale for why the answer is correct: Direct studies of disease probability are beneficial because there can be valuable information on the particular disease process in scholarly articles/research papers. Validated clinical prediction rules are carefully and thoughtfully developed based on s/s of the patient. The aim is to ‘rule in’ or ‘rule out’ a disease. Clinical experience and judgment is the least accurate as there are a vast array of s/s that a patient can present with and may or may not have a specific disease. Though, it can be helpful to narrow down differentials. Site for question/rationale: Diagnostic Process Video (timestamp 3:30)
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Question: Which of the following are NOT required in order to get your differential diagnoses: A. Labs B. Assessment C. History of present illness D. Chief complaint
Answer: A Rationale for why the answer is correct: You cannot get your differential diagnoses without an assessment (including HPI and CC) The labs come after you have decided on your diagnoses. Site for question/rationale: Differential Diagnosis video w/ Dr. Moore (timestamp 6:10)
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1. Question: Which type of white blood cell (WBC) will be elevated during a viral illness? A. Neutrophils B. Lymphocytes C. Monocytes D. Basophils
Answer: B Rationale for why the answer is correct: Lymphocytes are the WBC’s that increase with viral illnesses such as a CMV, mono, and malignancies (leukemias, lymphomas). Site for question/rationale: Complete blood count presentation by Dr. Seth; slide 16
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Question: A patient comes into the clinic complaining of diarrhea for the last 4 days. He states he recently travelled to Asia last week. Which type of white blood cell would be elevated if you suspected a parasitic infection? A. Basophils B. Monocytes C. Eosinophils D. Neutrophils
Answer: C Rationale for why the answer is correct: Worldwide, the main cause of elevated eosinophils is due to a parasitic infection. In the US, an increased eosinophil count is usually caused by a new-onset allergy the patient has developed. Site for question/rationale: Complete blood count presentation by Dr. Seth; slide 21
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Question: A patient comes to the clinic with severe abdominal pain. What exam techniques will help rule in appendicitis? A. Psoas Sign B. Rovsing’s Sign C. Rebound tenderness D. All of the above
Answer: D. All of the above Rationale for why the answer is correct: There are multiple exam techniques that can be done to determine appendicitis. Rebound tenderness, heal tap, Psoas sign, Obturator sign, Rovsing’s sign, and cutaneous hyperesthesia will help rule in appendicitis. Site for question/rationale: Abdominal Presentation by Dr. Moore, slide 4
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Question: When diagnosing pancreatitis, the enzymes lipase and amylase may not be produced by the body if the patient: A. Has diabetes B. Has a history of alcohol abuse C. Is bulimic D. None of the above
Answer: B Rationale for why the answer is correct: If the patient is an alcoholic or has consumed too much alcohol in their lifetime, their body may not produce lipase or amylase any longer. When you check their serum levels, none will be present. Site for question/rationale: Abdominal Presentation by Dr. Moore, slide 11
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Question: Which method of testing can you use to diagnosis chlamydia? A. Cervical B. Vaginal C. Urine D. All of the above
Answer: D Rationale for why the answer is correct: These three methods have been proven effective in diagnosing chlamydia. Site for question/rationale: STI Diagnostics Presentation, timestamp 8:50
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Question: Which characteristic lesion do providers sometimes not even test for but automatically just treat the infection based on the patient’s history? A. Gonorrhea B. Chlamydia C. Trichomoniasis D. Herpes Simplex Virus
Answer: D Rationale for why the answer is correct: The lesions that HSV produces are specific to that disease process therefore testing is not necessary. The provider can treat the patient with the antiviral. Site for question/rationale: STI Diagnostics Presentation, timestamp 14:00-16:00
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Question: The Assessment portion of your SOAP note should contain which elements? a. Physical Exam of the patient b. Diagnosis, Differentials, and Problems identified c. A thorough Review of Systems d. The patients Chief Complain
Answer: B: Diagnosis, Differentials, and Problems Rationale for why the answer is correct: The assessment is a portion of your SOAP note in which you place any diagnoses, differentials, or problems that you have found potential or pertinent to the patient. Site for question/rationale: “SOAP Note Presentation” by Dr. Shelly Seth approximately around minute 23.
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Question: In which area of your SOAP note should you use the mnemonic OLDCARTS to gather information from your patient? a. ROS (Review of Systems) b. PMH (Past Medical History) c. HPI (History of Present Illness) d. The Assessment
Answer: C: HPI (History of Present Illness) Rationale for why the answer is correct: Within the HPI you are obtaining pertinent information as to why the patient is here today. Using this mnemonic will help gain a clearer picture of the problem. Site for question/rationale: “SOAP Note Presentation” by Dr. Shelly Seth approximately at min 12:45
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Question: Your Differential Diagnosis is formed with which of the following information? a. Chief Complaint b. History c. Physical Exam d. All of the above
Answer: D: All of the above Rationale for why the answer is correct: “Once the chief complaint, history, and physical examination are established, a list of possible diseases is formed ranking the most common diagnoses and the most serious or “non to miss” diagnoses” (Rhoads et al., 2015, p.2).
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Question: Which of the following is a possible differential diagnosis for a patient? a. Pneumonia b. Cough c. Fatigue d. Shortness of Breath
Answer: A Rationale for why the answer is correct: Pneumonia is a potential diagnosis for a chief complaint, whereas the rest of the answers are simply symptoms that could be caused by the chief of complaint. Site for question/rationale: “Differential Diagnosis for Fatigue” by MD Mello, MD Hilliard, and MD Moore. Discussing the difference between symptoms that the patient presents with and possible diagnoses that may be the cause of such symptoms.
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Question: Which of the following could cause a rise in Neutrophil / Band count? a. Vancomycin b. Parasitic Infection c. Hemolytic anemia d. Mononucleosis
Answer: A: Vancomycin Rationale for why the answer is correct: Parasitic infection would cause a rise in the Eosinophil count. Hemolytic Anemia would increase the Monocyte count. Mononucleosis would increase the Lymphocyte count. Site for question/rationale: “CBC” Voice thread Presentation by Dr. Shelly Seth slides 14-21
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Question: Which of the following would NOT be a cause of hyperkalemia a. Renal Failure b. Diuretics c. Adrenal Insufficiency d. Ace Inhibitors
Answer: B: Hypovolemia Rationale for why the answer is correct: Renal failure, Adrenal insufficiency, and Ace Inhibitors are all sources of hyperkalemia – Diuretic use (such as Lasix) is a common cause of hypokalemia. Site for question/rationale: “BMP” VoiceThread by Dr. Shelley Seth - Slide 8-12
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Question: A patient Positive for Murphy’s Sign would indicate which differential diagnosis? a. Appendicitis b. Pancreatitis c. Cholecystitis d. Diverticulitis
Answer: C: Cholecystitis Rationale for why the answer is correct: A Positive murphy’s sign could indicate cholecystitis; whereas a positive Rovsing’s Sign would point towards appendicitis Site for question/rationale: Dr. Amy Moore’s VoiceThread presentation on “Common Abdominal Complaints” Slide 4
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Question: A pediatric patient is brought in with the complaint of gas, distended abdomen, and vomiting. A biopsy is performed and found to have the absence of ganglion cells. Which of the follow would you suspect? a. Intussusception b. Hirschsprung’s Disease c. Pyloric Stenosis d. Colic
Answer: Hirschsprung’s Disease Rationale for why the answer is correct: An absence of ganglion cells found on a biopsy is an indication of Hirschspring’s. “String Sign” would indicate pyloric stenosis. A barium enema with the appearance of “coiled spring” is the gold standard for intussusception. Colic would not be the right diagnosis for this patient. Site for question/rationale: Dr. Amy Moore’s VoiceThread presentation on “Common Abdominal Complaints” Slide 14
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Question: At what age are mammograms conducted? a. Starting at 35 years old, No later than 40 years old b. Starting at 40 years old, No later than 50 years old c. Starting at 45 years old, No later than 50 years old d. Starting at 50 years old, No later than 60 years old
Answer: B: Starting at 40 years old, no later than 50 years old Rationale for why the answer is correct: According to The American College of Obstetrics and Gynecologist mammograms should be performed starting at age 40 and no later than age 50 every 1 to 2 years. Site for question/rationale: Dr. Amy Moore slides on “Women’s health” Slide 5. The American College of Obstetrics and Gynecologists https://www.acog.org/topics/well-woman-health-care
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Question: A patient states that his scrotum looks like “a bag of worms”. It is noted that on the left side are largely dilated veins within the scrotum. Which of the following diagnoses fit this description? a. Varicocele b. Hydrocele c. Spermatocele d. Testicular Torsion
Answer: A: Varicocele Rationale for why the answer is correct: According to Dr. Amy Moore’s lecture, which is referenced Hollier, A. (2013), Varicocele can resemble a “bag of warms” and is diagnosed with a doppler ultrasound. The veins in the scrotum (usually left side) are unusually large and dilated. Site for question/rationale: Dr. Amy Moore “Male Reproductive” Presentation – slide 6. Hollier, A. (2013). Clinical guidelines in primary care: A reference and review book. Lafayette, LA
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Question: Pain would be an example of which portion of the SOAP note? a) S b) O c) A d) P
Correct answer A. Rationale for why the answer is correct: Any information that the patient reports that you can not verify by testing or examination is subjective information. Objective method is any information the provider can verify by examination or testing for example, blood pressure. Site for question/rationale: Dr. Seth’s SOAP note presentation beginning at 21:09.
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Question: Which of the following must be included in the plan portion of the SOAP note? Answer: a) The patient’s height and weight b) Patient follow-up c) Chief complaint d) Physical exam findings
Answer : B Rationale for why the answer is correct: Patient follow-up and education should always be documented in the plan portion of the SOAP note. The plan does not need to include a summary subjective or objective information gathered previously during the exam. Site for question/rationale: SOAP note presentation under additional resources in module 1 at 6:26.
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Question: What information is needed to help the provider form a differential diagnosis? Answer: a) A detailed health history b) Comprehensive physical exam c) Diagnostic testing d) All of the above
Answer D: Rationale for why the answer is correct: All portions of the exam contribute to clinical decision making and should be considered when forming a differential diagnosis. By neglecting any portion of the exam, the provider could misdiagnose or miss a life altering diagnosis. Site for question/rationale: - Differential diagnosis for fatigue, beginning at 1:15.
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Question: At what point in the decision making process is it appropriate for the APRN to order diagnostic testing? Answer: a) As soon as the patient presents to the clinic. b) When the patient asks to have their labs checked c) When the provider has a working differential diagnosis d) When the provider has ruled out a diagnosis
Answer : C Rationale for why the answer is correct: Diagnostic testing should be used to help a provider rule in or rule out a diagnosis. If the provider has already ruled out a diagnosis performing diagnostics at that point would be poor stewardship. The APRN should have narrowed down a differential diagnosis prior to diagnostic testing. Site for question/rationale: Differential diagnosis for fatigue, 13:35.
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Question: Dr. Day is precepting an APRN student in the hospital who asks why Dr. Day ordered a basal metabolic panel (BMP) instead of a complete metabolic panel (CMP) on their patient who has been admitted in the hospital for 7 days. What would be the most appropriate response from Dr. Day? Answer: a) There is no difference. b) I wanted to get a more complete picture of the patient’s health status. c) A BMP is more accurate than a CMP. d) A BMP changes more frequently than CMP and should be monitored more often.
Answer: D Rationale for why the answer is correct: A BMP is used for daily lab testing because it changes more frequently than a CMP. A CMP includes everything on a BMP plus total protein, total bilirubin, albumin, AST, ALT, and alkaline phosphatase. Therefore, a CMP does contain more information providing a more complete picture, however it does not need to be monitored every day. Accuracy of BMP and CMP should remain consistent when proper lab technique is used. Site for question/rationale: BMP voice thread slide # 2
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Question: Ericka, an 18-year-old female, presents to your clinic today as a new patient. She states she has a history of iron deficiency anemia. What lab abnormality would you expect to see on her complete blood count (CBC)? Answer: a) MCV\> 96 b) MCV\< 80 c) MCV 80-96 d) Platelets \>100,000
Answer : B Rationale for why the answer is correct: MCV \<80 would indicate microcytic anemia commonly caused by iron deficiency. An MCV\> 96 would indicate macrocytic anemia. An MCV of 80-96 in the presence of low hemoglobin and hematocrit would indicate a normocytic anemia, in the absence of low hemoglobin and hematocrit that range of MCV is normal. Platelets \>100,000 are a normal finding. Site for question/rationale: Complete blood count voice thread slides 28-31, and 43.
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Question: Amy, a 6-month-old female, presents to your clinic with a two-day history of vomiting and diarrhea. The patient’s caregiver reports decreased urine output and decreased appetite. What diagnostic testing should the APRN consider at this time? Answer: a) BMP b) Abdominal CT c) Influenza swab d) Stool culture
Answer A Rationale for why the answer is correct: The child is exhibiting signs of pediatric dehydration and the APRN should consider checking electrolytes for fluid replacement. Abdominal CT, influenza swab, or renal ultrasound could be indicated for the complaint of vomiting or diarrhea, however, to assess dehydration a BMP is the most correct answer for this scenario. Site for question/rationale: Dr. Moore’s presentation on abdominal pain, beginning at 7:00.
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Question: A 35-year-old female patient presents to your clinic today with a chief complaint of right upper quadrant pain. After further assessment, the patient has a positive Murphey sign and leukocytosis present on her CBC. At this point, what is your leading diagnosis? a) Appendicitis b) Diverticulitis c) Irritable bowel syndrome d) Cholecystitis
Answer D Rationale for why the answer is correct: A positive Murphey sign is a hallmark sign of cholecystitis. Leukocytosis is also a common finding in cholecystitis. Leukocytosis can also be present in diverticulitis or irritable bowel syndrome; however, it is a non-specific indicator. Appendicitis is more likely to have positive rebound tenderness. Site for question/rationale: Dr. Moore’s presentation on abdominal pain at 4:55 and 10:44.
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Question: Which of the following findings would be considered an abnormal finding in a gynecological exam? Answer: a) Many lactobacilli b) pH 5.0 c) Clear odorless discharge d) Scant white blood cells
Answer: B Rationale for why the answer is correct: Normal vaginal pH should be less than 4.5. Lactobacilli, clear odorless discharge, and a small amount of white blood cells are a normal finding. White blood cells are problematic when there is a large number present, or the patient is reporting gynecological symptoms. Site for question/rationale: Dr. Olenick’s presentation about Women’s Health Diagnostics on slide 7.
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Question: Nicolas, a 1-month old infant, presents to your clinic today to establish care after being discharged from the NICU. The infant was born at 35 weeks gestation. Upon exam you discover cryptorchidism. What is your plan of care? Answer: a) Refer to urology b) Send the patient to the emergency room c) Reassess at the infants next well child visit d) This is a normal finding that requires no further attention
Answer : C Rationale for why the answer is correct: Cryptorchidism often resolves on its own, however, if it does not resolve by 4 months the patient should be referred to a urologist. Since the patient is less than 4 months, a referral to urology is not indicated at this time. This is not a medical emergency requiring transfer to the emergency department. This would be an abnormal finding requiring further assessment. Site for question/rationale: Dr. Moore’s presentation on male reproduction beginning at 9:20.
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Question: When asking a patient about their medications, what MUST be included? Circle all that apply. A. Over the counter medications B. Prescribed medications C. Herbs/Supplements D. Water intake
Answer: A, B, C Rationale for why the answer is correct: When asking patients about their medication, OTC meds, prescribed medications, herbs, and supplements should be included. Water intake is not necessary. Site for question/rationale: SOAP Note presentation by Dr. Shelly Seth at 17:51 time
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Question: The following information is recorded in the patient’s health history. The patient is accompanied by his mother and states, “I feel lousy and have a sore throat.” Identify under which category this statement belongs. A. Present illness B. Chief complaint C. Social history D. Physical exam
Answer: B. Chief complaint Rationale for why the answer is correct: The chief complaint is a concise statement describing why the patient is seeking medical attention, and it is always in quotation marks. Site for question/rationale: SOAP Note presentation by Dr. Shelly Seth at 11:18 time.
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Question: A 39-year-old female presents to the clinic with complaints of fatigue. The CBC results come back with a hemoglobin of 10 g/dL and an MCV \>100 fL. What would you suspect? A. Blood loss B. Iron deficiency C. Vitamin deficiency D. Anemia of chronic disease
Answer: C. Iron deficiency Rationale for why the answer is correct: MCV greater than 100 fL is called macrocytic and is usually caused by vitamin deficiency (folate or B12). MCV less than \<80 fL could be due to iron deficiency, and MCV between 80-100 can be due to blood loss or anemia of chronic disease like in renal patients. Site for question/rationale: Differentials for Fatigue presentation by Dr. Inola Melo, Dr. Tara Hillard, and Dr. Amy Moore at 8:02 time.
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Question: A 63- year old female presents to the ED with complaints of fatigue. She has a diagnosis of diabetes mellitus type 2, seizures, hypertension, and hyperlipidemia. As the provider, you start thinking of differential diagnosis. What is the differential diagnosis for this patient? A. Seizures and hyperlipidemia B. Fatigue and seizures C. Anemia and acute illness D. Alcohol abuse and hyperlipidemia
Answer: C. Anemia and acute illness Rationale for why the answer is correct: Differential diagnoses are the things that could be causing the chief complaint. Seizures and hyperlipidemia are diagnoses. Fatigue is the chief complaint. Anemia and acute illness are the differential diagnosis for fatigue. Site for question/rationale: Differential Diagnosis presentation by Dr. Amy Moore at 2:58 time.
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Question: A basic metabolic panel is drawn on a patient. You notice that his sodium level is low at 118. 3% normal saline is ordered. In 24 hours, the sodium was corrected \>12 mEq. What is the patient at risk for? A. Tented T waves B. V-fib C. Muscle cramping D. Permanent flaccid paralysis
Answer: D. Permanent flaccid paralysis Rationale for why the answer is correct: Central Pontine Myelinolysis can occur when sodium is corrected \>12 mEq/24 hours. This can be a permanent problem causing permanent flaccid paralysis, dysphagia, and death. Tented T waves, v-fib, and muscle cramping is due to an imbalance of potassium levels. Site for question/rationale: Basic Metabolic Panel presentation by Dr. Shelly Seth, slide #7
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Question: When the liver is not functioning correctly, what are possible signs? A. High PT/PTT and high platelets B. Confusion, MCV is high, fatigue C. Bleeding gums, low albumin levels D. Bleeding gums, high bilirubin, confusion, and unstable blood sugars
Answer: D. Bleeding gums, high bilirubin, confusion and unstable sugars Rationale for why the answer is correct: Signs that the liver is not functioning correctly are low albumin levels, ammonia levels high causing confusion, fatigue, unstable blood sugars, bruising, and bleeding gums. This is due to low platelet count, high PT/PTT levels, high MCV, and elevated bilirubin. Site for question/rationale: Complete Metabolic Panel presentation by Shelly Seth, slide #16
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Question: A 35-year-old female presents to the emergency department with complaints of severe abdominal pain. Which position is the accurate way to inspect the abdomen? A. Fowler’s Position B. Prone Position C. Supine Position D. Lithotomy Position
Answer: C. Supine Position Rationale for why the answer is correct: Never inspect the abdomen with the patient sitting up. The ideal position to inspect the abdomen is lying down (supine position). You can have the patient do the Valsalva maneuver to look for rising abdominal hernias in this position. Site for question/rationale: Abdominal lab/test presentation by Dr. Amy Moore at 1:12 time
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Question: A 25-year-old female presents to the emergency department complaining of nausea, vomiting, and abdominal pain that started last night. After examining the patient, you have a positive Murphy’s sign. Which exams will your order? A. CBC, CMP, and ultrasound B. CT scan and ultrasound C. HIDA Scan and ESR D. CBC, CMP, stool for occult blood, abdominal x-rays
Answer: A. CBC, CMP, and ultrasound Rationale for why the answer is correct: A positive murphy’s sign can indicate acute cholecystitis. Ultrasound is the most sensitive and specific study for the diagnosis of acute cholecystitis. 90-95% of patients will have gallstones. CT scan, stool occult, abdominal x-rays do not rule in cholecystitis. HIDA SCAN is ordered if the ultrasound is negative. A CBC and CMP would be ordered to obtain a white blood cell count, ALT, AST, alkaline phosphate, and bilirubin. Site for question/rationale: Abdominal lab/test presentation by Dr. Amy Moore, slide #8
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Question: A 76-year old active female comes into the clinic for a regular women’s wellness check. Will you consider doing a mammogram on this patient? A. No, screening stops at age 75. B. Yes, continue to screen your patient. C. No, screening stops at age 50. D. Yes, because screening starts at age 75.
Answer: B. Yes, continue to screen your patient. Rationale for why the answer is correct: Most guidelines state to start mammogram exams at age 40 and continue screening until at least age 75. This does not mean to stop at age 75. So, the 76-year-old female could continue to have mammograms after 75 years of age. Site for question/rationale: Women’s Health Preventative Care presentation by Dr. Amy Moore, slide #5
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Question: A 5-month-old premature baby comes to the clinic for a wellness check. The baby was diagnosed with cryptorchidism. During your assessment, you palpate the scrotum and find that one of the testes is still absent. Your next step would be? A. Make parents aware that the child will have testicular cancer when older. B. Refer to a urologist C. Have the child come back at 6 months since it should descend by 6 months D. All of the above
Answer: B. Refer to a urologist Rationale for why the answer is correct: The patient is at an increased risk for testicular cancer, but it does not mean the child will have testicular cancer. The testes should descend by 6 months; however, by 4 months if one or both testes remain absent by four months, the child should be referred to a urologist. Site for question/rationale: Male Reproductive Health presentation by Dr. Amy Moore, slide #4
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What is the purpose of using quotation marks in your SOAP note? a. To quote what you said to the patient b. To separate differential diagnoses c. To quote what the patient said to you d. To bring attention to a finding
Answer: C Rationale for why the answer is correct: Quotations differentiate notes written by the provider from what was directly said by the patient. Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth
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Select all that apply. When obtaining a patient’s history, which components are included in the medication history? a. Prescription medications b. Prescriber of medications c. Herbal preparations d. Supplements e. Over the counter medications
Answer: A, C, D, E Rationale for why the answer is correct: The prescriber is not always a necessary piece of information when collecting a patient’s medication list. Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth
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What portions of the SOAP note can be used to rule out differential diagnoses? a. Review of systems b. Past medical/surgical history c. Physical examination d. All of the above
Answer: D Rationale for why the answer is correct: The review of systems, PMH, PE, and other portions of the SOAP note (FH, SH, medications, etc.) are all useful in identifying/ruling out differential diagnoses. Site for question/rationale: Differential Diagnosis video by Dr. Amy Moore
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If none of the presenting symptoms/assessment findings/lab results point to any differential diagnoses, what must the provider do? a. Discharge the patient b. Refer the patient to a specialty provider c. Rethink the differential diagnoses and review the patient’s information again d. Call another provider in for help
Answer: C Rationale for why the answer is correct: If none of the findings are ruling in or out any differential diagnoses, the provider may need to edit their list and review the information again to avoid missing any key points. Site for question/rationale: Differential Diagnosis for Fatigue video
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What may cause an elevated serum creatinine level? a. Volume depletion b. Overhydration c. Metabolic acidosis d. GI bleed
Answer: A Rationale for why the answer is correct: An elevated serum creatinine level may be caused by volume depletion, renal insufficiency, or renal failure. Site for question/rationale: BMP Voice Thread (slide 16)
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Which of the following is NOT a method you should consider for correcting hyponatremia? a. Using 3% NS when the patient presents with neurological signs/symptoms b. Infusing NS via IV at a maximum of 10meq/L per 24 hours c. Forced diuresis with Lasix and IV NS d. Infusing NS via IV as fast as the patient tolerates in order to achieve prompt correction
Answer: D Rationale for why the answer is correct: Rapid correction of hyponatremia may lead to central pontine myelinolysis. Site for question/rationale: BMP Voice Thread (slide 7)
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What is the gold standard exam for diagnosing intussusception? a. Plain abdominal x-ray b. Ultrasound c. Barium enema d. Stool for occult blood
Answer: C Rationale for why the answer is correct: The barium enema is the gold standard for diagnosing intussusception because it reveals a characteristic “coiled spring” appearance. It may also reduce the intussusception. Site for question/rationale: Abdominal Presentation by Dr. Amy Moore (slide 14)
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What exam may the practitioner order for a suspected cholecystitis in a patient whose ultrasound came back normal? a. CBC b. LFTs c. Barium x-ray d. HIDA scan
Answer: D Rationale for why the answer is correct: A HIDA scan may be ordered to evaluate gallbladder function in a patient whose ultrasound is normal. Site for question/rationale: Abdominal Presentation by Dr. Amy Moore (slide 8)
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How often should a 27-year-old woman have a pap smear exam if her previous pap smear was abnormal? a. Every 3 years b. At every appointment c. Every year d. Every 6 months
Answer: C Rationale for why the answer is correct: A woman 21-29 years old should have a pap smear exam every 3 years if her result is normal. If the patient has had an abnormal result, she should have an annual pap smear done. Site for question/rationale: Women’s Health presentation by Dr. Amy Moore (slide 4)
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Question: A patient’s PSA result comes back at 29. What should the provider do at this time? a. Consider prostate cancer as a possible diagnosis b. Consider referring the patient to a urologist/surgeon c. Immediately start the patient on chemotherapy d. Answers a and b
Answer: D Rationale for why the answer is correct: Any PSA result over 10 should warrant a referral to a urologist/surgeon. A level above 20 is indicative of cancer, although prostate cancer may present with a normal PSA. Site for question/rationale: Men’s Health presentation by Dr. Amy Moore (slide 2)
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Question: Subjective information in SOAP includes: A. Past medical history, physical examination, and ROS B. Vital signs, physical examination, diagnosis C. CC, HPI, PMH, surgical hx, social hx, medications, allergies, family hx, ROS D. Patient's chief complaint
Answer: C Rationale for why the answer is correct: Subjective information is what the patient states. Objective information includes vital signs and physical assessment. The A represents assessment and consists of the actual diagnosis. The P represents plan and includes testing that ties to the diagnosis. Site for question/rationale: Module one SOAP presentation
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Question The ROS includes: A. A review of all the patient's systems B. A review of the patient's systems pertinent to the CC. C. A review of the patient's healthy systems D. A review of the patient's systems related to past medical diagnoses
Answer: B Rationale for why the answer is correct: The ROS includes reviewing the patient's systems related to the chief complaint. The ROS provides the APRN with essential and relevant information in formulating a diagnosis and differential diagnoses. Site for question/rationale: Module 1 SOAP presentation
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A sensitivity test is used to: A. Rule in a disease B. Rule out a disease C. Diagnose a disease D. Rule in and rule out disease
Answer: B Rationale for why the answer is correct: Sensitivity tests are used to rule out a disease. Specificity tests are used to rule in a disease. Site for question/rationale: Module 1 diagnosis ppt slide 9
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Question: Specificity tests will .... A. Have a negative or low LR (likelihood ratio) B. Be used to rule out a disease C. Have a high and low LR (likelihood ratio) D. Have a high or positive LR (likelihood ratio)
Answer: D Rationale for why the answer is correct: High specificity tests will yield high or positive LR. High sensitivity tests will generate a low or negative LR. Site for question/rationale: Module 1 diagnostic video
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Question: The proper terminology for a low WBC count is? A. Leukopenia B. Leukocytosis C. Thrombocytopenia D. Polycythemia
Answer: A Rationale for why the answer is correct: The proper terminology for a low WBC count is leukopenia. Leukocytosis is a high WBC count, and polycythemia is an increased level of RBC. Site for question/rationale: Module 1 Lab WBC presentation slide 7
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Question: What lab value is used to adjust TPN? A. Albumin B. Total protein C. CRP D. Pre-albumin
Answer: D Rationale for why the answer is correct: The half-life of albumin is 20 days; therefore, it is not a good indicator for TPN adjustments. The half-life for pre-albumin is two days, which is appropriate for TPN adjustments. Site for question/rationale: Module 1 Lab CMP video & presentation slide 7
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Question: What test is the most sensitive and specific for cholecystitis? A. HIDA scan B. ERCP C. Ultrasound D. CT scan without contrast
Answer: C Rationale for why the answer is correct: An ultrasound is the most sensitive and specific study for cholecystitis. A HIDA scan can be done to determine the function of the gallbladder if the ultrasound is negative. Site for question/rationale: Common abdominal complaints slide 8
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Question: What test is used to diagnose diverticulitis? A. Abdominal CT scan B. Colonoscopy C. Positive abdominal exam with CBC, WBC, CMP D. Abdominal MRI
Answer: A Rationale for why the answer is correct: Physical exam would include abdominal assessment, labs which include a CBC, WBC, and CMP, but these findings are not used to diagnose diverticulitis. A colonoscopy is not warranted with uncomplicated diverticulitis and, when done, should be scheduled 4-6 weeks after symptoms resolve. An abdominal CT is used to diagnose diverticulitis. Site for question/rationale: Abdominal lecture, slide 10
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Question: A standard vaginal wet prep includes: A. Few lactobacilli, large amounts of WBCs, and no epithelia B. Large amounts of RBCs, a moderate number of lactobacilli, and no epithelia C. Predominance of lactobacilli, few WBCs or RBCs, and some epithelia D. No lactobacilli, a moderate number of WBCs, and no epithelia
Answer: C Rationale for why the answer is correct: Lactobacilli creates the acidic environment needed to kill or inhibit other bacterial growth. Site for question/rationale: Women Diagnostic lecture slide 7
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Question: What is the gold standard test to diagnose testicular cancer A. Scrotal ultrasound B. Scrotal CT scan with contrast C. Biopsy D. Scrotal MRI
Answer: A Rationale for why the answer is correct: Upon physical examination, there may be an enlarging mass that does not transilluminate, but an ultrasound is needed to make a diagnosis. Site for question/rationale: Male reproductive lecture slide 7
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Question: What does the acronym SOAP stand for? a. Subjective Observation Assessment Plan b. Subjective Objective Assessment Plan c. Situation Objective Assessment Plan d. Situation Objective Assignment Plan
Answer: B. Subjective Objective Assessment Plan Rationale for why the answer is correct: The best answer for this question is B. The question is asking what the acronym SOAP stands for. With this type of question for this subject to have only one answer out of the options provided. The reader must pay attention to the answers because there are multiple words the same in each acronym provided. Answers A, C, D are ruled out due to having the incorrect term in the SOAP. Site for question/rationale: See SOAP note presentation at 9:45.
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Question: What are the categories of medications a Nurse Practitioner must ask your patient they are taking? a. Prescribed & Over-the-counter. b. Prescribed & Herbs/Supplements c. Prescribed only d. Prescribed, Over-the-counter, Herbs/Supplements
Answer: D. Prescribed, Over-the-counter, Herbs/Supplements Rationale for why the answer is correct: The best answer for this question is D. The question is asking the categories of medications must be asked by the Nurse Practitioner to assess the patient. Most Nurse Practitioner students forget to ask all THREE categories during the OSCE examinations. All answers have the correct answer in them but do not have all THREE categories, making A, B, C incorrect. Therefore, answer D is the only correct choice. Site for question/rationale: See SOAP Presentation at 17:19. Page 3 of OSCE SOAP Note
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Question: When a patient comes into the clinic, what is the first piece of information the Nurse Practitioner obtained? a. Chief Complaint b. Review of Systems c. History d. Assessment
Answer: A. Chief Complaint Rationale for why the answer is correct: The best answer for this question is A. The question is asking the first piece of information the healthcare provider must obtain. A Nurse Practitioner must find out all the subjective information which is Chief Complaint, Review of Systems, and History. Knowing this information, we can eliminate D. As a Nurse Practitioner, however, the first step is to find out why the patient is in your clinic. The correct answer is A. Site for question/rationale: Rhodes & Jensen, p. 14 & Differential Diagnosis Presentation
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Question: For the Nurse Practitioner, which threshold does she use to determine if the patient needs a diagnostic test? a. Treatment Threshold b. Test Threshold c. Disease Threshold d. System Threshold
Answer: B. Test Threshold Rationale for why the answer is correct: The best answer for this question is B. The question is asking which threshold would be used to determine if the patient needs a diagnostic test. For this question we must know the definitions of each threshold. In our Diagnostic Basic presentation, Dr. Moore only covers Treatment and Test Threshold, therefore we can eliminate C &D. The test threshold determines the probability we are going to order a lab for a patient. The treatment threshold is the probability above which the nurse practitioner most likely knows the diagnosis and treat the patient without doing a diagnostic test. Site for question/rationale: Diagnostic Presentation at 13:58.
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Question: A 29 year old woman comes to your clinic complaining of frequent urination and having blurred vision. Patient’s mother, father, and brother have Type II Diabetes. Patient’s current BMI is greater than 40 and has a history of GDM with the last two pregnancies. As a NP, what lab test need to be ordered? a. CBC b. A1C & 2-hour Oral Glucose Tolerance Testing(OGTT) c. TSH d. CMP
Answer: B. A1C & 2 Hour Glucose Intolerance Test Rationale for why the answer is correct: According to Goyal &Jialal (2020), Diabetes can be diagnosed either by the hemoglobin A1C criteria or serum glucose concentration (2-hour serum glucose). In this test, the serum glucose level is measured before and 2 hours after the ingestion of 75 gm of glucose. DM is diagnosed if the serum glucose level in the 2-hour sample is more than 200 mg/dL. Site for question/rationale: Goyal, R. &Jialal, I. (2020). Diabetes Mellitus Type 2. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513253/
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Question: A patient who had his wisdom teeth removed a month ago complains of a sore mouth, fever, and feels like he cannot catch his breath. Which test is ordered by the nurse practitioner? a. Blood urea nitrogen level b. Complete blood count c. Liver function study d. All the above
Answer: D. All the above Rationale for why the answer is correct: When checking for sepsis, the nurse practitioner must evaluate the CBC for elevation of elevated WBCs, Liver function tests (LFTs) and levels of bilirubin, ALP, and lipase are important in evaluating multiorgan dysfunction or pancreatitis/hepatitis. Increased BUN levels show severe dehydration or renal failure. Site for question/rationale: Bailey, K. & Kalil, A. (2020). Septic Shock Clinical Presentation. Medscape. https://emedicine.medscape.com/article/168402-workup#c8
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Question: In adult patient presents to the clinic with left lower quadrant pain, nausea, and an elevated white blood cell count. which diagnosis is the most likely based on these symptoms? a. Acute cystitis b. Appendicitis c. Cholecystitis d. Diverticulitis
Answer: d. Diverticulitis Rationale for why the answer is correct: Presentation of diverticulitis includes classic left lower abdominal pain, nausea vomiting and possible elevations of WBC, CMP, CBC. An abdominal CT confirm the diagnosis. Site for question/rationale: power point: abdominal presentation; slide:10
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Question: An adult patient presents with a report of epigastric pain, initially occurring intermittently but becoming persistent after eating spicy foods. The nurse practitioner tells the patient to take a deep breath, and asks, “Where do you feel the most pain?” The patient points to his RUQ. Which examination finding is described? a. Psoas Sign b. Obturator Sign c. Murphy’s Sign d. Rovsing’s Sign
Answer: C. Murphy’s Sign Rationale for why the answer is correct: The Murphy sign is used to assess for RUQ pain to help diagnose cholecystitis. When you palpate the gallbladder and find RUQ tenderness which is worse with inspiration, it helps your finding on cholecystitis. Site for question/rationale: Powerpoint: Abdominal Presentation. Slides: 4 &8
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Question: 32 year old patient presents to the clinic with the history of the abnormal pap smear test and is HPV positive. The patient had a follow up colposcopy, which was negative for cervical intraepithelial neoplasia (CIN). When is the next Pap smear test due? a. 6 months b. 12 months c. 3 years d. 5 years
Answer: B. 12 months Rationale for why the answer is correct: According to the American College of Obstetricians and Gynecologist guidelines, if a colposcopy is negative for CIN and HPV is positive, repeat PAP smear and HPV testing should be done 12 months after. Site for question/rationale: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities. (2020). The American College of Obstetrics and Gynecologists https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/10/updated-guidelines-for-management-of-cervical-cancer-screening-abnormalities
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Question: A 66 year old patient ask if they should have a Pap smear test this year. The patient had 2 negative HPV test in the past 10 years. Which is the best response? a. “ Because of your age and history Pap smear screenings are no longer needed.” b. “ Further testing is not needed if you are a heterosexual and in a monogamous relationship.” c. “Pap smears should be done every 3 years until the age of 70.” d. “Pap smears should be continued every year until the age of 65.”
Answer: A. “ Because of your age and history cytology screenings are no longer needed.” Rationale for why the answer is correct: According to the American College of Obstetricians and Gynecologist guidelines, if the patient has had negative HPV test in the last 20 years and adequate screening, the patient no longer needs to be screened. Site for question/rationale: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities. (2020). The American College of Obstetrics and GynecOLOGY
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Question: What section in your SOAP are you going to place information the patient gives you. A. Subjective B. Objective C. Assessment D. Plan
Answer: A. Subjective Rationale for why the answer is correct: This is information the patient is stating to the NP during the interview process. Such as feelings, perception and concerns are gathered from the patient. Site for question: SOAP Note Presentation
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Question: This is where you will record respiratory, skin, and observable data obtained during your patients visit. A. Subjective B. Objective C. Assessment D. Plan
Answer: B Objective Rationale for why the answer is correct: Objective assessment is data that is observed and measurable through observation, physical examination and laboratory findings. Site for question: FNP SOAP note Templet pg. 4 and 5
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Question: Differential diagnosis involves making a list of possible medical conditions that could be causing a patient’s conditions. Which of the following will assist you in making a diagnosis? A. By speaking to friends and family B. By speaking to her pastor C. Conducting a medical history, physical examination and schedule diagnostic testing. D. Schedule a follow-up appointment in two weeks to see how she is doing.
Answer: C. Conducting a medical history, physical examination and schedule diagnostic testing. Rationale for why the answer is correct: A differential diagnosis looks at the possible disorders that could be causing your symptoms. It involves conducting a comprehensive medical history, physical exam and ordering several laboratory and diagnostic test. Site for question: Differential Diagnosis for Fatigue video
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Question: What is the first step in writing a differential diagnosis A. Obtain a comprehensive history B. Develop a treatment plan C. Diagnosis based on history and physical examination D. Obtain the patients chief complaint and write common problems that present with that symptom.
Answer: D. Obtain the patients chief complaint and write common problems that present with that symptom. Rationale for why the answer is correct: Making a list of possible conditions that could be causing a patient’s symptoms. Site for question: Differential Diagnosis for Fatigue video
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Question: That are the three main components that make up a CBC. A. Stem cells B. Bone cells C. RBC, WBC, and Platelets D. None of the above
Answer: C. RBC, WBC, and Platelets Rationale for why the answer is correct: C. The main components are RBC, WBC, and Platelets Site for question: CBC handout pg. 1 and 2
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Question: _________ represents the size of a red blood cell on the CBC lab result. A. MCV B. MMC C. ATT D. RBC
Answer: A. MCV Rationale for why the answer is correct: A. An MCV (Mean Corpuscular Volume) blood test measures the size of the red blood cells. Site for question: CBC handout pg. 9
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Question: The EMS arrives to the ER with a patient and states that the patient has a positive Murphy’s signs. What does that mean. A. When he takes a deep breath, he has pain when pressed in RUQ B. He has pain in the RLQ during left sided pressure C. He has pain in the tender area with pressure and quick release D. He has pain around his umbilicus
Answer: A. When he takes a deep breath, he has pain when pressed in RUQ Rationale for why the answer is correct: Murphy’s sign is useful for differentiating right upper quadrant abdominal pain for inflammation around the gallbladder. Site for question: Abdominal Presentation PP slide #4
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Question: What test will you order to help you diagnose cholecystitis. A. Upper GI serious B. Lower GI serious C. HIDA Scan D. Colonoscopy
Answer: C HIDA Scan Rationale for why the answer is correct: HIDA scan is an imaging procedure used to diagnose problems of the liver, gallbladder and bile duct. Site for question: Abdominal Presentation PP slide #8
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Question: AN NP will determine the severity of the symptoms for a patient with benign prostatic hyperplasia (BPH), she will ask the patient. A. Have you experience any erectile dysfunction B. Have you had hip pain C. Due you have a weak urinary stream D. What color is your urine
Answer: C Due you have a weak urinary stream Rationale for why the answer is correct: Patients with BPH have difficulties with force and frequency of urination, and nocturia. Site for question: Male reproductive health presentation video
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Question: A patient is seen in your office and reports these findings when she performs a breast exam. Which one are you most concern. A. Nipple deviation/ Pulled in nipple B. Different sized breast C. Denser breast tissue on both breast D. A firm ridge along the bottom of each breast
Answer: A Nipple deviation/Pulled in nipple Rationale for why the answer is correct: A pulled in or a deviation of a nipple may be a clinical indicator of breast cancer or other medical problems. Site for question: Women’s Health PP slide#5
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Question: Medical Conditions in what relatives should be listed under family history? a. Parents b. Parents and Children c. Parents, Children, and Siblings d. Grandparents, Parents, Siblings, and Children
Answer: d. Grandparents, Parents, Siblings, and Children Rationale for why the answer is correct: Always ask about these 4 relatives due to genetics. Site for question/rationale: Soap Note Lecture
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Question: Why would quotation marks be place around the results of a diagnostic test in a SOAP note? a. The patient reported the results verbally to the NP. b. The results are the opinion of the NP. c. Results are always in quotation marks. d. The results are still pending.
Answer: a. The patient reported the results verbally to the NP. Rationale for why the answer is correct: The results are in quotation marks because the patient verbally reported them to the NP. The NP has not seen the results themselves. Site for question/rationale: SOAP note lecture
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Which test is not granted waived status? a. Wet Mount b. Urine Pregnancy test c. Blood Glucose Monitor d. Blood Count
Answer: a. Wet Mount Rationale for why the answer is correct: Wet Mount’s are not waived due to requiring special training to perform the test. Training can be obtained through CMS Site for question/rationale: Slide 4 of Basic Diagnostics lecture
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When can a differential diagnosis be made? a. After the chief complain is made. b. Once the chief complaint, history, and physical exams are established. c. After the diagnostic testing is completed. d. After the history is collected.
Answer: b. Once the chief complaint, history, and physical exam are established. Rationale for why the answer is correct: Differential diagnosis made too early or too late can result in errors. The history must be collected in its entirety to get a clear picture of the patient. Physical exam must be done to accurately diagnose the patient and to order the correct tests. Site for question/rationale: Differential diagnosis lecture: fatigue
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Question: What condition would result in an elevated potassium level? a. Renal Failure b. Nausea/ Vomiting c. Volume Depletion d. Diuretics
Answer: a. Renal Failure Rationale for why the answer is correct: In Renal Failure, Kidneys are not working efficiently and can no longer remove excess potassium. Therefore, Potassium builds up in the body and causes levels to increase. Site for question/rationale: BMP lecture slide 9
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Question: Total Bilirubin must be over what value to produce jaundice? a. 0.7 b. 2.5 c. 1.4 d. 1
Answer: b. 2.5 Rationale for why the answer is correct: Typically, total bilirubin must be over 2.5 to produce jaundice. Normal levels are 0.3-1. Therefore, levels must be well above normal levels to produce systemic effects. Site for question/rationale: Complete metabolic panel lecture slide 9
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Question: What is Rovsing’s Sign? a. Pain in tender area with pressure and quick release b. Pain in RLQ during left-sided pressure c. Take a deep breath, pain when pressing RUQ. d. Pain when patient is lying on left side and right thigh is flexed backward.
Answer: B. Pain in RLQ during left sided pressure Rationale for why the answer is correct: palpation in the left iliac fossa may produce pain in the right iliac fossa Site for question/rationale: Abdominal lecture slide 4 under abdominal examination
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Question: In a pediatric patient, a GI barium enema is performed resulting in a “coiled spring” appearance. What is the diagnosis? a. Pyloric Stenosis b. Hirschsprung’s Disease c. Normal appearance d. Intussusception
Answer: D. Intussusception Rationale for why the answer is correct: Intussusception is a condition in which the intestine folds into the section immediately ahead of it giving it a coiled spring appearance. Site for question/rationale: Abdominal Lecture slide 14 under Pediatric GI complaints.
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Question: Which vaginal infection causes cottage cheese like discharge? a. Candidiasis b. Syphilis c. Trichomonas d. Bacterial Vaginosis
Answer: a. Candidiasis Rationale for why the answer is correct: Candidiasis (yeast infection) typically produces a thick, clumpy, white discharge that resembles cottage cheese. Site for question/rationale: Slide 10 on Women’s Health Overview of Diagnostics Part-2
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Question: What male reproductive disorder is typically due to an STI? a. Hydrocele b. Varicocele c. Epididymitis d. Testicular Torsion
Answer: c. Epididymitis Rationale for why the answer is correct: Epididymitis is inflammation of the epididymis typically due to an STI such as Chlamydia or Trichomonas. Site for question/rationale: Male Reproductive lecture slide 4
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Question: A patient states that feels tired because she cannot sleep at night and that she has been taking melatonin to see if it helps. These findings all belong in which part of the SOAP note? a. Objective b. Subjective c. Assessment d. Plan
Answer: B Rationale for why the answer is correct: These are all things that the person has said to us, therefore, there are subjective. Site for question/rationale: Dr. Mello, Hilliard and Moore’s SOAP note video
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Question What should the NP ALWAYS include in a plan? a. Education and follow up b. Diagnostics c. Medications d. Referrals
Answer: A Rationale for why the answer is correct: Diagnostics, medications and referrals are not necessarily going to be needed for every situation. However, education and follow up plan should be included for all patient at every visit. Site for question/rationale: Drs. Mello, Hilliard and Moore’s SOAP note video.
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Question: Which of the following components will affect your differential diagnoses? a. History b. Physical Examination c. Review of Systems d. All of the above
Answer: D Rationale for why the answer is correct: Your findings in the review of systems, physical examination and patient’s history will all affect (help narrow or broaden) your differential diagnosis Site for question/rationale: Dr. Amy Moore’s video on differential diagnosis.
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Question: When determining differential diagnoses, what does “must not miss” mean? a. A must not miss differentlal diagnosis is one that the provider must not miss because it is the most common diagnosis for patient’s complaints b. A must not miss differentlal diagnosis is the one diagnosis that the patient has been diagnosed before so the provider has to include it in the differentials c. A must not miss differentlal diagnosis is a diagnosis that if missed could cause mortality or morbity in the patient.
Answer: C Rationale for why the answer is correct: A must not miss diagnosis is one that if missed could cause harm to the patient. Site for question/rationale: Illness script example
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Question: A patient is found to have macrocytic anemia, what is the next lab diagnostic that the NP should order? a. Guaiac fecal occult blood test (gFOBT) b. Serum iron level c. B12 levels d. Folate levels
Answer: C &D Rationale for why the answer is correct: gFOBT would be good to test in a patient with normocytic anemia without an obvious; serum iron levels would be a lab diagnostic to order for someone with microcytic anemia; macrocytic anemias are frequently due to B12/folate deficiencies, therefore, drawing a B12 and folate level would be a good place to start. Site for question/rationale: Dr. Shelley Seth’s voice thread on CBC
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Question: Which lab is a very specific reflection of the liver? a. ALT b. AST c. Alkaline phosphatase d. Albumin
Answer: A Rationale for why the answer is correct: AST can be secreted by other tissues in the body (heart, brain); Alkaline phosphatase can also increase with issues in the gallbladder and pancreas and it is secreted by bones; albumin may also be affected by renal disease, severe malnutrition, heart failure or DM. Site for question/rationale: Dr. Shelley Seth’s voice thread on CMP LFTs
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Question: To diagnose pancreatitis, which diagnostic(s) need to be used? a. Elevated (greater than 3x’s normal) serum lipase and amylase and abdominal pain b. Abdominal pain and positive CT scan c. Positive CT scan and elevated (greater than 3x’s normal) serum lipase and amylase d. Positive CT scan and elevated (greater than 3x’s normal) serum amylase
Answer: B Rationale for why the answer is correct: Serum lipase and amylase may be back down to normal if not checked during early onset, alcoholism can skew results of serum lipase/amylase. Both abdominal pain and positive results on CT scan should be present to diagnose Site for question/rationale: Dr. Moore’s abdominal pain video
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Question: What is the most sensitive and specific diagnostic for cholecystitis? a. Elevated WBCs (leukocytosis) b. Elevated alkaline phosphatase, AST, ALT and bilirubin c. Ultrasound d. HIDA scan
Answer: C Rationale for why the answer is correct: HIDA scan is used if US is negative; elevated WBCs and elevated alkaline phosphatase, AST, ALT and bilirubin are not specific AND sensitive Site for question/rationale: Dr. Moore’s abdominal pain video
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Question: How often should a 21-29 year old average risk woman get a Pap Smear? a. Every 3 years b. Not needed if patient is not sexually active c. Every 5 years d. Annually
Answer: A Rationale for why the answer is correct: All of the guidelines state that a pap smear should be done every 3 years for all 21-29 year old women; annual pap smears are no longer recommended; for women 30-65, HPV + pap smear can be done in order to prolong interval of testing to every 5 years. Denial of sexual activity does not preclude need for pap smear. Site for question/rationale: Dr. Moore’s Women’s Health Preventative Care video and Women’s Health Screening Guidelines
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Question: Which of the followings diagnostic tests would the NP order for a male that presents with scrotal pain that decreases with elevation of the testes and urethral discharge? a. Chlamydia/gonorrhea b. Fractional urination examination c. CT d. Scrotal US
Answer: A &D Rationale for why the answer is correct: Epididymitis often is due to an STI such as chlamydia and gonorrhea, urethral discharge is another symptom that could indicate an STI fractional urination exam is used in prostatitis; Scrotal US would also be valuable here. Site for question/rationale: Dr. Moore’s male reproductive video
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Who do you all include in the family history? A. Grandparents and parents B. Parents, grandparents, siblings, and children C. However far back the patient can remember D. Including the family history is extra information
Answer: B. Rationale: You must include the parents, grandparents, siblings, and any children in the family history in order to help identify any genetic components Ref: (SOAP voice note lecture, minute 18:30)
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What kind of information should go into the review of systems (ROS)? A. Physical exam B. Subjective information C. Objective D. Heart rate, temperature, and blood pressure
Answer: B. Rationale: Subjective information is the only information listed that should go into the ROS Ref: (SOAP voice note lecture, minute 20:20)
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To rule IN a diagnosis, you would want which of the following? A. Low sensitivity B. High sensitivity C. Low specificity D. High specificity
Answer: D. Rationale: To rule IN a diagnosis, you would want a high specificity because it should be positive if it has a high specificity Ref: (Basic Diagnostics PP, slide 9)
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To rule OUT a diagnosis, you would want which of the following? A. Low sensitivity B. High sensitivity C. Low specificity D. High specificity
Answer: B. Rationale: To rule OUT a diagnosis, you would want a high sensitivity. This means how well the test can detect the disease. It excludes the diagnosis if negative Ref: (Basic Diagnostics PP, slide 9)
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What is one thing to know about lymphocytes and neutrophils? A. Lymphocytes often show viral infections whereas neutrophils show bacterial B. There is no major difference C. There are more lymphocytes than neutrophils D. They are equally present (in quantity) in the body
Answer: A. Rationale: Lymphocytes often show viral infections, neutrophils show bacterial. There are more neutrophils than lymphocytes in the body Ref: (CBC PP, slide 12 and 17)
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Which is false about BMPs? A. Does not include albumin. B. Order if daily labs are needed. C. Only order it once a year. D. Includes BUN.
Answer: C. Rationale: BMPs are usually included in daily labs. It does not include albumin but does include BUN Ref: (BMP PP, slide 1)
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What exam technique would you use when trying to rule in cholecystitis? A. Rebound tenderness B. Heal tap C. Murphy’s sign D. Psoas sign
Answer: C. Rationale: The other exams listed are for appendicitis Ref: (Common Abdominal Complaints PP, slide 5)
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8. If you see “coiled spring” which diagnosis are you likely going to rule in? A. Pyloric stenosis B. Hirschsprung’s C. Cholecystitis D. Intussusception
Answer: D. Rationale: The barium enema will show coiled spring in intussusception Ref: (Common Abdominal Complaints PP, slide 14)
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Which recommendation regarding pap smears is true? A. Starting at age 21 until 29, every 3 years, if sexually active B. If there is a family history of ovarian cancer, check sooner C. If there was an abnormality at age 21, check again in 3 years D. Starting at age 21 until 29, every 3 years
Answer: D. Rationale: Pap smears should start at age 21 to 29, every 3 years if normal results in order to detect cervical cancer, regardless if they are sexually active Ref: (Women’s Health PP, slide 4)
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Which one is false about testicular cancer? A. If corrected, there is no increased risk of testicular cancer with cryptorchidism B. Scrotal US is the gold standard for diagnosis C. Occurs ages 15-35 D. The testicular mass will be solid, firm, and nontender
Answer: A. Rationale: Even if corrected, there is still a 20-46x increased risk of testicular cancer with cryptorchidism. The rest of the information is correct about testicular cancer Ref: (Male Reproductive, slide 4 and 7)
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In a SOAP note, objective data includes? a. Review of systems b. Chief complaint c. Physical exam d. History of present illness
Answer: Physical exam Rationale for why the answer is correct: Review of systems, chief complaint and history of present illness are obtained by patient interview and are subjective data. Physical exam is objective data obtained by the provider’s assessment. Site for question/rationale: SOAP note presentation by Dr. Seth in Module 1
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Question: in OLD CARTS, a mnemonic used for describing the chief complaint, the C stands for describing the: a. Cause b. Character c. Corner d. Constitution
Answer: B. Character. Rationale for why the answer is correct: The character of a chief complaint is important when fully describing a patient’s chief complaint in the HPI. Site for question/rationale: Dr. Shelly Seth’s SOAP note presentation
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The probabilistic method of decision-making is: a. Based on the provider’s experience b. Based on the provider’s pattern recognition c. Based on the provider’s gut instinct d. Based on the diagnostic of a provider’s test results
Answer: D. Rationale for why the answer is correct: D. Probabilistic method of decision-making is based on a provider’s test results and utilizes pre-test probabilities that a patient is likely to have a diagnosis prior to testing for a disease process. Provider’s experience and pattern recognition describe pattern recognition as a method of decision-making. Gut instinct is incorrect. Site for question/rationale: Basics of diagnostics presentation by Dr. Amy Moore. 10:00
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Question: A provider would treat empirically when: a. A patient has a high probability of disease b. A patient has a low probability of disease c. A patient is below the test threshold d. A patient has a low treatment threshold
Answer: A Rationale for why the answer is correct: if a patient has a high probability of disease then the patient can be treated empirically. If a patient has a low probability of disease or is below the test threshold, you will not treat without doing further testing. A patient would need a high treatment threshold, not a low treatment threshold to empirically. Site for question/rationale: Basics of diagnostics presentation by Dr. Amy Moore. 15:30
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Your patient has a total bilirubin of 3.0, you order an indirect and a direct bilirubin to further investigate. The indirect bilirubin results come back higher than normal levels. You know that a high indirect bilirubin most likely indicates a problem with the: a. Spleen b. Pancreas c. Gallbladder d. Liver
Answer: D Rationale for why the answer is correct: Indirect or unconjugated bilirubin, if elevated, indicates a problem in the liver. An elevated direct or conjugated bilirubin indicates a problem past the liver (in the gallbladder or pancreas). Bilirubin levels do not indicate problem in the spleen. Site for question/rationale: Dr. Shelly Seth’s CMP & LFT presentation. Slide 9.
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Question: You suspect liver disease in your patient. You order LFTs and you notice that your GGT to ALP ratio is greater than 5. You know that this indicates: a. Shock Liver b. Alcoholic liver c. Gallbladder Disease d. Pancreatitis
Answer: B Rationale for why the answer is correct: GGT rises greater than ALP in alcoholism. A GGT ratio to ALP \>5 indicates alcoholic liver. Site for question/rationale: Dr. Shelly Seth’s CMP & LFT presentation. Slide 18.
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A diagnosis of pancreatitis would include all of the following diagnostics, except: A. Abdominal pain B. Positive Psoas sign C. Serum Lipase and/or Serum Amylase (\>3x normal limits) D. CT scan
Answer: B. Positive Psoas sign Rationale for why the answer is correct: Pancreatitis diagnostics include 2 of 3 of the following: abdominal pain, Serum Lipase and/or Serum Amylase (greater than 3x normal limits, CT scan. Positive Psoas sign is diagnostic of appendicitis. Site for question/rationale: Common abdominal complaints by Dr. Amy Moore Slide # 11, minute 16:00.
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Question: Your patient comes to you with a complaint of severe abdominal pain. The patient’s labs and physical exam are notable for the following: Leukocytosis (WBC 15,000), elevated ALT, AST, & bilirubin, and a positive Murphy’s sign. You know that the most likely diagnosis is \_\_\_\_\_\_\_\_\_, and you will order _________ to confirm your suspicions. a. Appendicitis, abdominal ultrasound B. Appendicitis, abdominal CT C. Cholecystitis, abdominal ultrasound D. Cholecystitis, abdominal CT
Answer: C. Cholecystitis, abdominal ultrasound Rationale for why the answer is correct: Cholecystitis is characterized by leukocytosis in \>70% of patients, can have elevated Alkaline phosphatase, ALT, AST & bilirubin, and a positive murphy’s sign on physical exam. The most specific and sensitive study for cholecystitis is ultrasound. Appendicitis is diagnosed with abdominal CT. Site for question/rationale: Common abdominal complaints by Dr. Amy Moore. Slide 8.
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Question: Pap smears are recommended every 3 years for patients aged 21 -29. A pap smear screens for the following: A. Ovarian cancer B. HPV C. Cervical Cancer D. Gonorrhea
Answer: C. cervical cancer Rationale for why the answer is correct: A pap smear tests for abnormal cells that lead to cervical cancer, a pap smear does not automatically test for HPV strains, unless abnormal cells are found. Ovarian cancer cannot be detected by a pap smear. Gonorrhea may be tested when a pap smear is completed but is not included in the pap smear test. Site for question/rationale: Women’s health presentation by Dr. Amy Moore, slide 4.
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Question: Mr. H is a 20-year-old male with no past medical history. He presents to your clinic with complaints of a testicular mass that he has had for a while, but it is enlarging and states that his scrotum “feels heavy.” For a diagnostic work-up you know that the gold standard for diagnosing testicular cancer is: A. Abdominal CT B. Tumor markers C. Sperm count D. Scrotal ultrasound
Answer: D. Scrotal ultrasound Rationale for why the answer is correct: Scrotal ultrasound is the gold standard for diagnosing testicular cancer. Abdominal CT and tumor markers may be ordered as supporting diagnostics. Sperm count would not be ordered to diagnose testicular cancer. Site for question/rationale: Dr. Amy Moore’s Male Reproductive health presentation. Slide 7.
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Question: A 24-year-old female presents to the clinic for “headache\*3 weeks and nausea.” Which part of the patient’s history and physical would be considered objective information? Answer: A) The patient states the headache has a throbbing-like quality B) The patient reports a 4-pound weight loss in the last 3 weeks C) The patient has pale mucous membranes on exam D) The patient’s family medical history is positive for migraines
Answer: C Rationale for why the answer is correct: Objective information is information gathered by the provider. In this case, answers A, B, and D are all information given to the provider by the patient, with answer choice C being the only data collected by the provider themselves. Site for question/rationale: “Soap Note Presentation” video from Module 1 Marker 20:26-22:29
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Question: A 57-year-old male presents to the emergency room for chest pain that began in the morning and persisted throughout the day. On exam, the patient is pale and diaphoretic with a BP 180/100, HR 104, RR 26, and T 37.0 oral. Where in the soap note would be the appropriate location to document the patient appearing pale and diaphoretic? Answer: A) Subjective information B) Chief complaint C) Patient assessment D) B or C
Answer: C Rationale for why the answer is correct: The patient appearing pale and diaphoretic is information gathered from the provider during a patient assessment. Although, this could be considered objective information, the most appropriate place for the documentation of a provider’s observation of a patient’s appearance is in the patient assessment section. Site for question/rationale: “Soap Note Presentation” video from Module 1 Marker 20:26-22:57
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Question: What statement about the difference about differential diagnosis is not correct? Answer: A) A differential diagnosis may be a working diagnosis B) A differential diagnosis is always a new diagnosis C) A differential diagnosis is a plausible explanation of the patient’s current chief complaint D) A differential diagnosis explains some of the patient’s current symptoms, but maybe not all of the patient’s symptoms
Answer: B Rationale for why the answer is correct: A differential can be a working diagnosis while running additional testing and labs. A differential diagnosis is also a plausible explanation of the patient’s current chief complaint. The differential diagnosis does not always have to be a new diagnosis, because it can be an exacerbation of a previous diagnosis. Site for question/rationale: Dr. Seth’s video on “SOAP notes” Time Mark 23:55-24:50 in Module
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Question: A 78-year-old patient presents to the emergency room with joint pain\*1 week and fever of unknown origin. What is the best way to develop differential diagnoses? Answer: A) Complete a full history and physical, making sure to ask to follow up questions when appropriate B) Begin to create a differential list before asking the patient any follow up questions C) Ask as many questions as your time allows D) Look at the patient’s comorbidities because likely the differential is related
Answer: A Rationale for why the answer is correct: In the differential diagnosis video, Dr. Moore refers many times to the importance of completing a full history and physical with relevant follow up questions before deciding on differential diagnoses. Site for question/rationale: Dr. Moore’s “Differential Diagnosis” video from Module 1 Marker 4:57-5:03, 5:36-5:38, 6:04-6:13
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Question: A 92-year-old patients with CKD presents to the ER for a fistula infection. The ER nurse draws a rainbow of labs and recognizes that which finding in the CBC best indicates that the patient has a bacterial infection rather than another type? Answer: A) An elevated WBC count B) An elevated monocyte count C) An elevated basophil count D) An elevated neutrophil count
Answer D Rationale for why the answer is correct: An elevated WBC count would be elevated in both a bacterial and viral infection. An elevated neutrophil count is more specific to a bacterial infection. An elevated basophil count would be expected most commonly in autoimmune type reactions or cancers of the bone. An elevated monocyte count would be elevated most often in chronic illness, hematological disorders, and malignancies. Site for question/rationale: Dr. Seth’s Lecture/Video on “CBC Lecture” in Module 1 Marker 8:10-8:26
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Question: A 62-year-old patient presents to the ER for non-specific abdominal pain and a PMH positive for ETOH abuse. The patient additionally reports nausea without vomiting and intermittent bloating for the past 2 days. He states the pain has been steadily increasing and today he could barely make it out of bed. The provider orders a rainbow of labs with concern for pancreatic or ductal problems given the patient's history. Which laboratory finding on the CMP would assist the provider in detecting a problem in the liver rather than in another organ? Answer: A) Elevated indirect (unconjugated) bilirubin B) Elevated ALT C) Elevated direct (conjugated) bilirubin D) Elevated WBC
Answer : A Rationale for why the answer is correct: The liver is the site of bilirubin conjugation, making an elevation in already conjugated bilirubin a problem that exists past the liver (since the liver has already conjugated the bilirubin). An elevation of unconjugated bilirubin is more specific to liver dysfunction because if the bilirubin is unconjugated the liver is not doing its' job to conjugate it. An elevated WBC count in this case would not help distinguish between a liver rather than another organ injury. ALT elevation although can occur in liver dysfunction or injury can also be elevated in with other organ dysfunction, such as with the gallbladder so would not be the best test to differentiate between liver or other organ issues. Site for question/rationale: Dr. Seth’s “CMP/LFT” Lecture in Module 1 Slide #9 (including title slide)
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Question: An 81-year-old female recently treated with at a local community hospital for Community Acquired Pneumonia where she was admitted for 5 days and completed her course of prescribed antibiotics. She now presents to the emergency room with generalized fatigue and diarrhea that she describes as “non-stop.” What patient finding would prompt the provider to send a stool culture? Answer: A) Recent course of antibiotics B) T 100.3 orally C) Diarrhea being described as “non-stop” for 1 day D) Non-specific complaint of fatigue
Answer: A Rationale for why the answer is correct: In the video, Dr. Moore discusses red flags on when to send a stool culture in a patient. She mentions antibiotic use, blood in stool, fever\>101.3, leukocytes in the stool, as well as lactoferrin in the stool. This patient meets one of these criteria with the recent course of antibiotics, which would make this the most appropriate choice. Site for question/rationale: Dr. Moore’s video on “Abdominal lab/tests” at 6:13-6:46
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Question: A 27-year-old patient familiar to the Emergency Department for ETOH withdrawal presents with diffuse abdominal pain. The provider orders a serum amylase and lipase, which were both markedly elevated. What further information is needed to diagnose the patient with pancreatitis? Amylase 215 U/L (normal values: 23-85 U/L) Lipase 206 U/L (normal values: 0-160 U/L) Answer: A) A CT scan will confirm the diagnosis of pancreatitis B) The patient meets the criteria for the diagnosis of pancreatitis C) A gastroenterology consult would be needed D) Check the patient’s current ETOH level and electrolytes
Answer: B Rationale for why the answer is correct: The patient meets the American Academy of Gastroenterology criteria for diagnosing pancreatitis presented in Dr. Moore’s video on Common Abdominal Complaints. The patient meets 2 of the 3 criteria including a complaint of abdominal pain and elevated serum lipase and/or serum amylase. Site for question/rationale: Dr. Moore’s video on “Abdominal labs/tests” Marker 15:01-16:39
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Question: A 25-year-old woman comes to her OB/GYN clinic with complaints of white discharge from her vagina. The APRN performs a wet prep to assess for vaginitis. What finding from the NaCl wet prep would be suspicious for candidiasis? Answer: A) Many lacto-bacilli present B) Few WBCs present C) Clue cells present \>20% D) Motile protozoa present
Answer B Rationale for why the answer is correct: According to slide 10 in the Women’s Health Diagnostics Lecture Part 2 by Patricia Olenick, few WBCs present would be the expected finding in a woman with candidiasis. Lacto-bacilli would be present in normal vaginal discharge. Clue cells\>20% would be present in bacterial vaginosis. Finally, motile protozoa present would be characteristic of trichomoniasis. Site for question/rationale: Dr. Olenick’s “Women’s Health Diagnostic Overview Part 2” Lecture/Video in Module 1 Slide #10
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Question: A 23-year-old male presents to the ER with an enlarged testicle. He reports the testicle is painless but “is really getting in the way.” As the APRN what is the best diagnostic study would be best to order on this patient to confirm your suspicion of testicular cancer? Answer: A) Abdominal CT scan B) Tumor markers C) The diagnosis can be made based on exam and physical findings D) Scrotal ultrasound
Answer D Rationale for why the answer is correct: According to Dr. Moore’s video on male reproductive diagnostics, a scrotal ultrasound is the gold standard for diagnosis of testicular cancer. The provider may order additional diagnostic studies such as tumor markers and CT, but they are not considered the gold standard. Site for question/rationale: Dr. Moore’s “Male Reproductive Health Presentation” Video/Lecture Slide #7 in Module 1
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Question: When documenting the patient’s chief complaint, it important to: a. Use the patient’s own words in quotations b. Include a short summary of the events leading to the incident or illness c. Included the onset, location, duration, characteristics, alleviating factors, timing, exacerbating factors, and severity of the symptoms d. Dismiss the patient’s complaint if physical exam and diagnostic testing do not support the patient’s complaint
Answer: A – use the patient’s own words whenever possible. Rationale for why the answer is correct: The chief complaint is a statement by the patient of why they are seeking medical attention. It is usually quoted by the provider during the ROS. Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth, Time Mark 2:08
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Question: Family history should include how many generations? a. 1 b. 2 c. 3 d. 4
Answer: D. Family history should include four generations: grandparents, parents, siblings and children (when applicable). Rationale for why the answer is correct: Family history should include investigating health history of patients’ immediate family going upwards (parents and grandparents), downwards (children) and sideways (siblings). Site for question/rationale: SOAP Note Presentation by Dr. Shelly Seth, Time Mark 3:57
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Question: What is the type of decision making referred to as ‘probabilistic’? a. Recognizing the pattern of a disease process which leads you to a diagnosis b. Likelihood of presence of disease based on scientific estimates of disease prevalence in a given patient population c. Provider intuition based on clinical knowledge and experience of how often a patient with symptoms has any given disease d. Likelihood of a disease after diagnostic testing is performed
Answer: B Rationale for why the answer is correct: Probabilisitic decision making is based on scientific research that predicts the likelihood of a disease in a given population exhibiting specific signs and symptoms Site for question/rationale: Dr. Terry Shaneyfelt’s video on Diagnostic Process, Time Mark 1:21
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Question: What is pre-test probability? a. Chance that the patient has a disease after further testing is performed b. The point at which diagnostic testing should be ordered c. Chance that the patient has a given disease prior to any further testing d. The point at which treatment should be given
Answer: C Rationale for why the answer is correct: Pre-test probability tells providers how likely it is that a patient has a disease or illness before any diagnostic testing is ordered. Patients who have a low pre-test probability likely do not need further testing. Site for question/rationale: Dr. Terry Shaneyfelt’s video on Diagnostic Process Time Mark 2:49
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Question: What is the most common electrolyte abnormality? a. Hypokalemia b. Hyperglycemia c. Hyponatremia d. Hyperkalemia
Answer: C Rationale for why the answer is correct: Hypokalemia is the most common electrolyte abnormality. Site for question/rationale: BMP lecture by Dr. Shelly Seth, Time Mark 2:12
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Question: A rise in eosinophils may be caused by a. Cancer b. Bacterial infection c. Chronic illness d. Parasitic infection
Answer: D Rationale for why the answer is correct: Rise in eosinophils may be caused by parasitic infection, allergies, addition of a new drug, or aspergillosis or Churg-Strauss syndrome in asthmatics. Site for question/rationale: CBC lecture by Dr. Shelly Seth, Time Mark 16:12
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Question: A patient experiences pain when taking a deep breath and pressure is applied to the RUQ. What is this test called and what is it a positive sign for? a. Obturator sign; appendicitis b. Psoas sign; pancreatitis c. Murphy’s sign; cholecystitis d. Heel tap; peritonitis
Answer: C Rationale for why the answer is correct: Murphy’s sign is considered positive for cholecystitis when the patient has pain while taking a deep breath and pressure is applied to the right upper quadrant. Site for question/rationale: Dr. Amy Moore’s Abdominal lecture, Time Mark 4:54
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Question: Leukocytosis, elevated liver function tests, and positive Murphy’s sign are indicative of what disease process? a. Appendicitis b. Gastroenteritis c. Hepatitis d. Cholecystitis
Answer: D Rationale for why the answer is correct: Cholecystitis is characterized by RUQ pain on inspiration, WBCs 12-20, elevated alkaline phosphates, ALT, AST and bilirubin, and elevated GGT if the bile duct is obstructed. Site for question/rationale: Dr. Amy Moore’s abdominal PowerPoint presentation, slide 8.
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Question: The absence of one or both testes on palpation of the scrotum is called: a. Testicular torsion b. Cryptorchidism c. Epididymitis d. Spermatocele
Answer: B Rationale for why the answer is correct: Chryptorchidism is definite as the absence or one or both testes on palpation of the scrotum. Site for question/rationale: Dr. Amy Moore’s Male Reproductive PowerPoint presentation, slide 4
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Question: On wet mount, the provider notes that a patient’s vaginal swab sample includes motile flagellated Protozoa and many WBCs. What is the most likely diagnosis? a. Candidiasis b. Bacterial vaginitis c. Trichomoniasis d. Chlamydia
Answer: C Rationale for why the answer is correct: Trichomoniasis is characterized by motile Protozoa and many WBCs on wet mount, itch, frothy gray or yellow discharge that is malodorous, and a “strawberry cervix”. Site for question/rationale: Dr. Olenick’s Women’s Health Diagnostic Overview Part 2 PDF, slide 10
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Question: In what section of your SOAP note would the use of a mnemonic like OLDCARTS be most appropriate: A. History of Present Illness (HPI) B. Chief Complaint (CC) C. Past Medical History (PMH) D. List of Medications
Answer: History of Present Illness (HPI) Rationale for why the answer is correct: Use of a mnemonic like OLDCARTS will help the provider gather pertinent information related to the patient’s chief complaint, including onset, location, duration, character, aggravating/alleviating, region/radiating, timing, and severity/scale. The information gathered is used to form a thorough history of present illness (HPI). The chief complaint should be a shortened or condensed patient statement/quotation. The mnemonic would not help to illicit or provide the patient’s past medical history and/or list of medications. Site for question/rationale: Dr. Shelly Seth’s “SOAP Note Presentation” at time stamp 12:50
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Question: What is not one of the three categories you as a provider should ask the patient when filling out the medication list in your SOAP note? A. Prescribed Drugs B. Over-the counter (OTC) Drugs C. Herbs/supplements D. Tobacco Use
Answer: Tobacco Use Rationale for why the answer is correct: The medication section of your SOAP note should include prescription drugs (including dose, route, frequency/schedule), any over the counter drugs (either currently in use or used occasionally), as well as any herbs/supplements used by the patient. It would be correct to address tobacco use in the social history section of your SOAP note, but tobacco should not be listed as a medication. Site for question/rationale: Dr. Shelly Seth’s “SOAP Note Presentation at time stamp 17:36
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Question: A provider should utilize all of the following except ________ to help form his or her list of differential diagnoses during a patient’s initial visit? A. Chief Complaint (CC) B. Lab/Test Results C. History of Present Illness (HPI) D. Review of Systems (ROS)
Answer: Lab/Test Results Rationale for why the answer is correct: Patient chief complaint (CC), history of present illness (HPI) and review of systems (ROS) help the provider formulate a working differential diagnosis, whereas test results help to confirm the differential diagnosis you suspect. Making a list of your differential diagnoses is done prior to ordering and obtaining test results. Site for question/rationale: “Differential Diagnosis for Fatigue” video by Dr. Mello, Dr. Hilliard, and Dr. Moore at time stamp 15:25
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Question: The provider begins to narrow down his/her list of differential diagnoses, knowing that _____ is an important factor to consider before ordering multiple laboratory tests. A. Cost B. Family presence C. Gender D. Age
Answer: Cost Rationale for why the answer is correct: Cost is always a factor when deciding to order which tests, how many tests, or to even order testing at all. If the patient does not have medical insurance, the patient’s insurance does not cover a test, or the patient cannot afford the out-of-pocket cost for a test, the provider must determine how to refer/provide patient resources for testing, or the provider must form another plan to confirm his or her differential diagnosis. Site for question/rationale: “Differential Diagnosis for Fatigue” video by Dr. Mello, Dr. Hilliard, and Dr. Moore at time stamp 13:41
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Question: During clinicals, you are discussing possible causes of a patient’s macrocytic anemia. During the work-up, both the B12 and folate levels are normal, and the patient’s social history is negative for alcohol abuse. Your preceptor asks what lab or labs would be appropriate to order next, based on the most common causes of macrocytic anemia. The correct response is: A. Ferritin B. TSH C. Serum Iron D. Transferrin
Answer: TSH Rationale for why the answer is correct: A serum iron, Ferritin, or Transferrin would be ordered as part of the workup for microcytic anemia. TSH is the next lab in the workup for macrocytic anemia, after testing B12 and folate levels initially. Site for question/rationale: Dr. Shelly Seth’s voice thread presentation, “CBC” at time stamp 24:24, 24:50, and 26:45. All three places provide the answer with an excellent explanation, but time stamp 24:50 specifically states the potential for a test question similar to this one and makes a point to say that iron studies would be the incorrect/distraction choices.
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Question: Why would you order a pre-albumin level instead of an albumin level? A. Pre-albumin values are profoundly affected by hydration. B. Pre-albumin is a standard part of the Complete Metabolic Panel (CMP) order set. C. Pre-albumin is used to evaluate response to treatment, as its half-life is 2 days. D. Pre-albumin levels are very slow to change, taking up to two weeks to normalize.
Answer: Pre-albumin is used to evaluate response to treatment, as its half-life is 2 days. Rationale for why the answer is correct: Hydration does not affect pre-albumin levels. Pe-albumin is not on a CMP. Albumin levels, not pre-albumin levels, are slow to change, taking up to 14 days to return to normal. Pre-albumin’s half life is 2 days, making it the better choice to evaluate a patient’s response to treatment, those who are depending upon protein for healing. Site for question/rationale: Dr. Shelly Seth’s voice thread presentation, “CMP/LFT’s” at time stamp 3:39
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Question: During your abdominal exam, you suspect appendicitis, so you place your hand above the patient’s right knee and have them raise it. What technique did you just perform? A. Rebound tenderness test B. Rovsing’s Sign C. Obturator Sign D. Psoas Sign
Answer: Psoas Sign Rationale for why the answer is correct: Rebound tenderness is a technique where the provider presses down on the tender area and then does a quick release of pressure. Rovsing’s sign is pain in the RLQ when the provider places pressure on the patient’s left side. The obturator sign is where the provider will flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. While all these techniques are used to examine for appendicitis, psoas sign is the correct name of the performed maneuver/technique. Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Abdominal lab/tests” at time stamp 2:43
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Question: You suspect your patient may have cholecystitis. The most sensitive and specific study for cholecystitis is: A. Ultrasound B. CT scan of the abdomen C. Abdominal Xray D. Barium enema
Answer: Ultrasound Rationale for why the answer is correct: Ultrasound is the most sensitive and specific test for cholecystitis because you are looking for gallstones. Abdominal CT scan would be used for appendicitis. Abdominal XR would be used for Hirschsprung’s Disease. Barium enema is the gold standard for intussusception. Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Abdominal lab/tests” at time stamp 11:27
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Question: Mammogram screenings should be performed until at least what age? A. Age 45 B. Age 55 C. Age 65 D. Age 75
Answer: 75 Rationale for why the answer is correct: Screening mammograms should start around age 40 (if no family or past medical history of breast cancer) and continue until at least age 75 (can continue past age 75 if the patient would like to). Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Women’s Health – Preventative Care” at time stamp 14:47
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Question: A 13-year-old male complains of sudden, acute, severe, unilateral scrotal pain and swelling. You strongly suspect testicular torsion and advise the patient to ______ ? A. Take a dose of OTC pain medication PRN and no sports for 1 week. B. Make an appointment to see you in the clinic within the next few days. C. Go immediately to the emergency room. D. Take a warm bath and avoid tight clothing for 48 hours.
Answer: Go immediately to the emergency room. Rationale for why the answer is correct: Testicular torsion is a medical, and potentially a surgical, emergency. Outcome is dependent upon the time of correction so early diagnosis and treatment is paramount. Site for question/rationale: Dr. Amy Moore’s voice thread presentation, “Male Reproductive Health Presentation” at time stamp 13:02
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Question: What is the difference between “Subjective” and “Objective” data while gathering information in a S.O.A.P. note? Answer: A. Subjective information is what the provider sees and develops a plan on. B. Objective information is what the patient is complaining about in chief complaint. C. Subjective information is what you as the provider are told from the patient. D. Objective information is what you as the provider sees and does to the patient. E. Both A and B F. Both C, D
Answer: F Rationale for why the answer is correct: A common mistake is distinguishing between symptoms and signs. Symptoms are the patient's subjective description and should be documented under the subjective heading, while a sign is an objective finding related to the associated symptom reported by the patient Site for question/rationale: Dr. Seth video on S.O.A.P note.
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Question: When ordering a diagnostic test, what is the role of the test? A. To Rule in a diagnosis B. To Rule out a diagnosis C. To confirm the patient’s chief complaint D. Answer A, B are both correct, E. All of the above are correct.
Answer: D Rationale for why the answer is correct: Rule in- the goal is to confirm patient has the disease. Rule out- the goal is to confirm the patient doesn’t have the disease. Site for question/rationale: How to choose a diagnostic test you tube video.
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Question: When ordering intricate diagnostic tests, what two parameters are important to consider. A. Patient age and gender B. Ethnicity and religious beliefs C. Sensitivity and specificity of test D. Patients insurance and coverage
Answer: C Rationale for why the answer is correct: Diagnostic testing can be very expensive. When intricate tests are ordered an important detail to consider is the sensitivity and specificity of the tests in order to rule in or out a diagnosis. Site for question/rationale: Differential Diagnosis for Advanced Practice Nurse Book, Pg 2, How to choose a diagnostic test you tube video, Dr Moore’s Basics of Diagnostics video.
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Question: What makes up a CBC blood test A. BNP, RBC, WBC B. WBC, RBC, Platelets C. TSH, BNP, Platelets D. Basophils, Platelets, BNP
Answer: B Rationale for why the answer is correct: The complete blood count (CBC) is a group of tests that evaluate the cells that circulate in blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect a variety of diseases and conditions, such as infections, anemia and leukemia. Site for question/rationale: CBC handout
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Question: What part of a CBC test is used to identify Worms, Parasites, and allergies A. Neutrophils B. Basophils C. Eosinophils D. Lymphocytes
Answer: C Rationale for why the answer is correct: Eosinophils are a type of disease-fighting white blood cell. Elevated Eosinophils most often indicates a parasitic infection, worms or allergies. Site for question/rationale: CBC handout
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Question: What diagnostic test is used primarily first to diagnose cholecystitis due in part to its sensitivity and specificity. A. CT scan B. MRI C. Ultrasound D. PET scan
Answer: C Rationale for why the answer is correct: Ultrasound is more useful than CT and MRI for the initial evaluation of acute biliary disease. Site for question/rationale: Dr. Moore’s Abdominal video 12.03 on video
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Question: In reference to chlamydia in females under the age of 25 that are sexually active. How often should these females be tested according to recommendations? A. Every 6 months B. Yearly C. Every 90 days D. Only if symptoms appear.
Answer: B Rationale for why the answer is correct: Because this group has the highest rate of infection, these women should consider getting screenings every year as well as when switching to a new sexual partner. Site for question/rationale: Sexually transmitted disease video 8.39 on video. Dr. Mello, Dr. Moore, Dr. Hilliard.
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Question: What pathological process can urine hesitancy or the inability to completely empty the bladder during urination be indicative of. A. Benign Prostatic Hyperplasia B. Epididymitis C. Testicular Torsion D. Inguinal hernia
Answer: A Rationale for why the answer is correct: An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. Additionally, other presenting symptoms are enlarged symmetrical smooth prostate upon exam. Nodular prostate can be indicative of cancer. Site for question/rationale: Male reproductive video Dr. Moore 2.01 on video.
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Question: Which mnemonic is best used to help be inclusive for criteria when questioning a patient’s complaint? A. OLD CARTS B. ABCDEF C. OLD SOCS D. There isn’t one
Answer: A- OLD CARTS Rationale for why the answer is correct: OLD CARTS is one of the mnemonics used to help providers see the complete picture of a patient’s complaint. The other answers were made up. Site for question/rationale: SOAP lecture by Shelly Seth, 12mins 47 secs
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Question: When writing a SOAP note, in which section do you include subjective data (what the patient tells you)? a. Review of systems b. Assessment c. Past medical history d. Diagnosis
Answer: A- Review of systems Rationale for why the answer is correct: The subjective data, or what the patients tells you, goes under the review of systems. Your physical examination goes under the assessment. Past medical history includes previous diagnoses. A diagnosis should be made only after a complete ROS and assessment are complete and does not verbally come from the patient. Site for question/rationale: SOAP lecture by Shelly Seth, 21mins 6secs
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Question: If you are trying to RULE OUT a diagnosis, which type of test should you order? One with… a. high sensitivity b. low sensitivity c. high specificity d. low specificity
Answer: A- high sensitivity Rationale for why the answer is correct: Tests with high sensitivity are meant to help rule out diagnoses. They have a low threshold for the probability of the disease. Site for question/rationale: Diagnostics lecture by Amy Moore, slide 9
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Question: If you are trying to RULE IN a diagnosis, which type of test should you order? One with… a. high sensitivity b. low sensitivity c. high specificity d. low specificity
Answer: C- high specificity Rationale for why the answer is correct: Tests with high specificity are meant to help rule in a diagnosis. They have a high threshold for the probability of the disease. Site for question/rationale: Diagnostics lecture by Amy Moore, slide 9
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Question: At what bilirubin level would you expect a patient to appear jaundice? a- 3.0 b- 0.3 c- 1.5 d- 2.0
Answer: A- 3.0 Rationale for why the answer is correct: Normal bili level is 0.3- 1.0. Levels higher than 2.5 start to turn the skin yellow (jaundice) Site for question/rationale: CMP lecture by Shelly Seth, slide 9
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Question: Which lab is most indicative of a liver problem? a. AST b. ALT c. Creatinine d. BUN
Answer: B- ALT Rationale for why the answer is correct: ALT is the most specific lab value on the CMP that indicates liver dysfunction. AST is also indicative but can be elevated by other organs (ie. Heart) as well. Creatinine and BUN are more indicative for kidney function. Site for question/rationale: CMP lecture by Shelly Seth, slide 13
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Question: What is the best patient position for examining the abdomen? A. Lying down B. Sitting C. Standing D. It doesn’t matter
Answer: A- lying down Rationale for why the answer is correct: The best way to examine a patient’s abdomen is when they are lying flat. Sitting or standing can cause certain abnormalities such as masses or hernias to be hidden and missed during an examination. Site for question/rationale: Abdominal lecture by Amy Moore, 1 min 20 secs
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Question: What is the most sensitive test used for diagnosing cholecystitis and stones? a. Psoas sign b. Ultrasound c. Xray d. Heel tap
Answer: b- ultrasound Rationale for why the answer is correct: Ultrasound is the most sensitive test. Psoas sign and heel tap are used to diagnose appendicitis. An abdominal Xray would not be able to see the gallbladder to diagnosis cholecystitis and stones. Site for question/rationale: abdominal lecture by Amy Moore, 12mins 10 secs
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Question: At which age would you include testicular torsion as a possible diagnosis for scrotal pain? a. 63 b. 81 c. 12 d. 30
Answer: C- 12 Rationale for why the answer is correct: Testicular torsion is most common during puberty ages. The other ages are not during the puberty stage. Site for question/rationale: Male reproductive lecture by Amy Moore, slide 4
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Question: Which is not a possible symptom of BPH? A. Urine dribbling B. Trouble initiating stream C. Firm, smooth, enlarged prostate D. Fever
Answer: D- Fever Rationale for why the answer is correct: Fever is not seen with BPH. All other answers are common symptoms of BPH. Site for question/rationale: Male reproductive lecture by Amy Moore, slide 1, 1 min 50 secs
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Question: All of the following should be included in a SOAP note of a new patient, except? a. The patient has a chief complaint of a headache b. The patient consumes a liter of wine a day c. The patient has a stepfather who died of cancer, and a nephew who has DM II d. The patient has an allergy to ASA for which he develops a rash when taken.
Answer: C. Rationale for why the answer is correct: A SOAP note should include: Chief complaint, Social hx (to include alcohol intake), Family history (3 generations; grandparents, parents and children), allergies and reactions, and ROS. Site for question/rationale: Shelly Seth, SOAP notes voice thread; Chief complaint 2:08, social history 5:00, family history 3:30-4:15, allergies and reactions 3:22.
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Question: What statement(s) should be included in an HPI of a patient who has a chief complaint of chest pain? a. “My chest pain started 3 days ago when I was doing yard work; it gets worse when I take in a deep breath; it’s like a 3 out of 10.” b. “I love to take road trips, I took one 3 months ago” c. “My great grandfather had a history of Hep C” d. “ I have a history of measles and mumps”
Answer: A. Rationale for why the answer is correct: Aggravating factors, pain scale and onset should be included in the HPI. The patient’s history of childhood illnesses should be included in the PMHx. The remaining statements are not relevant to the HPI. Site for question/rationale: Shelly Seth, SOAP notes voice thread, 13:40.
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Question: A patient arrives to the clinic complaining of signs and symptoms of a UTI. You want to rule out chlamydia. Which test would be the best test to rule out chlamydia? a. The test with the highest sensitivity and lowest likelihood (LR) ratio b. The test with the highest specificity and lowest likelihood ratio c. The test with the lowest sensitivity and highest likelihood ratio d. The test with the highest specificity and highest likelihood ratio
Answer: A. Rationale for why the answer is correct: In order to rule out disease, sensitivity should be high and LR should be low. In order to rule in a disease, specificity should be high and LR should be high. Site for question/rationale: Amy Moore, Basics of Diagnostics voice thread, 17:36 and 21:33.
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Question: Prior to ordering a diagnostic test, you should obtain all of the following except: a. Patient’s history b. Patient’s culture c. Practice recommendations d. Patient’s level of education
Answer: D. Rationale for why the answer is correct: The patient’s history is needed to determine appropriate labs. The patient’s culture is needed to obtain an idea of the patient’s desires and beliefs in regard to diagnostic tests. Practice recommendations are needed in order to have an awareness of what labs to order for the patient’s specific condition. The patient’s level of education is not needed to determine necessary diagnostic tests. Site for question/rationale: Amy Moore, Diagnostic Basics voice thread, 0:12- 1:45.
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Question: You are an advanced practice nurse working in an outpatient clinic and are reviewing Mr. Morales’ BMP. Mr. Morales has a history of HTN, DM II and hyperlipidemia. His lab results are as follow: Na 147 (135 – 145) K 3.1 (3.5 – 5.0) Cl 100 (98-106) CO2 17 (23- 29) BUN 20 (7 – 20) Creatinine 1.1 (0.7 – 1.2) Glucose 634 (70-110) By looking at his labs, you can determine: a. the patient is in metabolic acidosis b. the patient is in diabetic ketoacidosis c. the patient is in respiratory acidosis d. you need more information to determine exactly what is going on.
Answer: D. Rationale for why the answer is correct: You cannot accurately interpret what is happening with the patient unless you have a greater picture of what is going on with the patient. A full clinical picture should be established prior to diagnosing. Site for question/rationale: Shelly Seth, Diagnostics- BMP voice thread, 12:19- 12:47.
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Question: If you see these cells on a CBC with diff, you can assume the patient is fighting off a very bad infection. a. Bands b. Monocytes c. Thrombocytes d. Basophils
Answer: A. Rationale for why the answer is correct: Bands are immature WBCs that are “sent out” when there are not enough neutrophils to help “fight off” an infection. Site for question/rationale: Shelly Seth, Complete Blood Count Voice thread, 8:07 – 09:07.
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Question: You are working in the ER as an ACNP and a 32-year-old female presents with a chief complaint of abdominal pain. After your examination, you believe this patient has cholecystitis. Which exam is the most sensitive and specific study to help diagnose cholecystitis? a. HIDA scan b. ERCP c. CMP d. Ultrasound
Answer: D. Rationale for why the answer is correct: The ultrasound is the most specific and sensitive study to help visualize gallstones. A HIDA scan can be done to show the function of the gallbladder, if the US is negative. An ERCP is a surgical procedure. A CMP would not help diagnose cholecystitis but may help guide you to the correct diagnosis. Site for question/rationale: Amy Moore, Common Abdominal Complaints voice thread, 11:20.
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Question: You are evaluating a 4-month-old who comes in looking dehydrated. The mother states he has been projectile vomiting after every meal and has been losing weight. Upon assessment, you note an ‘olive shaped’ mass in the right upper quadrant of his abdomen. This finding is most consistent with: a. DKA b. Pyloric stenosis c. Intussusception d. Hirschsprung’s disease
Answer: B. Rationale for why the answer is correct: Pyloric stenosis signs and symptoms consist of vomiting, unable to tolerate food, dehydration, weight loss, and an olive shaped mass in the right upper quadrant of the abdomen. Hirschsprung’s disease is a condition in which the patient presents with constipation and thus dilated loops of bowel on x-rays due to decreased motility from the lack of ganglion cells. Intussusception is the ‘telescoping’ of the intestine, stools present with a “jelly like” consistency. DKA is not consistent with an olive shaped mass in the abdomen. Site for question/rationale: Amy Moore, Common Abdominal Complaints voice thread, 19:01-19:25.
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Question: You are collecting a vaginal swab to rule out gonorrhea, chlamydia and HSV. You know you should: a. Use wooden shafts due to obtain a sample for Chlamydia b. Use calcium alginate to activate HSV for viral cultures. c. Not use cotton swabs because they are toxic to N. gonorrhea. d. Use lube due to antiviral agents.
Answer: C. Rationale for why the answer is correct: Wooden shafts are toxic to Chlamydia. Cotton swabs are toxic to N. gonorrhea. Calcium alginate will inactivate HSV for viral cultures. Lube has antibacterial agents. Site for question/rationale: Patricia Olenick, Women’s Health Diagnostics-Part 2 voice thread ,33:07. Patricia Olenick, Wet prep, GYN and throat culture collection slide.
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Question: You are planning to perform a KOH prep on a female patient’s sample. You first instill saline to do a “whiff” test of the sample, knowing that after you instill the KOH prep it: a. will lyse all elements except bacterial b. will lyse all elements except fungal c. will help bacteria proliferate d. will lyse all elements except viral
Answer: B. Rationale for why the answer is correct: Instilling the KOH prep will obliterate all elements except fungal, which is why you should do a “whiff” test prior to the KOH prep to rule out anaerobic bacteria. Site for question/rationale: Patricia Olenick, Women’s Health Diagnostics-Part 2 voice thread, 2:54.
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Question: Your patient comes to your clinic complaining of pain with urination rated at a 5 on a scale of 0-10. Which part of the SOAP note would you document her complaint? A. Subjective B. Objective C. Assessment D. Plan
Answer: A Rationale for why the answer is correct: Subjective information is what the patient complaint is or symptoms that they report. Objective information is the factual things you can assess, see, feel, and hear. Assessment is for your differential diagnosis/ actual diagnosis. Your plan should include the tests that you will order, interventions, education, follow up, medication, referrals. Site for question/rationale: SOAP Note Presentation
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Question: Your patient comes to your clinic complaining of RLQ pain. You perform a physical exam, and the patient reacts in pain as you check for rebound tenderness. Which part of the SOAP note would you document the patient’s reaction to your abdominal assessment? A. Subjective B. Objective C. Assessment D. Plan
Answer: B Rationale for why the answer is correct: Subjective information is what the patient complaint is about or symptoms that they report. Objective information is the factual things you can assess, see, feel, and hear. Assessment is for your differential diagnosis/ actual diagnosis. Your plan should include the tests that you will order, interventions, education, follow up, medication, referrals. Site for question/rationale: SOAP Note Presentation
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Question: Which diagnosis would be considered a Must Not Miss Differential Diagnosis? A. Small Bowel Obstruction B. Constipation C. Peptic Ulcer D. Acute Gastroenteritis
Answer: A Rationale for why the answer is correct: A Bowel Obstruction is the diagnosis that would be the most harmful for the patient if missed. Site for question/rationale: Illness Script Example
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Question: Your differential diagnosis should be documented in what area of your soap note? A. Subjective B. Objective C. Assessment D. Plan
Answer: C Rationale for why the answer is correct: The differential diagnoses should be charted under the assessment in you SOAP note. This should include must not miss, leading, alternate, and concluding diagnoses. Site for question/rationale: Differential Diagnosis Video/ SOAP Note Presentation
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Question: Your patient’s CBC reveals a low Hgb and Hct with a MCV \> 96, what test would be the most important to order next? A. TSH B. Ferritin C. B12/ Folate D. Serum Fe
Answer: C Rationale for why the answer is correct: The most common cause of macrocytic anemia is B12 or Folate deficiencies. Site for question/rationale: CBC Lecture
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Question: Your patient has a low total protein level, you would suspect all of the following could be the cause, except? A. Chronic Inflammation B. Liver Disease C. Renal Disease D. Severe Malnutrition
Answer: A Rationale for why the answer is correct: High total protein levels are indicative of chronic inflammation. Low total protein levels are indicative of Liver/Renal Disease and Severe Malnutrition. Site for question/rationale: CMP/LFT lecture
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Question: You are evaluating a patient in the emergency room that has presented with a chief complaint of right lower quadrant pain and fever. You perform a physical exam which reveals positive rebound tenderness, Psoas sign, and pain while doing a heal tap. You order a CBC and Urinalysis, what would be your most concerning finding? A. Hematuria B. WBC \> 20,000 C. Pyuria D. C-Reactive protein \< 10mg/L
Answer: B Rationale for why the answer is correct: WBC \> 20,000 have a 90% chance of indicating perforation of the appendix. With appendicitis, hematuria and pyuria may be present on the UA, but is not the greatest concern. A C-reactive protein \< 10mg/L is normal. Site for question/rationale: Common Abdominal Complaints, slide 4 & 7.
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Question: A patient has just been admitted to the hospital with Acute Pancreatitis. Which of the following findings would the APRN NOT use for evaluating the patient’s risk for mortality using Ranson’s Criteria for Severity of Acute Pancreatitis? A. WBC \> 16,000 B. Patient older than 45 C. Blood Glucose level \>200 D. AST level \>250
Answer: B Rationale for why the answer is correct: Criteria present on admission using Ranson’s tool include: Patient older than 55, WBC count higher than 16,000, blood glucose level \>200, serum LDH level \> 350, AST level \>250. Site for question/rationale: Common Abdominal Complaints, slide 12 & 13.
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Question: Your patient has presented to the clinic with a chief complaint of vaginal discharge. After obtaining the patient’s history and performing a physical examination, which of the following findings would the APRN NOT expect to find if her lead differential diagnosis was Bacterial Vaginosis? A. Thin milky white discharge with a “foul fishy” odor B. NaCl wet mount finding of \> 20% clue cells and no/few WBCs C. Vaginal PH \< 4.5 D. Positive KOH “whiff” test
Answer: C Rationale for why the answer is correct: Findings with Bacterial Vaginosis include thin milky white discharge with a “foul fishy” odor, Vaginal PH \> 4.5, positive KOH “whiff” test, and a NaCl wet mount with \>20% clue cells and no/few WBCs. Site for question/rationale: Women’s Health Overview of Diagnostics, Slide 10
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Question: ACOG recommends which of the following about breast exams? A. Women should start getting mammograms at age 30 with no family history of breast cancer B. Women should have mammograms every 1-2 years starting at age 40 until at least age 75 C. Clinical breast exams should be done annually for women age 21 years and older D. Mammograms are not recommended at any age unless there is a family history of breast cancer
Answer: B Rationale for why the answer is correct: ACOG recommends women should have mammograms every 1-2 years starting at age 40, and no later than age 50. Screening should continue until the patient is at least 75 years old. Clinical breast exams should be done annually and start at age 19. Site for question/rationale: Women’s Health, Slide 5
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Question: Which of the following is not included in the subjective portion of the SOAP note? a. Review of systems b. Physical exam c. Past medical history d. medications
Answer: B physical exam Rationale for why the answer is correct: The physical exam is part of the Objective portion of the SOAP Note. The subjective portion of the SOAP note includes chief complain CC, History of present illness (HPI), Pash medical history (PMH), Medications, allergies, Family medical history (FMH), Surgical history (SH) and Review of systems (ROS). Site for question/rationale: OSCE SOAP note page 2-5 and the SOAP Note audio lecture.
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Question When asking a patient if they are taking any medications, which of the following should be included? a. Prescribed medications b. Over the counter medication c. Herbs & supplements d. All of the above
Answer: D. All of the above Rationale for why the answer is correct: All of the above components are important to ask a patient if they are taking any medications. In addition, you should also ask the patient the dose, route and amount taken. Site for question/rationale: SOAP note lecture
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Question: Specificity _________ and Sensitivity \_\_\_\_\_\_\_\_\_. a. Rules out, rules in b. They both rule in c. Rules in, rules out d. The both rule out
Answer: C Rationale for why the answer is correct: Specificity rules in and sensitivity rules out. This was mentioned multiple times. Site for question/rationale: Diagnostics PowerPoint presentation slide 10
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Question: When would you do further diagnostic testing? a. All the time to confirm diagnosis b. If the patient is below the threshold for testing c. If the patient is at 95% treatment threshold d. If the patient is above the test threshold and below the treatment threshold.
Answer: D Rationale for why the answer is correct: Further diagnostic testing lies above the testing threshold but below the treatment threshold. Site for question/rationale: Diagnostic PowerPoint presentation slide 9
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Question: Which of the following would cause an increase to the neutrophil/bands “the bad babies”? a. Acute ill infection (viral also) b. Chronic illness, malignancies and inflammatory problems c. Medication effect such as vancomycin, phenytoin, Dapsone, Plavix (there are many) d. All of the above
Answer: D. All of the above Rationale for why the answer is correct: It is essential to keep an eye on the bands when looking at a CBC. All of the above cause an increase in the neutrophil bands and must be further assess to evaluate what caused the “bad babies”. Site for question/rationale: CBC presentation slide 14
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Question: Which of the following is the most common cause of microcytic anemia \<80? a. B12 deficiency b. Iron deficiency c. Folate deficiency d. Thalassemia
Answer: B. Iron deficiency Rationale for why the answer is correct: B12 deficiency and folate deficiency are causes of macrocytic anemia. Even though thalassemia is also a microcytic anemia, Iron is the most common type of microcytic anemia. Site for question/rationale: CBC presentation slide 30
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1.Question: Which of the following signs would you assess when suspecting cholecystitis? a. Murphy’s sign- Have patient take a deep breathe, there is pain while pressing in the RUQ. b. Psoas sign- place hand above the patient’s right knee and have them raise it c. Obturator sign- flex the patient’s right thigh the hip, with the knee bent, and rotate the leg internally at the hip. d. Rovsing’s sign- pain in the RLQ during left sided pressure.
Answer: A. Murphy’s sign Rationale for why the answer is correct: Murphy’s sign is used when suspecting a patient with cholecystitis. Psoas sign, obturator sign, & rovsing’s signs are for appendicitis. Site for question/rationale: Common abdominal complaints PowerPoint, slide 4
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Question: You suspect a patient has intussusception, which of the following is a gold standard for diagnosis? a. CT scan b. Barium enema c. Stool for occult blood d. Plain abdominal x-ray
Answer: B: Barium enema Rationale for why the answer is correct: The barium enema is the gold standard for diagnosis of intussusception. However, a plain abdominal x-ray should be done prior to a barium enema to exclude intestinal perforation. Site for question/rationale: Common abdominal complaints PowerPoint, slide 14
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Question: Screening for breast cancer should last until the age of \_\_\_\_? a. 50 years old b. 75 years old c. 65 years old d. 40 years old
Answer: B 75 years old. Rationale for why the answer is correct: Dr. Moore stressed in her PowerPoint to continue to screen patients for breast cancer until the age of at least 75 years old. Mammograms should start at the age of 40 years old but no later than 50-year-old. Site for question/rationale: Women’s health PowerPoint, slide 5
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Question: A child born with cryptorchidism has an increase lifelong consequence to what type of cancer? a. Prostate b. Testicular c. Colorectal d. Bladder cancer
Answer: B: testicular cancer Rationale for why the answer is correct: A child born with cryptorchidism is at increased risk for Testicular cancer. It is important to educate parents about this risk. Site for question/rationale: Male reproductive PowerPoint slide 4
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Question: When documenting family history it is important to obtain information on the patients a. Parents and grandparents b. Spouse and children c. Siblings d. A and C
Answer: A and C Rationale for why the answer is correct: It is important to have 3 areas of family history, “go up the family tree to parents and grandparents, sideways on the family tree to siblings, and down the family tree to children.” -Dr. Seth
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Question: When writing a SOAP note, the physical assessment should include a. Patient diagnosis b. Your physical findings of the chief complaint c. Review of systems d. Description of symptoms
Answer: B Rationale for why the answer is correct: The assessment should include what you as the providers see from the patient. A full assessment and focus on the chief complaint in depth. Site for question/rationale: Additional SOAP note Presentation, 4:25 time mark
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Question: What is needed to start a list of differential diagnoses? a. Past medical history b. Medication list c. Chief complaint d. Review of symptoms
Answer: C Rationale for why the answer is correct: In order to start a list you need to know the patients chief complaint and then move to a detailed history comprised of open ended and detailed questions as well as an assessment. Site for question/rationale: Dr. Moore’s Differential Diagnosis Presentation, 2:00 time mark and Differential Diagnosis book pg. 2-3
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Question: What is needed to rule out a differential diagnosis? a. Diagnostic testing b. Treatment plan c. Family history d. Referral to specialist
Answer: A Rationale for why the answer is correct: Once the history is obtained along with a physical assessment a list of differential diagnoses can be created. In order to rule out a diagnosis further diagnostic testing may be needed. Site for question/rationale: Differential Diagnosis book pg. 3
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Question: A 15 year old female arrives to the ED complaining of low back pain for 3 days. Upon further assessment you find she has a burning sensation when she voids that has been constant for the past week. Initially a urinalysis, CBC, and BMP are sent to the lab. What lab findings would you expect to see? a. K 3.5 b. WBC 10.7 c. ANC 12,000 d. Hemoglobin 8.5
Answer: C Rationale for why the answer is correct: The patient is presenting with a UTI that could potentially develop into pyelonephritis if untreated. Her WBC are slightly elevated within limits but her ANC is elevated out of range. Site for question/rationale: CBC presentation, slide 10-12.
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Question: A teenage boy presents via EMS to the ED. MVC rollover at highway speeds, restrained in the back seat. Driver lost control and hit cement barrier in median. Pt had to be pried out of the car by EMS with the “jaws of life”. Initial assessment indicated a crushing injury to chest and multiple fractures. Trauma labs are sent including CBC, CMP, Coags, ABG, and type and screen. Initial labs show an elevated potassium. What process would validate the increase in potassium? a. The patient is dehydrated b. The crushing injury to the chest c. The patient is in renal failure d. The patient is fluid overloaded
Answer: B Rationale for why the answer is correct: Trauma is an indication for hyperkalemia. The patient has a crush injury which causes Na to be released from the intracellular compartment and free floating K. Site for question/rationale: BMP presentation, 9:00 time mark, slide 9
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Question: A 50 year old woman presents with epigastric pain. Her differentials would include all of the following except: a. Gastroenteritis b. Myocardial Infarction c. Appendicitis d. Gastroesophageal Reflux Disease
Answer: C Rationale for why the answer is correct: The hallmark sign for GERD is epigastric pain with a sour taste in their mouth. A MI in women can present with epigastric pain and burning. Gastroenteritis s/s include abdominal pain N/V/D. Appendicitis specifically has pain to the umbilicus or RLQ. Site for question/rationale: Abdominal Lab/Tests presentation by Dr. Moore, 7:30 time stamp. Slide 6
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Question: A patient admitted for pancreatitis to your service. Which finding below would not be of the highest concern? a. WBC 20,000 b. Lipase 250 c. Calcium 8.5 d. Blood alcohol level 150
Answer: C Rationale for why the answer is correct: With a presentation of pancreatitis we would expect to see severe abdominal pain, and increase in WBC’s and an elevated lipase. The calcium level is at risk of dropping within the first 48 hours but it within normal limits. Patients diagnosed with pancreatitis can also be linked to alcoholism. Site for question/rationale: Abdominal Lab/Tests presentation by Dr. Moore, 15:00 time stamp. Slide 11-12
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Question: A 23 year old female in your clinic reports vaginal itching and discharge after recent sexual intercourse with her partner. The discharge is reported to have a foul smell and milky in texture. Your initial diagnosis would be a. Bacterial Vaginosis b. Candidiasis c. Trichomoniasis d. Chlamydia
Answer: A Rationale for why the answer is correct: The hallmark sign of BV is milky foul fishy odor. Site for question/rationale: Women’s Health Overview of Diagnostics, slide 10
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Question: A 12 year old boy presents to the ED with scrotal pain and edema. What finding would indicate the diagnosis of testicular torsion? a. Present cremasteric reflex b. No relief of pain with elevation c. Bilateral scrotal pain d. A boggy mass within the testicle
Answer: B Rationale for why the answer is correct: Testicular torsion is a medical emergency. Signs and symptoms include unilateral scrotal pain, firm tender mass, no relief of pain with elevation, lower abdominal pain, N/V, and absent cremasteric reflex. Site for question/rationale: Male Reproductive Presentation, slide 5
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Question: The APRN is treating a patient in the clinic with chief complaint of gastrointestinal distress. Which of the following would correctly be documented in the subjective section of the SOAP note? a. Abdominal distension b. Rebound tenderness c. Nausea d. Psoas sign
Answer: C) Nausea Rationale for why the answer is correct: Patient symptoms are what is described and told to the APRN, and as such are data points that cannot be tangibly seen. Nausea is subjective and dependent on the patient's report. Site for question/rationale: SOAP Note Presentation (9-minute video) by Inolla Mello, DNP, APRN FNP-C, Tara Hilliard, PhD, APRN, ACNP-BC, and Amy Moore, DNP, APRN, FNP-C; Module 1 at the 3:30 time-stamp.
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Question: The APRN is evaluating a stroke patient recently admitted to the Emergency Department. The patient has observable aphasia. Which individual is the most appropriate source of information for chief complaint documentation? a. The patient b. The delivering paramedic at handoff c. The patient's spouse present at bedside d. None, as all individuals are not legally acceptable
Answer: C) The patient's spouse present at bedside Rationale for why the answer is correct: In cases where the patient is limited in ability to communicate, be it in cases of aphasia or even newborns, the APRN may utilize a legal next of kin or guardian who can attest to the patient's chief complaint. In addition to directly quoting the source of information, the individual should be clearly identified and a rationale provided expressing the patient's inability to provide their chief complaint independently. Site for question/rationale: SOAP Note Presentation (26:50 video) by Shelly Seth, DNP, APRN, ACNP-C, FNP-C, CCRN-K, Module 1; 11:45-12:12 time-stamp.
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Question: During the process of differential diagnosis for fatigue, which finding might the APRN use to exlude the possibility of acute anemia? a. Family history of colon cancer b. Hemoglobin of 14.1 g/dL c. Medical history of arthritis d. Use of herbal remedies for stress
Answer: B) Hemoglobin of 14.1 g/dL Rationale for why the answer is correct: The process of differential diagnosis is the cumulative synthesis of pertinent patient findings used to rule out associated causes with shared symptoms. In this case, the APRN should inquire further regarding the patient's arthritis management, as well as their herbal remedy selection, as possible NSAID use for arthritis and types of herbal supplements can precipitate gastrointestinal bleeding. A family history of colon cancer may add to the differential diagnosis list, but does not directly exclude anemia. The patient however does exhibit a stable hemoglobin, indicating acute anemia is unlikely and may warrant exclusion. Site for question/rationale: Differential Diagnoses by Amy Moore, DNP, APRN, FNP-C; time-stamp at 5:50 to 6:30.
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Question: The APRN correctly understands that a differential diagnosis process should: a. Be specific to the patient and only their immediate history. b. Include a review of systems inquiries specific only to the chief complaint. c. Streamline diagnostic selection based on established past medical history. d. Synthesize possible causative sources as it relates to the chief complaint.
Answer: D) Synthesize possible causative sources as it relates to the chief complaint. Rationale for why the answer is correct: A differential diagnosis should be the synthesis of possible causative sources responsible for the chief complaint. It should include data about the patient's family, cultural, and spiritual history, and requires additional inquiry targeted at the chief complaint and its associative possible differential diagnoses during the review of systems. Lastly, while past medical history and diagnoses may assist in differential diagnosis formulation, the two are not the same, nor should it limit selection of further diagnostic inquiry. Site for question/rationale: Differential Diagnoses
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Question: The APRN is reviewing lab results for a patient recently admitted to the ICU. Using the attached results, which causative source would best explain the patient's BMP results? BMP Sodium 130 mEq/L Chloride 10 mEq/L Potassium 5.4 mEq/L BUN 18 mg/dL Creatinine 1.1 mg/dL Glucose 68 mg/dL a. ACE Inhibitor prescription history b. Acute renal failure c. Dehydration d. Adrenal insufficiency
Answer: D) Adrenal insufficiency Rationale for why the answer is correct: The patient's creatinine and BUN are not suggestive of dehydration or renal failure, as they are within normal values. While the patient does have hyperkalemia, which may be suggestive of ACE inhibitor use, the patient also shows active hyponatremia and a depressed glucose, indicating potential adrenal insufficiency. Site for question/rationale: BMP lecture by Shelly Seth, DNP, APRN, ACNP-C, FNP-C, CCRN-K, Module 1: Labs; slide 12 of 18, time-stamp at 10:40-11:15.
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Question: An APRN is conducting a wellness visit with a first-time patient. The APRN understands which past medical history might explain the patient's Mean Corpuscular Volume (MCV) of 120 fL? a. Iron deficiency b. Hypothyroidism c. Thalassemia d. Undiagnosed metastasis
Answer: B) Hypothyroidism Rationale for why the answer is correct: An MCV of 114 fL is indicative of macrocytic anemia. Hypothyroidism, alcohol abuse, and Vitamin B12 and Folate deficiencies are common causes of macrocytic anemia. Iron deficiency and Thalassemia may be causes of microcytic anemia (MCV of \<80 fL). Whereas, an undiagnosed metastasis may cause acute, normocytic anemia. Site for question/rationale: Complete Blood Count presentation
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Question: The APRN is conducting an abdominal examination on a patient. Which finding would indicate correct performance when assessing for Murphy's Sign? a. Pain elicited when pressure is applied to the RUQ as the patient inhales deeply. b. Pain elicited in the RLQ when pressure is applied to the left side of the abdomen. c. Pain experienced during flexion of the patient's right thigh at the hip and rotated internally at the hip. d. Pain experienced by the patient on applied abdominal palpation with quick release.
Answer: Pain elicited when pressure is applied to the RUQ as the patient inhales deeply. Rationale for why the answer is correct: Murphy's Sign evaluates for possible Cholecystitis and is correctly performed by applied pressure to the RUQ while the patient inhales deeply. Pain experienced by the patient on applied abdominal palpation with quick release is known as rebound tenderness. Pain experienced during flexion of the patient's right thigh at the hip and rotated internally at the hip is known as a positive Obturator Sign. Pain elicited in the RLQ when pressure is applied to the left side of the abdomen is indicative of a positive Rovsing's sing. Site for question/rationale: Abdominal Presentation
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Question: The APRN is managing care for a patient with gastroesophageal reflux disease (GERD). Which statement made by the patient indicates ineffective teaching? a. "An endoscopy is only needed if my Helicobacter pylori test is positive." b. "I am more at risk for cancer because I have Barrett's Esophagus." c. "If my heartburn causes prolonged chest pain, I should be seen immediately." d. "My asthma can become exacerbated if I don't take my Protonix."
Answer: A) "An endoscopy is only needed if my Helicobacter pylori test is positive." Rationale for why the answer is correct: H. Pylori is no longer an effective means to evaluate treatment and diagnosis of GERD. Endoscopy with biopsy should be performed if treatments with H2 antagonists and proton pump inhibitors (e.g., Protonix) are ineffective. Patients with asthma may experience worsened wheezing in the presence of uncontrolled GERD. Symptoms of persistent chest pain should not be confused or disregarded as common dyspepsia, and require evaluation of acute coronary syndrome. Lastly, patients with GERD who are diagnosed with Barrett's Esophagus will require routine check-ups by their gastroenterologist due to the heightened risk for cancer. Site for question/rationale: Abdominal Presentation
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Question: The APRN is educating a 21-year-old female patient regarding women's wellness check-ups. How often should the patient receive a pap smear? a. After the age of 24 years, or if sexually active b. Annually c. Every 3 years, if normal d. Every 5 years with HPV co-testing
Answer: C) Every 3 years Rationale for why the answer is correct: Female patients aged 21-29 should receive a pap smear every 3 years (if previously normal), and then every 5 years with HPV co-testing during 30-65 years of age. Sexually transmitted infection testing should be performed during years of sexual activity or after the age of 24. Site for question/rationale: Presentation of Women's Health by Amy
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Question: A 29-year-old male is being seen today following reports of scrotal heaviness and an enlarging firm, nontender mass. Which diagnostic should be the APRN's priority of choice? a. Abdominal and chest CT scan b. Scrotal ultrasound c. Tissue biopsy d. Tumor marker panel
Answer: B) Scrotal ultrasound Rationale for why the answer is correct: The APRN should be knowledgeable that all options are acceptable, as well as a referral to a urologist, but that a scrotal ultrasound is the gold standard when diagnosing possible testicular cancer. Incidence of testicular cancer is highest between the ages of 15-35 years, and assessment typically includes a solid, firm and nontender testicular mass with sensation of scrotal heaviness or fullness. Site for question/rationale: Men's Health
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Question: When conducting a patient interview and completing a SOAP note, it is important to ask what specifically regarding medications? a. Prescription, OTC, Herbals/Vitamins b. Drug and alcohol use c. What medications their spouse takes d. Family history
Answer: A Rationale for why the answer is correct: Simply asking the patient “What medications do you take” may not be direct enough to get the required information. It is important to ask each category individually. Site for question/rationale: Dr. Seth’s video lecture on SOAP notes (3:20)
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Question: When completing the HPI portion in a SOAP note, be sure to include what information? a. Review of Systems b. Pertinent history to chief complaint and events leading up to present illness c. List of medical history d. Childhood illnesses, surgical history, and family medical history
Answer: B Rationale for why the answer is correct: The HPI should be limited to events surrounding the patient’s complaint and pertinent medical history related to chief complaint. Other information such as PMH, medications, and allergies can be found in other places in the SOAP note. Site for question/rationale: Dr. Seth’s video lecture regarding SOAP notes. (12:20)
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Question: When ordering a test to rule-in a suspected condition, what is the most beneficial type of test to order? a. A test with a high sensitivity b. A test with a low sensitivity c. A test with a high specificity d. A test with a low specificity
Answer: C Rationale for why the answer is correct: Ordering a test with a high specificity to rule-in a diagnosis gives the provider the most accurate likelihood of an accurate test and diagnosis. In order to “rule-out” a diagnosis the provider should utilize testing with a high sensitivity. Site for question/rationale: “Diagnostic Basics” video lecture (17:30)
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Question: What are two general ways, or thinking patterns, to make a diagnosis? a. Experience and guidelines b. Pattern recognition and probabilistic (Bayesian) c. Specificity and sensitivity d. Treat empirically and point of care testing
Answer: B Rationale for why the answer is correct: Pattern recognition is a diagnosis decision making process that utilizes experience with similar presentation and symptomology to make diagnosis. Probabilistic is a pathway of ordering tests based on the likeliness of the patient having a disease. Site for question/rationale: Terry Shaneyfelt’s lecture “Diagnostic Process” (0:42)
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Question: You are an APRN reviewing a patient’s lab work who has been in the hospital two days for a stroke. You notice the WBC count has doubled since the day before, and the neutrophils are significantly elevated. This alerts the APRN to assess the patient for what likely possibility a. A chronic UTI b. Hyperglycemia c. Another stroke d. New infectious process
Answer: D Rationale for why the answer is correct: Neutrophils are immature WBCs that are released from the bone marrow in response to a new infectious process to start an early defense. Site for question/rationale: Dr. Seth’s lecture CBC (9:00)
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1. Question: A Clonal cause of thrombocytosis refers to? a. Heparin overdose b. Heparin underdosing c. Bone marrow involvement d. Acute DIC
Answer: C. Rationale for why the answer is correct: A clonal cause of thrombocytosis refers to a disruption in the bone marrow platelet formation. This can be from diseases such as Leukemia and polycythemia vera. Site for question/rationale: Dr. Seth’s CBC lecture (Slide 46)
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Question: When performing an abdominal examination, what is the best position to place your patient? a. Standing b. Laying down (supine) c. Left lateral recumbent d. Sitting on side of bed
Answer: B- Laying down (supine) Rationale for why the answer is correct: This position allows the provider full access to the abdomen in order to perform visual inspection, auscultation, palpation, and percussive assessment. Site for question/rationale: Dr. Moore’s abdominal exam lecture (1:15)
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Question: In patient’s with suspected appendicitis, a WBC count of \> 20,000 will alert the provider to the possibility of what serious condition? a. Myocardial infarction b. Barrett’s esophagus c. Cholecystitis d. Perforated appendix
Answer: D Rationale for why the answer is correct: A significantly elevated WBC in a patient with suspected appendicitis is indicative of systemic infection caused by the release of harmful bacteria into the body. Site for question/rationale: Dr. Moore’s abdominal exam lecture (9:50)
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Question: You are viewing a wet prep sample from a 32-year-old female who has come to your facility complaining of vaginal irritation. During the microscopic examination, you note the presence of WBCs 5+ per hpf. This indicates the significant possibility of what condition? a. Menses b. Pregnancy c. STI d. HIV
Answer: C Rationale for why the answer is correct: Only a few WBCs should be present in the prep. A cell count of ≥ 5+ is significantly elevated and should alert the APRN to the presence of and an inflammatory process and STI, especially chlamydia. Site for question/rationale: Dr. Olenick’s lecture Women’s Health Diagnostic Overview Part 2 (4:00)
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Question: You are an APRN caring for a 28-year-old male patient who is being discharged from your facility with a diagnosis of Epididymitis. When providing discharge education about self-testicular examination, you explain signs of testicular cancer include a. Solid, firm, non-tender mass, sensations of heaviness in scrotum, enlarging mass that does not transilluminate b. Nausea, vomiting, diarrhea, and constipation c. Sudden, acute on set of severe pain unrelieved with scrotal elevation d. Burning and pain during urination or ejaculation
Answer: A Rationale for why the answer is correct: Signs of testicular cancer as outlined by Dr. Moore include all of the criteria listed in correct answer. In addition, compare both testicles for asymmetry. Site for question/rationale: Dr. Moore’s lecture- Male Reproductive (18:00)
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Mr. Jackson, a 68-year-old man, presents to the clinic complaining of chest pain, which of the following is an example of an objective finding documented in the SOAP note? a. Pain at 6/10 b. ECG without ST elevation c. History of coronary artery disease d. Pain does not radiate
Answer: ECG without ST elevation Rationale: The ECG is something that we observed, whereas the other answers are what the patient tells us. Objective findings are things that we observe, and subjective findings are information the patient gives us. (SOAP Note Presentation Video - Drs Hilliard, Mello, and Moore.; 0.25 min)
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The determined diagnosis of your patient belongs in which section of the SOAP note? a. Objective b. Plan c. Subjective d. Assessment
Answer: Assessment Rationale: The actual diagnosis belongs in the Assessment section of the SOAP note as the diagnosis is your assessment of the patient's problem. (SOAP Note Presentation Video - Drs Hilliard, Mello, and Moore.; 5.09 min)
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Which of the following are characteristic of probabilistic or Bayesian decision making? a. Uses diagnostic test results b. Uses pattern recognition c. Uses pre-test and post-test probabilities d. Both a. and b.
Answer: Both a. and b. Rationale: Probabilistic decision making uses pre-test, post-test probabilities, and diagnostic testing to decide on a diagnosis. (Diagnostic 10-minute video – Dr. Shaneyfeld; 1.08 min)
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If the probability of disease falls above the treatment threshold, we would: a. Order diagnostic testing b. Treat the patient c. Do nothing d. None of the above
Answer: We would empirically treat the patient without further testing. Rationale: Probabilities above the treatment threshold mean that the benefit of treatment is high and the risk of harm is low. (Basics of Diagnostics PowerPoint, slide eight and Diagnostic 10-minute video – Dr. Shaneyfeld; 6.31 min)
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In a patient with microcytic anemia, in which of the following should the NP be most concerned? a. Vitamin B12 levels b. Sulfa drugs c. Folate levels d. Iron levels
Answer: Iron levels Rationale: The most common cause of microcytic anemia is iron deficiency. The other items are causes of macrocytic anemia. (CBC Lecture - Dr. Seth; Slide 30)
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A 32-year-old female presents to the clinic with complaints of feeling "sluggish," cold intolerance, and insomnia. Physical exam reveals brittle nails, delayed DTRs, and periorbital edema. Which of the following diagnostic tests would be most appropriate initially? a. Magnesium b. BMP c. TSH d. Cortisol level
Answer: TSH Rationale: These findings, when considered together, fit the profile for hypothyroidism. The first test we should evaluate for thyroid function is the TSH level. (Endocrine & Autoimmune Disorders – Dr. Moore; Slides 3 & 4)
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Which of the following is the correct order for an abdominal exam? a. Inspect, Auscultate, Palpate, Percuss b. Inspect, Palpate, Auscultate, Percuss c. Auscultate, Inspect, Palpate, Percuss d. Inspect, Auscultate, Percuss, Palpate
Answer: Inspect, Auscultate, Palpate, Percuss Rationale: Inspection is the first assessment we typically and stimulating the intestines with palpation and percussion may induce a change in the patient's bowel sounds. (Abdominal lab/tests – Dr. Moore; Slide 3)
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A 16-year-old female complains of RLQ abdominal pain that started last night. The pain has progressively worsened throughout the night, and she is now having nausea and vomiting. When attempting to palpate the abdomen, the patient tightens the abdominal muscles. Which alternative assessment techniques would test for rebound tenderness? a. Tap the heel firmly with the palm of the hand b. Deep palpation of the RUQ and release slowly c. Gentle palpation of the suprapubic area d. All of the above
Answer: Tap the heel firmly with the palm of the hand Rationale: The heel tap causes symptoms similar to testing for rebound tenderness. Rebound tenderness is tested by quickly releasing with palpation, not slowly. Palpating the suprapubic are tests for urinary issues. (Abdominal Presentation – Dr. Moore; Slide 4)
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Which of the following is NOT characteristic of a wet prep slide with normal findings? a. Lactobacilli present b. Epithelial cells present c. pH 4.6 d. All of these are characteristics of a normal wet prep slide
Answer: pH 4.6 Rationale: Normal findings on a wet prep slide have a pH range of 3.8 - 4.2, with epithelial cells and lactobacilli present. A pH of 4.6 may be indicative of bacterial vaginosis or trichomoniasis. (Women's Health Diagnostic Overview Part 2 – Dr. Olenick; Slide 9 and 8:25 in video)
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Which of the following is not a characteristic of the prostate in benign prostatic hyperplasia? a. The prostate is enlarged b. The prostate feels rough c. The prostate is symmetrical d. The prostate feels smooth
Answer: The prostate feels rough. Rationale: The prostate should feel smooth, symmetrical, and will be enlarged in BPH. A rough surface on the prostate could indicate prostate cancer. (Male Reproductive Health Presentation – Dr. Moore: Slide 2 and 1:18 on video)
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A SOAP Note is used to: a. Document a patient encounter utilizing the Subjective, Objective, Assessment and Plan form of organization. b. An order to perform hygiene on a patient. c. Obtain consent for invasive procedures d. Document Shots, Operations, Allergies and Prescriptions for new patients.
Answer: A Rationale for why the answer is correct: • SOAP is the acronym for Subjective, Objective, Assessment, Plan. The other answers are fictitious. Site for question/rationale: Hillard, Mellow, Moore, “SOAP Note Presentation” video @0:16
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When interviewing a new patient, you ask about the following to document the Family History: a. Health history of the childhood best friend b. Health history of parents and siblings c. Health history of children and grandparents d. B & C
Answer: D Rationale for why the answer is correct: • Inquiring and documenting about three levels of 1st degree relatives is required at a minimum to document a complete family history and to assess the risk for certain diseases. Site for question/rationale: Seth, “SOAP Note Presentation” video @4:00
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When considering which test to order, the clinician thinks about: a. The test with high specificity to rule in disease b. The test with high sensitivity to rule in disease c. The test with low sensitivity to rule in disease d. The test with low specificity to rule out disease.
Answer: A Rationale for why the answer is correct: • Tests with high specificity are more likely to identify disease when it is present (high pretest probability) and tests with high sensitivity are more likely to rule out disease when it is not present (low prestest probability). Site for question/rationale: Shaneyfelt, “How to Choose a Diagnostic Test” @4:42. Moore, “Basics of Diagnostics” @17:18
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How do you rule out a diagnosis on your differential? a. Perform Diagnostic Testing b. Perform a Physical Assessment c. Ask the patient additional follow up questions regarding their medical history and symptoms d. All of the above
Answer: D Rationale for why the answer is correct: Site for question/rationale: Seth, “Basics of Diagnostics” presentation @17:19. Moore, “Differential Diagnosis” presentation @5:28 and 6:07
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Possible causes of Eosinophilia (\>500) may include: a. Parasitic Infections, Allergen exposure, Medication Reactions b. Viral Illness and Lymphoma c. Bacterial Infection, Inflammation, and Medication Reactions d. Iron Deficiency
Answer: A Rationale for why the answer is correct: • Answer A lists common causes of Eosinophilia. • Changes in lymphocyte counts are related to malignancies and viral illness • Iron Deficiency and Blood Loss are associated with changes in MCV Site for question/rationale: Seth, “Complete Blood Count” slides 17, 21, 33
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Elevation of Indirect Bilirubin is: a. Likely due to problems with the Gallbladder or Pancreas b. Likely due to problems with the Kidneys c. Likely due to problems with the Liver d. A & B
Answer: C Rationale for why the answer is correct: • Indirect Bilirubin is a measure of unconjugated bilirubin. The liver is responsible for conjugating bilirubin. • Answers A&B relate to elevated Direct Bilirubin levels. Site for question/rationale: Seth, “CMP/LFT” slide 9
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A 15-year old female presents to your clinic with her parents with a complaint of “abdominal pain.” She is afebrile, reports “normal” periods and occasional red blood when she wipes after a bowel movement. The CBC is concerning for hgb 10 and the physical exam is positive for generalized tenderness without rebound at McBurney’s. You then: a. Refer to Gastroenterology for EGD and H. Pylori testing. b. Refer to Gastroenterology for Colonoscopy c. Order a limited RUQ Abdominal US followed by a HIDA Scan d. Send her home with instructions to follow up in six months and take ibuprofen for her pain symptoms in the meantime.
Answer: B Rationale for why the answer is correct: • Inflammatory bowel disease should be high on the differential given the age of the patient, the finding of anemia and reported hematochezia. Colonoscopy is the recommended study to diagnose Crohn’s and UC. • Not A because EGD and H. Pylori testing are inappropriate tests for IBD. • Not C because these tests are used to diagnose cholecystitis. • Not D because the patient is presenting with anemia with evidence of GI bleeding and continued evaluation is required. Also, NSAIDs are contraindicated for GI bleeding. Site for question/rationale: Moore, “Common Abdominal Complaints” presentation, slides 4-9.
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The parents of a 12-week-old boy bring their child to the Emergency Room and tell you the baby had 4 episodes of projectile vomiting today and has not had a wet diaper in 2 hours. You order a GI series and the radiologist reports “String sign.” Your primary diagnosis is: a. Intussusception b. Hirschsprung's Disease c. Diverticulitis d. Pyloric Stenosis
Answer: D Rationale for why the answer is correct: • Projectile vomiting and “String sign” - Thin elongated pyloric canal are hallmarks of Pyloric stenosis. • Hirschprung’s disease presents with dilated loops of bowel on X-ray imaging. • Intussusception typically presents with “jelly” stools and imaging is expected to reveal a “coiled spring” appearance. • Diverticulitis is typically diagnosed with CT or colonoscopy. Site for question/rationale: Moore, “Common Abdominal Complaints” presentation, slides 10 &14.
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A 40-year-old single female visiting from out of town presents to your urgent care practice with complaints of “vaginal discomfort and itching with a smelly discharge” that started 2 days ago. She is diabetic and takes Metformin. She denies pain with urination. Your pelvic examination and wet prep reveal: White, thin discharge that is fishy, pH 4.7, few WBCs, and “positive whiff test.” You suspect: a. Candidiasis b. HPV c. Bacterial Vaginosis d. Trichomoniasis
Answer: C Rationale for why the answer is correct: • Not Candidiasis because discharge will typically have thick, clumpy appearance and pH would be lower than 4.5 and Whiff test should be negative. • Not HPV because the primary symptom is presence of genital warts and HPV is not diagnosed with the methods in this scenario. • Bacterial Vaginosis is the correct answer because the characteristics of the reported symptoms, negative dysuria, finding of thin and white discharge, few WBCs, increased pH (\>4.5) and positive Whiff test are usual findings for BV. • Not Trichomoniasis because pain with urination is a normal symptom, discharge is typically froth, green or grey or yellow, and microscopy usually reveals many WBCs and motile flagellated protozoa. Site for question/rationale: Olenick, Women’s Health Overview of Diagnostics presentation, slide #10. Moore, Hilliard, Mellow, “STI Diagnostics” presentation “HPV” @19:20.
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A 21-year-old male presents to your clinic complaining of "swollen testicles" that he first noticed a week ago. You palpate a firm, enlarged and nontender mass. You should then order which diagnostic test? a. MRI of the Abdomen and Pelvis with and without contrast. b. Scrotal Ultrasound c. Hip and Pelvis X-ray d. CT of the Testicles
Answer: B Rationale for why the answer is correct: • Given the age of the patient and finding of firm, enlarged and nontender mass testicular cancer should be high on the differential diagnosis and ultrasound of the testicles is the gold standard for diagnosis. Site for question/rationale: Moore, “Male Reproductive” presentation, Slide 7.
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1Question: The “S” in SOAP note includes which patient finding? Answer: A) What the patient tells you, B) Findings from a physical exam, C) Findings from lab testing, D) none of the above.
ANSWER: A Rationale for why the answer is correct: The “S” in SOAP note stands for subjective findings. These findings are what the patient tells you. Site for question/rationale: The SOAP note presentation by Dr. Seth at minute 2:50.
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Question: The Objective part of the SOAP note includes which findings? A) B/P of 175/90, B) Nausea, C) Abdominal Pain, D) Both A and B
ANSWER :A Rationale for why the answer is correct: The Objective part of the SOAP note are findings by the clinician that are factual and can be identified by performing a physical exam or testing such as a blood pressure. Site for question/rationale: SOAP note presentation by Dr. Seth at minute 3:18.
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Question: A patient has a chief complaint of fatigue and has a history of HTN, DM2, HLD, and arthritis. Which diagnosis is not part of a differential diagnosis for this patient? Answer: A) Hypothyroidism, B) High cholesterol, C) Anemia, D) GI Bleed
ANSWER: B Rationale for why the answer is correct: A differential diagnosis are diagnosis that a patient potentially has by examining the ROS and medical history of patient. Fatigue could be d/t hypothyroidism , anemia, or GI bleed. HLD, one of patient’s co-morbidities, has nothing to do with fatigue. Site for question/rationale: Differential Diagnosis video with Dr. Amy Moore (under Additional Resources) at minute 0:49.
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Question: A 64 y/o male patient complains of chronic knee pain, which differential diagnosis should be at the top of the list? Answer: A) Septic Arthritis B) Malignancy, C) Patellar Tendonitis, D) Osteoarthritis
ANSWER : D Rationale for why the answer is correct: The patient's age needs to be taken into consideration, and the most likely diagnosis should be at the top of the list. OA is most common for the older population, malignancy and septic arthritis is possible but unlikely, and patellar tendonitis is more commonly seen in the younger population. Site for question/rationale: Differential Diagnosis for The Advanced Practice Nurse textbook on pages 2 and 173.
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Question: Which WBC line is elevated during an allergic reaction? Answer: A) lymphocytes B) Monocytes C) neutrophils D) eosinophils
Answer: D Rationale for why the answer is correct: In industrialized nations, allergies are the main cause of elevated eosinophils, in third world countries, parasitic infections are main cause. Site for question/rationale: Complete Blood Count by video by Dr. Seth slide 21.
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Question: Which of the following tests is not included in a BMP? A) creatinine B) BUN C) total protein D) CO2
Answer: C Rationale for why the answer is correct: Total protein is part of the CMP, a CMP includes the BMP in addition to total protein, albumin, total bili, ALT, AST, AND ALK Phos Site for question/rationale: CMP video by Dr. Seth slide
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Question: Which of the following tests is used for diagnosing cholecystitis? A) Psoas sign B) Rovsings sign C) Rebound tenderness D) Murphy’s sign
ANSWER D Rationale for why the answer is correct: Murphy’s sign is where the provider places hand in RUQ and applies pressure then asks patient to breath in, if patient experiences severe pain, this is positive for cholecystitis, the other three tests are used for appendicitis. Site for question/rationale: Abdominal pain video by Dr. Moore slide 4.
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Question: Which diagnostic test (s) is used for diagnosing pancreatitis? (select all) A) CT scan B) HIDA scan C) Serum lipase/amylase D) Abdominal pain on palpation
ANSWER: B Rationale for why the answer is correct: Site for question/rationale: Common Abdominal Complaints video by Dr. Moore slide 11.
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Question: Mammograms should be performed until at least what age? A) 60 B) 65 C) 70 D) 75
Answer : D Rationale for why the answer is correct: Screening should be performed until at least 75 years of age. If patient is still high risk, screening can continue. Site for question/rationale: Women’s Health- Preventative Care video by Dr. Moore slide 5.
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Question: When assessing for vaginitis, a wet prep is performed. Which elements are normally found in a wet prep sample of a patient with vaginitis? (select all) Answer: A) RBCs B) epithelial cells C) Gram + bacteria D) moderate WBCs
Answer :B & C Rationale for why the answer is correct: Lactobacillus (gram + rods) and epithelial cells are normal findings, RBCs indicate bleeding (irritative vaginitis), and WBCs indicate an infection is may be present. Site for question/rationale: Women’s Health Overview of Diagnostics video by Dr. Olenick slides 2 and 5.
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During your initial visit, your patient is unable to speak due to a previous stroke, and his brother (POA) is at bedside accompanying him providing you with information. How would you document the chief complaint within the SOAP note? a. Patient is unable to speak from verbal aphasia. Here for “bright red blood in stools for 3 days.” b. Patient is unable to speak due to verbal aphasia. Accompanied by brother (POA) who stated, “He is having bright red blood in his stools for 3 days now.” c. Patient is here for having bright red blood in his stools for 3 days duration. d. Patient’s brother (POA) states that he is having bright red stools for 3 days.
Answer: B Rationale: You can write the CC one of two ways. You can just place it in quotation marks, or you can write it in a paragraph if you are trying to clarify the circumstances. If you are unable to obtain the information from the patient for whichever reason, that needs to be addressed (why) in addition to who the information was obtained from and what their relation is to the patient. Site for question/rationale: Module 1- Diagnostic Reasoning/SOAP note. Dr. Seth’s SOAP note video presentation, time stamp 11:57 / 26:50.
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During a clinical rotation, you have just finished assessing your patient and gathering all necessary information. Which is best described as objective data? a. Your patent describes 4/10, radiating chest pain to the jaw. b. The previous chart reveals an EKG that was performed a month prior. c. Current troponin is 0.9. d. Troponin on chart from transferring hospital was 0.7.
Answer: C Rationale: Objective information is your work and what is coming from you. It is what you observe and assess at your facility. Subjective data comes from the patient, a previous facility, or a previous chart and can potentially be wrong. Site for questions/rationale: Module 1- Diagnostics/SOAP note. Dr. Seth’s SOAP note video presentation, time stamp 20:55 / 26:50.
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Which subjective information is crucial in gathering all necessary data to formulate your potential differential diagnoses? a. History b. Physical examination c. Ordered labs d. Diagnostic tests
Answer: A Rationale: The patient’s history is subjective as it is what the patient tells you and/or what is from a previous chart. A physical examination, ordered labs, and diagnostics are objective as it pertains to what you will be performing. Site for question/rationale: Module 1- Diagnostic Reasoning/SOAP Note under “additional resources”, Dr. Moore’s video presentation “Differential Diagnosis” time stamp 3:54 / 7:20
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During your clinical rotation, your preceptor asks you to describe what a differential diagnosis is. This can best be described as what? a. A differential diagnosis is what the patient’s diagnosis is determined to be. b. The differential diagnosis is the actual diagnosis and should be documented with your plan. c. A differential diagnosis is a potential diagnosis that could be causing your current chief complaint. d. A differential diagnosis is a potential diagnosis for your chief complaint and should be ruled out with labs and diagnostics.
Answer: C Rationale: A differential diagnosis is a potential diagnosis that could be causing your chief complaint. Although it could potentially be, it is not your patient’s actual diagnosis and does not always have to be ruled out with labs and/or diagnostics. The patient’s history, HPI, ROS, and assessment can rule out a differential as well. Diagnostics should only be ordered when the pretest probability falls between the test threshold and the treatment threshold (Module 1- Diagnostic Reasoning/SOAP Note, Additional Resources “How to Choose a Diagnostic Test” video, time stamp 0:59 /7:16). Site for question/rationale: Module 1- Diagnostic Reasoning/SOAP Note under “additional resources”, Dr. Moore’s video presentation “Differential Diagnosis” time stamp 3:00/7:20.
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A 36-year-old female patient comes to the clinic with complaints of fatigue x 3 months. After completing your assessment and obtaining labs, your H/H is decreased and your MCV is 98% of your total RBC count. Which lab will you order next? a. TSH b. B12 c. Serum Iron d. Ferritin
Answer: B Rationale for why the answer is correct: A MCV \>96% of the absolute value of RBCs indicates macrocytic anemia. The main cause of macrocytic anemia is B12 or Folate deficiencies. Although there can be many other causes, you should always order a B12 and/or Folate first. Site for question/rationale: Module 1- Dr. Seth’s CBC voice thread presentation, time stamp 24:15 / 39:09
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During your ICU rounds, you assess a patient who has a history of diabetes and liver disease. He has a stage 3 sacral wound, is malnourished, and is starting to third space. TPN is currently ordered, along with albumin and Lasix. His last CMP was ordered two days ago. To evaluate response to current treatment, which lab would you consider? a. Pre-Albumin b. Albumin c. Globulin d. Total Protein
Answer: A Rationale: Pre-Albumin is not part of the CMP but is better used to assess response to treatment in the hospital setting due to its half-life being only two days. Albumin and globulin are part of the total protein, which is part of the CMP. His last ordered CMP was two days prior and albumin has a half life of approximately 20 days, so its value is slow to change (approx. 14 days). Site for question/rationale: Module 1- Labs, Dr. Seth’s CMP/LFT’s voice thread presentation, time stamp 3:42 / 24:13.
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A mother brings her 10-year-old son to the ED with 8/10 pain to his lower right abdomen. During the physical examination, the provider notices the patient’s pain is increased when he places pressure and then releases his hand over that specific area. What is this indicative of? a. Gastroenteritis b. Appendicitis c. Cholecystitis d. Pancreatitis
Answer: B Rationale: Rebound tenderness is pain to the tender area with pressure and quick release. The patient with appendicitis will have pain once the pressure is released from the tender area. Site for question/rationale: Module 2 Abdominal/Reproductive Health, Dr. Amy Moore’s Abdominal Lab/Tests, voice thread presentation, time stamp 3:01/23:06.
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You have an Xray that shows a “coiled spring” appearance. What should you initially be thinking as a diagnosis? a. Pyloric Stenosis b. Intussusception c. Hirschsprung’s Disease d. Inflammatory Bowel Disease
Answer: B Rationale: Barium enema is the gold standard for diagnosis of Intussusception and will show a “coiled spring” appearance. A plain abdominal Xray should be done prior to BE to exclude any intestinal perforation. Site for question/rationale: Module 2 Abdominal/Reproductive Health, Dr. Amy Moore’s Abdominal/ Reproductive Health voice thread presentation, time stamp 20:37 / 23:06.
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An APRN student is communicating with her preceptor about when the best time to start PAP Smears is. What is the best response? a. Once the patient turns 21 years if sexually active. b. At 21 years regardless of sexual activity. c. 30 years of age. d. At 35 years of age.
Answer: B Rationale: Pap Smears start at age 21 regardless of sexual activity. Performing Pap Smears under the age of 21 is not recommended as many young females were having abnormal results. Site for question/rationale: Module 2 Abdominal/ Reproductive Health, Dr. Amy Moore’s Women’s Health Preventative Care voice thread presentation, time stamp 20:21 / 20:31
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Why does the recommendation for HPV testing offered to women over 30? a. This age has the highest incidence for cervical cancer. b. Women less than 30 years of age do not get HPV. c. Cervical cancer is fast growing. d. Women less than 30 do not get cervical cancer.
Answer: A Rationale: Cervical cancer is slow growing and is caused mainly by HPV. When adolescents contact HPV, most of the time their bodies will heal themselves. Most women will contract HPV at some point in their lives. The reason for recommendation for HPV testing to be offered to women over 30- is that the age range has the highest incidence for cancer. Site for question/rationale: Module 2 Abdominal /Reproductive Health. Dr. Olenick’s
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Tympanic membrane clear bilaterally, no exudates, minimal ear wax noted.” Where does this information belong in a SOAP note? a. Subjective b. Objective c. Assessment d. Plan
Answer: B. Objective. Rationale: It belongs in your physical assessment documentation, which is in the Objective part of your SOAP note. The patient did not tell you this, it is not your differential, and not part of your plan. Site for question/rationale: Found in SOAP note presentation and Sample SOAP note H&P example - page 5.
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Where would you mainly document the answers to your OLD CARTS questions in your SOAP note? a. Subjective section b. History of Present Illness c. Social History d. A and B are both correct e. B and C are both correct
Answer: D: A and B Rationale for why the answer is correct: OLD CARTS is used to investigate the chief complaint and is documented in the History of Present Illness (HPI). The HPI is part of the Subjective section of the SOAP note, therefore, A and B are correct. Site for question/rationale: Found in SOAP note presentation and Sample SOAP note H&P example - page 2.
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What is NOT considered a valid reason to order a certain diagnostic test? a. To gather data for your personal research project b. To rule out certain disease process c. Patient presents with high probability of disease d. To follow-up test based on ordered care plan
Answer: A. To gather data for your personal research project. Rationale: Gathering data for personal reasons is not a valid reason for ordering diagnostic tests on a patient who is not part of a research study. B, C and D are valid reasons to order diagnostic tests. Site for question/rationale: Basics of Diagnostics presentation, slide 9.
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What is a guiding factor to consider when deciding what diagnostic tests to order? a. What is the cost of the test? b. Will this test change the treatment plan for this patient? c. What guidelines do I need to follow or reference when ordering tests? d. All of the above
Answer: D. All of the above. Rationale: All of these are important to consider, in addition to many more factors. You must also consider gold standard tests, necessity, and urgency. Site for question/rationale: Basics of Diagnostics presentation, slide 14.
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Mr. Smith, a 65-year-old diabetic, comes into your office complaining of blood in his urine, painful urination, and cloudy urine. He has a family history of renal problems. You are concerned and want to start with some bloodwork and urine labs. What bloodwork labs are you likely to order? a. Basic Metabolic Panel (BMP) b. Complete Blood Count (CBC) c. Complete Metabolic Panel (CMP) d. All of the above
Answer: D. All of the above. Rationale: All of these bloodwork labs are helpful to start with, in addition to the urine labs. The BMP includes electrolytes and renal function labs, like BUN and serum creatinine, that can provide insight into the kidneys functionality and filtering ability. The CBC can give you insight into acute infection WBC markers and polycythemia. A CMP (with UA results in mind) can tell you if there is a problem with the kidneys filtering or reabsorbing protein like albumin. Site for question/rationale: BMP handout, slides 5, 14-17. CBC handout, slides 4, 9-24, 37. CMP handout, slide 3-4.
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You are in clinicals reviewing labs on a recent patient that presented with cough and congestion. You hear your preceptor say “Oh, that patient has a shift to the left!” What did your preceptor see when looking at the labs? a. Patient’s CBC shows polycythemia b. Patient’s CBC shows absolute neutrophil count of 1500 c. Patient’s CBC shows band neutrophils are \>5% d. Patient’s CBC shows a high monocyte count
Answer: C. Patient’s CBC shows band neutrophils are \>5% Rationale: A normal band neutrophil percentage is 0-5%. Bands are immature neutrophils that increase in number when the body is mounting a defense against an acute infection. The other answers are incorrect. Site for question/rationale: CBC handout, slides 11-14.
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You enter your patient’s room to find Mrs. Williams moving about, restless, and unable to get comfortable. She states she is here because her “abdomen hurts.” When palpating her abdomen, you notice hepatomegaly and tenderness in the RUQ. What kind of abdominal pain is most likely the cause of Mrs. William’s discomfort? a. Colic pain b. Stretching pain c. Ischemic pain d. Inflammatory pain
Answer: B. Stretching pain. Rationale: Stretching pain is “caused by acute stretching of an organ, such as the liver, spleen, or kidney, due to enlargement” and the patient is “restless, moves about, and has difficulty getting comfortable.” Mrs. Williams’ presentation of restlessness, hepatomegaly, and RUQ tenderness fits this description. Colic pain and ischemic pain are not the best answer due to patient presentation. Patients with inflammatory pain usually do not move about constantly, instead they want to lie still. Site for question/rationale: Differential Diagnosis, Rhoades book: page 5-7.
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Mr. John (60 years old) comes into your ER after getting some labs at his PCP office where he presented with abdominal pain. He states that his PCP sent him to the ER because she was worried his “pancreas was inflamed…or something like that.” Mr. Smith’s labs show: WBCs: 18,000 Glucose: 232 High serum lipase and amylase (3x normal) According to the American Academy of Gastroenterology, which 2 items are needed to diagnose Mr. John with pancreatitis? a. Abdominal pain + high serum lipase and/or amylase b. WBCs 18,000, Glucose 232 c. Abdominal pain, WBCs 18,000 d. High serum lipase and/or amylase + glucose 232
Answer: A. Abdominal pain + high serum lipase and/or amylase Rationale: According to the American Academy of Gastroenterology, 2 out of these 3 items are needed to pancreatitis: abdominal pain, serum lipase and/or amylase greater than 3x normal limits, and a CT scan. Site for question/rationale: Common Abdominal Complaints PowerPoint presentation, slide 11.
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You are working at a pediatric primary care clinic. A mother comes in with her 16-year-old daughter and states that she is worried because her daughter has recently been sexually active, and they have 2 family members that have had cervical cancer. The mother is asking if it is a good time to start her daughter’s pap smear screening. What is your best response? a. Yes, with a family history of cervical cancer, it is best to start Pap smears as soon as possible in a sexually active teen. b. Yes, we usually start pap smear screening starts at 16 years old if the teen or parent is concerned. c. No, it is not recommended to start pap smear screening until 18 years of age regardless of risk factors. d. No, it is not recommended to start pap smear screening until 21 years of age regardless of risk factors.
Answer: D. No, it is not recommended to start pap smear screening until 21 years of age regardless of risk factors. Rationale: The guideline not to start Cervical Cancer Screening until age 21 regardless of risk factors is recommended by the ACS, ASCCP, ASCP, USPSTF, and ACOG. Site for question/rationale: Women’s Health PowerPoint
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Mr. Jones (72 years old) presents to your clinic, and before he comes in the room, your nurse tells you he is here for complaints of difficulty urinating. What are you thinking may be the problem? a. Benign Prostatic Hyperplasia b. Acute Bacterial Prostatitis c. Prostate Cancer d. A or C are most likely for Mr. Jones
Answer: D. A or C are most likely for Mr. Jones. Rationale for why the answer is correct: Due to his age, BPH and Prostate cancer are more likely and can both cause difficulty urinating if the prostate is enlarged enough. Acute Prostatitis is most common in 30-50-year-old men. Site for question/rationale: Male reproductive PowerPoint, slides 2-3.
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Question: Which mnemonic does not aid in the History of Present Illness (HPI) a. OLDCARTS b. OPQRST c. SOCRATES d. SYMPTOM
Answer: D Rationale for why the answer is correct: OLDCARTS- Onset, Location, Duration, Character, Aggravating/Alleviating, Region/Radiating, Timing, Severity/Scale. OPQRST- Onset, Palliation/Provocation, Quality, Radiation, Severity, Time, SOCRATES- Site, Onset, Characteristics, Radiating, Associating Factors/Alleviating, Timing, Exacerbating/Alleviating, Severity Site for question/rationale: Mnemonics PDF page 1
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Question: Which is NOT a component of a structured SOAP note? a. Chief Complaint b. History of Present Illness c. Family members date of birth d. Past Medical History
Answer: C. Rationale for why the answer is correct: Chief Complaint, History of Present Illness (HPI), Past Medical History (PMH), Past Surgical History, Pertinent/relevant social or health maintenance history, Medication, Allergies, Family History, Review of Systems (ROS), Physical Exam (PE), Lab/Radiology or other Diagnostic Data, Diagnosis, Differential Diagnosis, Plan. Site for question/rationale: FNP-SOAP note template.
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Question: Before ordering a diagnostic test for a patient, one should a. Not consider the patients culture if the test is absolutely necessary b. Order all the tests the patient requests, to give them piece of mind c. Follow guidelines and practice recommendations d. Only order the absolute minimum because labs can be pricey.
Answer: C Rationale for why the answer is correct: Before you order a diagnostic test, you should always look at the history of the patient, keep in mind the patient’s culture and beliefs, be able to find practice guidelines and recommendations, keep in mind diagnostic stewardship, and have good ethics. Site for question/rationale: Basics of Diagnostics PowerPoint Slide 2.
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Question: How many methods are there when estimating pretest possibility? a. 2 b. 3 c. 4 d. 5
Answer: B Rationale for why the answer is correct: The three methods to estimate pretest probability are 1. Direct studies of disease probability. 2. Validate clinical prediction rules 3. Clinical experience and judgement. Site for question/rationale: Basics of Diagnostics PowerPoint Slide 7.
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Question: Examining a serum CBC can be done by a. Manual or Automated count b. Peripheral blood smear c. Bone Marrow d. All the above
Answer: D. All the above Rationale for why the answer is correct: A serum CBC can be examined by a manual or automated count, peripheral blood smear, or bone marrow. Site for question/rationale: Complete Blood Count PowerPoint slide 2.
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Question: A high BUN can be caused by a. over-hydration b. liver disease c. nutritional deficiency d. GI bleed
Answer: D. Rationale for why the answer is correct: A high BUN can be caused by renal disease, dehydration, GI bleed, and post-renal obstruction. Site for question/rationale: Diagnostic BMP PowerPoint Slide 14.
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Question: On a physical exam for appendicitis, the Psoas sign is performed by a. Flexing the patient’s right thigh at the hip, with the knee bent, and rotating the leg internally b. Picking up folds of the skin on the abdominal wall c. Placing a hand above the patient’s right knee and having the patient raise it d. Raising the heel 10-20% and hitting the heel firmly with the palm of your hand
Answer: C Rationale for why the answer is correct: Psoas sign- place hand above the patient’s right knee and have them raise it Site for question/rationale: Abdominal Presentation PowerPoint Slide 4.
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Question: In appendicitis, what would be present on exam if perforation had occurred a. Hematuria b. WBC’s greater than 20,000 c. An elevated ALT, AST, and bilirubin d. A GGT of 48 U/L
Answer: B Rationale for why the answer is correct: Elevated WBC (90%) greater than 20,000 is indicative of perforation Site for question/rationale: Abdominal Presentation PowerPoint Slide 7
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Question: How often should 24-year-old women get a routine pap smear if her last pap smear was normal? a. Every 3 years b. Every 5 years c. Once a year d. Every 2 years
Answer: A Rationale for why the answer is correct: Women aged 21-29 with past normal pap smear should have annual pap smears every 3 years. Site for question/rationale: Women’s Health Preventative Care PowerPoint Slide 4.
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Question: Mammograms should be performed until what age? a. 40 b. 50 c. 65 d. 75
Answer: D Rationale for why the answer is correct: Screening should occur until at least age 75. Site for question/rationale: Women’s Health Preventative Care PowerPoint slide 5.
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59-year-old male patient presents to the ER with complaints of “8/10 headache pain and right arm weakness”. He also has difficulty recalling his birthday. VS: 189/89, HR 84, RR 22, SpO2 98% on RA, and Temp. 99.0 F oral. The attending provider begins to work on differentials and formulate a plan. What data is documented in “S” of the SOAP note? a) 8/10 HA pain, right arm weakness b) 8/10 HA pain, right arm weakness, memory problems c) Memory problems & all VS d) Only VS
Answer: A Rationale for why the answer is correct: Patient’s perception of a weak right arm and headache pain are subjective complaints. A finding during the PE of right arm weakness would be an objective finding and not be in the “S” but that is not how it is listed here. Memory problems and VS are objective findings. Site for question/rationale: Dr. Seth, SOAP lecture audio clip; 11:45/26:50 (time in video)
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In the pneumonic “OLD CARTS” used to question the patient further regarding HPI, which answer would be included in the “A”? a) “Four days ago” b) “Dull” c) “Feels better when laying down and worse after eating”. d) “Intermittent”
Answer: C Rationale for why the answer is correct: The “A” includes aggravating or alleviating factors like described. The other answers are examples of other parts of “OLD CARTS”. Site for question/rationale: Dr. Seth, SOAP lecture audio clip, 13:15/ 26:50 (time in video)
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When creating a list of differential diagnoses, which statement is not correct? a) They are listed in order of most likely to least likely. b) It is completed after medical history and physical exam. c) The whole list may be MNM (Must Not Miss) differential diagnoses. d) Creating a list of DDX is part of the “plan” in the SOAP note.
Answer: D Rationale for why the answer is correct: The first 3 are correct. Creating a list of differential diagnoses is part of the “assessment” portion of a SOAP note. Site for question/rationale: Dr. Seth, SOAP lecture handouts: extended focused note & illness script instructions.
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In creating differential diagnoses in a patient with fatigue, it is important to consider: a) Age b) Gender c) Cultural/ population concerns d) All the above
Answer: D Rationale for why the answer is correct: Narrowing down risk/ likelihood by gender, age and population increases the probability of an actual diagnosis and decreases the need/ and costs associated with some diagnostic testing. Site for question/rationale: Differential diagnosis for fatigue video; 14:27/17:48 (time on video)
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Adult female presents to the clinic with complaints of fatigue, low grade fever and nausea x3 days. The CBC with diff includes WBC 11.5, Neutrophils 50, Lymphocytes 120, Monocytes 2, Eosinophils 1, and Basophils 1. Without additional diagnostic information, what type of illness are you suspecting at this point? a) Bacterial b) Viral c) Both d) Cannot tell from this information.
Answer: B Rationale for why the answer is correct: This infection is most likely viral because the lymphocytes are increased. Bacterial infections typically increase the percentage of neutrophils. Site for question/rationale: Dr. Seth, CBC lecture, slides 16-17
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79-year-old male presents with staph infection to right leg. IV Antibiotics need to be started. He is noted to also have renal insufficiency. Which diagnostic test results would be most useful in deciding if renal dosing is indicated? a) Serum creatinine b) Blood Urea Nitrogen c) Creatinine Clearance (Urine) d) Glomerular Filtration Rate
Answer: C Rationale for why the answer is correct: Renal dosing of meds is based on Creatinine clearance not GFR. Serum creatinine and creatinine clearance (tested in a 24-hour urine sample) are not synonymous. Site for question/rationale: Dr. Seth, BMP lecture, slide 17.
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Mrs. S presents to the clinic with sharp, intermittent right upper quadrant pain, 4/10 x 2 days. She has a positive murphy’s sign. What lab tests would the provider order? A) CMP B) WBC C) ABD ultrasound D) B&C
Answer: D. Rationale for why the answer is correct: In diagnosing cholecystitis a WBC and ABD ultrasound are indicated. Site for question/rationale: Dr. Moore’s common abdominal complaints lecture, slide 8
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A 4-month-old presents to the clinic with its mother reporting “jelly stools”, fussiness and not wanting to eat. What test would be the gold standard if intussusception is suspected? A) ABD x-ray B) ABD CT C) Barium enema D) Stool Sample
Answer: C. Rationale for why the answer is correct: A barium enema is the gold standard in diagnosing Intussusception. Site for question/rationale: Amy Moore’s common abdominal complaints lecture, slide 14
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Question: A 62-year-old postmenopausal, female reports to clinic today for annual check-up 2 months post ankle fracture. She has not had any complications post-surgery and has started physical therapy. She does not take any medications. What test would the provider recommend for examination? A) Bone Density Test/ DEXA scan B) Urine toxicity screen C) Depression screening D) WBC
Answer: A. Rationale for why the answer is correct: A fracture is a risk facture for osteoporosis and a DEXA scan is indicated even though the patient is not yet 65. Site for question/rationale: Dr. Moore’s Women’s Health Lecture, Slide 2
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Question: 20-year-old male presents to the clinic with tender unilateral testicular mass. What test should the provider order to confirm or rule out testicular cancer? A) ABD & chest CT B) PSA C) Scrotal US D) WBC
Answer: C Rationale for why the answer is correct: A scrotal US is the gold standard to diagnose testicular cancer. Site for question/rationale: Dr. Moore Male Reproductive lecture, slide 7
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Question: How many generations should be listed in the family history of your patient? A. one generation B. two generations C. at least three generations D. five generations
Answer: C. at least three generations Rationale for why the answer is correct: A three generation pedigree is used for diagnostic considerations and risk assessment of genetic disorders. Site for question/rationale: SOAP Note Presentation starting at 4 minutes
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Question: Where in the mnemonic OLD CARTS would the patient’s statement “The pain in my back started suddenly while I was moving boxes in the garage” ? A. Onset B. Aggravating C. Character D. Severity
Answer: A. Onset Rationale for why the answer is correct: OLD CARTS stands for Onset, Duration, Location, Character, Aggravating/Alleviating, Region/Radiating, Timing, Severity/Scale Site for question/rationale: SOAP Note Presentation starting at 13 minutes
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Question: What does a test with high sensitivity that is negative tell the clinician? A. A test with high sensitivity that is negative rules out the disease B. A test with high sensitivity that is negative rules in the disease C. A test with high sensitivity that is negative is not specific D. A test with high sensitivity that is negative is 100% accurate
Answer: A. A test with high sensitivity that is negative rules out the disease Rationale for why the answer is correct: Sensitivity is the probability that a person with disease has a positive test known as the true positive rate. Site for question/rationale: Diagnostic Basics Presentation at 18 minutes 40 seconds
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Question: What does a positive likelihood ratio (LR+) tell the clinician? A. The positive likelihood ratio (LR+) tells the clinician it is unlikely to get a true positive test B. The positive likelihood ratio (LR+) tells the clinician how likely it is that a result is a true positive (TP), rather than a false positive (FP) C. The positive likelihood ratio (LR+) tells the clinician how likely it is that a result is a false negative (FN), rather than a true negative (TN) D. The positive likelihood ratio (LR+) pushes the clinician below the test threshold
Answer: B. The positive likelihood ratio (LR+) tells you how likely it is that a result is a true positive (TP), rather than a false positive (FP) Rationale for why the answer is correct: The likelihood ratio (LR) is the likelihood that a given test result would occur in a patient with the disease compared with the likelihood that the same result would occur in a patient without the disease, enabling you to calculate how much the probability would shift. Therefore, the positive likelihood ratio (LR+) tells you how likely it is that a result is a true positive (TP), rather than a false positive (FP). Positive LRs that are significantly above one indicate thata true positive is much more likely than a false positive, pushing you across the treatment threshold. Site for question/rationale: Diagnostic Basics Presentation at 19 minutes 38 seconds
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Question: Which of the following is not included in a complete blood count (CBC)? A. White blood cell count B. Hematocrit C. Mean Corpuscular Volume D. Glucose level
Answer: Glucose level Rationale for why the answer is correct: A glucose level is included in a completely metabolic panel. Site for question/rationale: Differential Diagnosis for the Advance Practice Nurse pg. 302
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Question: What does a high neutrophil count most likely represent? A. Autoimmune disease B. High blood pressure C. Bacterial infection D. Affluenza
Answer: C. Bacterial infection Rationale for why the answer is correct: Neutrophils are a type of white blood cell that are released when the body is mounting a defense on a bacterial infection. Site for question/rationale: Complete Blood Count video at 8 minutes and 30 seconds
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Question: Appendicitis is most common between what ages? A. Between 5 - 50 years old B. Under 5 years C. Over 50 years old D. Between 5- 25 years old
Answer: A. Between 5 - 50 years old Rationale for why the answer is correct: The instance of appendicitis occurs most often between the ages of 5 and 50 years old. Site for question/rationale: Abdominal Exam- Diagnostics lecture at 9 minutes and 50 seconds
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Question: A 4-month-old infant present to the clinic with projectile vomiting, unable to satisfy with feeding, weight loss, dehydration, and an olive shaped mass in the upper right quadrant of the abdomen. Which of the following diagnosis would you suspect? A. Appendicitis B. Affluenza C. Pyloric stenosis D. Reflux
Answer: C. Pyloric stenosis Rationale for why the answer is correct: The complaints of projectile vomiting, unable to satisfy with feeding, weight loss, dehydration, and an olive shaped mass in the upper right quadrant of the abdomen are consistent with pyloric stenosis. Site for question/rationale: Abdominal Exam- Diagnostics lecture at 18 minutes and 52 seconds
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Question: A healthy vaginal ecosystem would be indicated by what pH? A. 3.8 - 4.2 B. \> 4.5 C. 6.8 – 7.2 D. \< 3.8
Answer: A. 3.8 – 4.2 Rationale for why the answer is correct: A normal vaginal pH level is between 3.8 - 4.2 which is moderately acidic and would be one beneficial guide for the clinician in interpreting vaginitis differentials. Site for question/rationale: Women’s Health Overview of diagnostics at 8 minutes and 50 seconds
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Question: If you suspect cancer in a patient with acute bacterial prostatitis how long should you wait to check a PSA? A. Wait 4 weeks until after the infection has cleared B. It should always be done right away C. Wait 2 weeks D. Wait 24 hours
Answer: A. Wait 4 weeks until after the infection has cleared Rationale for why the answer is correct: The PSA will be elevated during an acute infection and will not accurately diagnose prostate cancer Site for question/rationale: Male Reproductive Health Presentation at 8 minutes and 24 seconds
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Question: Which of the following data should be in the “O” portion of the SOAP note? a. Pt reports a PMH of HTN and HLD b. Pt is a smoker x5 years. c. Rebound tenderness is present with abdominal exam. d. Pt lives with wife and kids in an apartment.
Answer: C. Rebound Tenderness Rationale for why the answer is correct: The “O” in SOAP stands for “Objective” which are data gathered through physical examination and assessment while “Subjective” data are information that was received from the patient. Site for question/rationale: SOAP note presentation 22:18 of video
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Question: A 65 y/o male presents in the ER with an abdominal pain. When gathering the HPI data from the patient. Which question would fit the “S” in the mnemonic “OPQRST?” a. What were you doing when the pain started? b. How bad is the pain from 0-10 pain scale? (pain scale explained to patient) c. Is the pain radiating/moving somewhere else? d. Is there anything the makes it feel better or worse?
Answer: B. Rationale for why the answer is correct: The mnemonic OPQRST is used to gather more information regarding the patient’s symptoms. “S” stands for Severity and asking the patient to rate the abdominal pain will help examiner determine the severity of the symptom. Site for question/rationale: SOAP Note Presentation 11:09 of video
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Question: What diagnostic test information is needed to “Rule OUT” a specific disease a. High Sensitivity % b. High Specificity % c. Low Sensitivity % d. Low Specificity %
Answer: A. high Sensitivity Rationale for why the answer is correct: A diagnostic test with a high sensitivity is used to “rule out” a specific disease when the test result is negative. This is because when a patient does have the disease, there is a high chance that the patient will test positive in a high sensitivity diagnostic test. Site for question/rationale: Basics of Diagnostics 27 min video 19:00
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Question: Answer: Which of the following does NOT help a provider determine pre-test probability of a disease? a. Implicit decision making and not being probabilistic. b. Studies related to probability of a specific disease. c. Experience and judgement d. Clinical prediction questionnaires and tools
Answer: A Rationale for why the answer is correct: A direct study of a disease, clinical experience, and validate clinical prediction rules are used to determine pretest probability. Explicit and probabilistic approach to decision making will help in differential diagnosis and ordering appropriate tests. Site for question/rationale: Basics of Diagnostics 27 min video 08:30
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Question: Which lab result would indicate the need for neutropenic precautions? a. ANC of 400 b. WBC 19,000 and Neutrophils 85% c. WBC 12,000 d. ANC of 900
Answer: A Rationale for why the answer is correct: ANC less than 500 is Sever Neutropenia and neutropenic precautions is indicated. Site for question/rationale: CBC presentation 12:00 of video
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Question: Which of the following conditions would cause an MCV of 98? a. Iron deficiency b. Lead poisoning c. B12 deficiency d. Thrombocytopenia
Answer: C. Rationale for why the answer is correct: MCV over 96 is Macrocytic Anemia which is commonly caused by B12 or Folate deficiencies Site for question/rationale: CBC presentation 23:30 of video
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Question: In conducting an abdominal exam for a patient who presented with abdominal pain, which palpation exam may be performed to check for Cholecystitis? a. Obturator Sign b. Heel Tap c. Murphy’s Sign d. Rebound Tenderness
Answer: D. Murphy’s Sign Rationale for why the answer is correct: In Murphy’s test, the patient is asked to take a deep breathe while the examiner is pressing the RUQ. If cholecystitis is present, the patient will feel pain and the inhalation will be disrupted. Site for question/rationale: Common Abdominal Complaints PPT, Slide 4
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Question: In a pediatric patient suspected of having Intussusception, which Diagnostic test is considered the gold standard? a. Ultrasound to look for “String Sign.” b. Barium Enema to look for “coiled spring.” c. Abdominal Xray to look for “looped bowel.” d. ERCP to look for “bile obstructions.”
Answer: B. Barium enema Rationale for why the answer is correct: Coiled spring bowel appearance is found in patients with Intussusception by performing a Barium enema. Barium gets trapped in affected area which shows a coiled spring appearance in the X ray. Site for question/rationale: Common Abdominal Complaints PPT, Slide 14
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Question: Which of the following is not correct regarding breast exams? a. Mammograms every 1-2 years starting at 40 years and no later than 50 years old. b. Screening only until 75 years old. c. Clinical breast exams annually for women age 19 and older d. Self-Breast Awareness is very important.
Answer: B Rationale for why the answer is correct: Screening does not have to stop after 75 years of age. Site for question/rationale: Women’s Health Preventative Care Slide 5 and 16:00 on Video presentation
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Question: Which of the following conditions is an emergency? a. Cryptorchidism b. Epididymitis c. Testicular Torsion d. BPH
Answer: C Rationale for why the answer is correct: The patients will be in sudden, severe, and unilateral pain with scrotal edema and erythema. Pain not relieved by elevation and may have lower abdominal pain, nausea, and vomiting. Site for question/rationale: Male Reproductive health Slide 5
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Question: When asking questions regarding medications for your SOAP note, it is important to include all of the following types of medications the patient may take, EXCEPT which? A. Over the counter Medications B. Prescription Medications C. Placebo Medications D. Herbal Medications and supplements
Answer: C: Placebo Medications Rationale for why the answer is correct: This is not a form of medication that is necessary to review when collecting medication history for the soap note. It has no chance of having an interaction and would only have a perceived effectiveness. The other three choices must be included.
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Question: When determining which test to order for a patient who has symptoms of Covid-19 and was recently exposed to a person who tested positive; which test is the most desirable? A. A high specificity test B. A high sensitivity test C. A low specificity test D. A low sensitivity test
Answer: A. A high specificity test Rationale for why the answer is correct: A test with a high specificity is used to rule in a diagnosis in a high-risk person. Since the patient was exposed and has symptoms we need to rule in the diagnosis. A high Sensitivity test would be used to rule out a diagnosis but is not appropriate in this scenario because of the high likelihood the patient has Covid. Site for question/rationale: from Module 1, under additional resources.
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Question: A patient presents with a complaint of chest pain. Considering the test and treatment thresholds, when would you order additional testing on the individual to rule in or rule out a differential diagnosis? A. When the probability is below the test threshold. B. When the probability is above the treatment threshold. C. When the probability falls above the test threshold and below the treatment threshold. D. When the probability falls below the test threshold and above the treatment threshold.
Answer: C. When the probability falls above the test threshold and below the treatment threshold. Rationale for why the answer is correct: The probability must be between the test threshold and the treatment threshold to justify ordering additional testing. If the probability is below the test threshold, we assume the patient does not have the disease and do no further testing, effectively ruling out the diagnosis. If the threshold is above the treatment threshold, we do not require additional testing because it is extremely likely the patient has the disease and therefore, we begin treatment without additional testing. It is not feasible for the probability to fall both below the test threshold and also above the treatment threshold simultaneously. Site for question/rationale: under module 1, additional resources heading, Diagnostic Reasoning: Diagnostic Process 10 minute video - TerryShaneyfeld
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Question: Which of the following lab values would be consistent of a patient presenting with jaundice that is attributed to pancreatitis? A. Total bilirubin 1.0mg/dl with elevated indirect/unconjugated bilirubin B. Total bilirubin 3mg/dl with elevated direct/conjugated bilirubin C. Total bilirubin 0.3mg/dl with elevated direct/conjugated bilirubin D. Total bilirubin 3mg/dl with elevated indirect/unconjugated bilirubin
Answer: B. Total bilirubin 3mg/dl with elevated direct/conjugated bilirubin Rationale for why the answer is correct: For a patient to display Jaundice the total bilirubin must be \>2.5mg/dl. An elevated direct/conjugated bilirubin is consistent with the pancreas or gallbladder being involved because the conjugation takes place past the liver. Site for question/rationale: Module 1, under Lab section,
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Question: Which of the following changes in WBC count could be indicative of an acute severe bacterial infection? A. Increase in Eosinophil count B. Decrease in Neutrophil count C. Increase in Lymphocyte count D. Increase in Neutrophil count with bands
Answer: D. Increase in Neutrophil count with bands Rationale for why the answer is correct: Elevated Neutrophil counts are consistent with a bacterial infection and the presence of bands show the body is attempting to fight off the severe infection with immature neutrophils due to the neutrophil being overwhelmed by the infection. Eosinophil’s are associated with a parasitic infection and allergies. A low neutrophil count is not consistent with an infection. Increased Lymphocytes are consistent with malignancy and other viral illnesses.
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Question: A patient presents with abdominal pain and on exam has a positive psoas sign and a temp of 101 degrees Fahrenheit. Which lab number MAY indicate that the patient has appendicitis that has ruptured? A. A WBC count greater than 20,000 B. A WBC count less than 10,000 C. A hemoglobin level less than 8g/dl D. A platelet count of more than 100,000
Answer: A. A WBC count greater than 20,000 Rationale for why the answer is correct: A WBC count over 20,000 can be a marker of a ruptured appendix, although a CT or other diagnostics must be used to confirm. A WBC of less than 10,000 could be WNL. A hemoglobin of less than 8 is low and could indicate a blood loss, but is not related to a ruptured appendix. A platelet count of greater than 100,000 is not a significant finding.
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Question: A patient presents with excruciating upper right quadrant pain and nausea and vomiting. What imagining would you order due to it being the most sensitive and specific, along with your labs, to confirm your diagnosis of Cholecystitis due to gallstones? A. An abdominal Xray/KUB B. An abdominal CT C. An abdominal ultrasound D. An MRI
Answer: C. An abdominal ultrasound Rationale for why the answer is correct: Although other imaging may be used to help diagnosis cholecystitis, the one with the highest sensitivity and specificity of diagnosis is the abdominal ultrasound. Also noted that it doesn’t subject the patient to radiation like a CT or Xray would and is much cheaper than an MRI. Site for question/rationale: Module 2 lectures, Under Diagnostics/labs, Abdominal lab/tests lecture
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Question: At what age should a woman have mammograms conducted to at a minimum? A. 50 years old B. 65 years old C. 40 years old D. 75 years old
Answer: D. 75 years old Rationale for why the answer is correct: Mammograms should be conducted until at least 75 years old and may be continued well beyond then if the woman is still active with a good quality of life.
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Question: A 30-year-old patient presents with a solid, firm, non-tender mass in the scrotum. Which of the following test is considered the gold standard diagnostic to test for testicular cancer? A. P.E.T Scan B. Scrotal Ultrasound C. X-RAY D. M.R.I
Answer: B. Scrotal Ultrasound Rationale for why the answer is correct: A scrotal ultrasound is the gold standard for diagnosis of testicular cancer. The remaining answers are not indicated. Site for question/rationale: Module 2, Under Diagnostics/Reproductive heading, Male Reproductive Health Presentation 22min by Dr. Amy Moore. Time Stamp 18:26
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Question: Which of the following is true of the chief complaint (CC) in a SOAP note? a. The CC is objective b. The CC should be in the provider’s own words c. The CC should be in the patient’s own words d. None of the above
Answer C Rationale for why the answer is correct: The CC in a SOAP note should be a direct quotation from the patient as to why they are seeking care. Site for question/rationale: This is found in the “Sample SOAP note H&P Example.pdf” in Module 1.
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Question: A minimum of __ element(s) should be addressed in each system during the ROS that is/are pertinent to the chief complaint. a. 1 b. 3 c. 2 d. There is no minimum requirement
Answer: b Rationale for why the answer is correct: According to the “SOAP Notes for FNP” example handout, “A minimum of 3 elements should be addressed in each system that is relevant to the presenting concern”. Site for question/rationale: SOAP Notes for FNP handout
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Question: Which of the following statements is true regarding the relationship between diagnoses and differential diagnoses? a. There is no difference between diagnoses and differential diagnoses. b. The differential diagnoses are medical conditions the patient has previously been diagnosed with, and the diagnosis is an illness the patient may have based on their chief complaint. c. The diagnoses are medical conditions the patient has been previously diagnosed with, and the differential diagnoses are illnesses the patient may have based on their chief complaint. d. The list of differential diagnoses will always include diagnoses the patient already has in their past medical history.
Answer: c Rationale for why the answer is correct: A diagnosis listed in past medical history is a medical condition the patient has been previously diagnosed with. The list of differential diagnoses are conditions that the provider comes up with as potential diagnoses for the patient based on their current chief complaint. The list of differential diagnoses may be related to previously diagnosed illnesses; however, they are not always the same. Site for question/rationale: This is from the “Amy Moore Light Board Presentation” on SOAP notes and differential diagnoses.
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Question: Before developing a list of differential diagnoses, it is necessary to first obtain \_\_. a. Physical exam b. History of present illness c. Lab results d. Review of systems
Answer: b Rationale for why the answer is correct: In order to create a list of potential diagnoses, it is necessary to first obtain the patient’s chief complaint followed by the history of present illness. Following this, you can adjust your review of systems questions to obtain adequate information, order labs, and do a physical exam that is pertinent to the differential diagnoses.
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Question: Your 50-year-old male patient has an elevated indirect bilirubin. Which problem would you anticipate this patient having? a. Gall bladder stones b. Liver disease c. Pancreatitis d. Kidney disease
Answer: b Rationale for why the answer is correct: Bilirubin is conjugated in the liver. Indirect bilirubin is the amount of unconjugated bilirubin in the blood. If the indirect bilirubin is elevated, the problem lies in the liver. If the direct bilirubin is elevated, the problem lies in the outflow of bilirubin from the body.
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Question: You suspect liver failure in your patient that reports chronic alcohol consumption. LFTs are normal. Which lab findings may indicate liver damage despite normal LFTs? (Select all that apply). a. Low albumin b. Stable blood glucose c. Elevated PT/PTT d. Elevated bilirubin e. High platelets f. High total protein g. Elevated MCV
Site for question/rationale: This is covered on slide 9 of the CMP VoiceThread. Answer: a, c, d, & g Rationale for why the answer is correct: Some patients may have evidence of liver damage without transaminitis. Signs of liver damage include low albumin, unstable blood glucose, fatigue, elevated PT/PTT, low platelets, elevated bilirubin, elevated MCV, and low total protein.
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Question: When assessing a patient’s abdomen, the patient should be positioned \_\_\_. a. Standing b. Sitting on the exam table c. So that the patient is most comfortable d. Laying supine on the exam table
Answer: d Rationale for why the answer is correct: When a patient is laying down, you are able to better assess the contour of the abdomen, look for pulsations, see hernias, auscultate, percuss, and palpate superficially as well as deep with the patient in one position that provides optimal access. Site for question/rationale: This is found in the abdominal exam video by Dr. Amy Moore around 1 minute.
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Question: While assessing your patient, you have the patient take a deep breath while you press into the right upper quadrant of the abdomen. The patient reports pain. You suspect \_\_. a. Cholecystitis b. Gastroenteritis c. Appendicitis d. Pyelonephritis
Answer: a Rationale for why the answer is correct: This is indicative of Murphy’s sign. A positive Murphy’s sign indicates cholecystitis. Appendicitis would exhibit a positive heal tap, psoas sign, obturator sign, Rovsing’s sign, cutaneous hyperesthesia, and/or rebound tenderness.
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Question: It is February 2021. A 43-year-old pre-menopausal female patient arrives for her annual gynecological appointment. She has no surgical history. Her last PAP smear was January 2016 (result: negative), last colonoscopy was March 2019 (result: negative), and last mammogram was 2 years ago (result: negative). At this appointment, she is due for _ (Select all that apply). a. Mammogram b. Colonoscopy referral c. Clinical breast exam d. DEXA scan referral e. PAP smear f. HPV test g. Blood pressure screening
Answer: a, c, e, f, & g Rationale for why the answer is correct: Guidelines are as follows: mammogram every 1-2 years starting at 40 years of age, colonoscopy every 5 years starting at age 45, clinical breast exam annually over the age of 19, DEXA scan every recommended in post-menopausal women \<65 years or women \>65 years of age, PAP smears every 5 years from the age of 30-65 years (every 3 years in some patients), HPV test every 5 years in women aged 30-65 years, and blood pressure readings annually. Site for question/rationale: This information is found in the Women’s Health Presentation – DX video by Dr. Amy Moo
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Question: A 35-year-old man arrives at the clinic with a 20-hour history of chills, lower back pain, dysuria, and malaise. His temperature is 101.2. Digital rectal exam confirms an enlarged, tender, and boggy prostate. He reports having multiple sexual partners and sometimes uses condoms. The most likely diagnosis is \_\_. a. Chronic prostatitis b. Acute prostatitis c. BPH d. Prostate cancer
Answer: b Rationale for why the answer is correct: Acute prostatitis may differentiate from chronic prostatitis in that acute has a more abrupt onset, fever, chills, malaise, dysuria, pain, and tender prostate. Acute prostatitis is more common in men aged 30-50, while chronic is more common in men \>50 years. Acute prostatitis is more common in men that have multiple sexual partners, history of STIs, and frequent UTIs. BPH will not present with fever, chills, and malaise. The prostate may be enlarged in all answer choices provided, but it will be firm in BPH, hard in prostate cancer, and mildly tender in chronic prostatitis.
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Question: When collecting family history, on who should you collect data? a) Parents b) Grandparents & parents c) Grandparents, parents, siblings, and children d) Parents & siblings
Answer: Grandparents, parents, sibling, and children Rationale for why the answer is correct: Grandparents and parents can pass down inherited genes, siblings can sometimes have the same inherited genes, and children can have some genetic problems. Need to know if children has gene abnormalities to ensure parent is also tested.
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Question: In which part of your SOAP note should you clarify if information is being gathered by someone other than the patient? a) Objective b) Assessment c) Plan d) Subjective
Site for question/rationale: SOAP minute 4:00 Answer: In the Subjective- chief complaint Rationale for why the answer is correct: Okay to gather information from someone other than patient if patient is too young to talk or if patient is unable to speak or other reason why patient may be unable to communicate.
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Question: What are signs/symptoms of hypothyroid issue in a patient presenting with complaint of fatigue? a) Heat intolerance b) Dry skin, loosing hair, constipation, and cold intolerance c) Exophthalmos d) Weight loss
Answer: Dry skin, loosing hair, constipation, and cold intolerance Rationale for why the answer is correct: signs and symptoms of hypothyroidism Site for question/rationale: Differential Diagnosis for fatigue minute 5: 20
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Question: What components of a CBC do you look at when considering Anemia in a patient that comes in complaining of Fatigue? a) WBCs b) RDW c) ANC d) H/H, MCV
Answer: H/H, MCV Rationale for why the answer is correct: If Hemoglobin in female \<12 we know we have some anemia. MCV helps determine what type of anemia (Microcytic, normocytic, macrocytic anemia) Site for question/rationale: Differential Diagnosis for fatigue minute 6:40
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Question: What should be the hemoglobin to hematocrit ratio? a) 1:2 b) 2:3 c) 1:3 d) 1:4
Answer: 1:3 Rationale for why the answer is correct: Site for question/rationale: CBC presentation Minute 19:43
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Question: What lab test should you run in a patient with Macrocytic anemia MCV \>96? a) Iron panel b) B12 and Folate c) CMP d) Magnesium
Answer: B12 and Folate Rationale for why the answer is correct: Macrocytic can occur when there is a deficiency of B12 or folate so you have a large cell because the Bone marrow cannot produce new cells because they are low on B12 and Folate. Site for question/rationale: CBC presentation Minute 24:15
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Question: When is it important to check for electrolytes in children with Gastroenteritis? a) If they have a fever b) If you suspect dehydration due to N/V/D c) If patient drinking fluids but not wanting to eat d) If parent is concerned
Answer: If you suspect dehydration due to N/V/D, Rationale for why the answer is correct: They will probably need to be sent to the hospital for fluids to replenish electrolytes Site for question/rationale: Abdominal exam: minute 7:23
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Question: What is the preferred study to diagnose cholecystitis? a) MRI b) CT c) Ultrasound d) Xray
Answer: Ultrasound Rationale for why the answer is correct: it is the most sensitive and specific study, and can rule out gallstones Site for question/rationale: Abdominal exam: Minute11:20
376
Question: For what reasons would you do a serum quantitative hCG exam as opposed to qualitative (urine or serum)? a) To verify qualitative hCG results b) if you suspect miscarriage or tubal pregnancy c) If you suspect pregnancy d) If the patient can afford it
Answer: If you suspect miscarriage, tubal pregnancy Rationale for why the answer is correct: Qualitative hCG tells if the pregnancy is progressing, continues to rise after first trimester. Site for question/rationale: Women’s Health Presentation- Dx Minute 18:48
377
Question: Family history includes: Answer: A. Only parents and grandparents B. Grandparents, parents, siblings, and children C. Family history is not part of the SOAP note D. Parents, wife, and children
ANSWER:B Rationale for why the answer is correct: Genetic disease presentations may be present in blood related family members. Site for question/rationale: SOAP note presentation by Dr. Shelly Seth
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Question: The differential diagnoses is formulated from which of the following: Answer: A. The objective information B. The subjective information C. Review of systems and physical examination D. All of the above
ANSWER :D Rationale for why the answer is correct: Your differential diagnosis is a list of possible diagnoses based on chief complaint, HPI, past medical history, family history, medications and physical examination. Site for question/rationale: SOAP note presentation by Dr. Amy Moore
379
Question: Which of the following is not a common differential diagnoses of a patient who presents to the clinic with fatigue: Answer: A. Hypothyroidism B. Anemia C. Vitamin deficiency D. Ankle pain
ANSWER: D Rationale for why the answer is correct: A patient who presents to the clinic with ankle pain will have possible swelling, bruising, tenderness, and pain. Fatigue is not a common symptom of this diagnosis. Site for question/rationale: Differentials for fatigue presentation by Dr. Mello, Dr. Moore, and Dr. Hilliard.
380
Question: A basic metabolic panel (BMP) can detect which of the following problems (select all that apply) Answer: A. Hypokalemia B. Hypoglycemia C. Leukocytosis D. Hypernatremia
ANSWER: A,B,&D Rationale for why the answer is correct: The basic metabolic panel (BMP) is a serum blood test that evaluates for electrolyte imbalances in sodium, chloride, potassium, CO2, BUN, creatinine, and glucose. Site for question/rationale: CBC PowerPoint presentation by Dr. Shelley Seth
381
Question: Which of the following is an indication of diabetes in a patient: Answer: A. A hemoglobin A1c of 7.5% B. A fasting plasma glucose of 105 mg/dL C. A 2-hour oral glucose tolerance test of 195 mg/dL D. A random glucose of 175 mg/dL
ANSWER:A Rationale for why the answer is correct: All of the above lab tests can be used for diagnosing diabetes along with signs and symptoms. A hemoglobin A1c greater than 6.5% , a fasting plasma glucose greater than 126 mg/dL, a 2-hour oral glucose tolerance test greater than 200 mg/dL, and random glucose greater than 200 mg/dL are all indications of diabetes. Site for question/rationale: Endocrine and autoimmune disorders PowerPoint presentation by Dr. Amy Moore, slide 6
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Question: What are possible differential diagnoses for a 14-year-old male who presents to the clinic with abdominal pain Answer: A. Pyloric stenosis B. Appendicitis C. Bacterial vaginosis D. Hirschsprung's disease
ANSWER:B Rationale for why the answer is correct: Pyloric stenosis and Hirschsprung's disease are diagnosed in patients from birth to the age of 5 months. Bacterial vaginosis is found only in female genitalia Site for question/rationale: Abdominal lab/test PowerPoint presentation by Dr. Amy Moore, slide 7 and slide 14
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Question: Which 3 diagnostic signs, symptoms and/or tests can be used to confirm pancreatitis: Answer: A. CT scan B. Colonoscopy C. Abdominal pain D. Serum lipase and serum amylase
ANSWER: A,C,& D Rationale for why the answer is correct: The American Academy of Gastroenterology guidelines indicate that 2 of the 3 following diagnostics can be used diagnostics in pancreatitis: abdominal pain, serum lipase and/or serum amylase (greater than 3 times normal limits), and a CT scan. Site for question/rationale: Abdominal lab/test PowerPoint presentation by Dr. Amy Moore, slide 11
384
Question: A 19-year-old female presents to the clinic and ask how often she should get a Pap smear, which of the following is your likely response: Answer: A. Every 3 years as soon as you are sexually active B. Every year starting at the age of 21 C. Every 3 years ages 21 to 29 years old D. Only if a sexually transmitted infection is present
ANSWER:C Rationale for why the answer is correct: Pap smears are done every 3 years ages 21 to 29 years old and every year if there is an abnormal Pap smear until 3 negative test results. A Pap smear and HPV tests are done every 5 years or Pap smear every 3 years ages 30-65. At the age of 65, if there is no history of moderate or severe abnormal cervical cells or cancer no Pap smear is needed. A Pap smear for post hysterectomy patients depends on history of cervical cancer and whether cervix is removed.
385
Question: A 13-year-old male presents to the clinic with severe unilateral testicular pain with no pain relief with testicular elevation, which diagnostics is appropriate for this patient: Answer: A. Urinalysis B. Urethral Gram stain C. Biopsy to rule out prostate cancer D. Send immediately to ER for Doppler ultrasound
answer:D Rationale for why the answer is correct: Testicular torsion is a medical emergency in male patients up to the age of 14 years old. Patients present with sudden severe unilateral testicular pain, scrotal edema and erythema, firm tender mass that may appear retracted upward and no pain relief with testicular elevation. Referral to emergency room immediately for surgical intervention.
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Question: Mr. Smith is a 23 year old male who presents to the clinic with a chief complaint of “fever, body aches, fatigue and feeling really crummy.” After completing a thorough history and physical, it is revealed that Mr. Smith’s 4 roommates all tested positive for the flu 2 days ago. The NP concludes with high probability Mr. Smith has influenza. What part of the SOAP note would a diagnosis of influenza be put in? A. S B. O C. A D. P
Answer: C Rationale for why the answer is correct: The ‘A’ portion of SOAP note is the assessment. This is where the diagnosis is put. ‘S’ is for subjective findings, including the CC and HPI. The ‘O’ is for objective finds, including a fever. The ‘P’ is for planning, including prescribed medications and a rapid flu test. Site for question/rationale: SOAP presentation video with Moore, Hilliard and Mello at 20 seconds through 1:30
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Question: Ms. Johnson is a 21 year old female who presents to the clinic with a chief complaint of “ just feeling really yucky.” What would be an appropriate follow-up question when exploring differential diagnoses for this chief complaint? A. How many siblings do you have? B. Where do you go to college? C. What do you mean by “yucky?” D. What were the results of your last Pap smear?
Answer: C Rationale for why the answer is correct: It’s important to clarify what the patient means by “yucky” in this scenario. By seeking clarity, the clinician would be more efficient in narrowing differentials. If the patient clarifies by stating she has a 104 degree fever versus feeling fatigued after missing this month’s period, the answer could provide very critical information. Site for question/rationale: Differential diagnosis video presentation with Moore, Hilliard and Mello from 1:28 through 5:09, when discussing the patient scenario
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Question: Which of the following would be the most cost-effective initial diagnostic test for 22 year old male with no significant PMH and a CC of a “sore throat and fever?” A. Rapid strep test B. Chest x-ray C. Abdominal ultrasound D. CT of abdomen
Answer: A Rationale for why the answer is correct: A rapid strep test would be the most cost-effective diagnostic test for a sore throat and fever. The other answer choices would be costly and unnecessary for a patient presenting with no indications for these tests. Site for question/rationale: Differential presentation video with Mello, More and Hilliard discussing the importance of considering cost for diagnostic test, at 13:37 through 13:50.
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Question: What type of WBC is most indicative of a viral infection? A. Neutrophil B. Lymphocyte C. Monocyte D. Band neutrophil
Answer: Lymphocyte Rationale for why the answer is correct: Lymphocyte are most indicative of viral infections, including mononucleosis, measles or CMV. Site for question/rationale: CBC presentation voice-over with Shelly Seth at 12:40, page 5 in the notes slide.
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Question: What component of a CMP would you expect for a patient presenting with jaundice? A. Total bilirubin 2.9 B. Total bilirubin 2.1 C. Albumin 3.7 D. Albumin 4.6
Answer: total bilirubin 2.9 Rationale for why the answer is correct: Total bilirubin must be greater than 2.5 to produce jaundice. Site for question/rationale: CMP-LFT presentation voice-over with Shelly Seth at 5:10, and page 3 in the notes.
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Question: What is the gold standard diagnostic test for an appendicitis? A. History and physical are sufficient for a confirmed diagnosis. B. Abdominal xray C. CT scan D. CBC and CMP
Answer: C. CT scanRationale for why the answer is correct: CT scan is the gold standard diagnostic for appendicitis. Site for question/rationale: Abdomen presentation with Moore at 10:05 and slide 7 in PowerPoint.
392
Question: Which of the following is part of the normal, vaginal ecosystem? A. pH ~ 5.0 (alkaline) B. Predominance of lactobacilli on wet-prep C. Viscous discharge D. Clear discharge with
Answer: B. Predominance of lactobacilli on wet-prep Rationale for why the answer is correct: The vagina has a pH of \<4.5, making it acidic. It is normal to find predominance of lactobacilli on a wet prep. Viscous and/ or clear discharge is normal in the vaginal ecosystem. Site for question/ rationale: Women’s health presentation with Dr. Olenick at 5:25 and slide 7 of notes handout.
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Question: Which of the following male reproductive disorders is a medical emergency and must be addressed with urgency? A. Unilateral testicular torsion B. Epididymitis with relief of pain of elevation of scrotum C. Hydrocele in a 1 month old infant D. Varicocele
Answer: Unilateral testicular torsion Rationale for why the answer is correct: A testicular torsion is a medical emergency. Epididymitis may be tender and painful, but it not treated as an emergency. Hydrocele in infants is common and usually resolves without intervention. Varicocele is a collection of abnormal blood vessels in the scrotum and is not treated as an emergency. Site for question/rationale: Presentation with More at 10:30 through 16:12, and slides 5 and 6 in the PowerPoint on male reproductive health.
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Question: When ordering a diagnostic test, what term is used to describe prioritizing necessary testing to avoid unnecessary treatment? a. Guidelines of diagnostic testing b. Practice recommendations c. Diagnostic stewardship d. Ethics
Answer: c. diagnostic stewardship Rationale for why the answer is correct: diagnostic stewardship refers to management of treatment keeping healthcare system costs and patient safety and quality of life in mind. Site for question/rationale: Slide 2 of Dr. Amy Moore’s Basic Diagnostics presentation
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Question: What type of test would need to be ordered to diagnose an asymptomatic patient for a specific condition/disease? a. Test with high sensitivity b. Test with high specificity c. Test with high sensitivity and specificity d. neither
Answer: a. test with high sensitivity Rationale for why the answer is correct: To diagnose for a specific condition/disease a test with a high sensitivity with low likelihood ratio would be indicated for an asymptomatic patient to rule out the specific condition/disease for a low risk person Site for question/rationale: Slide 9 of Dr. Amy Moore’s Basic Diagnostics presentation (IDK IF THIS IS CORRECT)?
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Question: A pt has sustained injuries from a car accident and you’ve noticed that H&H has dropped. Which WBC’s would you expect to increase with this condition? a. Neutrophils b. Monocytes c. Lymphocytes d. Eosinophils
Answer: b. monocytes Rationale for why the answer is correct: an increase in monocytes can be seen in bleeding disorders and in stressful situations such as trauma from a car accident. Site for question/rationale: Dr. Shelly Seth’s CBC presentation, 14:30 minutes
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Question: What other electrolyte should be considered with low levels of potassium? a. Sodium b. Calcium c. Magnesium d. Chloride
Answer: c. magnesium Rationale for why the answer is correct: if obvious causes of potassium cannot be determined, obtain a CMP to check magnesium levels as a low level can also decrease potassium level Site for question/rationale: Dr. Shelly Seth’s BMP presentation, 8:47 minutes
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Question: Which diagnostic test is not accurate for proper diagnosis of acute pancreatitis? a. Serum lipase b. Serum amylase c. CT scan
Answer: b. serum amylase Rationale for why the answer is correct: Because of the limitations in sensitivities and specificities and positive and negative value, serum amylase alone cannot be used to diagnose acute pancreatitis Site for question/rationale: Dr. Amy Moore’s Abdominal Exam presentation, 15:30 minutes
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Question: Discharge with a frothy, gray appearance, with cervical petechiae, but with no symptoms would most likely be treated for which condition? A. No treatment, this is a normal vagina B Bacterial vaginosis C. Candidiasis D. Trichomoniasis
Answer: d. trichomoniasis Rationale for why the answer is correct: Findings for trichomoniasis include symptoms with itch, discharge, but 50% of pts may be asymptomatic, frothy, gray or yellow-green, malodorous discharge, cervical petechiae or “strawberry cervix”, vaginal pH of \> 4.5, positive for whiff test, and motile flagellated protozoa with many WBC’s seen on NaCl wet mount
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Question: What type of collecting tool might not be appropriate when swabbing a patient for Chlamydia trachomatis? Select all that apply. a. Lubricants b. Cotton swabs c. Wooden shafts d. Calcium alginate
Answer: a. lubricants and c. wooden shafts Rationale for why the answer is correct: do not use lubricants due to antibacterial agents; swabs with wooden shafts are toxic to Chlamydia trachomatis. Site for question/rationale: Dr. Olenick’s Women’s Health Overview of Diagnostic presentation, 33:00 minutes
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Question: You are interviewing a female male patient who is thirty-years-old, presenting for a physical examination. Which of the following statements made by the patient will you be sure to further investigate? A. “My brother drinks too much alcohol.” B. “My dad raised me because my mom died when I was a child.” C. “My baby had colic for three months.” D. “My sister has high cholesterol.”
Answer: B, “My dad raised me because my mom died when I was a child.” Rationale for why the answer is correct: Although the patient was talking about who raised her, the provider should inquire about the cause of death of her mother when she was young. This is important because there could be a genetic trait that has not been investigated in this patient, such as breast cancer (BRCA) gene.
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Question: A 53-year-old male patient arrives to your office to establish care. He recently moved here from out of state and mentioned that he had and EKG and echocardiogram “a couple years ago” at his regular doctor’s office. This important information will be noted in which part of the SOAP note? A. Assessment B. Objective C. Plan D. Subjective
Answer: D. Subjective Rationale for why the answer is correct: This information is provided by the patient as part of his past medical history and it is considered a procedure. It can be listed under past medical history or a sub-category of past surgical history. Either way, this is subjective information provided by the patient.
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Question: You are seeing a patient who presents to your office with certain complaints. You go through the process of obtaining her chief complaint, previous medical history, surgical history, social history, medications, culture, then order tests. At what point in the encounter would you begin considering possible differential diagnoses? A. After reviewing results of the tests. B. After obtaining her full medical history. C. After hearing her chief complaint. D. All of the above
Answer: C. After hearing her chief complaint. Rationale for why the answer is correct: Although you adjust your list of differential diagnoses along the course of the patient encounter, the time to begin considering possible differential diagnoses is after hearing the patient’s chief complaint. Site for question/rationale: Module 1: Diagnostic Reasoning/SOAP Note, Dr. Amy Moore’s Differential Diagnosis presentation video, no slide number (at 2:10 of 7:20 minutes total length). (Moore, n.d.)
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Question: A 55-year-old female patient presents as a new patient to APRN’s office with a chief complaint of fatigue that has lasted more than two months. During the interview, she reveals a previous medical history of hyperlipidemia, hypertension, and diabetes. With this information, what are the differential diagnoses the APRN might suspect? A. Hypertension B. Anemia C. Diabetes D. High Cholesterol
Answer: B. Anemia. Rationale for why the answer is correct: A differential diagnosis is different from a diagnosis in that it cannot be a previously diagnosed condition. In this scenario, the patient already has been diagnosed with A, C, and D. A differential diagnosis is what the APRN suspects may be causing the chief complaint, which is “fatigue”. Anemia is what should be further investigated as a potential new diagnosis.
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Question: A young adult patient presents to your office complaining of generalized lethargy for a few weeks. After obtaining a history and completing a physical examination to rule out any obvious findings, a complete blood count with differential is ordered. Upon receiving results, which elevated component of the results might lead you to believe the patient might have a viral illness, such as mono? A. Basophils B. Lymphocytes C. Neutrophils D. Eosinophils
Answer: B. Lymphocytes Rationale for why the answer is correct: An elevation in lymphocytes could mean the patient has a viral illness, such as mono, CMV or measles. A chronic rise in lymphocytes could possibly indicate a malignancy, such as leukemia or lymphoma.
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Question: A 67-year-old female patient has been in the hospital receiving IV Vancomycin for an infection. While looking at her lab results from this morning, you calculate her absolute neutrophil count (ANC), which is 1,500. You decide she has: A. Severe neutropenia and should be placed on neutropenic precautions. B. Moderate neutropenia and should be placed on neutropenic precautions. C. No neutropenia and can continue her treatment plan without special precautions. D. Mild neutropenia and should be placed on neutropenic precautions.
Answer: D. Mild neutropenia and should be placed on neutropenic precautions. Rationale for why the answer is correct: Absolute neutrophil count (ANC) is calculated by Total WBC count x neutrophil % ÷ 100. This number is important to calculate to determine if a patient has neutropenia and if she is at higher risk for infection. Mild neutropenia = 1,500 / moderate neutropenia = 1,000 / severe neutropenia = 500 or less. Site for question/rationale: Module 1: Lab
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Question: The APRN is performing a physical examination on a patient who complains of right lower quadrant abdominal pain. The examiner places her hand above the patient’s right knee and asks the patient to raise his leg. This test is called _______________ and is one test to investigate \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. A. Rovsing’s Sign; appendicitis B. Psoas Sign; appendicitis C. Murphy’s sign; cholecystitis D. Rovsing’s Sign; cholecystitis
Answer: B. Psoas sign; appendicitis Rationale for why the answer is correct: Placing a hand above the patient’s right knee and having the patient raise their right leg while applying pressure will elicit immediate pain, indicating a positive psoas sign, which could indicate possible appendicitis in the patient. Site for question/rationale: Module 2: Abdominal /Reproductive Health
408
Question: You are seeing a patient in the office who presents with severe abdominal pain and has a history of alcoholism. Understanding the American Academy of Gastroenterology guidelines and having knowledge of how a history of alcoholism should be considered, which are the two most reliable ways to diagnose pancreatitis in this scenario? A. Symptomatic abdominal pain and elevated serum lipase levels B. Symptomatic abdominal pain and elevated serum amylase levels C. Elevated serum lipase and serum amylase D. Symptomatic abdominal pain and CT scan
Answer: D. Symptomatic abdominal pain and CT scan Rationale for why the answer is correct: Serum lipase and serum amylase levels can rise and fall within three days of onset of pancreatitis. Also, in alcoholism, the body may not produce the enzymes and therefore, may not be an accurate test alone to confirm pancreatitis. Site for question/rationale: Module 2: Abdominal /Reproductive
409
Question: A 26-year-old female patient presents to your office with a chief complaint of vaginal itching. After obtaining a history and completing a physical exam, you collect a vaginal sample and prepare a wet mount slide with sodium chloride (NaCl). While viewing the sample through a microscope, you see a significant number of WBCs. In this circumstance, you suspect: A. Candidiasis B. Trichomoniasis C. Bacterial vaginosis D. This is a normal finding
Answer: B. Trichomoniasis Rationale for why the answer is correct: In trichomoniasis, many WBCs are present. In Candidiasis, few WBCs are present. In Bacterial Vaginosis, no or few WBCs are present, and in a normal finding, Lacto-bacilli are present, not WBCs. Site for question/rationale: Module 2: Abdominal /Reproductive Health,
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Question: When utilizing a wet mount with only potassium hydroxide (KOH) and the patient’s vaginal secretion sample, you are attempting to isolate which of the following? A. Trichomoniasis B. Bacterial Vaginosis C. WBCs D. Candidiasis
Answer: D. Candidiasis Rationale for why the answer is correct: When KOH is applied to a wet mount slide, everything except fungus (such as candidiasis) is lysed/destroyed. Site for question/rationale: Module 2: Abdominal /Reproductive Health, Dr. Patricia Olenick’s lecture on Women’s Health Diagnostic Overview, Part 2 presentation video, slides 4 and 10 (starting at 2:08 and at 9:22 of 36:01 minutes total length). (Olenick, 2019)
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Question: Which patient information belongs in the ROS (Select all that apply)? Patient complains of fever, chills, malaise HR 70, RR 12, BP 130/82 No medical History, surgical history, or family history Denies any change in bowel/urinary habits No nausea, vomiting, constipation
A, D, E Rationale for why the answer is correct: Review of systems is for any additional subjective information/issues that are not found in the patient History. Site for question/rationale:Module 1- SOAP note presentation/video & sample SOAP note p. 3 & 4.
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Question Which of the following sections of a SOAP note contains OBJECTIVE information? Review Of Systems (ROS) History of Present Illness (HPI) Physical Exam (PE) Social History
C Rationale for why the answer is correct: ROC, HPI, and Social history are all subjective information. Subjective information is something the patient tells you rather than the practitioner observing for themselves. A Physical Exam includes all of the objective findings like vitals, heart sounds, bowel sounds etc. Site for question/rationale:Sample SOAP note in Module 1 p. 2 & 5.
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Question: In a case where a young woman ultimately ends up diagnosed with PID (Pelvic Inflammatory Disease), of the following symptoms which would be considered pertinent positives? Negative pregnancy test Dyspareunia, greenish vaginal discharge, dysuria Afebrile Regular Menstrual cycle
B Rationale for why the answer is correct:Pertinent positive is a symptom etc. which is present that helps lead to a diagnosis.Site for question/rationale: Rhoads, J., & Jensen, M., M. (2015). Differential diagnosis for the advanced practice nurse. Springer Publishing Company. p. 3 & 11
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Question: In a 16 year old female who presents with vomiting for the past four months, which of the following would be appropriate direct history of complaint questions to ask? Date of LMP (last menstrual period), sexually active, timing of vomiting Smoking history Emesis characteristics Alleviating or aggravating factors
A Rationale for why the answer is correct: Answer C & D are both open ended questions. B is a social history question. A is the only option that includes direct, appropriate history of complaint questions for a 16 year old who has been vomiting for four months. Site for question/rationale:
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Question: A patient with a WBC count of 32,000, a neutrophil count of 85%, and a band count of 10% could be said to have Neutropenia, probable viral illness, increased lymphocytes Increased production of B cells & T cells, a probable bacterial infection, leukocytosis Leukocytosis, probable bacterial infection, “shift to the left” Allergic reaction, increased eosinophils, reaction to a new medication
C:Rationale for why the answer is correct: Normal WBC is 5,000-10,000, normal neutrophils is 45%-65%, normal bands is 0-5% Leukocytosis is the term for increased WBC count. Neutrophils signify an infection, usually bacterial. Small increases seen with Viral infections, larger increases seen in a bacterial infection. Shift to the left means more immature WBC’s are being produced. This is usually due to an infection, could also be due to inflammation.
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Question: A patient presents to the clinic with fatigue, course dry skin, hair loss, weight gain, constipation, intolerance to cold and bradycardia. The practitioner suspects a Thyroid issue. Based on these clinical findings what TSH, T3, & T4 results and diagnosis could belong to this patient? Hypothyroidism, elevated TSH, decreased T3 & T4 levels Hypothyroidism, decreased TSH, decreased T3 & T4 levels Hyperthyroidism, elevated TSH, decreased T3 & T4 levels Hyperthyroidism, decreased TSH, increased T3 & T4 levels
A:Rationale for why the answer is correct: Patient has symptoms of hypothyroidism. With hypothyroidism TSH levels are increased and T3/T4 levels are decreased. Site for question/rationale: Module 1: labs- Endocrine & Autoimmune Disorders video
417
Question: Your previously diagnosed gastroenteritis patient now has a temperature of 1020F (38.80C) and hematochezia what additional diagnostic tests should the practitioner consider? a.Potassium, Magnesium, Calcium b.Stool culture c.HIDA scan d. UA
B:Rationale for why the answer is correct: If your patient has a fever and blood in their stool (hematochezia), then send a stool culture to look for C. Diff. Site for question/rationale: Module 2: Common Abdominal Complaints
418
Question: A 15 year old Male presents to the Emergency Department with RLQ abdominal pain, rebound tenderness, guarding, and a temperature of 1000F (37.70C). he has no significant medical/surgical history. The practitioner orders a CBC, UA, & CT scan. What is the leading hypothesis (most likely diagnosis) for this patient based on these symptoms? GERD Colon Cancer Crohn’s Disease Appendicitis
D:Rationale for why the answer is correct: The signs and symptoms listed above are indicative of Appendicitis. Site for question/rationale: Module 2: Common Abdominal Complaints video & ppt; slide 7.
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Question: A 28 year old Female with multiple sexual partners presents to the clinic with complaints of vaginal/vulval itching, increased discharge, frothy, and gray malodorous discharge. On examination you observe cervical petechiae (“strawberry cervix”), a vaginal pH \>4.5, a positive “whiff test’, and flagellated protozoa via wet mount. These findings are most closely related to a diagnosis of: Bacterial Vaginosis These are expected vaginal findings Trichomonas Candidiasis
C:Rationale for why the answer is correct: The items listed above are indicative of Trichomonas infection. Site for question/rationale: Module 2: Women’s Health Overview of Diagnostics video & ppt; slide 10.
420
Question: Clinical findings most closely associated with Hydrocele include Painless, heavy, large scrotum A scrotum with a “bag of worms” appearance on the left side A freely moveable painless mass along the spermatic cord One absent teste on palpation of scrotum
A Rationale for why the answer is correct:A hydrocele is a collection of peritoneal fluid in the scrotum. It presents as a painless, heavy large scrotum. Site for question/rationale: Module 2: Male Reproductive video & ppt; slides 4 & 6
421
Question: The APRN has ordered a test for a patient after collecting information for their SOAP note. What part of the SOAP note supports the decision to order any test? A. Objective B. Differential or Actual diagnosis C. plan D. Subjective
Answer: B. Differential or Actual Diagnosis Rationale for why the answer is correct: There must be a supporting diagnosis when ordering any tests for a patient.
422
Question: The APRN considers ordering lab work to review the patient’s Mean Corpuscular Volume (MCV) level after the patient has a chief complaint of fatigue. What is the standard range for RBC’s MCV? A. \>96 B. \<80 C. 80-96 D. 85-90
Answer: C. 80-96 Rationale for why the answer is correct: The standard range for RBC’s MCV is 80-96. \>96 Macrocytic anemia (eg: B12 or Folate deficiency), \< 80 Microcytic anemia (eg: Iron deficiency). Site for question/rationale: Fatigue Differentials - 18 min Video on differentials for fatigue (Drs. Amy Moore, Tara Hilliard & Inola Mello)
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Question: The APRN considers hypothyroidism as a differential diagnosis to explain why the patient with a chief complaint of fatigue is feeling like they do. The APRN orders a TSH and T3 and T4 level to review if hypothyroidism is the actual diagnosis for this patient. What would the APRN expect the lab results to read if the patient were suffering from hypothyroidism? A. Increased TSH and decreased T3 and T4 B. Decreased TSH and Increased T3 and T4 C. Increased TSH and increased T3 and T4 D. Decreased TSH and decreased T3 and T4
Answer: A. Increased TSH and decreased T3 and T4 Rationale for why the answer is correct: The TSH increases because the pituitary gland is signaling to the body to release more TSH because the body is low on TSH. Site for question/rationale: Fatigue Differentials - 18 min Video on differentials for fatigue (Drs. Amy Moore, Tara Hilliard & Inola Mello)
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Question: The APRN is reviewing a patient’s BMP, their Serum Creatinine level is elevated. What organ does this result suggest the patient may be experiencing issues with? A. Hepatic B. Renal C. Splenic D. Cardiac
Answer: B. Renal Rationale for why the answer is correct: Serum Creatinine can be elevated secondary to volume depletion or renal insufficiency/failure.
425
Question: The lab results of a patient show a slight change in Albumin levels. The patient asks the APRN how long will it take for their Albumin levels to return to normal. What will the APRN tell the patient? A. It can take up to 10 days for Albumin levels to return to normal. B. It can take up to 14 days for Albumin levels to return to normal. C. It can take up to 30 days for Albumin levels to return to normal. D. It can take up to 120 days for Albumin levels to return to normal.
Answer: B. It can take up to 14 days for Albumin levels to return to normal. Rationale for why the answer is correct: Albumin has a half-life of 20 days, therefore, the return to normal will be slow to change. Site for question/rationale: Complete Metabolic Panel PPT Slide # 6
426
Question: A patient presents with symptoms of pancreatitis. What scoring criteria will the APRN use to quantify the severity of acute pancreatitis? A. Scoring for Ranson’s Criteria for Severity of Acute Pancreatitis B. Scoring for Edinburgh’s Criteria for Severity of Acute Pancreatitis C. Scoring for Braden Scale for Severity of Acute Pancreatitis D. Scoring for Morse Scale for Severity of Acute Pancreatitis
Answer: A. Scoring for Ranson’s Criteria for Severity of Acute Pancreatitis Rationale for why the answer is correct: The greatest the number of diagnostic criteria, the higher the percentage of mortality for the patient. Site for question/rationale: Abdominal PPT Side #13
427
Question: The APRN assesses a 2-month old infant and does not palpate testicles. By what age should the baby be sent to a Urologist for further examination of undescended testicles? A. 2-months B. 3-months C. 4-months D. 6-months
Answer: C. 4-months Rationale for why the answer is correct: Site for question/rationale: Reproductive PPT Slide # 4
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Question: A healthy 25-year old female patient asks the APRN how often they should get a PAP smear. What will the APRN tell this patient? A. Every 5-years B. Every 3-years C. Yearly D. Every 2-years
Answer: B. Every 3-years Rationale for why the answer is correct: Females 21-29 years of age should receive a PAP smear every 3-years to observe for changes to the cells of the cervix which could lead to cancer. Site for question/rationale: Women’s Health PPT Slide # 4
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2. Question: Which of the following does not belong in the social history component of the SOAP note? a. Patient is married with 2 kids b. Patient had a hysterectomy at age 43 c. Patient drinks 1-2 alcoholic drinks per week d. Patient is in a monogamous heterosexual relationship
Answer: B. Patient had a hysterectomy at age 43 Rationale for why the answer is correct: Any surgeries or procedures should be in the past surgical history section of the SOAP note. Site for question/rationale: SOAP note presentation
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Question: To rule in a diagnosis a desirable test would be? a. A test with high sensitivity b. A test with low sensitivity c. A test with high specificity d. A test with low specificity
Answer: C. A test with high specificity Rationale for why the answer is correct: Specificity is the likelihood of a negative test in patients with a disease, therefor a positive rules in a diagnosis because a negative on a test would be at true negative.
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Question: It is okay to treat a patient empirically if the probability of the disease is? a. An explicit decision b. Below the treatment threshold c. Above the test threshold d. Above the treatment threshold
Answer: D. Above the treatment threshold Rationale for why the answer is correct: If a patient is above the treatment threshold it means they have signs or symptoms that strongly suggests a diagnosis. Therefor there is no reason to run a test when you are sure of the diagnosis. If the patient was below the treatment threshold, then you would run a diagnostic test before treatment. Site for question/rationale: Basics of Diagnostics
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Question: You are working up a patient for microcytic anemia, an increase in which lab would be concerning? a. An increase in serum iron b. An increase in transferrin c. An increase in total iron binding capacity d. An increase in ferritin
Answer: Increase in total iron binding capacity Rationale for why the answer is correct: An increase in the total iron binding capacity is how many open sites there are for transferrin to bind to. If too many sites are open that means, there is not enough iron for the transferrin to carry and bind to sites with. Site for question/rationale: CBC lecture at 28min, slide 34
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Question: What lab would be best to look at to evaluate your patient’s response to albumin replacement from 4 days prior? a. Albumin b. Bilirubin c. Total protein d. Pre-Albumin
Answer: D Pre-albumin Rationale for why the answer is correct: The pre-albumin is best to evaluate a patient’s response to albumin replacement because the albumin level will take up to 14 days to respond. Site for question/rationale: CMP lecture at 3:15, slides 6-7
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Question: You raise a patient right heal 10-20% and hit firmly with the palm of your hand, eliciting a pain response. What diagnosis are you suspicious of? a. Cholecystitis b. Appendicitis c. GERD d. Pancreatitis
Answer: B. Appendicitis Rationale for why the answer is correct: This is the heal tap and a pain response suggests appendicitis. Site for question/rationale: Slide 4 Abdominal labs/tests presentation
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Question: A patient with GERD comes to you after treatment with a PPI and antacid, complaining that they have seen no improvements. What study would you consider after multiple unsuccessful treatments? a. Endoscopy with possible biopsy b. Test for H. pylori c. Rovsing’s sign d. Abdominal CT
Answer: A Endoscopy with possible biopsy Rationale for why the answer is correct: GERD affects the esophagus which can be seen with an endoscope. A positive for H. Pylori is not helpful in diagnosis or treatment. Rovsing’s sign is a test for appendicitis. An abdominal CT is not indicated. Site for question/rationale: Slide 6 Abdominal labs/tests presentation
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Question: A patient comes in with the chief complaint of pain during sex. You obtain a vaginal sample from a patient and assess via wet prep. You note many white blood cells (\>5 per high powered field), what diagnosis are you likely to suspect? a. Chlamydia b. Pregnancy c. Yeast infection d. Nothing, this is a normal finding
Answer: A. Chlamydia Rationale for why the answer is correct: The presence of WBCs indicates inflammation or inflammatory cause. Site for question/rationale: Women's Health Diagnostic Overview Part 2 (Dr. Olenick) Slide 6 @5minutes
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Question: A 14-year-old male patient comes in with sudden severe unilateral pain in one testicle as well as nausea and lower abdominal pain. Upon physical examination you note scrotal edema, erythema, a firm tender mass and absent cremasteric reflex. What do you plan to do next with this patient? a. Urinalysis b. STI testing c. Send immediately to ER d. Refer to urologist
Answer: C. Send immediately to ER Rationale for why the answer is correct: The patient likely has testicular torsion, which is a medical emergency. Site for question/rationale: Men’s Health Lecture Slide 5
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Question: The nurse practitioner knows that which of the following are “subjective” components of the “SOAP” note? • Chief complaint, medications, vital signs, review of systems • Past medical history, allergies, chief complaint, diagnosis • History of present illness, social history, medications, allergies • Past surgical history, physical examination, social history, allergies
Answer: History of present illness, social history, medications, allergies Rationale for why the answer is correct: Two of the answers have “objective components” including “vital signs” and “physical examination,” and one answer has the “assessment component” of “diagnosis.”
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Question: A 49-year-old patient presents to you with acute chest pain. How would you document the patient’s chief complaint and to what part of the soap note does it belong? • “I feel like an elephant is sitting on my chest;” objective • The patient reports chest pain and pressure; objective • “I feel like an elephant is sitting on my chest;” subjective • The patient reports chest pain and pressure; subjective
Answer: “I feel like an elephant is sitting on my chest;” subjective Rationale for why the answer is correct: The chief complaint should always be documented in their own words using quotation marks and it is subjective information. Site for question/rationale: Sample soap note H&P example
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Question: Which would be the best scenario if the nurse practitioner is using a test to rule help rule IN a disease? • Negative result: Sensitivity 95% • Negative result: Sensitivity 25% • Positive result: Specificity 25% • Positive result: Specificity 95%
Answer: Positive result: Specificity 95% Rationale for why the answer is correct: Specificity is important when you are ruling IN a disease. With a high specificity you would expect that the test would be positive because it is specific for that test. A test with high sensitivity is used to rule OUT a disease when the results are negative.
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Question: A patient presents to you for her annual examination. She mentions that she has an occasional sore throat and notices it when her seasonal allergies flare up. Her exam is benign and there are no HEENT abnormalities. Where in the probability of disease does this fall? • Test threshold: treat empirically • Treatment threshold: treat empirically • Treatment threshold: do not test • Test threshold: do not test
Answer: Test threshold: do not test Rationale for why the answer is correct: The test threshold is the probability below which the diagnosis is so unlikely it is excluded without testing. Conversely, the treatment threshold is the probability above which the diagnosis is so likely you would treat the patient without further testing. The patient’s throat pain is associated with allergies and there are no findings on the physical exam to indicate a viral or bacterial infection. There is no need to test or treat the patient.
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Question: A patient presents to you with complaints of fatigue. The complete blood count indices shows the MCV is \>96. What would be the most likely cause? • Blood loss • Iron deficiency • Vitamin B12/folate deficiency • COPD
Answer: Vitamin B12/folate deficiency Rationale for why the answer is correct: An MCV \>96 is a macrocytic anemia. The cells are large and not formed properly, usually due to vitamin b12 or folate deficiency. Other causes can be hypothyroidism or alcohol abuse. Iron deficiency anemia is a microcytic anemia (MCV\<80). Blood loss typically results in a normocytic anemia (MCV normal). COPD results in polycythemia, a higher hemoglobin and hematocrit.
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Question: Which of the following is not true about bilirubin? • Stored in the gallbladder as bile • Turns urine yellow • Elevates with hemolytic anemia of hemolysis • Conjugated (made water soluble) in the kidneys
Answer: Conjugated (made water soluble) in the kidneys Rationale for why the answer is correct: Bilirubin is conjugated in the liver. Small amounts of bilirubin are reabsorbed into the blood as urobilinogen and secreted through the kidneys. Site for question/rationale: Handouts CMP/LFTs page 4
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Question: A 45-year-old woman presents to you complaining of acute extreme abdominal pain, nausea, and vomiting. Her WBCs are 18,000 and the ALT, AST, bilirubin, and alkaline phosphatase are elevated. The patient experiences pain when pressing in the RUQ during a deep breath. What diagnostic test should you order? • Ultrasound • Gamma – Glutamyl Transferase (GGT) • Abdominal x-ray • HIDA scan
Answer: Ultra-sound Rationale for why the answer is correct: The patient’s presenting symptoms along with labs and positive murphy’s sign suggest cholecystitis. An ultrasound is the most sensitive and specific study for cholecystitis diagnosis. IF ultrasound is negative, a HIDA scan can be performed next to see the function of the gallbladder. GGT may be normal in cholecystitis unless there is bile duct obstruction. An abdominal x-ray is not indicated. Site for question/rationale: Abdominal lab/tests PowerPoint with Dr. Moore slide 8 (slide 4 for murphy’s sign)
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Question: You are assessing a 2-month-old infant and palpate an olive shaped mass in the RUQ. The parents report projectile vomiting and despite their efforts the baby cannot be satisfied and continues to lose weight. What is the likely diagnosis and what diagnostic test will you perform? • Pyloric stenosis; barium enema • Intussusception; barium enema • Intussusception; ultrasound • Pyloric stenosis; ultrasound
Answer: Pyloric stenosis; ultrasound Rationale for why the answer is correct: the patient’s signs and symptoms along with the PE finding of an olive shaped mass in the RUQ is indicative of pyloric stenosis. The first diagnostic test of choice would be ultra-sound. A baby with intussusception would likely not have the projectile vomiting seen in pyloric stenosis, and instead have jelly-like stools. A barium enema is the gold standard test for intussusception. Site for question/rationale: Abdominal lab/tests PowerPoint with Dr. Moore slide 14
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Question: A 19-year-old woman comes into your clinic for a gynecological exam. She describes profuse, frothy, yellow-green, foul smelling discharge. Upon internal examination, you see cervical petechiae, sometimes described as strawberry cervix. The vaginal pH is 6.5 and on the NaCl wet mount you observe motile flagellated protozoa and many WBCs. What would be the most appropriate statement? • “Bacterial vaginosis is not an STI, so your partner will not need to be treated.” • “Trichomoniasis is an STI. I will treat both you and your partner to prevent a re-infection.” • “Candidiasis is an STI. I will treat both you and your partner to prevent re-infection” • “The infection should clear on its own. Come back within two weeks if you are not feeling better.”
Answer: “Trichomoniasis is an STI. I will treat both you and your partner to prevent a re-infection.” Rationale for why the answer is correct: The patient’s signs and symptoms along with PE and lab findings indicate trichomoniasis. This is an STI and both partners should be treated to prevent current infection. The signs and symptoms along with the PE findings and wet mount do not indicate BV or candidiasis as a diagnosis; candidiasis also is not an STI. The patient should not be sent home without treatment.
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Question: The acronym SOAP represents subjective, objective, assessment, and plan. What element is included in the subjective portion? a) Physical Exam b) Vital signs c) Diagnosis d) History of Present Illness
Answer: D Rationale for why the answer is correct: Subjective information is the information that the patient provides such as chief complaint, history of present illness, family, medical, or surgical history. Site for question/rationale:
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Question: It is best to obtain family medical history because they may share similar genes, or types of familial risk factors such as heart disease, hypertension, and certain cancers. When obtaining information on family history, we obtain information on family members which include: a) Parents/grandparents/siblings/children b) Cousin/siblings/aunt/uncle c) Parents/grandparents/siblings/second cousin d) Grandparents/siblings/neighbor/children
Answer: A Rationale for why the answer is correct: The importance of family history in a SOAP note is essential since family members share similar genes or have a high risk for certain diseases such as cancers, heart disease, or any genetic conditions which the patient might have been tested for. Site for question/rationale: Seth, S. (n.d.). SOAP Note Presentation. Video time presentation 4:00.
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1. Question: To acquire several differential diagnosis, the provider must obtain information from the patient to get to an actual diagnosis. Which of the following information is not crucial to obtaining a differential diagnosis: a) Social security number b) Obtaining history of patient, as well as family history c) Chief complaint of problem and symptoms d) Physical exam of patient
Answer: A Rationale for why the answer is correct: To obtain several differential diagnoses, it is always crucial to ask questions such as history of patient, symptoms, onset, chief complaint, and lastly, the physical exam to see if signs are consistent with differentials. Social security is not part of obtaining differential diagnosis.
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Question: Jennifer, a 25-year-old female, comes to your clinic with complaint of fever, myalgias, cough, shortness of breath, and chills which started last night. You have several differential diagnoses which comes to mind, but you will need more information from the patient. You will need: a) Chief complaint, date of birth, history present illness, and yearly salary. b) Chief complaint, history present illness, review of systems, and last pregnancy test. c) Chief complaint, history present illness, review of systems, and good physical exam. d) History of present illness, review of systems, and last menstrual period.
Answer: C Rationale for why the answer is correct: According to the video, chief complaint, history present illness, review of systems, and good physical exam are all needed to shape our differential diagnosis and can go from there to decide what diagnostics to order. Site for question/rationale: Mello, I., Hilliard, T., & Moore, A. (n.d.). Differential Diagnosis for fatigue. Video presentation time 17:20.
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Question: Point of care tests, which can be done in a clinic, is granted waiver status by the Clinical Laboratory Improvement Amendments (CLIA) that include which of the following tests except: a) HIV b) Urinalysis c) Urine hcg d) Blood glucose monitor
Answer: The answer is A. Rationale for why the answer is correct: HIV test is not considered a point of care test. This test cannot be done at the bedside. This test has to be ordered and sent to the laboratory. Site for question/rationale: Moore, A. (n.d.). Basics of Diagnostics. Video time presentation 25:57.
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Question: Amanda, who is 34 years old, comes to your clinic with complaint of fatigue and lack of energy for the past 4 months. A CBC is obtained and shows that she has macrocytic anemia. What are some of the causes of macrocytic anemia? a) Alcohol abuse, B12 and folate deficiency b) Vitamin D deficiency c) Iron deficiency d) Vitamin C deficiency
Answer: A Rationale for why the answer is correct: The size or MCV is greater than 96 and the cell is large because there is no other cells to replace, so the bone marrow cannot make any more cells due to low B12 or folate. Alcohol and folate deficiencies are two of the many causes of macrocytic anemia. Site for question/rationale: Seth, S. (n.d.). Complete Blood Count [PP presentation]. Video time presentation 23:50. PP presentation slide #30.
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1. Question: A 65-year-oldmale presents to the clinic with complaint of diarrhea for the last 3 days. While talking to him, he reports that he has had fever, blood in his stool, and was recently discharged from the hospital for pneumonia. What questions would you ask the patient? a) Have you taken any over the counter medications for your diarrhea? b) How many episodes of diarrhea did you have today? c) When you were hospitalized, were you give any antibiotics? d) When did you get discharged?
Answer: C Rationale for why the answer is correct: Acute diarrhea can represent as an acute infectious state such as clostridum difficile which is one of the main causes from taking antibiotics orally or intravenously as well as the infecting the elderly population. Site for question/rationale
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Question: A 26-year-old female presents to the clinic with right upper quad abdominal pain, worse after eating, and nausea with vomiting. Which sign would be positive if you ask the patient to take a deep breath and palpate right upper abdomen? a) Obturator sign b) Psoas c) Rovsing’s sign d) Murphy’s
Answer: D Rationale for why the answer is correct: The physical exam evaluating for choleycystitis is having patient take a deep breath, while palpating the right upper abdominal wall and usually the pain will take the patients breath away which is also known as murphy’s sign. Site for question/rationale: Moore, A. (n.d.). Common Abdominal complaints. Video presentation 4:55.
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Question: John, 14-year-old male, suddenly develops unilateral pain, edema, and erythema to his left scrotum which started about a couple hours ago. He reports also he is experiencing some nausea and lower abdominal pain. You know this is an emergency for what condition? a) Varicocele b) Testicular Torsion c) Epididymitis d) Prostatitis
Answer: B Rationale for why the answer is correct: Testicular torsion is more common during puberty and it causes scrotal pain and swelling. This affects about 1 out of 4000 and usually cases for testicular torsion account for about 40% of scrotal pain. Site for question/rationale: Moore, A. (n.d.). Male Reproductive. Video presentation time 12:55. Power Point presentation slide #5.
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1. Question: Sarah is a 34-year-old female who presents to the clinic with complaint of some odorous vaginal discharge, reports white in color, but has no vaginal bleeding and last LMP was 2 weeks ago which was normal for this patient. You decide to do a pelvic exam which shows homogenous thin and milky white discharge and wet mount shows clue cells. What type of clinical syndrome is associated with these findings? a) Candidiasis b) Trichomoniasis c) Bacterial Vaginosis d) Chlamydia
Answer: C Rationale for why the answer is correct: Bacterial vaginosis causes changes in the vaginal flora and there can be multiple reasons for these changes such as douching, or having multiple sex partners (Youngkin, Davis, Schadewald, & Juve, 2013). Some of the symptoms can include fishy odor after sexual intercourse, or a thin milky white discharge and is tested by a KOH whiff test which is positive or show clue cells in the wet prep. Site for question/rationale: Olenick,
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Question: A health history is as follows: “A 29-year-old female patient has had abdominal pain for 3 days. She has nausea, denies vomiting, and states her pain feels “sharp” and “shooting” with ambulation and movement. On a scale of 1 to 10, her pain severity is a 7. When asked where her pain is located, she points to her right lower quadrant.” Which of these categories does it belong to? a. Review of Systems b. Chief Complaint c. History of Present Illness d. Physical Examination
Answer: History of Present Illness Rationale for why the answer is correct: History of Present Illness should address all problems associated with the chief complaint. Site for question/rationale: Sample SOAP Note H&P Example (Handout)
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Question: A patient walks into clinic holding his chest and states, “I have really bad chest pain that won’t go away and feel like I can’t breathe.” Which of these categories does this statement belong to? a. History of Present Illness b. Subjective c. Review of Systems d. Chief Complaint
Answer: Chief Complaint Rationale for why the answer is correct: Chief complaint is a statement made in the patient’s own words and should have quotation marks around it. Site for question/rationale: Sample SOAP Note H&P Example (Handout)
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Question: A 32-year-old woman presents to clinic holding her right side. When interviewing the patient, she states “my pain comes and goes and feels like cramping”. During physical examination you find tenderness to both the RLQ and LLQ. What would be an appropriate differential diagnosis for this scenario? a) Appendicitis b) Ectopic Pregnancy c) Pelvic Inflammatory Disease d) All of the above
Answer: All of the above Rationale for why the answer is correct: According to the patient’s presentation, pelvic inflammatory disease, ectopic pregnancy, and appendicitis are all appropriate differential diagnosis. Site for question/rationale: Differential Diagnosis Book Page 9
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Question: Which of following is not an essential step when determining a differential diagnosis? a) Obtaining a patient’s chief complaint b) Obtaining a detailed history c) Physical examination findings d) Premature closure
Answer: Premature Closure Rationale for why the answer is correct: Steps to writing a different diagnosis include: obtaining the patient’s chief complaint, obtaining a detailed history, review your differential diagnosis list, establish a clear diagnosis, and develop a treatment plan. Site for question/rationale: Differential Diagnosis Book Page 3
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Question: What electrolyte is NOT included within the Basic Metabolic Panel? a) Potassium b) Magnesium c) Sodium d) Chloride
Answer: Magnesium Rationale for why the answer is correct: BMP includes Sodium, Chloride, Potassium, CO 2, BUN, Creatinine, and Glucose. Site for question/rationale: Basic Metabolic Panel Powerpoint Slide 2 and BMP Voice threat at 7 minutes and 40 seconds.
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Question: Which of the following does the liver NOT do regarding function? a) Makes albumin b) Breaks down fat into energy c) Filters toxins such as ammonia d) Filters old WBC’s
Answer: Filters old WBC’s Rationale for why the answer is correct: The liver functions to make albumin, filter toxins like ammonia, breaks down fats into energy, stabilizes blood sugar levels, uses Vitamin K to produce clotting factors, filters old RBC’s, and conjugates bile and secrets into the bowel. Site for question/rationale: Complete Metabolic Panel Powerpoint Page 6 Slide 1: Liver Function
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Question: During an abdominal examination for appendicitis, the NP flexes the patient’s right thigh at the hip, with the knee bent, and rotates the leg internally at the hip. What type of sign is this? a) Psoas Sign b) Murphy’s Sign c) Obturator Sign d) Rovsing’s Sign
Answer: Obturator Sign Rationale for why the answer is correct: Obturator Sign is when pain is produced by flexing the patient’s right thigh at the hip, with the knee bent, and rotating the leg internally at the hip. Site for question/rationale: Common Abdominal Complaints Powerpoint Slide 4
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Question: A 17-year-old female patient presents to her primary care and states, “I have been having more discharge than normal, it is yellow in color, smells different, and I have been really itchy.” Her wet prep reveals a positive whiff test, a pH of 4.7, and many WBC’s present. Which of the following diagnoses best represents her complaints and diagnostic results? a) Bacterial Vaginosis b) Trichomoniasis c) Candidiasis d) Chlamydia
Answer: Trichomoniasis Rationale for why the answer is correct: Trichomoniasis causes itching, malodorous discharge that can be yellow or green in color, a pH of 4.5 or higher, a positive whiff test, and many WBCs present. Site for question/rationale: Women’s Health Overview of Diagnostics Part 2 Lecture Slide 10
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Question: A 19-year-old female patient presents to her primary care clinic and states, “2 days ago I noticed that my discharge is white in color, watery, and smells different.” Upon examination, you notice a foul-fishy odor and a moderate amount of milky white discharge. In addition, you find many clue cells present on her wet prep with a pH of 4.5. Which of the following diagnoses best represents her complaints and diagnostic results? a) Candidiasis b) Normal wet prep c) Trichomoniasis d) Bacterial Vaginosis
Answer: Bacterial Vaginosis Rationale for why the answer is correct: Bacterial Vaginosis can cause itching, a thin, milky, white discharge, foul “fishy” odor, a pH of 4.5 or higher, as well as clue cells present on a wet prep. Site for question/rationale: Women’s Health Overview of Diagnostics Part 2 Lecture Slide 10
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Question: If you are ruling in a test, you want the specificity to be \_\_\_\_. If you are ruling out a test, you want the sensitivity to be \_\_\_\_. Answer: A) High, low B) High, high C) Low, high D) Low, low
Answer b: Rationale for why the answer is correct: Sensitivity is how well you can detect a disease. A test with high sensitivity is used to exclude a diagnosis when the results are negative. Specificity is the likelihood of a negative test resulting in patients with the disease. If a test has a high specificity then it is likely to be positive.
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Question: What is an example of a test that has been granted waived status? Answer: A) Wet mounts B) Fern Test C) KOH preparation D) Blood glucose monitor
Answer : d Rationale for why the answer is correct: Dipstick UA, urine pregnancy test, blood glucose monitor, hemoglobin, blood count, and blood chemistry (Abaxis Piccolo) are all example of waived status test. Wet mounts, KOH preparation, pinworm examinations, Fern Test, UA, and semen analysis are examples of PPMs.
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Question: How long will it take albumin to return to normal? Answer: A) Up to 14 days B) Up to 20 days C) Up to 10 days D) Up to 7 days
answer: A: Rationale for why the answer is correct: Albumin’s half-life is 20 days; it is very slow to return to normal. Site for question/rationale: Diagnostics: CMP & LFT’s by Shelly Seth, DNP, APRN, ACNP-C, FNP-C, CCRN-K at 24:13.
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Question: Bands are what kind of premature white blood cells? Answer: A) Monocytes B) Lymphocytes C) Eosinophils D) Neutrophils
Answer: d Rationale for why the answer is correct: Neutrophils include bands which are premature neutrophils that are mounting a defense against a severe bacterial infection.
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Question: If a patient has appendicitis, where will they have cutaneous hyperesthesia? Answer: A) McBurney’s Point B) LUQ C) RUQ D) Murphy’s Point
Answer: a Rationale for why the answer is correct: They will have pain over McBurney’s point which is in the RLQ where the appendix is located. Site for question/rationale: Common Abdominal Complaints
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Question: If an ultrasound is negative for gallstone in a patient with what appears to be cholecystitis, what further imaging can be done? A) Abdominal CT scan B) HIDA scan C) Abdominal x-ray D) no further imaging in necessary
Rationale for why the answer is correct: HIDA scan indicate the function of the gallbladder and if it is not functioning then the patient needs to be referred to a general surgeon.
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Question: When would vaginal pH be greater than 4.5? Answer: A) In a normal healthy patient B) Vaginal candidiasis C) Bacterial Vaginosis D) UTI
Answer:c Rationale for why the answer is correct: A healthy vaginal ecosystem will have a low pH. Vaginal pH is \>4.5 in Bacterial Vaginosis and Trichomoniasis. Site for question/rationale: Women’s Health Overview of Diagnostics by Patricia Olenick
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Question: If a male has BPH, what other organ function should be examined? Answer: A) Kidney function B) Liver function C) GI function D) Testicular function
Answer: a Rationale for why the answer is correct: Kidney function should be assessed because the backflow of urine due to an enlarged prostate could cause renal issues such as post-renal kidney failure.
