entify the choice that best completes the statement or answers the question.
____ 1. Which statement about confusion is true?
| a. | Confusion is a disease process. |
| b. | Confusion is always temporary. |
| c. | Age is a reliable predictor of confusion. |
| d. | Polypharmacy is a major contributor to confusion in older adults. |
____ 2. Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?
| a. | Meclizine |
| b. | Diphenhydramine |
| c. | Diamox |
| d. | Promethazine |
____ 3. The hallmark of an absence seizure is:
| a. | No activity at all |
| b. | A blank stare |
| c. | Urine is usually voided involuntarily |
| d. | The attack usually lasts several minutes |
____ 4. How often should drug levels be monitored when a seizure medication has controlled the seizures, and the drug level is adequate?
| a. | Every 3 months |
| b. | Every 6 months |
| c. | Annually |
| d. | Whenever there is a problem |
____ 5. Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)?
| a. | A teenage male |
| b. | A 65-year-old male |
| c. | A 25-year-old female |
| d. | A 60-year-old female |
____ 6. Which of the following is a specific test to MS?
| a. | Magnetic resonance imaging (MRI) |
| b. | Computed tomography (CT) scan |
| c. | A lumbar puncture |
| d. | There is no specific test. |
____ 7. Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?
| a. | Cholinesterase inhibitors |
| b. | Anxiolytics |
| c. | Antidepressants |
| d. | Atypical antipsychotics |
____ 8. Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery?
| a. | Epidural hematoma |
| b. | Subdural hematoma |
| c. | Subarachnoid hematoma |
| d. | Intraparenchymal hemorrhage |
____ 9. Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing?
| a. | CN V |
| b. | CN VII |
| c. | CN IX |
| d. | CN X |
____ 10. Which statement best describes a carotid bruit?
| a. | It is felt with the middle three fingers over the carotid artery. |
| b. | A bruit becomes audible when the lumen is narrowed to 1 mm or less. |
| c. | A low-pitched bruit is a medical emergency. |
| d. | The higher the pitch of the bruit, the higher the degree of stenosis. |
____ 11. Which patient is more likely to have a cluster headache?
| a. | A female in her reproductive years |
| b. | A 40-year-old African American male |
| c. | A 55-year-old female who drinks 10 cups of coffee daily |
| d. | A 45-year-old male awakened at night |
____ 12. Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of?
| a. | Dementia |
| b. | Alzheimer’s disease |
| c. | Parkinson’s disease |
| d. | Delirium |
____ 13. Which type of meningitis is more benign, self-limiting, and caused primarily by a virus?
| a. | Purulent meningitis |
| b. | Chronic meningitis |
| c. | Aseptic meningitis |
| d. | Herpes meningitis |
____ 14. Which is the most sensitive neuroimaging test to evaluate patients with encephalitis?
| a. | MRI |
| b. | CT |
| c. | Electroencephalogram (EEG) |
| d. | An initial lumbar puncture |
____ 15. What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?
| a. | A stabbing pain on one small area of the body |
| b. | A vesicular skin lesion on one side of the body |
| c. | A pain that is worse upon awakening |
| d. | A lesion on the exterior ear canal |
____ 16. Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her?
| a. | “Most patients have complete recovery in 3 to 6 months.” |
| b. | “Unfortunately, you’ll probably have a small amount of residual damage.” |
| c. | “Don’t worry, I’ll take care of everything.” |
| d. | “You may have a few more episodes over the course of your lifetime but no permanent damage.” |
____ 17. Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him:
| a. | “L-dopa is neuroprotective.” |
| b. | “The primary goal of therapy is to replace depleted stores of dopamine.” |
| c. | “This is the only drug that can provide symptomatic benefit.” |
| d. | “This is the initial monotherapy drug.” |
____ 18. Which of the following signs is seen in a patient with more advanced PD?
| a. | Resting tremor |
| b. | Bradykinesia |
| c. | Rigidity |
| d. | Postural instability |
____ 19. Which of the following is the most commonly experienced symptom of migraine?
| a. | Light sensitivity |
| b. | Pulsatile pain |
| c. | Sound sensitivity |
| d. | Experiencing an aura |
____ 20. Which of the following characteristics differentiates peripheral vertigo from central vertigo?
| a. | The duration of central vertigo is shorter than that of peripheral vertigo. |
| b. | There is an auditory-associated symptom with peripheral vertigo and a visual-associated symptom with central vertigo. |
| c. | Central vertigo is positional, and peripheral vertigo is not. |
| d. | The onset of central vertigo is more sudden than that of peripheral vertigo. |
____ 21. Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis?
| a. | Greater than 25% |
| b. | Greater than 50% |
| c. | Greater than 75% |
| d. | Only for 100% occlusion |
____ 22. What antiplatelet agent is most widely used for secondary prevention of stroke?
| a. | Aspirin |
| b. | Ticlopidine |
| c. | Clopidogrel |
| d. | Aspirin and clopidogrel |
____ 23. Which adjunctive diagnostic test should be used in the work-up of a patient with suspected Creutzfeldt-Jakob disease or transient epileptic amnesia?
| a. | MRI |
| b. | CT |
| c. | Cerebrospinal fluid analysis |
| d. | EEG |
____ 24. Which herbal preparation may cause delirium and should be avoided in an elderly patient?
| a. | Sam-e |
| b. | Saint John’s Wort |
| c. | Melatonin |
| d. | Saw Palmetto |
____ 25. Which of the following activities is part of the functional activities questionnaire?
| a. | Asking the patient to unravel a Rubik’s cube |
| b. | Determining if the patient can drive on the highway |
| c. | Asking the patient about a news event from the current week |
| d. | Seeing if the patient can keep his or her home clean |
____ 26. About 90% of all headaches are?
| a. | Tension |
| b. | Migraine |
| c. | Cluster |
| d. | Without pathological cause |
____ 27. Which statement is true regarding driving and patients with a seizure disorder?
| a. | Once diagnosed with a seizure disorder, patients must never drive again. |
| b. | After being seizure free for 6 months, patients may drive. |
| c. | Each state has different laws governing driving for individuals with a seizure disorder. |
| d. | These persons may drive but never alone. |
____ 28. Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given intravenously once a month?
| a. | Glatiramer acetate |
| b. | Natalizumab |
| c. | Fingolimod |
| d. | Glucocorticoids |
____ 29. The ‘freezing phenomenon’ is a cardinal feature of?
| a. | Parkinson’s disease |
| b. | Alzheimer’s disease |
| c. | A CVA |
| d. | Bell’s palsy |
____ 30. A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as?
| a. | Spinothalamic dysfunction |
| b. | Ratcheting |
| c. | Cogwheeling |
| d. | Hand tremors |
____ 31. Clinical features of insidious onset, slow progression, and a lack of other findings to explain the symptoms are fairly diagnostic of which condition?
| a. | Guillain-Barré syndrome |
| b. | Parkinson’s disease |
| c. | Alzheimer’s disease |
| d. | Huntington’s disease |
____ 32. Which condition is characterized by the impaired ability to learn new information along with either a cognitive disturbance in language, function, or perception?
| a. | Guillain-Barré syndrome |
| b. | Parkinson’s disease |
| c. | Alzheimer’s disease |
| d. | Delirium |
____ 33. A score of 20 to 25 on this test indicates early-stage Alzheimer’s disease:
| a. | SLUMS |
| b. | MoCA |
| c. | FAST |
| d. | MMSE |
____ 34. Intravenous thrombolytic therapy following an ischemic CVA should be given within how many hours of symptom onset?
| a. | 1 hour |
| b. | 3 hours |
| c. | 6 hours |
| d. | 12 hours |
____ 35. When administered at the beginning of an attack, oxygen therapy may help this kind of headache?
| a. | Tension |
| b. | Migraine |
| c. | Cluster |
| d. | Stress |
Chapter 7. Skin Problems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause?
| a. | “You must be under a lot of stress lately.” |
| b. | “It is hereditary. Did your father experience this also?” |
| c. | “The cause is unknown, but we suspect it is due to an immunologic mechanism.” |
| d. | “We’ll have to do some tests.” |
____ 2. Which of the following is “a linear crack extending from the epidermis to the dermis?”
| a. | An ulcer |
| b. | A fissure |
| c. | Lichenification |
| d. | An excoriation |
____ 3. A bulla is:
| a. | A vesicle larger than 1 cm in diameter |
| b. | An elevated solid mass with a hard texture; the shape and borders can be regular or irregular |
| c. | A superficial elevated lesion filled with purulent fluid |
| d. | Thinning of the skin (epidermis and dermis) that appears white or translucent |
____ 4. An example of ecchymosis is:
| a. | A hematoma |
| b. | A keloid |
| c. | A bruise |
| d. | A patch |
____ 5. When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?
| a. | Spores |
| b. | Leukocytes |
| c. | Pseudohyphae |
| d. | Epithelial cells |
____ 6. Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is a treatment that you usually recommend/order in nonpregnant patients, but is listed as a Pregnancy category D?
| a. | Vagistat vaginal cream |
| b. | Monistat combination pack |
| c. | Terazol vaginal cream |
| d. | Diflucan, 150 mg |
____ 7. Tinea unguium is also known as:
| a. | Onychomycosis |
| b. | Tinea versicolor |
| c. | Tinea manuum |
| d. | Tinea corporis |
____ 8. Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this?
| a. | Bullous impetigo |
| b. | Staphylococcal scalded skin syndrome (SSSS) |
| c. | Nonbullous impetigo |
| d. | Ecthyma |
____ 9. Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria?
| a. | Staphylococcal aureus |
| b. | Clostridium perfringens |
| c. | S. pyrogenes |
| d. | Streptococcus |
____ 10. When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect?
| a. | A piece of hair or a thread |
| b. | Hyphae |
| c. | Leukocytes |
| d. | Spores |
____ 11. Marci has a wart on her hand. She says she heard something about “silver duct tape therapy.” What do you tell her about his?
| a. | It is an old wives’ tale. |
| b. | It is used as a last resort. |
| c. | Salicylic acid is more effective. |
| d. | It is a simple treatment that should be tried first. |
____ 12. Which is the most potent and irritating dose of tretinoin?
| a. | 0.05% liquid formulation |
| b. | 0.1% cream |
| c. | 1% foam |
| d. | 0.02% cream |
____ 13. Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers?
| a. | Necrotizing fasciitis |
| b. | Periorbital cellulitis |
| c. | Erysipelas |
| d. | “Flesh-eating” cellulitis |
____ 14. Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and document this as a:
| a. | Filiform/digitate wart |
| b. | Dysplastic cervical lesion |
| c. | Condyloma acuminata |
| d. | Koilocytosis |
____ 15. Jeffrey has atopic dermatitis. You are prescribing a low-dose topical corticosteroid for him. Which would be a good choice?
| a. | Betamethasone dipropionate 0.05% |
| b. | Hydrocortisone base 2.5% |
| c. | Halcinonide 0.1% |
| d. | Desonide 0.05% |
____ 16. Harvey has a rubbery, smooth, round mass on his chest that is compressible and has a soft-to-very-firm texture. What do you diagnose this as?
| a. | A lipoma |
| b. | A nevi |
| c. | A skin tag |
| d. | A possible adenoma |
____ 17. Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using liquid nitrogen?
| a. | Do not use lidocaine as it may potentiate bleeding. |
| b. | Pinch the skin taut together. |
| c. | Use gel foam to control bleeding. |
| d. | This should be performed by a dermatologist only. |
____ 18. The “B” in the ABCDEs of assessing skin cancer represents:
| a. | Biopsy |
| b. | Best practice |
| c. | Boundary |
| d. | Border irregularity |
____ 19. The majority of HSV-1 and HSV-2 infections are asymptomatic so that only which elevated antibody titer shows evidence of previous infection?
____ 20. Eighty percent of men have noticeable hair loss by what age?
____ 21. Prevalence of psoriasis is highest in which group?
| a. | Scandinavians |
| b. | African Americans |
| c. | Asians |
| d. | Native Americans |
____ 22. The most common precancerous skin lesion found in Caucasians is:
| a. | A skin tag |
| b. | Actinic keratosis |
| c. | A melanoma |
| d. | A basal cell lesion |
____ 23. Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is warm and tender to palpation. There is some edema involved. You suspect:
| a. | Necrotizing fasciitis |
| b. | Kaposi’s sarcoma |
| c. | Cellulitis |
| d. | A diabetic ulcer |
____ 24. Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition?
| a. | There are round, hypopigmented macules on his back. |
| b. | Josh has red papules on his face. |
| c. | There are crusted plaques in Josh’s groin area. |
| d. | There are white streaks on his neck. |
____ 25. Tori is on systemic antifungals for a bad tinea infection. You are aware that the antifungals may cause:
| a. | Renal failure |
| b. | Skin discoloration |
| c. | Breathing difficulties |
| d. | Hepatotoxicity |
____ 26. Which scalp problem can be caused by a fever and certain drugs?
| a. | Telogen effluvium (TE) |
| b. | Trichotillomania |
| c. | Psoriasis |
| d. | Alopecia areata |
____ 27. Why do people of African descent have a lower incidence of non-melanoma skin cancer?
| a. | They have an increased number of melanocytes. |
| b. | Their darker skin protects from ultraviolet radiation. |
| c. | Their skin is thicker. |
| d. | Their immune system is stronger. |
____ 28. Which statement is true regarding chloasma, the ‘mask of pregnancy’?
| a. | It is caused by a decrease in the melanocyte-stimulating hormone during pregnancy. |
| b. | This condition only occurs on the face. |
| c. | Exposure to sunlight will even out the discoloration. |
| d. | It is caused by increased levels of estrogen and progesterone. |
____ 29. When instructing your elderly client about treating her xerosis, what do you tell her?
| a. | A daily hot bath may help the associated pruritus. |
| b. | Rub the skin briskly to make sure it is completely dry after bathing. |
| c. | Only take short tepid showers. |
| d. | Use a gel that is alcohol-based after bathing to soften the skin. |
____ 30. Which medication used for scabies is safe for children 2 months and older?
| a. | Permethrin cream |
| b. | Lindane |
| c. | Crotamiton lotion and cream |
| d. | Ivermectin |
____ 31. Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis?
| a. | Keratosis pilaris |
| b. | Dennie’s sign |
| c. | Keratoconus |
| d. | Pityriasis alba |
____ 32. Which of the following statements about performing cryosurgery for actinic keratosis is true?
| a. | It is better to slightly overfreeze the area, so you only have to do it once. |
| b. | Using liquid nitrogen, freeze each lesion for at least 30 seconds. |
| c. | Every lesion should be biopsied after using liquid nitrogen. |
| d. | The ‘freeze balls’ should be approximately one-and-a-half times as wide as they are deep. |
____ 33. An example of a primary skin lesion is a/an:
| a. | Bulla |
| b. | Scale |
| c. | Excoriation |
| d. | Fissure |
____ 34. Which statement regarding necrotizing fasciitis is true?
| a. | The hallmark of this infection is its slow and steady progression. |
| b. | Once the border of the infection is “established,” it does not spread. |
| c. | Loss of life or limb is a potential complication. |
| d. | The lesion is most dangerous, because it is painless. |
____ 35. When staging a malignant melanoma using Clark’s levels, which level extends into the papillary dermis?
| a. | Level I |
| b. | Level II |
| c. | Level III |
| d. | Level IV |
Chapter 9. Respiratory Problems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A chronic cough lasts longer than:
| a. | 3 weeks |
| b. | 1 month |
| c. | 6 months |
| d. | 1 year |
____ 2. You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex?
| a. | Baker phenomenon |
| b. | Arnold reflex |
| c. | Cough reflex |
| d. | Tragus reflex |
____ 3. Julie has a postnasal drip along with her cough. You assess her for:
| a. | Asthma |
| b. | Sinusitis |
| c. | Allergic or vasomotor rhinitis |
| d. | Influenza |
____ 4. A patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from:
| a. | Metoprolol |
| b. | Clopidogrel |
| c. | Tadalafil |
| d. | Captopril |
____ 5. African American patients seem to have a negative reaction to which of the following asthma medications?
| a. | Inhaled corticosteroids |
| b. | Long-term beta-agonist bronchodilators |
| c. | Leukotriene receptor agonists |
| d. | Oral corticosteroids |
____ 6. Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis?
| a. | Asthma |
| b. | Emphysema |
| c. | Chronic bronchitis |
| d. | Influenza |
____ 7. You are using the CURB-65 clinical prediction tool to decide whether Mabel, whom you have diagnosed with community-acquired pneumonia (CAP), should be hospitalized or treated at home. Her score is 3. What should you do?
| a. | Consider home treatment. |
| b. | Plan for a short inpatient hospitalization. |
| c. | Closely supervise her outpatient treatment. |
| d. | Hospitalize and consider admitting her to the intensive care unit. |
____ 8. Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TBT)?
| a. | She is on a high-protein diet. |
| b. | She is an adolescent. |
| c. | She has been on long-term corticosteroid therapy. |
| d. | She just got over a cold. |
____ 9. Marci has been started on a tuberculosis (TB) regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically?
| a. | Pyridoxine |
| b. | Thiamine |
| c. | Probiotic |
| d. | Phytonadione |
____ 10. Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?
| a. | The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated. |
| b. | The cancer is in situ; it is spreading into the lymph nodes, but the spread cannot be evaluated otherwise. |
| c. | The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body. |
| d. | The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant spreading. |
____ 11. Nathan, a 32-year-old policeman, has a 15-pack-a-year history of smoking and continues to smoke heavily. During every visit, he gets irate when you try to talk to him about quitting. What should you do?
| a. | Hand him literature about smoking cessation at every visit. |
| b. | Wait until he is ready to talk to you about quitting. |
| c. | Document in the record that he is not ready to quit. |
| d. | Continue to ask him at every visit if he is ready to quit. |
____ 12. Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?
| a. | He should stop smoking today. |
| b. | He should stop smoking tomorrow. |
| c. | His quit date should be in 1 week. |
| d. | He will be ready to quit after the first 30 days. |
____ 13. Which information should be included when you are teaching your patient about the use of nicotine gum?
| a. | The gum must be correctly chewed to a softened state and then placed in the buccal mucosa. |
| b. | Patients should not eat for 30 minutes prior to or during the use of the gum. |
| c. | Initially, one piece is chewed every 30 minutes while awake. |
| d. | Acidic foods and beverages should be encouraged during nicotine therapy. |
____ 14. Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead?
| a. | Fever |
| b. | Headache |
| c. | Exudative pharyngitis |
| d. | Rhinorrhea |
____ 15. What is the first-line recommended treatment against Group A b-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis?
| a. | Penicillin |
| b. | Quinolone |
| c. | Cephalosporin |
| d. | Macrolide |
____ 16. Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily but not continual symptoms, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity?
| a. | Mild intermittent |
| b. | Mild persistent |
| c. | Moderate persistent |
| d. | Severe persistent |
____ 17. Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking?
| a. | Inhaled corticosteroid |
| b. | Leukotriene receptor antagonist |
| c. | Systemic corticosteroid |
| d. | Methyl xanthenes |
____ 18. Your patient is on Therabid for his asthma. You want to maintain his serum levels between:
| a. | 0 to 5 mcg/mL |
| b. | 5 to 10 mcg/mL |
| c. | 5 to 15 mcg/mL |
| d. | 10 to 20 mcg/mL |
____ 19. George has chronic obstructive pulmonary disease (COPD) and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD?
| a. | Stage 1 mild COPD |
| b. | Stage 2 moderate COPD |
| c. | Stage 3 severe COPD |
| d. | Stage 5 very severe COPD |
____ 20. Most nosocomial pneumonias are caused by:
| a. | Fungi |
| b. | Viruses |
| c. | Gram-negative bacteria |
| d. | Pneumococcal pneumonia |
____ 21. Which of the following statements regarding TST is true?
| a. | Tests should be read 48 hours after the injection. |
| b. | The size of the TST reaction has nothing to do with erythema but is based solely on induration. |
| c. | It is a type V T cell-mediated immune response. |
| d. | The diameter of the induration is measured in centimeters. |
____ 22. Which obstructive lung disease is classified as reversible?
| a. | Asthma |
| b. | Chronic bronchitis |
| c. | Emphysema |
| d. | COPD |
____ 23. You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her?
| a. | “Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow.” |
| b. | “Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.” |
| c. | “Drive to the emergency room now.” |
| d. | “Call 911.” |
____ 24. Which statement about adenocarcinoma of the lung is accurate?
| a. | It is the least common type of lung cancer, representing approximately 5% to 10% of cases. |
| b. | It is the most prevalent carcinoma of the lungs in both sexes and in nonsmokers, representing 35% to 40% of all tumors. |
| c. | It is more common in men than in women and occurs almost entirely in cigarette smokers. |
| d. | It is aggressive, with rapid growth and early local and distant metastases via the lymphatic and blood vessels. |
____ 25. Jason, age 62, has obstructive sleep apnea. What do you think is one of his contributing factors?
| a. | He is a recovering alcoholic of 6 years. |
| b. | His collar size is 17 inches. |
| c. | He is the only person in his family who has this. |
| d. | He is extremely thin. |
____ 26. The forced vital capacity is decreased in:
| a. | Asthma |
| b. | Chronic bronchitis |
| c. | Emphysema |
| d. | Restrictive disease |
____ 27. The most common cause of CAP is?
| a. | Streptococcus pneumoniae |
| b. | Klebsiella pneumoniae |
| c. | Legionella pneumoniae |
| d. | Pseudomonas aeruginosa |
____ 28. Which of the following patients would you expect to have a decreased response to TST?
| a. | Julie, a 50-year-old postal worker |
| b. | Sandy, a 40-year-old patient who recently survived a fire that left 40% of her total body surface covered in burns |
| c. | Jill, a 16-year-old cheerleader |
| d. | Mark, a 29-year-old tennis player |
____ 29. Which of the following is a possible consequence of sleep apnea?
| a. | Asthma |
| b. | Increased white blood cells |
| c. | Insulin resistance |
| d. | Hyperactivity |
____ 30. Which of the following conditions is associated with cigarette smoking?
| a. | Glaucoma |
| b. | Increased sperm quality |
| c. | Bladder cancer |
| d. | Eczema |
____ 31. Marta is taking TB drugs prophylactically. How do you instruct her to take them?
| a. | Take them on an empty stomach to facilitate absorption. |
| b. | Take them with aspirin (ASA) to prevent flushing. |
| c. | Take them with ibuprofen to prevent a headache. |
| d. | Take them with food to prevent nausea. |
____ 32. Which of the following statements regarding pulmonary function is true?
| a. | Cigarette smoking accelerates the decline in pulmonary function tenfold. |
| b. | Smoking cessation can reverse most pathological changes. |
| c. | Cigarette smoking decreases mucus production. |
| d. | There is a normal age-related decline in pulmonary function. |
____ 33. The barrel chest characteristic of emphysema is a result of:
| a. | Chronic coughing |
| b. | Hyperinflation |
| c. | Polycythemia |
| d. | Pulmonary hypertension |
____ 34. Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD?
| a. | 3 to 5 hours |
| b. | 6 to 10 hours |
| c. | 11 to 14 hours |
| d. | 15 to 18 hours |
____ 35. Which ethnic group has the highest lung cancer incidence and mortality rates?
| a. | African American men |
| b. | Scandinavian men and women |
| c. | Caucasian women |
| d. | Asian men |
Chapter 11. Abdominal Problems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical examination?
| a. | Digital rectal exam |
| b. | Pelvic exam |
| c. | Sexual history |
| d. | All of the above |
____ 2. A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation?
| a. | Multivitamin |
| b. | Magnesium hydroxide |
| c. | Pepto-Bismol® |
| d. | Ibuprofen |
____ 3. A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis?
| a. | Gastroenteritis |
| b. | Inflammatory bowel disease |
| c. | Lactase deficiency |
| d. | All of the above |
____ 4. Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes Tums® with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain?
| a. | The pain seems better when he smokes to relieve his nerves. |
| b. | Coffee and fried foods don’t bother him, |
| c. | He wakes at night coughing with a bad taste in his mouth. |
| d. | All of the above |
____ 5. A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer?
| a. | His gender |
| b. | His age |
| c. | His use of Alka-Seltzer |
| d. | His ethnic origin |
____ 6. Which of the following is most effective in diagnosing appendicitis?
| a. | History and physical |
| b. | Sedimentation rate |
| c. | Kidney, ureter, and bladder x-ray |
| d. | Complete blood count (CBC) with differentials |
____ 7. Which of the following is associated with celiac disease (celiac sprue)?
| a. | Malabsorption |
| b. | Constipation |
| c. | Rectal bleeding |
| d. | Esophageal ulceration |
____ 8. A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis?
| a. | Endometriosis |
| b. | Colon cancer |
| c. | Diverticulitis |
| d. | All of the above |
____ 9. A 46-year-old patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient?
| a. | CBC with differential |
| b. | Urine human chorionic gonadotropin |
| c. | Barium enema |
| d. | Computed tomography of the abdomen |
____ 10. A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be?
| a. | Obtain a complete history. |
| b. | Order a barium enema. |
| c. | Schedule a Bernstein’s test. |
| d. | Prescribe a trial of antispasmodics. |
____ 11. A 28-year-old patient is seen in the clinic with colicky abdominal pain particular with meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely?
| a. | Her age |
| b. | Frequent constipation |
| c. | Flatulence |
| d. | Colicky abdominal pain |
____ 12. A 28-year-old patient is seen with complaints of diarrhea. Which of the following responses to the history questions would help the primary care physician (PCP) establish the diagnosis of irritable bowel syndrome?
| a. | Feels relief after a bowel movement |
| b. | Sometimes is constipated |
| c. | Does not defecate in the middle of the night |
| d. | All of the above |
____ 13. A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following should the PCP include in the explanation of the pathology report?
| a. | This is a premalignant tissue. |
| b. | This tissue is resistant to gastric acid. |
| c. | This tissue supports healing of the esophagus. |
| d. | All of the above |
____ 14. Which of the following dietary instructions should be given to a patient with GERD?
| a. | Eliminate coffee. |
| b. | Drink peppermint tea to relieve stomach distress. |
| c. | Recline and rest after meals. |
| d. | Limit the amount of antacids. |
____ 15. The patient with GERD should be instructed to eliminate which of these activities?
| a. | Swimming |
| b. | Weight lifting |
| c. | Golfing |
| d. | Walking |
____ 16. A patient is diagnosed with giardia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment?
| a. | Vancomycin |
| b. | Penicillin |
| c. | Metronidazole |
| d. | Bactrim |
____ 17. A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis?
| a. | Very early |
| b. | 3 to 4 hours after perforation |
| c. | Late in inflammation |
| d. | Appendicitis never presents with vague pain. |
____ 18. The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion?
| a. | Use of NSAIDs |
| b. | Cigarette smoker |
| c. | Ethanol consumption |
| d. | All of the above |
____ 19. A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin. Which of the following could be a cause of this problem?
| a. | Increased breakdown of red blood cells |
| b. | Inadequate hepatocyte function |
| c. | Biliary obstruction |
| d. | All of the above |
____ 20. A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point?
| a. | Stool culture |
| b. | Liver enzymes |
| c. | Antihepatitis D virus |
| d. | Thyroid-stimulating hormone test |
____ 21. On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis?
| a. | Hepatitis A virus (HAV) IgM |
| b. | HAV IgG |
| c. | Anti-HAcAg |
| d. | Anti-HAsAg |
____ 22. A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings?
| a. | Decreased alanine aminotransferase and decreased aspartate aminotransferase |
| b. | Elevated alkaline phosphatase |
| c. | Elevated indirect bilirubin |
| d. | Decreased white blood cells |
____ 23. A patient has acute pancreatitis with seven of the diagnostic criteria from Ranson’s criteria. In order to plan care, the NP must understand that this criteria score has which of the following meanings?
| a. | A high mortality rate |
| b. | An increased chance of recurrence |
| c. | A 7% chance of the disease becoming chronic |
| d. | All of the above |
____ 24. A patient is seen in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the NP to a diagnosis of inflammatory bowel disease?
| a. | Intermittent constipation with periods of diarrhea |
| b. | Wakens at night with diarrhea |
| c. | History of international travel |
| d. | All of the above |
____ 25. Which of the following is part of the treatment plan for the patient with irritable bowel syndrome?
| a. | High fiber diet |
| b. | Tylenol with codeine |
| c. | Daily laxatives |
| d. | All of the above |
Chapter 13. Men’s Health Problems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis?
| a. | Psychogenic nocturia |
| b. | Urethral polyp |
| c. | Irritative posterior urethral lesion |
| d. | Benign prostatic hypertrophy |
____ 2. A 76-year-old man is seen in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men?
| a. | Urethral polyps |
| b. | Urinary tract infection (UTI) |
| c. | Anticholinergic medication |
| d. | All of the above |
____ 3. A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?
| a. | Refer to a urologist immediately. |
| b. | Obtain a computed tomography (CT) scan. |
| c. | Instruct the patient to elevate the scrotum. |
| d. | Prescribe ibuprofen. |
____ 4. An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses?
| a. | Benign prostatic hyperplasia (BPH) |
| b. | Parkinson’s disease |
| c. | Prostate cancer |
| d. | All of the above |
____ 5. Which of the following would be an appropriate treatment for a patient with mild BPH?
| a. | Refer to a urologist for surgery. |
| b. | Prescribe a trial of tamsulosin. |
| c. | Recommend cranberry supplements. |
| d. | Reevaluate symptoms in 1 to 3 months. |
____ 6. A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?
| a. | Testosterone level |
| b. | Prostate-specific antigen |
| c. | Nocturnal penile tumescence and rigidity |
| d. | Prolactin level |
____ 7. Which of the following should be considered in a patient presenting with erectile dysfunction?
| a. | Diabetes mellitus |
| b. | Hypertension |
| c. | Atherosclerosis |
| d. | All of the above |
____ 8. A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis?
| a. | Peyronie’s disease |
| b. | Damage to the pudendal artery |
| c. | Scarring of the cavernosa |
| d. | All of the above |
____ 9. The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects?
| a. | Erectile dysfunction |
| b. | Glaucoma |
| c. | Hypotension |
| d. | Headache |
____ 10. The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis?
| a. | Gram-positive cocci |
| b. | Gram-negative cocci |
| c. | Gram-positive bacillus |
| d. | Gram-negative bacillus |
____ 11. The 56-year-old man with chronic prostatitis should be treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long?
| a. | 3 to 7 days |
| b. | 14 to 21 days |
| c. | 3 to 6 weeks |
| d. | 6 to 12 weeks |
____ 12. A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate, and a diagnosis of prostatodynia is made. Which is the appropriate treatment?
| a. | Terazosin 2 mg PO once a day |
| b. | Ice pack to the scrotal area |
| c. | Saw palmetto 320 mg per day |
| d. | All of the above |
____ 13. A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism?
| a. | Escherichia coli |
| b. | Staphylococcus aureus |
| c. | Chlamydia trachomatis |
| d. | Pseudomonas aeruginosa |
____ 14. Which test is used to confirm a diagnosis of epididymitis?
| a. | Urinalysis |
| b. | Gram stain of urethral discharge |
| c. | Complete blood cell count with differential |
| d. | Ultrasound of the scrotum |
____ 15. Treatment for epididymitis includes which of the following?
| a. | Warm sitz baths |
| b. | Scrotal elevation |
| c. | Masturbation |
| d. | All of the above |
____ 16. Which of the following data is indicative of testicular torsion?
| a. | Absent cremasteric reflex |
| b. | Pain relieved on testicular elevation |
| c. | Testicle very low in the scrotum |
| d. | Swollen scrotum with “red dot sign” |
____ 17. A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?
| a. | The scrotum will be dark. |
| b. | The scrotum will appear light pink or yellow. |
| c. | The scrotum will appear milky white. |
| d. | The internal structures will be clearly visible. |
____ 18. During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?
| a. | An enlarged rubbery gland |
| b. | A hard irregular gland |
| c. | A tender gland |
| d. | A boggy gland |
____ 19. A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system?
| a. | The cancer involves the seminal vesicles. |
| b. | There is metastatic disease to regional lymph nodes. |
| c. | The cancer is confined to the capsule. |
| d. | There is metastasis to distant organs. |
____ 20. A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects?
| a. | Risk of osteoporosis |
| b. | May have hot flushes |
| c. | May have impotence |
| d. | All of the above |
____ 21. A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should be included in the list of differential diagnoses?
| a. | Testicular cancer |
| b. | Inguinal hernia |
| c. | Varicocele |
| d. | All of the above |
____ 22. What is the treatment of choice for a patient diagnosed with testicular cancer?
| a. | Radical orchidectomy |
| b. | Lumpectomy |
| c. | Radiation implants |
| d. | All of the above |
____ 23. A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan?
| a. | Every month |
| b. | Every 3 to 4 months |
| c. | Every 6 to 12 months |
| d. | Every year |
True/False
Indicate whether the statement is true or false.
____ 1. Patients treated for Neisseria gonorrhoeae also should be treated for Chlamydia trachomatis.
____ 2. Hepatitis A is considered a sexually transmitted infection by the Centers for Disease Control and Prevention.
Chapter 15. Musculoskeletal Problems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?
| a. | Bone |
| b. | Synovium |
| c. | Tendons |
| d. | Fascia |
____ 2. You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
| a. | Articular |
| b. | Inflammatory |
| c. | Nonarticular |
| d. | A and B |
____ 3. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
| a. | Decreased C-reactive protein |
| b. | Hyperalbuminemia |
| c. | Morning stiffness |
| d. | Weight gain |
____ 4. Which of the following statements concerning the musculoskeletal examination is true?
| a. | The uninvolved side should be examined initially and then compared to the involved side. |
| b. | The part of the body that is causing the patient pain should be examined first. |
| c. | When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain. |
| d. | Radiographs should always be obtained prior to examination so as not to cause further injury to the patient. |
____ 5. You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient?
____ 6. Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis?
| a. | History of hypertension |
| b. | Her affected shoulder is also her dominant arm. |
| c. | Her history of diabetes mellitus |
| d. | Her work as a secretary predisposes her to repetitive motions. |
____ 7. Jennifer is an 18-year-old who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
| a. | Posterior dislocations are more common than anterior dislocations. |
| b. | There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses. |
| c. | Recurrent dislocations are uncommon and would require great force to result in injury. |
| d. | Surgery is most commonly the treatment of choice. |
____ 8. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
| a. | Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. |
| b. | Only people with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. |
| c. | An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel. |
| d. | Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. |
____ 9. Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
| a. | The goal of treatment is to prevent flexion and extension movements of the wrist. |
| b. | Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position. |
| c. | Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection. |
| d. | All of the above |
____ 10. Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
| a. | Morning stiffness and limited mobility of the lumbar spine |
| b. | Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain |
| c. | Fever, chills, and elevated erythrocyte sedimentation rate |
| d. | Pathologic fractures, severe night pain, weight loss, and fatigue |
____ 11. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
| a. | “You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.” |
| b. | “You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.” |
| c. | “You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.” |
| d. | “It is important to take NSAIDs on an empty stomach in order to increase absorption.” |
____ 12. Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
| a. | Gastrocnemius weakness |
| b. | A reduced or absent ankle reflex |
| c. | Numbness in the lateral foot |
| d. | Paresthesia of the perineum and buttocks |
____ 13. Which of the following statements is true concerning the management of the client with a herniated disc?
| a. | Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use. |
| b. | An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred. |
| c. | Intolerable pain for more than a 3-month period is an indication for surgical intervention. |
| d. | All of the above |
____ 14. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
| a. | Valgus stress test |
| b. | McMurray circumduction test |
| c. | Lachman test |
| d. | Varus stress test |
____ 15. The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
| a. | Apprehension sign |
| b. | Bulge sign |
| c. | Thumb sign |
| d. | None of the above |
____ 16. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?
| a. | Inability to bear weight immediately after the injury |
| b. | Development of marked ankle swelling and discoloration after the injury |
| c. | Crepitation with palpation or movement of the ankle |
| d. | All of the above |
____ 17. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician?
| a. | “Complementary therapies should be considered only if surgical interventions are not successful.” |
| b. | “I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your condition.” |
| c. | “I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy.” |
| d. | “It would be crazy to use complementary therapies to treat such a serious condition.” |
____ 18. Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways?
| a. | By decreasing the erosive activity of osteoclasts |
| b. | By promoting osteoclastogenesis |
| c. | By inhibiting osteoclast apoptosis |
| d. | All of the above |
____ 19. Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis?
| a. | Bone alkaline phosphatase levels |
| b. | Urinary N-telopeptide assay |
| c. | Bone mass density measurement by densitometry |
| d. | Magnetic resonance imaging |
____ 20. What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
| a. | 1,200 mg/day |
| b. | 1,000 mg/day |
| c. | 1,300 mg/day |
| d. | 1,500 mg/day |
____ 21. Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?
| a. | Taking bisphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs. |
| b. | There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying. |
| c. | This class of drugs can be taken at any time of the day without regard to meals. |
| d. | None of the above |
____ 22. Which stage of Paget’s disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
| a. | Lytic |
| b. | Mixed |
| c. | Sclerotic |
| d. | All of the above |
____ 23. Which of the following statements concerning the treatment of fibromyalgia syndrome is true?
| a. | There is currently no cure for the disorder; however, patients should be made aware that symptom relief is possible. |
| b. | Treatment is directed toward controlling discomfort, improving sleep, and maintaining function. |
| c. | Fibromyalgia syndrome can be difficult to manage, requiring a variety of approaches and multiple medications. |
| d. | All of the above |
____ 24. One of the most frequent presenting signs/symptoms of osteoporosis is:
| a. | Goiter |
| b. | Abnormal serum calcium |
| c. | Elevated urine biochemical markers |
| d. | Bony fracture |
____ 25. Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
| a. | Ecchymosis, edema, and erythema over the lateral epicondyle |
| b. | Pain at the elbow with resisted movements at the wrist and forearm |
| c. | Inability to supinate and pronate the arm |
| d. | Inability to flex or extend the elbow against resistance |
____ 26. A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
| a. | Make an immediate referral for an orthopedic evaluation without further assessment. |
| b. | Tell her that it takes time for these bruises to improve, so she should be patient. |
| c. | Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint. |
| d. | Send her to the emergency room for reduction of this obvious wrist fracture. |
True/False
Indicate whether the statement is true or false.
____ 1. Osteoarthritis is primarily a noninflammatory condition.
____ 2. The presence of a positive rheumatoid factor is always indicative of rheumatoid arthritis.
