KAPLAN MN568 2018 March Unit 4 Exam Latest

 

MN568   Primary Care Across the Span

Unit 4 Exam

Question 1                         

Jamie, age 55, has just started on a statin after having his liver function tests (LFTs) come back normal. He now asks you how often he has to have the LFTs repeated. What do you tell him?

Question options:

 

a)

 

Initially in 6 weeks

 

b)

 

Every 3 months

 

c)

 

Every 6 months

 

d)

 

It’s no longer necessary for his statin regimen.

Question 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?

Question options:

 

a)

 

Multivitamin

 

b)

 

Magnesium hydroxide

 

c)

 

Pepto-Bismol®

 

d)

 

Ibuprofen

Question 3                         

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?

Question options:

 

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

Question 4                         

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?

Question options:

 

a)

 

Her age

 

b)

 

Frequent constipation

 

c)

 

Flatulence

 

d)

 

Colicky abdominal pain

Question 5                         

A 46-year-old female patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient?

 

Question options:

 

a)

 

CBC with differential

 

b)

 

Urine human chorionic gonadotropin

 

c)

 

Barium enema

 

d)

 

Computed tomography of the abdomen

Question 6                         

There are four stages of heart failure, classified as A to D, that describe the evolution and progression of disease. In which stage are patients hospitalized or treated with specialized interventions or hospice care for refractory symptoms of heart failure despite medical therapy?

Question options:

 

a)

 

Stage A

 

b)

 

Stage B

 

c)

 

Stage C

 

d)

 

Stage D

Question 7                         

Which of the following is part of the treatment plan for the patient with irritable bowel syndrome?

Question options:

 

a)

 

High fiber diet

 

b)

 

Tylenol with codeine

 

c)

 

Daily laxatives

 

d)

 

All of the above

Question 8                         

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?

Question options:

 

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

Question 9                         

Mary has hypertension and previously had a stroke. Which hypertensive drug would you order for her?

Question options:

 

a)

 

Angiotensin converting enzyme inhibitor

 

b)

 

Calcium channel blocker

 

c)

 

Angiotensin II receptor blocker

 

d)

 

Beta blocker

Question 10                       

In which type of arterioventricular (AV) block does the pulse rate (PR) interval lengthen until a beat is dropped?

Question options:

 

a)

 

First-degree AV block

 

b)

 

Second-degree Mobitz I AV block

 

c)

 

Second-degree Mobitz II AV block

 

d)

 

Third-degree AV block

Question 11                       

Your patient with permanent afib asks when he can discontinue his warfarin. You tell him:

Question options:

 

a)

 

When your internalized normalized ratio reaches 3.0, you can stop taking your warfarin permanently.

 

b)

 

When you no longer feel ill

 

c)

 

One month after your symptoms dissipate

 

d)

 

You’ll probably be on it indefinitely.

Question 12                       

For the best therapeutic effect after a myocardial infarction (MI), thrombolytics should be administered within the first 3 hours (ideally 30 minutes) of symptom onset. Studies have shown, however, that thrombolytic therapy can be of benefit up to how many hours after the initial presentation of MI symptoms?

Question options:

 

a)

 

6 hours

 

b)

 

8 hours

 

c)

 

10 hours

 

d)

 

12 hours

Question 13                       

You just started Martha on HTN therapy. The Eighth Joint National Committee recommends that if her goal BP is not reached in what length of time, you should increase the initial drug or add a second drug to it?

Question options:

 

a)

 

1 month

 

b)

 

3 months

 

c)

 

6 months

 

d)

 

1 year

Question 14                       

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?

Question options:

 

a)

 

His gender

 

b)

 

His age

 

c)

 

His use of Alka-Seltzer

 

d)

 

His ethnic origin

Question 15                       

If chest pain can be alleviated with time, analgesics, and heat applications, what might the differential diagnosis be?

Question options:

 

a)

 

Peptic ulcer

 

b)

 

Hiatal hernia

 

c)

 

Costochondritis

 

d)

 

Pericarditis

Question 16                       

Which high-density lipoprotein (HDL) level is considered cardioprotective?

Question options:

 

a)

 

Greater than 30

 

b)

 

Greater than 40

 

c)

 

Greater than 50

 

d)

 

Greater than 60

Question 17                       

A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis?

Question options:

 

a)

 

Gastroenteritis

 

b)

 

Inflammatory bowel disease

 

c)

 

Lactase deficiency

 

d)

 

All of the above

Question 18                       

Which test has long been considered the gold standard for a diagnosis of venous thromboembolism?

Question options:

 

a)

 

Ultrasound

 

b)

 

Magnetic resonance imaging (MRI)

 

c)

 

Ascending venogram

 

d)

 

D-dimer

Question 19                       

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?

Question options:

 

a)

 

Intermittent constipation with periods of diarrhea

 

b)

 

Wakens at night with diarrhea

 

c)

 

History of international travel

 

d)

 

All of the above

Question 20                       

Which of the following medications can cause hyperlipidemia?

Question options:

 

a)

 

Diuretics

 

b)

 

NSAIDs

 

c)

 

Opioids

 

d)

 

Insulin

Question 21                       

Which of the following is associated with celiac disease (celiac sprue)?

Question options:

 

a)

 

Malabsorption

 

b)

 

Constipation

 

c)

 

Rectal bleeding

 

d)

 

Esophageal ulceration

Question 22                       

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?

Question options:

 

a)

 

Obtain a complete history.

 

b)

 

Order a barium enema.

 

c)

 

Schedule a Bernstein’s test.

 

d)

 

Prescribe a trial of antispasmodics.

Question 23                       

When teaching post MI patients about their NTG tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are packaged and should not be put in another pill box or remain in areas that are or could become warm and humid. Once opened, the bottle must be dated and discarded after how many months?

Question options:

 

a)

 

1 month

 

b)

 

3 months

 

c)

 

6 months

 

d)

 

As long as the tablets are kept in this special bottle, they will last forever.

Question 24                       

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?

Question options:

 

a)

 

Increased breakdown of red blood cells

 

b)

 

Inadequate hepatocyte function

 

c)

 

Biliary obstruction

 

d)

 

All of the above

Question 25                       

In the CHADS2 Index for the stroke risk score for AF, the ‘A’ stands for:

Question options:

 

a)

 

Anticoagulation

 

b)

 

Autoimmune disease

 

c)

 

Age

 

d)

 

Antihypertension

Question 26                       

What value on the ankle-brachial index diagnoses peripheral artery disease?

Question options:

 

a)

 

Less than 0.25

 

b)

 

Less than 0.50

 

c)

 

Less than 0.90

 

d)

 

Greater than 1

Question 27                       

Which of the following dietary instructions should be given to a patient with GERD?

Question options:

 

a)

 

Eliminate coffee.

 

b)

 

Drink peppermint tea to relieve stomach distress.

 

c)

 

Recline and rest after meals.

 

d)

 

Limit the amount of antacids.

Question 28                       

George, age 64, has cardiovascular disease (CVD), a total cholesterol of 280 mg/dL, and a systolic BP of 158. He is being treated for hypertension. You are doing a Framingham Risk Assessment on him. Which assessment factor would give him the highest number of points on the scale?

Question options:

 

a)

 

His age

 

b)

 

His cholesterol level

 

c)

 

His systolic BP

 

d)

 

The fact that he is on antihypertensive medication

Question 29                       

Which type of angina do you suspect in Harvey, who complains of chest pain that occurs during sleep and most often in the early morning hours?

Question options:

 

a)

 

Stable angina

 

b)

 

Unstable angina

 

c)

 

Variant (Prinzmetal’s angina)

 

d)

 

Probably not angina but hiatal hernia

Question 30                       

Which heart sound may be heard with poorly controlled hypertension, angina, and ischemic heart disease?

Question options:

 

a)

 

A physiologic split S2

 

b)

 

A fixed split S2

 

c)

 

S3

 

d)

 

S4

Question 31                       

A patient is diagnosed with giardia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment?

Question options:

 

a)

 

Vancomycin

 

b)

 

Penicillin

 

c)

 

Metronidazole

 

d)

 

Bactrim

Question 32                       

A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis?

Question options:

 

a)

 

Very early

 

b)

 

3 to 4 hours after perforation

 

c)

 

Late in inflammation

 

d)

 

Appendicitis never presents with vague pain.

Question 33                       

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?

Question options:

 

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

Question 34                       

Which of the following is most effective in diagnosing appendicitis?

Question options:

 

a)

 

History and physical

 

b)

 

Sedimentation rate

 

c)

 

Kidney, ureter, and bladder x-ray

 

d)

 

Complete blood count (CBC) with differentials

Question 35                       

Statins are approved for which age group?

Question options:

 

a)

 

Children over the age of 2

 

b)

 

Children over the age of 6

 

c)

 

Children over the age of 10

 

d)

 

Only adolescents and adults

Question 36                       

The patient with GERD should be instructed to eliminate which of these activities?

Question options:

 

a)

 

Swimming

 

b)

 

Weight lifting

 

c)

 

Golfing

 

d)

 

Walking

Question 37                       

Which pain characteristic is usually indicative of cardiac pathology?

Question options:

 

a)

 

Fleeting

 

b)

 

Moving

 

c)

 

Diffuse

 

d)

 

Localized

Question 38                       

Which ECG change is typical of cardiac ischemia?

Question options:

 

a)

 

T-wave inversion

 

b)

 

ST-segment elevation

 

c)

 

Significant Q wave

 

d)

 

U-wave

Question 39                       

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?

Question options:

 

a)

 

Decreased alanine aminotransferase and decreased aspartate aminotransferase

 

b)

 

Elevated alkaline phosphatase

 

c)

 

Elevated indirect bilirubin

 

d)

 

Decreased white blood cells

Question 40                       

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?

Question options:

 

a)

 

Stool culture

 

b)

 

Liver enzymes

 

c)

 

Antihepatitis D virus

 

d)

 

Thyroid-stimulating hormone test

Question 41                       

A Delta wave on the ECG may be present in which condition?

Question options:

 

a)

 

Prinzmetal’s angina

 

b)

 

Bundle branch block

 

c)

 

Wolff-Parkinson-White syndrome

 

d)

 

Aortic stenosis

Question 42                       

The American College of Cardiology/American Heart Association states which of the following regarding the use of non-statin lipid-lowering agents?

Question options:

 

a)

 

Nicotinic acid derivatives are effective for lowering LDL and triglycerides (TGs).

 

b)

 

Bile acid sequestrates increase HDL.

 

c)

 

Cholesterol absorption inhibitors decrease LDL.

 

d)

 

There is no sufficient evidence to use non-statin lipid-drugs.

Question 43                       

Which group would most benefit from statins?

Question options:

 

a)

 

Those with a low density lipoprotein-cholesterol greater than 100 mg/dL

 

b)

 

Individuals with clinical arteriosclerotic cardiovascular disease

 

c)

 

Individuals with a 10-year risk greater than 10%

 

d)

 

Individuals of all ages with diabetes mellitus (DM)

Question 44                       

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?

Question options:

 

a)

 

Digital rectal exam

 

b)

 

Pelvic exam

 

c)

 

Sexual history

 

d)

 

All of the above

Question 45                       

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?

Question options:

 

a)

 

Endometriosis

 

b)

 

Colon cancer

 

c)

 

Diverticulitis

 

d)

 

All of the above

Question 46                       

You are assessing Sigred for metabolic syndrome. Which of her parameters is indicative of this syndrome?

Question options:

 

a)

 

Her waist is 36 inches.

 

b)

 

Her triglyceride level is 140 mg/dL.

 

c)

 

Her BP is 128/84.

 

d)

 

Her fasting blood sugar (BS) is 108 mg/dL.

Question 47                       

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?

Question options:

 

a)

 

Use of NSAIDs

 

b)

 

Cigarette smoker

 

c)

 

Ethanol consumption

 

d)

 

All of the above

Question 48                       

Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test?

Question options:

 

a)

 

B-type natriuretic peptide

 

b)

 

C-reactive protein

 

c)

 

Serum albumin

 

d)

 

Erythrocyte sedimentation rate

Question 49                       

Which of the following statements about dabigatran is true?

Question options:

 

a)

 

It is difficult to keep the patient in therapeutic range.

 

b)

 

Anticoagulation cannot be immediately reversed.

 

c)

 

It allows for the use of tPA if the patient has a stroke despite anticoagulation.

 

d)

 

None of the statements are true.

Question 50                       

Lifestyle modifications to manage hypertension (HTN) include:

Question options:

 

a)

 

Maintaining a body mass index of 17

 

b)

 

Restricting dietary sodium to 2 grams per day

 

c)

 

Engaging in exercise or physical activity for 90 minutes a day

 

d)

 

Limiting beer intake to 24 ounces per day