NR511 2020 MAY FINAL EXAM Latest

NR511 Differential Diagnosis and Primary Care

FINAL EXAM

Question 1 The most cost-e?ective screening test for determining HIV status is which of the following?               

                Western blot    

                Enzyme-linked immunosorbent assay   

                Venereal Disease Research Laboratory test        

                Viral load            

Question 2.         Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process? 

                Erythrocyte sedimentation rate               

                White blood cell count  

                Polymorphonuclear cells             

                C-reactive protein (CRP)              

Question 3.         Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?             

                GABA   

                Acetylcholine    

                Dopamine          

                Serotonin           

Question 4.         Mrs. Thomas was seen in the o?ce 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 di?erentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:         

                Ecchymosis, edema, and erythema over the lateral epicondyle 

                Pain at the elbow with resisted movements at the wrist and forearm    

                Inability to supinate and pronate the arm            

                Inability to flex or extend the elbow against resistance 

               

                               

Question 5.         Which of the following statements concerning the musculoskeletal examination is true?              

                The uninvolved side should be examined initially and then compared to the involved side.          

                The part of the body that is causing the patient pain should be examined first.  

                When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid   

                causing pain.     

                Radiographs should always be obtained prior to                examination so as not to cause further injury to the patient.               

Question 6.         Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?   

                Decreased C-reactive protein    

                Hyperalbuminemia        

                Morning sti?ness            

                Weight gain                       

Question 7.         Which causes the greatest percentage of mammalian bites?      

                Dogs     

                Cats      

                Humans              

                Rodents                              

Question 8.         A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states           she can no longer exercise. Pelvic exam reveals a single,               very large mass. Which of the following diagnostic tests should the clinician order first? 

                Transvaginal ultrasound               

                Endometrial biopsy        

                MRI       

                Abdominal computed tomography scan                               

Question 9.         A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?    

                "Control of glucose will help postpone or delay  complications."

                "Regularly checking blood sugar will help establish a routine."    

                "Monitoring glucose will promote a sense of control."   

                All of the above               

                               

Question 10.      A 25-year-old patient presents to the clinic with fatigue, cold  intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular sti?ness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?              

                Serum calcium  

                TSH       

                Electrolytes       

                Urine specific gravity     

Question 11.      Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?       

                Insulin  

                Metformin         

                Glucotrol            

                Precose               

Question 12.      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?    

                An enlarged rubbery gland         

                A hard irregular gland    

                A tender gland 

                A boggy gland   

Question 13.      Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your 

                first step?           

                Remove the insect with tweezers.          

                Immobilize the insect with 2% lidocaine.              

                Sedate Eddie with diazepam.    

                Shine a light in the ear for the insect to "find its way out."            

Question 14.      What is the most common cause of microcytic anemia?

                Anemia of chronic disease          

                Sideroblastic anemia     

                Iron-deficiency anemia

                Thalassemia      

Question 15.      An 82-year-old man is seen in the primary care o?ce with complaints of dribbling urine and di?culty starting his stream. Which of the following should be included in the list                of di?erential diagnoses?            

                Benign prostatic hyperplasia (BPH)         

                Parkinson's disease        

                Prostate cancer               

                All of the above               

Question 16.      Early rheumatoid disease is characterized by:

                Pain and swelling in both small and large peripheral joints            

                Rigid joints with diminished range of motion      

                Joint swelling and immobility on rising   

                A cardiac rub or pulmonary friction rub 

               

Question 17.      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?   

                Make an immediate referral for an orthopedic evaluation without further assessment.

                Tell her that it takes time for these bruises to improve, so she should be patient.             

                Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint.  

                Send her to the emergency room for reduction of this obvious wrist fracture.                   

Question 18.      The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:              

                1 month              

                3 months            

                6 months            

                12 months                          

Question 19.      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?     

                The scrotum will be dark.            

                The scrotum will appear light pink or yellow.      

                The scrotum will appear milky white.     

                The internal structures will be clearly visible.      

Question 20.      According to Kübler-Ross, the stages of grief occur in which order?         

                Anger, denial, depression, bargaining, acceptance          

                Anger, denial, bargaining, acceptance, depression          

                Denial, anger, depression, bargaining, acceptance           

                Denial, anger, bargaining, depression, acceptance           

Question 21.      Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate?             

                A favorable prognostic trend     

                Disease progression      

                The need to be more aggressive with Reuben's

                medications      

                The eradication of the HIV          

Question 22.      The exanthem of Lyme disease is:          

                Erythema infectiosum  

                Laterothoracic exanthem            

                Erythema migrans          

                Morbilli exanthem          

Question 23.      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:            

                Articular              

                Inflammatory   

                Nonarticular      

                A and B