NSG 6420 Week 2&3 Quiz.

Which of the following is the most common cause of heartburn-type epigastric pain? Question 1 options: a) Decreased lower esophageal sphincter tone b) Helicobacter pylori infection of stomach c) Esophageal spasm Save Question 2 (1 point) An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD? Question 2 options: a) Identification of a fluid wave b) Positive Murphy’s sign c) Palpable spleen Save Question 3 (1 point) Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: Question 3 options: a) Diverticulitis c) Appendicitis d) Peptic ulcer disease Save Question 4 (1 point) A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: Question 4 options: a) Digital rectal examination b) Endoscopy d) Urinalysis Save Question 5 (1 point) A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: Question 5 options: a) Appendicitis b) Cholecystitis d) Diverticulitis Save Question 6 (1 point) Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? Question 6 options: b) Staphylococcal food poisoning c) Acute hepatitis A d) E coli gastroenteritis Save Question 7 (1 point) A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: Question 7 options: a) CBC with differential b) Stool culture and sensitivity c) Abdominal X-ray Save Question 8 (1 point) A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: Question 8 options: a) Peptic ulcer disease b) Barrett’s esophagus d) Pancreatitis Save Question 9 (1 point) An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: Question 9 options: a) Mallory-Weiss tear b) Esophageal varices d) Colon cancer Save Question 10 (1 point) When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to: Question 10 options: a) Use all the medication c) Use should exceed one week for effectiveness d) These drugs provide exactly the same pharmaceutical effects Save Question 11 (1 point) When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions? Question 11 options: a) Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins. b) Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime. c) Sit up for an hour after taking any medication and restrict fluid intake. Save Question 12 (1 point) In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen? Question 12 options: a) Left upper quadrant b) Right upper quadrant d) Right lower quadrant Save Question 13 (1 point) Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? Question 13 options: a) It is highly contagious and a mask should be worn at home. b) Treatment regimen is multiple lifetime medications. d) Treatment regimen is complicated and is not indicated unless the patient is symptomatic. Save Question 14 (1 point) An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include? Question 14 options: a) Atypical pneumonia b) Peptic ulcer disease d) Mononucleosis (Epstein-Barr) Save Question 15 (1 point) Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease? Question 15 options: a) Cases of dyspepsia with constipation c) All clients with dyspepsia who smoke and drink alcohol d) When a therapeutic response to empiric treatment is obtained Save Question 16 (1 point) A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: Question 16 options: a) Inflammatory bowel disease c) Giardiasis d) Norovirus gastroenteritis Save Question 17 (1 point) What test is used to confirm the diagnosis of appendicitis? Question 17 options: a) CBC b) Flat plate of abdomen c) Rectal exam Save Question 18 (1 point) If it has been determined a patient has esophageal reflux, you should tell them: Question 18 options: a) They probably have a hiatal hernia causing reflux b) They probably need surgery c) They should avoid all fruit juices Save Question 19 (1 point) A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis? Question 19 options: C-reactive protein level of 3 mg White blood cell count of 11,000 Direct serum bilirubin level of 0.3 mg/dl Save Question 20 (1 point) Which of the following is not a contributing factor to the development of esophagitis in older adults? Question 20 options: b) Regular ingestion of NSAIDs c) Decreased salivation d) Fungal infections such as Candida Save Question 21 (1 point) The major impact of the physiological changes that occur with aging is: Question 21 options: a) Reduced physiological reserve b) Reduced homeostatic mechanisms c) Impaired immunological response Save Question 22 (1 point) Men have faster and more efficient biotransformation of drugs and this is thought to be due to: Question 22 options: a) Less obesity rates than women b) Prostate enlargement d) Less estrogen than women Save Question 23 (1 point) The cytochrome p system involves enzymes that are generally: Question 23 options: a) Inhibited by drugs b) Induced by drugs d) Associated with decreased liver perfusion Save Question 24 (1 point) Functional abilities are best assessed by: Question 24 options: a) Self-report of function c) A comprehensive head-to-toe examination d) Family report of function Save Question 25 (1 point) When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Question 25 options: a) Hemoglobin 8 g/dl, MCV increased, MCH increased b) Hemoglobin 12 g/dl, MCV increased, MCH increased d) Hemoglobin 12 g/dl, MCV decreased, MCH increased Save Question 26 (1 point) Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? Question 26 options: a) Hemoglobin and Hematocrit c) Serum ferritin and Serum iron d) Total iron binding capacity and transferrin saturation Save Question 27 (1 point) The pathophysiological hallmark of ACD is: Question 27 options: a) Depleted iron stores c) Chronic uncorrectable bleeding d) Reduced intestinal absorption of iron Save Question 28 (1 point) The main focus of treatment of patients with ACD is: Question 28 options: a) Replenishing iron stores b) Providing for adequate nutrition high in iron d) Administration of monthly vitamin B12 injections Save Question 29 (1 point) In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? Question 29 options: a) Serum iron b) Total iron binding capacity c) Transferrin saturation Save Question 30 (1 point) Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except: Question 30 options: a) Sore throat b) Fever d) Headache Save Question 31 (1 point) Essential parts of a health history include all of the following except: Question 31 options: a) Chief complaint b) History of the present illness d) All of the above are essential history components Save Question 32 (1 point) Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? Question 32 options: a) Clinical practice guideline c) Clinical algorithm d) Clinical recommendation Save Question 33 (1 point) The first step in the genomic assessment of a patient is obtaining information regarding: Question 33 options: b) Environmental exposures c) Lifestyle and behaviors d) Current medications Save Question 34 (1 point) In autosomal recessive (AR) disorders, individuals need: Question 34 options: a) Only one mutated gene on the sex chromosomes to acquire the disease b) Only one mutated gene to acquire the disease d) Two mutated genes to become carriers Save Question 35 (1 point) In AR disorders, carriers have: Question 35 options: a) Two mutated genes; one from each parent that cause disease b) A mutation on a sex chromosome that causes a disease c) A single gene mutation that causes the disease Save Question 36 (1 point) A woman with an X-linked dominant disorder will: Question 36 options: a) Not be affected by the disorder herself c) Not transmit the disorder to her daughters d) Transmit the disorder to only her daughters Save Question 37 (1 point) According to the Genetic Information Nondiscrimination Act (GINA): Question 37 options: a) Nurse Practitioners (NPs) should keep all genetic information of patients confidential b) NPs must obtain informed consent prior to genetic testing of all patients c) Employers cannot inquire about an employee’s genetic information Save Question 38 (1 point) Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? Question 38 options: a) Colon cancer in family member at age 70 b) Breast cancer in family member at age 75 d) All of the above Save Question 39 (1 point) Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: Question 39 options: a) Variable expressivity related to inherited disease c) De novo mutations of genetic disease d) Different penetrant signs of genetic disease Save Question 40 (1 point) In order to provide a comprehensive genetic history of a patient, the NP should: Question 40 options: a) Ask patients to complete a family history worksheet b) Seek out pathology reports related to the patient’s disorder c) Interview family members regarding genetic disorders Save Question 41 (1 point) An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: Question 41 options: a) Acoustic neuroma c) Otitis media d) Ménière’s disease Save Question 42 (1 point) In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: Question 42 options: a) Bacterial sinusitis c) Drug abuse d) Skull fracture Save Question 43 (1 point) Which of the following symptoms is common with acute otitis media? Question 43 options: b) Bright light reflex of tympanic membrane c) Increased tympanic membrane mobility d) All of the above Save Question 44 (1 point) Presbycusis is the hearing impairment that is associated with: Question 44 options: b) Ménière’s disease c) Cerumen impaction d) Herpes zoster Save Question 45 (1 point) Epistaxis can be a symptom of: Question 45 options: a) Over-anticoagulation b) Hematologic malignancy c) Cocaine abuse Save Question 46 (1 point) Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Question 46 options: a) Malignant melanoma c) Aphthous ulceration d) Behcet’s syndrome Save Question 47 (1 point) Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of: Question 47 options: a) Thrush c) Carotidynia d) Thyroiditis Save Question 48 (1 point) Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? Question 48 options: a) History of bright flash of light followed by significantly blurred vision c) History of monocular severe eye pain, blurred vision, and ciliary flush d) All of the above Save Question 49 (1 point) The first assessment to complete related to the eyes is: Question 49 options: a) Eye lids c) Extraocular movements d) Peripheral vision It is important to not dilate the eye if is suspected. Question 50 options: a) Cataract b) Macular degeneration d) Chronic open-angle glaucoma Save Question 51 (1 point) Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient? Question 51 options: Checking the macula Verifying a red reflex Extraocular movements Save Question 52 (1 point) The most common cause of eye redness is: Question 52 options: b) Acute glaucoma c) Head trauma d) Corneal abrasion Save Question 53 (1 point) A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Question 53 options: a) Bacterial conjunctivitis b) Allergic conjunctivitis c) Chemical conjunctivitis Save Question 54 (1 point) In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? Question 54 options: a) History of prior red-eye episodes c) Exophthalmos d) Photophobia Save Question 55 (1 point) A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Question 55 options: a) Bacterium c) Virus d) Fungi Save Question 56 (1 point) Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Question 56 options: a) Sinus pain, increased vascular permeability, and bronchodilation c) Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction d) Vasodilatation, bronchodilation, and increased vascular permeability Save Question 57 (1 point) You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Question 57 options: b) Benign paroxysmal positional vertigo c) Transient ischemic attack (TIA) d) Migraine Save Question 58 (1 point) In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Question 58 options: a) Fictional keratosis b) Keratoacanthoma c) Lichen planus Save Question 59 (1 point) Rheumatic heart disease is a complication that can arise from which type of infection? Question 59 options: a) Epstein-Barr virus b) Diphtheria d) Streptococcus pneumoniae Save Question 60 (1 point) A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Question 60 options: a) Mono spot b) Strep test c) Throat culture Save Question 61 (1 point) Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Question 61 options: a) Seasonal allergies b) Acute bronchitis c) Bronchial asthma Save Question 62 (1 point) A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: Question 62 options: a) 50 x 2-pack years c) 50-year, 2-pack history d) 100-pack history Save Question 63 (1 point) Emphysematous changes in the lungs produce the following characteristic in COPD patients? Question 63 options: a) Asymmetric chest expansion b) Increased lateral diameter d) Pectus excavatum Save Question 64 (1 point) When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction: Question 64 options: b) Decreased fremitus is felt c) Increased fremitus is felt d) Vibration is referred to the non-obstructed lobe Save Question 65 (1 point) During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: Question 65 options: a) COPD b) Pneumothorax d) Pleural effusion Save Question 66 (1 point) Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? Question 66 options: b) Chest X-ray with PA, lateral, and lordotic views c) Ultrasound d) Positron emission tomography (PET) scan Save Question 67 (1 point) Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: Question 67 options: b) Pleural effusion c) Pneumonia d) Pulmonary embolism Save Question 68 (1 point) A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely? Question 68 options: a) Pulmonary edema b) Heart failure d) Pneumonia Save Question 69 (1 point) A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to: Question 69 options: a) Exercise-induced cough b) Bronchiectasis d) Pericarditis Save Question 70 (1 point) A cough is described as chronic if it has been present for: Question 70 options: a) 2 weeks or more c) 3 months or more d) 6 months or more Save Question 71 (1 point) Which of the following medications are commonly associated with the side effect of cough? Question 71 options: a) Beta blocker b) Diuretic d) Calcium antagonist Save Question 72 (1 point) Which of the following details are NOT considered while staging asthma? Question 72 options: a) Nighttime awakenings c) Frequency of symptoms d) Spirometry findings Save Question 73 (1 point) The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: Question 73 options: a) Age over 40 b) Fever greater than 101 d) Productive cough Save Question 74 (1 point) The most common etiologic organism for community-acquired pneumonia is: Question 74 options: b) Beta hemolytic streptococcus c) Mycoplasma d) Methicillin resistant staphylococcus Save Question 75 (1 point) A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: Question 75 options: a) Can be treated as an outpatient c) Requires a high dose of parenteral antibiotic d) Can be treated with oral antibiotics Save Question 76 (1 point) Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? Question 76 options: a) Fever of 102 b) Infiltrates on chest X-ray d) Elevated white blood cell count Save Question 77 (1 point) A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: Question 77 options: a) Barrel-shaped chest c) Pectus excavatum d) Prolonged capillary refill Save Question 78 (1 point) Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: Question 78 options: a) Legionnaires' disease b) Malaria d) Pneumonia Save Question 79 (1 point) A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: Question 79 options: b) Tuberculosis c) Pneumonia d) COPD Save Question 80 (1 point) A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: Question 80 options: a) Pulmonary embolism b) Pleural effusion d) Fracture of ribs Save Question 81 (1 point) Which of the following is the most important question to ask during cardiovascular health history? Question 81 options: a) Number of offspring b) Last physical exam d) Use of caffeine Save Question 82 (1 point) Aortic regurgitation requires medical treatment for early signs of CHF with: Question 82 options: a) Beta blockers c) Surgery d) Hospitalization Save Question 83 (1 point) A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because: Question 83 options: a) Women with ischemic heart disease many times do not present with chest pain b) Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction c) Elderly patients have the most severe symptoms Save Question 84 (1 point) The best evidence rating drugs to consider in a post myocardial infarction patient include: Question 84 options: ACE, ARB, Calcium channel blocker, ASA Long-acting nitrates, warfarin, ACE, and ARB ASA, clopidogrel, nitrates Save Question 85 (1 point) A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include: Question 85 options: a) Echocardiogram c) Cardiac catheterization d) Myocardial perfusion imaging Save Question 86 (1 point) Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be: Question 86 options: a) Mitral Valve Prolapse b) Referred Pain from Cholecystitis d) Pulmonary Embolus Save Question 87 (1 point) Which symptom is more characteristic of Non-Cardiac chest pain? Question 87 options: a) Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm c) Pain usually lasts less than 10 minutes and is relieved by nitroglycerine d) Pain is aggravated by exertion or stress Save Question 88 (1 point) What is the most common valvular heart disease in the older adult? Question 88 options: a) Aortic regurgitation c) Mitral regurgitation d) Mitral stenosis Save Question 89 (1 point) Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms? Question 89 options: a) Acute MI b) GERD c) Pneumonia Save Question 90 (1 point) Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of: Question 90 options: a) Angina b) Pericarditis d) Congestive heart failure Save Question 91 (1 point) Which test is the clinical standard for the assessment of aortic stenosis? Question 91 options: a) Cardiac catheterization b) Stress test c) Chest X-ray Save Question 92 (1 point) The aging process causes what normal physiological changes in the heart? Question 92 options: b) Cardiology occurs along with prolapse of the mitral valve and regurgitation c) Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves d) Hypertrophy of the right ventricle Save Question 93 (1 point) Which of the following statements is true concerning anti-arrhythmic drugs? Question 93 options: a) Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile. b) Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality. d) Anti-arrhythmic therapy should be initiated in the hospital for all patients. Save Question 94 (1 point) Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left- sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? Question 94 options: a) Musculoskeletal chest wall syndrome with radiation b) Esophageal motor disorder with radiation c) Acute cholecystitis with cholelithiasis Save Question 95 (1 point) A common auscultatory finding in advanced CHF is: Question 95 options: a) Systolic ejection murmur c) Friction rub d) Bradycardia Save Question 96 (1 point) Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of: Question 96 options: a) Anemia b) Anxiety c) Hyperthyroidism Save Question 97 (1 point) The best way to diagnose structural heart disease/dysfunction non-invasively is: Question 97 options: a) Chest X-ray b) EKG d) Heart catheterization Save Question 98 (1 point) During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: Question 98 options: b) Pleuritis c) Pneumothorax d) A and B Save Question 99 (1 point) A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms? Question 99 options: b) Femoral vein thrombus c) Venous insufficiency d) Peripheral neuropathy Save Question 100 (1 point) Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms? Question 100 options: a) Femoral vein thrombosis b) Femoral artery thrombus d) Musculoskeletal injury Save Question 101 (1 point) (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? Question 101 options: a) Abdominal plain films b) Liver function tests c) Amylase/lipase Save Question 102 (1 point) (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? Question 102 options: a) Abdominal upright and flat plate x-ray b) Abdominal MRI c) Abdominal CT scan with contrast Save Question 103 (1 point) (*There are multiple questions on this exam related to the following scenario. Be sure to read the whole way through to the question.) Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? Question 103 options: a) Trial of ursodiol b) ‘Watchful waiting’ c) Surgical consult Save Question 104 (1 point) A specific exam used to evaluate the gall bladder is: Question 104 options: a) Psoas sign b) Obturator sign c) Cullens sign Save Question 105 (1 point) Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal. Question 105 options: a) Acute pancreatitis b) Duodenal ulcer c) Biliary colic Save 1. Question : An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: Student Answer: Acoustic neuroma Cerumen impaction Otitis media Ménière’s disease Instructor Explanation: Elderly clients frequently present with complaints of hardened cerumen and decreased hearing resulting from cerumen impaction aggravated by hearing aid wear. (Goolsby 137-138) Conductive hearing loss is caused by a lesion involving the outer and middle ear to the level of the oval window. Various structural abnormalities, cerumen impaction, perforation of the tympanic membrane, middle ear fluid, damage to the ossicles from trauma or infection, otosclerosis, tympanosclerosis, cholesteatoma, middle ear tumors, temporal bone fractures, injuries related to trauma, and congenital problems are some of the causes. (Kennedy-Malone 170-171) Points Received: 2 of 2 Comments: Question 2. Question : In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: Student Answer: Bacterial sinusitis Allergic rhinitis Drug abuse Skull fracture Instructor Explanation: When examining the nose, assess the mucosa for integrity, color, moistness, and edema/lesions and the nasal septum for patency. The turbinates should be assessed for color and size. Pale, boggy turbinates suggest allergies; erythematous, swollen turbinates are often seen with infection. Any discharge should be noted. Clear, profuse discharge is often associated with allergies. (Goolsby 128-129) Patients with seasonal allergic rhinitis report rhinorrhea, sneezing, obstructed nasal passages, and pruritic eyes, nose, and oropharynx during the spring and fall. Patients with perennial allergic rhinitis have similar symptoms associated with exposure to environmental allergens typically in their homes. Physical examination may reveal a pale, boggy nasal mucosa, injected conjunctiva, enlarged turbinates, dark discoloration or bags under the eyes, and mouth breathing; absence of pale, boggy nasal mucosa does not rule out allergic rhinitis. (Kennedy-Malone 182-183) Points Received: 2 of 2 Comments: Question 3. Question : A 45 year old patient presents with ‘sore throat’ and fever for one week. After a quick strep screen you determine the patient has Strep throat. You know that streptococcal pharyngitis should be treated with antibiotics to prevent complications and to shorten the course of disease. Which of the following antibiotics should be considered when a patient is allergic to Penicillin? Student Answer: Amoxicillin EES (erythromycin) Bicillin L-A Dicloxacillin Instructor Explanation: MedU Card #1 Points Received: (not graded) Comments: Question 4. Question : Presbycusis is the hearing impairment that is associated with: Student Answer: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster Instructor Explanation: Presbycusis is an age-related cause of gradual sensorineural hearing loss and involves diminished hairy cell function within the cochlea as well as decreased elasticity of the TM. Although the changes associated with presbycusis often start in early adulthood, the decreased hearing acuity is usually not noticed until the individual is older than 65. (Goolsby 138) Because presbycusis is gradual and insidious, hearing loss may go unnoticed until it has progressed significantly. (Kennedy-Malone 170) Points Received: 2 of 2 Comments: Question 5. Question : Epistaxis can be a symptom of: Student Answer: Over-anticoagulation Hematologic malignancy Cocaine abuse All of the above Instructor Explanation: Cocaine abuse, which is more common than might be expected, frequently causes epistaxis. Hematologic disorders likely to cause bleeding include thrombocytopenia, leukemia, aplastic anemia, and hereditary coagulopathies. High doses of anticoagulants can cause epistaxis and bleeding from the gums. (Goolsby 142) Epistaxis results from a spontaneous rupture of a blood vessel in the nose, usually in the anterior septum in Kiesselbach's plexus (Nguyen, 2012). The bleeding may be secondary to local infections, systemic infections, drying of the nasal mucous membrane, trauma, arteriosclerosis, hypertension, or bleeding disorders. Trauma is usually the primary mechanism of disruption of the nasal mucosa. Posterior epistaxis can result in nausea and respiratory compromise. In older adults, nasal and paranasal tumors may be involved (Mäkitie, 2010). (Kennedy-Malone 168-169) Points Received: 2 of 2 Comments: Question 6. Question : Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Student Answer: Malignant melanoma Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome Instructor Explanation: Most oral malignancies are painless until quite advanced, so patients are often unaware of the lesion unless the lip or anterior portion of the tongue is involved. The patient may become aware of the lesion if it bleeds. Squamous cell cancer lesions vary in appearance, from the reddened patches of erythroplakia to areas of induration/thickening, ulceration, or necrotic lesions. Lesions of malignant melanoma have varied pigmentation, including brown, blue, and black. Even lesions that appear flat and smooth may be nodular, indurated, or fixed to adjacent tissue on palpation. Even though patients with squamous cell malignancies often have a history of heavy alcohol and/or tobacco use or poor dentition, these are not risk factors for malignant melanoma. In Behcet’s syndrome, the patient complains of recurrent episodes of oral lesions that are consistent with aphthous ulcers. The number of lesions ranges from one to several; the size of the ulcers varies from less than to greater than 1 cm. Like aphthous ulcers, the lesions are well defined, with a pale yellow or gray base surrounded by erythema. The majority of patients also develop lesions on the genitals and eyes. (Goolsby 153) Tobacco use and heavy alcohol consumption, alone or synergistically, are strongly related to the development of oral cancer. Pipe smoking and sun exposure have been implicated in lip cancer. Leukoplakia and erythroplasia are often precursors to oral cancer. Relationships between oral cancer and Epstein-Barr virus, HPV, herpes simplex virus, and immunodeficiency states also have been found (Stenson, 2011). (Kennedy-Malone 177). Points Received: 2 of 2 Comments: Question 7. Question : A 26 year old patient presents with cough and general malaise for 3 days. They note that their eyes have been watering clear fluid and a ‘runny nose’ since yesterday. They note they ‘feel miserable’ and demand something to make them feel better. What would be the best first plan of treatment? Student Answer: Saline nasal spray for congestion and acetaminophen as needed for pain. Z-pack (azithromycin) for infection and Cromolyn nasal for congestion Hydrococone/acetaminophen as needed for pain and Guaifensin for congestion Cephalexin for infection and Cromolyn ophthalmic for congestion Instructor Explanation: MedU Card #4 Points Received: (not graded) Comments: Question 8. Question : Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? Student Answer: History of bright flash of light followed by significantly blurred vision History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, and ciliary flush All of the above Instructor Explanation: Amaurosis fugax is a monocular, transient loss of vision. It stems from transient ischemia of the retina and presents an important warning sign for impending stroke. Depending on the circumstances reported, the patient should be immediately referred to either a cardiovascular or neurological specialist. (Goolsby 108) Points Received: 0 of 2 Comments: Question 9. Question : Dizziness that is described as "lightheaded" or, "like I'm going to faint," is usually caused by inadequate cerebral perfusion and is classified as? Student Answer: Presyncope Disequilibrium Vertigo Syncope Instructor Explanation: MedU Card #5 Points Received: (not graded) Comments: Question 10. Question : It is important to not dilate the eye if is suspected. Student Answer: Cataract Macular degeneration Acute closed-angle glaucoma Chronic open-angle glaucoma Instructor Explanation: If the patient has experienced sudden onset of eye pain, it is important not to dilate the eyes before determining whether acute closed-angle glaucoma is present because dilating the eye may increase the intraocular pressure. (Goolsby 108) Acute glaucoma, also known as angle-closure or narrow-angle glaucoma, is an obstruction to the outflow of aqueous humor from the posterior to the anterior chamber through the trabecular meshwork, canal of Schlemm, and associated structures. It results in an elevation of intraocular pressure, damaging the optic nerve and causing loss of peripheral vision, eye pain, and redness. This type of glaucoma is uncommon but may occur as a primary disease or secondary to other conditions and constitutes an ophthalmic emergency (Kennedy-Malone 161) Points Received: 2 of 2 Comments: Question 11. Question : Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports occasional ‘dizziness’ that got better with change in position. He denies a recent history of URI or any history of headaches or migraines. What would the most likely diagnosis be? Student Answer: Vestibular neruitis Benign paroxysmal positional vertigo Vestibular migraine Benign hypertensive central vertigo Instructor Explanation: MedU Card #9 Points Received: 0 of 2 Comments: Question 12. Question : Which of the following patients with vertigo would require neurologic imaging? Student Answer: A 68-year-old woman with a history of hypertension and sudden acute onset constant vertigo. She has right nystagmus that changes direction with gaze and that does not disappear when she focuses. A 45-year-old man with recurrent episodes of brief intense vertigo every time he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix-Hallpike maneuver. A 66-year-old man with recurrent episodes of vertigo associated with tinnitus and hearing loss. His head thrust test is positive. A 28-year-old otherwise well woman with new onset constant vertigo with no other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when her gaze is fixed. Instructor Explanation: MedU Card #11. There are multiple reasons to be concerned about a central lesion and possible infarct in this patient. Her age puts her at risk as does her hypertension. Her physical exam shows nystagmus that changes direction and that does not inhibit with focus. Both of these findings are consistent with a central lesion. She needs an urgent MRI. Points Received: 0 of 2 Comments: Question 13. Question : A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Student Answer: Bacterial conjunctivitis Allergic conjunctivitis Chemical conjunctivitis Viral conjunctivitis Instructor Explanation: Preauricular nodes are nonpalpable and nontender in allergic conjunctivitis, usually nonpalpable in bacterial conjunctivitis, and palpable in viral conjunctivitis. (Goolsby 112) Points Received: 0 of 2 Comments: Question 14. Question : In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? Student Answer: History of prior red-eye episodes Grossly visible corneal defect Exophthalmos Photophobia Instructor Explanation: Red flag warnings for eye redness include pain (not discomfort or irritation), decreased vision, profuse discharge, and corneal defect grossly visible. (Goolsby 112) Points Received: 2 of 2 Comments: Question 15. Question : A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Student Answer: Bacterium Allergen Virus Fungi Instructor Explanation: Patients with seasonal allergic rhinitis report rhinorrhea, sneezing, obstructed nasal passages, and pruritic eyes, nose, and oropharynx during the spring and fall. Patients with perennial allergic rhinitis have similar symptoms associated with exposure to environmental allergens typically in their homes. Physical examination may reveal a pale, boggy nasal mucosa, injected conjunctiva, enlarged turbinates, dark discoloration or bags under the eyes, and mouth breathing; absence of pale, boggy nasal mucosa does not rule out allergic rhinitis. (Kennedy-Malone 182-183) Points Received: 2 of 2 Comments: Question 16. Question : Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Student Answer: Sinus pain, increased vascular permeability, and bronchodilation Bronchospasm, vascular permeability, and vasodilatation Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction Vasodilatation, bronchodilation, and increased vascular permeability Instructor Explanation: Rhinitis may be either allergic or nonallergic. Allergic rhinitis results as a response of the nasal mucosa to airborne allergens in atopic genetically prone individuals. This response is mediated by the production of immunoglobulin E (IgE). IgE antibodies produced in response to the initial and subsequent exposure to allergens bind to the nasal mucosa. With repeated exposure, immediate type 1 hypersensitivity reactions may occur (Simoens & Laekeman, 2009). Antigen-specific T cells are activated through the lymphatic system in response to the antigen. The activated antigen- specific T cells activate B cells, and IgE is created in lymphoid tissue and at local tissue sites (Adelman, Casale, & Corren, 2002; Novak, 2009). The newly created antigen-specific IgE is released by plasma cells and binds to high-affinity IgE receptors located on the basophils and mast cells. This leads to the sensitization of the cells in the tissues of the nose, lung, or skin (Adelman et al., 2002; Cirillo, Pistorio, Tosca, & Ciprandi, 2009). IgE also binds with the antigen protein, beginning degranulation of the mast cells and basophils. These actions start the allergic cascade. Mediators are released as a result of the degranulation and include histamine, proteoglycans, enzymes, leukotrienes, cytokines, and many others. The chain in the release of mediators is responsible for the immediate and late phase responses of the cells. Histamine may be fully released within 30 minutes of degranulation, whereas cytokines may be released over many hours (Adelman et al., 2002; Derendorf & Meltzer, 2008). (Kennedy-Malone 181- 182) Points Received: 2 of 2 Comments: Question 17. Question : You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions? Student Answer: Ménière’s disease Benign paroxysmal positional vertigo Transient ischemic attack (TIA) Migraine Instructor Explanation: Ménière's disease commonly involves a triad of symptoms—severe vertigo, tinnitus, and hearing loss (Goolsby 140) Points Received: 2 of 2 Comments: Question 18. Question : In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? Student Answer: Fictional keratosis Keratoacanthoma Lichen planus Leukoplakia Instructor Explanation: The cause of most episodes of leukoplakia is not determined. However, this condition, which results in the development of white patches on the oral mucosa, is associated with an increased risk of oral squamous cell cancer. Risk factors for the development of leukoplakia include chronic/recurrent trauma to the affected site and the use of smokeless and smoked tobacco and alcohol. (Goolsby 152) Points Received: 2 of 2 Comments: As a nurse practitioner it is important for you to know (select all that apply): Question 2 options: Question 19. Question : Rheumatic heart disease is a complication that can arise from which type of infection? Student Answer: Epstein-Barr virus Diphtheria Group A beta hemolytic streptococcus Streptococcus pneumoniae Instructor Explanation: Group A beta-hemolytic streptococcal (GABHS) pharyngitis is a bacterial infection of the pharynx, commonly called strep throat. Complications of GABHS pharyngitis, although rare, include rheumatic heart disease and glomerulonephritis, and the condition requires prompt diagnosis and definitive treatment. Most patients with GABHS pharyngitis are children and youths. Other bacterial causes of pharyngitis include mycoplasmal pneumonia, gonorrhea, and diphtheria. (Goolsby 156) Question 2 (1 point) As a nurse practitioner it is important for you to know (select all that apply): Question 2 options: Which of the following are types of immune responses? (check all that apply) Question 3 options: Question 4 (1 point) Frailty can be defined as a clinical syndrome which the following criteria is present (check all that apply) Question 4 options: Unintentional weight loss of 10lb in the last year Self-reported exhaustion Weakness based on grip strength Which of the following is true regarding Lync syndrome: Question 5 options: Individuals with Lynch syndrome have an 80% lifetime risk of developing colon cancer Lych syndrome is an autosomal recessive genetic condition Individuals with Lynch syndrome have 90% lifetime risk of developing colon cancer Points Received: 2 of 2 Comments: Question 20. Question : A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered? Student Answer: Mono spot Strep test Throat culture All of the above Instructor Explanation: The physical examination for sore throat should include a comprehensive assessment of the upper and lower respiratory systems, including ears, nose, mouth, throat, and lungs. The neck assessment should include, at a minimum, assessment of the cervical lymph nodes. Strep screens, throat cultures, and mononucleosis screens are common diagnostic studies used to narrow the differential diagnosis of sore throat. A CBC with differential count is helpful in determining the cause of sore throat. (Goolsby 156) A 22-year-old woman presents with a "pimple" on her right eyelid. Examination reveals a 2-mm pustule on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion B. a hordeolum/ C. blepharitis D. cellulitis A 22-year-old woman presents with a "bump" on her right eyelid. Examination reveals a 2-mm hard, non-tender swelling on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion/ B. a hordeolum C. blepharitis D. cellulitis Question 1 (1 point) The nurse practitioner educates the patient that antihistamines have what effect? Question 1 options: Vasodilatation Blocking leukotriene effects Inhibiting histamine receptor sites Vasoconstriction What are the effects of sensory impairment (vision and hearing) in elderly adults? Select all that apply. Question 2 options: Impaired quality of life Decreased function Increased mortality Decreased morbidity What is the mechanism of action of Cromolyn sodium? Question 3 options: Mast cell stabilization Blocking the effects of IgE Leukotriene inhibition Histamine blockade Points Received: (not graded) Which of the following conditions is the leading cause of blindness in the United States? Question 5 options: Macular degeneration Diabetic retinopathy NSG6420 QUIZ 3 1. Question : Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? Student Answer: Seasonal allergies Acute bronchitis Bronchial asthma Chronic bronchitis Instructor Explanation: The pulmonary component includes an abnormal inflammatory response to noxious stimuli, principally tobacco, but also occupational and environmental pollutants. The hallmark of chronic bronchitis is a daily chronic cough with increased sputum production lasting for at least 3 consecutive months in at least 2 consecutive years, usually worse on awakening; this may or may not be associated with COPD (GOLD, 2011). Emphysema is characterized by obstruction to airflow caused by abnormal airspace enlargement distal to terminal bronchioles. Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company, . VitalBook file. (page 206) & Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file. (page 213) Question 2 . Question : A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be? Student Answer: Observation and reassurance Treatment with an antibiotic such as amoxicillin Treatment with an antibiotic such as a fluoroquinoline or amoxicillin- clavulanate Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler. Instructor Explanation: MedU Card #4. According to the American Academy of Ortolaryngology—Head and Neck Surgery Foundation guidelines (2007) on sinusitis, making the distinction between a lingering viral upper respiratory infection that affects the nose and sinuses (viral rhinosinusitis) or early acute bacterial sinusitis can be difficult. It is more likely to be a viral rhinosinusitis if the duration of symptoms is less than ten days and they are not worsening. In this case, you can continue to observe the patient and reassure him that antibiotics are not necessary at this time. Question 3 Question : Emphysematous changes in the lungs produce the following characteristic in . COPD patients? Student Answer: Asymmetric chest expansion Increased lateral diameter Increased anterior-posterior diameter Pectus excavatum Instructor Explanation: In COPD, patients commonly develop a barrel-shaped chest due to emphysematous changes in the lungs. A barrel shape is due to an increased anterior-posterior (AP) diameter. In emphysema, there is a 1:1 ratio of AP to lateral diameter; AP diameter equals the lateral diameter. Normally the AP diameter is twice the lateral diameter. Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company, 11/2014. VitalBook file( page 213-214) & Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults. F.A. Davi