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CMN 577 Final Exam with complete solution (1)
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CMN 577 Final Exam with completesolution
A 70-year-old African female presents today for an annual well visit. She has a
history of Diabetes, hypertension, and Asthma. During her routine visual exam,
abnormalities are noted bilaterally in her paracentral region. Her Intraocular
pressures are elevated (25 mmHg). She reports patches of visual loss over the
last year. She denies any pain. What is this suspected diagnosis?
a. Cataracts
b. Chronic Open-Angle Glaucoma
c. Retinal Detachment
d. Acute Angle-Closure Glaucoma - CORRECT ANSWER-b. Chronic
Open-Angle Glaucoma
You are seeing a 10-year-old female today for an influenza vaccination. Today's
visit her BMI is 99th percentile. Past visits report her BMI has been greater than
95th percentile. All the following are expected complications of childhood obesity
except:
a. Type 2 Diabetes
b. GERD
c. Hyperthyroidism
d. Depression - CORRECT ANSWER-c. Hyperthyroidism
All statins are metabolized by cytochrome P450 enzymes except for
______________ and _____________.
a. atorvastatin and rosuvastatin
b. atorvastatin and simvastatin
c. pravastatin and simvastatin
d. pravastatin and rosuvastatin - CORRECT ANSWER-d. pravastatin and
rosuvastatin
What is the maintenance fluid requirement for a 30 kg child without fever,
dehydration, or sickle cell disease?
a. 1500 ml
b. 1700 ml
,c. 2200 ml
d. 3000 ml - CORRECT ANSWER-b. 1700 ml
Maintenance fluid requirements account for water lost in sweat, urine, and stool,
as well as normal insensible losses without the presence of excessive water loss.
Excessive loss through fever, vomiting, diarrhea, or respiratory infection requires
approximately 1.5 x the maintenance fluid needed. Sickel cell disease also
requires increased maintenance fluids. Use the same formula to calculate both
water and caloric requirements. Kcal/kg = ml of water/kg, so calculating infant
formula volume also indicates caloric need. Here is the calculation for a 30 kg
child:
100 ml of fluid/kg/24 hrs. for the first 10 kg of weight = 1000
50 ml of fluid/kg/24 hrs. for 2nd 10 kg of weight = 500
20 ml of fluid/kg/24 hrs. for each kg > 20 kg of weight = 200
Total maintenance fluids = 1700 ml/24 hrs
A patient presents to the clinic with a history of advanced CKD, chronic overuse
of laxatives, and enema for a routine visit. Vital signs today are HR 77, BP 96/61,
RR 18, SPO2 98%. Her recent labs show elevated BUN and creatine. The
patient complained of recent weakness. You, as a provider, suspect which
electrolyte imbalance?
a. Hyperkalemia
b. Hypomagnesemia
c. Hypocalcemia
d. Hypermagnesemia - CORRECT ANSWER-d. Hypermagnesemia
Which of these statements is not true about potassium disorders?
a. Loop diuretics causes significant renal potassium loss.
b. Hypokalemia does not lead to progressive changes on electrocardiogram.
c. Gastrointestinal loss is the most common cause of non-renal potassium loss.
d. Correction of magnesium deficiency is important in the treatment of
hypokalemia - CORRECT ANSWER-b. Hypokalemia does not lead to
progressive changes on electrocardiogram.
An 86-year-old female recently diagnosed with SIADH presents to the clinic with
complaints of falls and unsteady gait. Which electrolyte imbalance is most likely
the cause of this problem?
,a. Hyperkalemia
b. Hypernatremia
c. Hyponatremia
d. Hypocalcemia - CORRECT ANSWER-c. Hyponatremia
A 55-year-old male with a history of diabetes mellitus, acute kidney injury, and
hypothyroidism and has a long history of taking simvastatin for more than 30
years is at risk of which of the following?
a. Rhabdomyolysis
b. Acute kidney injury
c. Hematuria
d. Glomerulonephritis - CORRECT ANSWER-a. Rhabdomyolysis
A 34-year-old female presents to the clinic with a new onset of headaches worse
with standing for the past 3 months. The patient describes the pain as
generalized intense pressure. The pain improves with lying down but does not
resolve. Acetaminophen and ibuprofen provide no relief. She also reports double
vision in her right eye. The patient denies a family history of headaches. Medical
history includes diagnosis of polycystic ovarian syndrome, obesity, and T2DM.
Physical examination shows papilledema otherwise normal exam. Your
preliminary diagnosis is:
a. Migraine headaches
b. Tension headache
c. Idiopathic intracranial hypertension
d. Transient Ischemic Attack(s) - CORRECT ANSWER-c. Idiopathic intracranial
hypertension
The confirmatory test for idiopathic intracranial hypertension is:
a. Lumbar puncture
b. Arteriogram of the vertebral arteries
c. CBC CMP with ESR
d. MRI of the head - CORRECT ANSWER-a. Lumbar puncture
You are the primary provider to a newly diagnosed 35 year old male with
GERD.You have prescribed him Famotidine 20mg PO daily x 6 weeks. In
addition to this pharmacologic intervention, all of these lifestyle modifications
need to be addressed except:
, a. Avoid lying down at least 3 hours after meals
b. Avoid trigger producing foods such as citrus, tomatoes, coffee and spicy food
c. Smoking cessation if applicable
d. All patients diagnosed with GERD need to have an endoscopy to confirm
diagnosis prior to treatment - CORRECT ANSWER-d. All patients diagnosed with
GERD need to have an endoscopy to confirm diagnosis prior to treatment
The USPSTF recommends blood pressure screenings for individuals 18 years
old and above. Obtaining a blood pressure for a low risk individual during an
annual physical is considered what category of preventative medicine?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Palliative care - CORRECT ANSWER-b. Secondary prevention
A 25-year-old Caucasian female presents to the clinic with a chief complaint of
headaches three times a week. Patient has no medical history and takes no
medications. She states headaches usually last 72 hours unilaterally and are
preceded by physical activity. What other clinical findings would present with this
type of headache?
a. Constant dull ache that is generalized
b. Conjunctival tearing
c. Intense pain around the neck and back of the head
d. Geometric patterns - CORRECT ANSWER-d. Geometric patterns
An 8-year-old boy recently diagnosed with seizures comes to the office for a
wellness exam. The mother feels like she needs further education regarding
seizures. As a provider, what is an appropriate teaching in this diagnosis?
a. Neurological behaviors before seizures should be normal.
b. Depression is common in children with seizures.
c. Activities for children with seizures won't be limited.
d. When a seizure occurs, don't record the event. - CORRECT ANSWER-b.
Depression is common in children with seizures.
A 45-year-old obese male patient presents to the outpatient clinic complaining of
nausea, vomiting, and severe epigastric pain that is radiating to the back. When
you walk into the room, he is sitting up and leaning forward, diaphoretic, and
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