Midterm Exam: NR511/ NR 511 (Latest 2024/ 2025 Update) Differential Diagnosis & Primary Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain
Midterm Exam: NR511/ NR 511 (Latest
2024/ 2025 Update) Differential Diagnosis &
Primary Care Review| Questions and
Verified Answers| 100% Correct |Grade A –
Chamberlain
Q: Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical.
During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of
the tongue that you suspect to be cancerous. You document your finding as
Answer:
A white, painless, firm, ulcerated lesion with indurated borders
Q: Maryann, age 28, presents to the clinic because of a rapid onset of patchy hair loss. The skin
within these oval patches of hair loss is very smooth. Ta- pered hairs that resemble exclamation
points are seen at the margin of a patch of hair loss. Based on these findings, you suspect
Maryann has
Answer:
Alopecia areata The findings are consistent with alopecia areata, ie, nonscarring hair loss
of rapid onset,
the pattern of which is most commonly sharply defined round or oval patches.
Q: Which of the following is not a complication of group a strep
hemolytic anemia glomerular nephritis
Answer:
Q: Which of the following is an example of conductive hearing loss?
Answer:
Serous
OM
Q: Medical coding is the process of submitting and following up on claims made to the payer in
order
Answer:
Coding is done in order to process demographic, insurance, … number as shown on insured’s ID
card for the payer to whom the claim is being submitted.
Q: Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on
his leather jacket. He recalls having a slightly similar rash last year when he wore his jacket. The
annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed,
and both flat and elevated. His voice seems a little raspy, although he states that his breathing is
normal. What is your first action?
Answer:
Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
Q: Which of the following is a non systemic non scarring cause of alopeciaAnswer:
alopecia areata
Q: a clinician diagnoses an 18 year old female with extensive poison ivy on the face, neck and
eye, what are the
best treatment options?
corticosteroids antihistamine prednisone
Answer:
Q: WHICH OF THE FOLLOWING PATIENTS SHOULD BE REFERRED TO AN ENT
SPECIALIST?
Answer:
d. a girl with tympanic rupture
Q: Which of the following medications is a treatment for alopecia
Answer:
minoxidil
Q: A screening test identified correctly identified 80 individuals who did not have colon cancer
out of 100 individuals that were known to be free of the disease (true negatives). Thus, the test
failed to recognize 20 individuals who did not have colon cancer. What is the specificity of the
screening test?
Answer:
80%
Q: The OLDCARTS Mnemonic is best used in which part of the chart note.
Answer:
–
History of present illness. (HPI)
Q: Three elements needed to determine the level of complexity including risk, diagnosis and…
Answer:
Data
Q: Which of the following is a subjective finding?
Answer:
SOB Pain
Q: Which of the following demonstrates an objective finding?
Answer:
Respiratory rate
Q: Which of the following statements regarding the patient histories is true?-
Answer:
c. The HP is a detailed breakdown of the patients chief complaint
Q: -Which of the following statements does not belong in the past medical history portion of
your chart note?
Answer:
Your patient had lab work done at their last appointment; CBC was normal
Q: In relation to writing a patient encounter note, the acronym SOAP stands for which of the
following?
Answer:
Subjective, objective, assessment, plan
Q: BILLING
Q: What must you do as an advanced practice registered nurse (APRN) before billing for visits?
Powered by https://learnexams.com/search/study?query=
High specificity high percentage of healthy individuals will show a normal result
Low specificity -getting a positive result when it i not present-a high number of false-positives- meaning that a healthy person has a disease when they actually do not
Sensitivity the proportion of true positives out of all patients with a designated condition
If a diagnostic study has a high specificity: then a high % of health individuals will show a normal result
If a diagnostic study has a high sensitivity: then a high percentage of persons with the given condition will have an abnormal result
Part A medicare covers: inpatient hospital stay; skilled nursing care; hospice; and home care
Part B medicare covers: outpatient services; provider visits; surgery; lab tests; medical equipment; and preventive exams
Part C medicare covers: vision exams, hearing exams, eye glasses, and hearing aids
Part D medicare covers: prescription drugs
Tinea vesicolor flat to slightly elevated brown papules and plaques that scale when they are rubbed along with areas of hypopigmentation;prurtis; most commonly found on trunk and shoulders
Balantitis candidiasis in the glans of the penis
Tinea corporis Annual lesions with scaly borders and central clearing on the trunk; has ring-shaped lesions (ring worm) with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk.
Tinea pedis athletes foot-feet and between toes
Tinea cruis jock-itch in groin area
Tinea unguium white or yellow nail discoloration, thickening of the nail and separation of the nail from the nail bed (most common in toe nails)
Cellulitis spreading infection of the epidermis and subcutaneous tissues that usually begins after a break in the skin
Folliculitis bacterial infection of the hair follicle (think papules)
Impetigo -highly contagious -symptoms may be burning and itching with lymphadenopathy
Epidermal inclusion cyst history of cyst on the same site for months to years, may have cheesy white discharge with strong odor when expressed
Cholinergic urticaria hives or wheels that are pruritic and occur on the trunk and arms following exercise, anxiety, elevated body temperature, or hot baths/showers*treat with antihistamine
Atopic dermatitis “extremely low threshold for pruritus and the “”itch”” often appears before the rash -cardinal sign is severe pruritus”
Herpes simplex Symptoms include:-blistering sores-itching-pain during urination (during genital outbreak) -fever-headache -tiredness -lack of appetite
Goal of treatment for herpes simplex suppress virus
Herpes zoster -caused by varicella-zoster and is characterized by a painful rash with blisters -rash is unilateral along dermatome -begins as erythema then changes to papular lesions that rapidly form into vesicles
First line of treatment for acne Benzoyl peroxide
Who would be good candidates for oral abx treatment for acne? -those at risks for pigmentation changes or scarring-nodulocystic acne-those who need quick relief from inflammatory acne
Acne teaching -always use sunscreen with acne treatment-wash face gently atleast twice daily with antibacterial soap
Rosacea common skin condition that causes blushing or flushing and visible blood vessels in the face
Treatment for rosacea metronidazole cream but may take 6-8 weeks for response
Seborrhea Keratosis, who is at risks? -older white women
Seborrhea Keratosis lesions -often itching and irritation with friction or clothing -may be dark keratin plugs or cysts on surface -differential diagnosis of seborrheic keratosis is pigmented basil cell carcinoma and malignant melinoma
Actinic keratosis assesment flesh colored, hard, sand-paper like lesion that is found on exposed areas of the skin
Actinic keratosis treatment cryotherapy and dermatology referral
Lipoma benign, rubbery, smooth and round mass of compressible tissue with soft texture (most commonly seen in neck, shoulders, armpits, and thighs)
Scabies -intensely itchy rash caused by a mite -treat with ivermectin for systemic treatment
Pediculosis -hallmark sign of nits that are firmly cemented in place on hair shaft
Patient teaching pediculosis -itching may continue for up to one week after successful treatment because fo the slow resolution of inflammatory reaction by lice infestation
Furuncle (boil) painful red bump under the skin due to infection of hair follicles or in oil glands
Hallmark for viral conjunctivits itching, red eyes, and periauricular lymphnode swelling and tenderness
Hallmark sign of HSV-1 or HSV-2 conjunctivitis skin vesicles and corneal infection with a dendrite appearance
Bacterial conjunctivitis -red eye with crusted eye lid-normal visual acuity
Cataracts gradual painless and progressive loss of vision
Age-related cataracts presentation bilateral blurred or distorted vision with complaints of glare when driving at night or bright light
Blepharatis inflammation around the eyelid margins that is caused by staph infection at the lash base and dysfunctional meiobian glands
Treatment for blepharatis bacitracin 0.5% ointment
Chalazion cysts or small lump or swelling the develops in the eyelid as a result of a blockage in the gland (typically not painful)
Treatment for chalazion if persists longer than 4 weeks then refer to opthalmologists for incision and drainage, biopsy or steroid treatment
Tests for dry eyes slit-lamp test or schirmer tests
Epiphora overflow of tears onto the face due to insufficient tear film drainage from the eyes
subconjunctival hemorrhage bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva
Risk factors for subconjunctival hemorrhage -valsalva type maneuvers, blood thinners, diabetes, and HTN
Herpes zoster ophthalmicus (HZO) -rash of the forehead with swelling of the eyelid -eye pain and redness, inflammation of the conjunctiva, cornea, or uvea and mucoid discharge-fever and tingling of the skin and allodynia near the eye may precede the rash -cornea may be clear or cloudy
First line of defense against Herpes zoster ophthalmicus (HZO) prevention through vaccination (shingles vaccine)
Treatment for Herpes zoster ophthalmicus (HZO) Acyclovir (preferred treatment should start within 72 hours of onset)
Hordeolum (Stye) -small, painful, red lump in the edge of the eyelid that is typically caused by a bacterial infection
Sinusitis assessment -tender maxillary sinus and over cheeks-discolored nasal discharge with little response to decongestants
The presence of 2 more of the following confirm sinusitis dx: -URI of at least 7 days-colored nasal drainage-facial/sinus pain (aggravated by postural change)-headache
Otitis media -bulging, red tympanic membrane without visible effusion -diminished cone of line
Treatment for otitis media -healthy pediatric clients with mild symptoms and no-day care attendance and no abx within the last 90 days then treat with Amoxil 40-45 mg/kg/day PO in two divided doses x 10 days-follow up in 48-72 hours if symptoms have not resolved
Acute angle-closure glaucoma -results in increased IOP and if left untreated can cause blindness-sudden dramatic onset of symptoms that include blurred vision, red eye, unilateral pain, pressure, headache, seeing halos around lights, loss of peripheral vision, and then loss of central vision
Strategy to relieve middle ear pressure due to barotrauma use of nasal steroids and oral decongestants
Barotrauma assessment sensation of abnormal middle ear pressure
Presbycusis conductive hearing loss, producing high frequency hearing loss that is bilateral and symmetric
What tests should be performed for conductive hearing loss Weber test
Mononucleosis -fatigue, sore throat, low-grade fever-nasal and throat erythema-enlarged tonsils with exudate-inflamed posterior cervical lymph nodes
Test for mono monospot test
Epiglottitis -symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and fever but no pharyngeal erythema or cough
Pharyngitis -inflammation of pharynx that causes discomfort, scratchiness, pain, and difficulty swallowing
Treatment for pharyngitis 10 day course of PCN
Hoarseness (Dysphonia) -changes in pitch or quality of the voice that may sound weak, scratchy, or husky -differential dx: papillomatosis (r/t infection)
Peritonsilar abcess “-unilateral and located between the tonsil and the superior pharyngeal constrictor muscle -symptoms include: severe unilateral sore throat, fever, lock jaw, “”hot potato”” voice”
Rhinitis (Hay fever) -IgE mediated type 1 hypersensitivity to airborne irritants
Rhinitis assessment -pale and congested turbinates
Allergic rhinitis -symptoms: sneezing, runny nose, red, watery and itchy eyes
Rebound rhinitis can be caused by over use of nasal decongestants or use or topical vasoconstrictive medications & typically resolves in 2-3 weeks
Atopic triad asthma, allergic rhinitis, and eczema
What is the most common bacterial pathogen associated with acute otitis media? Streptococcus pneumoniae.
When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse practitioner should document this finding as: a normal finding
You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? Grade 3
Which of the following is not a cause of conductive hearing loss? presbycusis
Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal turbinates. What is your diagnosis? allergic rhinitis
Mrs. Johnson, a 54-year-old accountant, presents to the office with a painful red eye without discharge. You should suspect: Iritis.
April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that they may be cancerous skin lesions. You tell her that they are probably: Xanthelasmas.
A 62-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She states that her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has: angle-closure glaucoma
“A 25-year-old male presents with “”bleeding in my eye”” for 1 day. He awoke this morning with a dark area of redness in his eye. He has no visual loss or changes. He denies constitutional symptoms, pruritus, drainage, or recent trauma. The redness presents on physical exam as a dark red area in the patient’s sclera of the right eye only and takes up less than 50% of the eye. The patient’s remaining sclera is clear and white. He also notes he was drinking alcohol last night and vomited afterward. What is the best treatment?” Reassurance that this lesion will resolve without any treatment in 2 to 4 weeks.
A 20-year-old male presents to your primary care clinic. This patient is a college student. He complains of fatigue, sore throat, and low-grade fever for 3 days. On physical exam, he has a temperature of 100.7°F. His ear exam is normal. His nose and throat exam shows mild erythema of the nasal mucosa and edematous, enlarged tonsils bilaterally, with erythema of the pharyngeal wall and tonsillar exudates. He has inflamed posterior cervical lymph nodes. He has a mild nonproductive cough and clear lung exam. What is his most likely diagnosis? Mononucleosis.
When you are assessing the internal structure of the eye of your 59-year-old patient, the absence of a red reflex may indicate: A cataract or hemorrhage into the vitreous humor.
What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more follow up There is a change in the child’s hearing threshold to greater than 25 dB.
Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? Prescribe nasal steroids and oral decongestants.
Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer’s ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? Start using a cotton-tipped applicator to dry the ears after swimming.Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming.
“Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look “”sunken in.”” What do you suspect?” Normal age-related changes.
Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? “””Swish and swallow the medication.”””
The most common cause of a white pupil (leukokoria or leukocoria) in a newborn is: A congenital cataract.
You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? stridor
A 27-year-old female comes in to your primary care office complaining of a perioral rash. The patient noticed burning around her lips a couple days ago that quickly went away. She awoke from sleep yesterday and noticed a group of vesicles with erythematous bases where the burning had been before. There is no burning today. She is afebrile and has no difficulty eating or swallowing. What test would confirm her diagnosis? Tzanck smear.
Which condition is not included in the atopic triad? atopic triad
The ABCDEs of melanoma identification include which of the following? Asymmetry: one half does not match the other half.
Your 24-year-old client whose varicella rash just erupted yesterday asks you when she can go back to work. What do you tell her? “””Once all the vesicles are crusted over.”””
Tom, age 50, is complaining of an itchy rash that occurred about a half hour after putting on his leather jacket. He recalls having a slightly similar rash last year when he wore his jacket. The annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed, and both flat and elevated. His voice seems a little raspy, although he states that his breathing is normal. What is your first action? Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously.
You suspect a platelet abnormality in a 40-year-old woman who presents to your clinic with: Red, flat, nonblanchable petechiae.
Justin, an obese 42-year-old, cut his right leg 3 days ago while climbing a ladder. Today his right lower leg is warm, reddened, and painful, without a sharply demarcated border. What do you suspect? Cellulitis.
During a camping trip, Jim, age 35, abruptly developed fever, headache, and joint pain. A few days after the onset of the fever, a blanchable macular rash began on his wrists and ankles and quickly spread to the palms and soles before becoming generalized. The rash is now petechial. You suspect Jim has: Rocky Mountain spotted fever.
You’re teaching Mitch, age 18, about his tinea pedis. You know he doesn’t understand your directions when he tells you which of the following? “””I should wear rubber shoes in the shower to prevent transmission to others.”””
A 75-year-old female presents to your office complaining of dizziness and hearing loss. The patient states she awoke yesterday with dizziness, which she described as feeling the room spinning. She also notes intermittent ringing in her ears. On physical exam, the patient has lateralization of her hearing loss to the unaffected ear. Rinne test shows air conduction lasts longer than bone conduction. What is the next step in helping this patient’s symptoms? Start the patient on a low-salt, low-caffeine diet and give her meclizine for vertigo attacks.
Which of the following is not recommended for hoarseness? Oral steroids.
Kevin, a 56-year-old lawyer, has throbbing pain in the left eye, an irregular pupil shape, marked photophobia, and redness around the iris. What is your initial diagnosis? Iritis.
You are the nurse practitioner caring for Martha, a 47-year-old accountant. You have made a diagnosis of acute sinusitis based on Martha’s history and the fact that she complains of pain behind her eye. Which sinuses are affected? Ethmoid.
Marlene, a 57-year-old cashier, comes to the clinic because she is unable to differentiate between sharp and dull stimulation on both sides of her face. You suspect: A lesion affecting the trigeminal nerve.
While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? The openings between the margins of the upper and lower eyelids.
A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and he has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headache? Migraine.
Your client, a 72-year-old smoker of 50 years, is at the office today for a routine physical. During your inspection of the oral mucosa, you discover a white lesion on the lateral surface of the tongue that you suspect to be cancerous. You document your finding as: A white, painless, firm, ulcerated lesion with indurated borders.
“Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look “”sunken in.”” What do you suspect?” Normal age-related changes.
“A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that “”some foods get stuck”” and she has been having “”heartburn”” at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis?” Gastroesophageal reflux disease (GERD).
Mr. Johnson, age 69, has had Meniere disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? A vestibular neurectomy.
Marjorie, age 37, has asthma and has been told she has nasal polyps. What do you tell her about them? Nasal polyps are benign growths.
Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient that the best cure for cataracts is: Corrective lens surgery.
In a young child, unilateral purulent rhinitis is most often caused by: A foreign body.
Kathleen, age 54, has persistent pruritus of the external auditory canal. External otitis and dermatological conditions, such as seborrheic dermatitis and psoriasis, have been ruled out. What can you advise her to do? Apply mineral oil to counteract dryness.
At the clinic, you are assessing Kyle, a 4-month-old baby, for the first time and notice that both eyes are turning inward. What is this called? Esotropia.
“Kevin, age 26, has AIDS and presents to the clinic with complaints of a painful tongue covered with what look like creamy white, curdlike patches overlying erythematous mucosa. You are able to scrape off these “”curds”” with a tongue depressor, which assists you in making which of the following diagnoses?” Oral candidiasis.
Which of the following patients would not be at risk of Candida infection? A patient with a history of coronary artery disease.
Which of the following has/have not been linked to the use of isotretinoin? Pancreatitis.
Which disease usually starts on the cheeks and spreads to the arms and trunk? Erythema infectiosum (fifth disease).
Jennifer, age 32, is pregnant and has genital warts (condylomata) and would like to have them treated. What should you order? Trichloroacetic acid.
Louis, age 52, presents with pruritus with no rash present. He has hypertension, diabetes, and end-stage renal disease (ESRD). Which of the following would be included in the differential diagnosis? Uremia from chronic renal disease.
Susan states that her fiancé has been frostbitten on the nose while skiing and is fearful that it will happen again. What do you tell her? “””Infarction and necrosis of the affected tissue can happen with repeated frostbite.”””
What is the most important thing a person can do to maintain healthy skin and hopefully reduce wrinkles? Avoid smoking.
Which of the following statements about malignant melanomas is true? The prognosis is directly related to the thickness of the lesion.
“Lee brings her 13-year-old son to your clinic. He has been complaining of a rash on the buttocks, anterior thighs, and posterolateral aspects of his upper arms. He tells you it is mildly pruritic and looks like “”gooseflesh.”” On examination, the rash appears as small, pinpoint, follicular papules on a mildly erythematous base. You explain to Lee that the benign condition is likely to resolve by the time her son reaches adulthood, and it is known as:” Keratosis pilaris.
Jim, age 59, presents with recurrent, sharply circumscribed red papules and plaques with powdery white scale on the extensor aspects of his elbows and knees. What do you suspect? Psoriasis.
Mildred, age 72, presents to the clinic with a blistering rash that is generalized but located mostly in skin folds and on flexural areas. She describes the course of the rash as beginning with pruritic urticarial papules that coalesced into plaques that turned dark red in about 2 weeks, followed by the development of vesicles and bullae. She tells you that the lesions are moderate to severely pruritic. During your exam, you determine the bullae are very tense and do not rupture when pressure is applied. Her daily medications include an angiotensin-converting enzyme (ACE) inhibitor, a loop diuretic, and a nonsteroidal anti-inflammatory drug (NSAID). What is your diagnosis? Bullous pemphigoid.
Sandra, age 69, is complaining of dry skin. What do you advise her to do? Bathe or shower with lukewarm water and use a mild soap or skin cleanser.
Caroline has a 13-year-old daughter who has had 2 recent infestations of lice. She asks you what she can do to prevent this. You respond: “””Don’t let her share hats, combs, or brushes with anyone.”””
Candidiasis may occur in many parts of the body. James, age 29, has it in the glans of his penis. What is your diagnosis? Balanitis.
Mr. Swanson, age 67, presents to the clinic for his annual health exam. He asks you if there is anything he can do to prevent the painful, blistering sores that develop on his lip in the summertime when he plays golf. You explain to Mr. Swanson that the way to prevent the development of these lesions is to: Protect the lips from sun exposure with a blocking agent, such as zinc oxide, or a lip balm that contains a broad-spectrum sunscreen.
A biopsy of a small, yellow-orange papulonodule on the eyelid will probably show Lipid-laden cells.
A 75-year-old African American male presents to your family practice office complaining of visual impairment. He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past 6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is 23 mm Hg. What is his most likely diagnosis? Open-angle glaucoma.
Which of the following is not a complication of untreated group A streptococcal pharyngitis? Hemolytic anemia.
The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is: Amoxicillin and potassium clavulanate (Augmentin).
“Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like “”a curtain came down over my eye.”” She doesn’t have any pain or redness. What do you suspect?” Retinal detachment.
While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are abnormally narrow. What are you examining? The openings between the margins of the upper and lower eyelids.
Mia, a 27-year-old school teacher, has a 2-day history of severe left ear pain that began after 1 week of upper respiratory infection (URI) symptoms. On physical examination, you find that she has acute otitis media (AOM). She has a severe allergy to penicillin. The most appropriate antimicrobial option for this patient is: Azithromycin (Zithromax).
Mario, a 17-year-old high school student, came to the office for evaluation. He is complaining of persistent sore throat, fever, and malaise not relieved by the penicillin therapy prescribed recently at the urgent care center. As the nurse practitioner, what would you order next? A Monospot test.
Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It started approximately 2 days ago and is still present. What kind of headache is she describing? Tension headache.
Ellen, a 56-year-old social worker, is seen by the nurse practitioner for complaints of fever; left-sided facial pain; moderate amounts of purulent, malodorous nasal discharge; and pain and headache when bending forward. The symptoms have been occurring for approximately 6 days. On physical assessment, there is marked redness and swelling of the nasal passages and tenderness/pain on palpation over the cheekbones. The nurse practitioner should suspect: Acute rhinosinusitis
Sally, age 19, presents with pain and pressure over her cheeks and discolored nasal discharge. You cannot transilluminate the sinuses. You suspect which sinus to be affected? Maxillary sinus
A 3-year-old patient presents to your pediatric office with her mother. She has recently been started in day care. Her mother noted slight perioral erythema on the right side of the patient’s mouth prior to bed last night. The patient awoke today with 3 small, superficial, honey-colored vesicles where the erythema was last night. The patient has no surrounding erythema. She had no difficulty eating this morning and is active and energetic and doesn’t appear lethargic or fatigued. She is also afebrile. How would you treat this child? Local debridement and mupirocin for 5 days.
Sandra, age 32, comes in to the clinic. She has painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? Systemic lupus erythematosus.
The nurse practitioner (NP) tells Samantha, age 52, that she has an acrochordon on her neck. What is the NP referring to? A skin tag.
Thomas, age 35, uses a high-potency corticosteroid cream for a dermatosis. He also currently has tinea corporis. You tell him the following regarding the cream: “””It may exacerbate your concurrent tinea corporis.”””
A mother complains that her newborn infant, while lying on his side, appears red on the dependent side of the body and pale on the upper side. When she picks up the baby, this coloring disappears. You explain to her about which of the following? Harlequin sign.
Helen, age 39, comes to your clinic for generalized joint pain, especially in the knees and hands. She tells you that the pain is moderate, spreading, and symmetrical. She reports having had a sore throat and low-grade fever for a few days and then developing a rash, described as warm erythema of the cheeks, which lasted about 4 days before disappearing. You ask her if the rash on the cheeks included the nasolabial folds or circumoral skin, and she tells you that it did not cover these areas. Two days later, she developed a nonspecific macular eruption that preceded the joint pain. Her rash faded within 2 weeks, but she tells you that it comes and goes if she bathes in hot water or spends time in the sunlight. Your patient’s symptoms are most consistent with a diagnosis of: Erythema infectiosum.
Which of the following statements about macular degeneration is not true? Macular degeneration is characterized by gradual loss of peripheral vision.
A 6-year-old female presents to your pediatric office with her mother complaining of right ear pain for 3 days. This pain resolved with Tylenol. The patient has also had noted fevers of 101.3°F over the last 2 nights. The patient had a nonproductive cough for 7 days prior to the ear pain. On physical exam, the patient has tenderness with tugging on the auricle of the ear. The tympanic membrane is not mobile with pneumatic otoscopy and is erythematous and full. The patient has no drainage from the ear and no mastoid tenderness. What is the next step? Amoxicillin 80 to 90 mg/kg/d.
What is the most common cause of epistaxis? Digital trauma.
Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? Jonathan should avoid contact sports and heavy lifting.
Martin, age 24, presents to the office with an erythematous ear canal and pain on manipulation of the auricle. He is on vacation and has been swimming daily at the resort. What is your diagnosis? External otitis.
Samantha, age 12, presents with ear pain. When you begin to assess her ear, you tug on her normal-appearing auricle, eliciting severe pain. This leads you to suspect: Otitis externa.
A 22-year-old African American female presents to your family practice office complaining of progressive skin discoloration. She is adopted and has no known family history of skin problems. The patient notes nonpalpable patches of skin loss and blanching of her forehead and both hands and feet. It has developed over a period of 6 months and appears to have stopped. It is not pruritic, and there is no erythema or sign of infectious etiology. What is the most likely diagnosis? Vitiligo.
A 16-year-old male presents to your office. He was sent by an orthopedist. He has recently had surgical fixation of a humerus fracture. The patient has been going to physical therapy and has been developing a rash on his arm after therapy that disappears shortly after returning home. He does not have the rash prior to therapy. The patient denies fevers and chills, and his incision is well healed, with no signs of infection. Of note, the patient has been experiencing more hand edema than the average patient and has had edema wraps used at the end of therapy to help with his swelling. The wraps are made of a synthetic plastic material. The rash the patient gets is erythematous and blotchy, not raised; it is on the operative upper extremity. What is the most likely diagnosis? Contact dermatitis.
Buddy, age 13, presents with annular lesions with scaly borders and central clearing on his trunk. What do you suspect? Tinea corporis.
Sandy asks what she can do for Dolores, her 90-year-old mother, who takes a bath every day and who has extremely dry skin. You respond: “””Your mother does not need a bath every day.”””
Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive.
You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: Supportive measures and lubricating drops (artificial tears).
Which presentation is most concerning for skin cancer? Dark pigmentation of 1 solitary nail that has developed quickly and without trauma.
A 4-year-old male presents to your pediatric clinic with his mother complaining of an itchy rash, mostly between his fingers. This has been going on for multiple days and has been getting worse. The patient recently started at a new day care. On physical exam, the patient is afebrile and has multiple small (1-2 mm) red papules in sets of 3 located in the web spaces between his fingers. He also has signs of excoriation. What is the treatment for this problem? Permethrin lotion for the patient and also his family members.
Which of the following statements about psoriasis is not true? Psoriatic lesions often occur in the folds of the elbows and behind the knees.
Eric, age 52, has gout. What do you suggest? Limiting consumption of purine-rich foods.
Which disease usually starts on the cheeks and spreads to the arms and trunk? Erythema infectiosum (fifth disease).
Which of the following should be used with all acne medications? Sunscreen.
In a burn trauma, which blood measurement rises as a secondary result of hemoconcentration when fluid shifts from the intravascular compartment? Hct
Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless, white, slightly raised patches in her mouth. This is probably caused by: Candidiasis.
Aaron, age 4, is brought in to the clinic by his father. His tympanic membrane is perforated from otitis media. His father asks about repair of the eardrum. How do you respond? “””The eardrum, in most cases, heals within several weeks.”
A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the club. These symptoms are most characteristic of which of the following? Sensorineural loss.
Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect? Epiglottitis.
An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus. Based on what you know to be complications of this disease, you explain to her that she needs: Ophthalmological consultation.
Regular ocular pressure testing is indicated for older adults taking: High-dose inhaled glucocorticoids.
Client teaching is an integral part of successfully treating pediculosis. Which of the following statements would you incorporate into your teaching plan? “””Itching may continue for up to a week after successful treatment.”””
A 70-year-old client with herpes zoster has a vesicle on the tip of the nose. This may indicate: Ophthalmic zoster.
Which skin cancer that arises from skin cells, characteristically occurs on body areas exposed to the sun, most commonly presents as a pearly nodule with fine telangiectasias over the surface and a border that appears rolled, and is the most common skin cancer? Basal cell carcinoma.
Ashley, age 6 months, has a Candida infection in the diaper area. What do you suggest to the parent? “””Keep the area as dry as possible.”
Danny, age 18, presents with a pruritic rash on his upper trunk and shoulders. You observe flat to slightly elevated brown papules and plaques that scale when they are rubbed. You also note areas of hypopigmentation. What is your initial diagnosis? Tinea versicolor.
Elizabeth, age 83, presents with a 2-day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules at that site. What do you suspect? Herpes zoster.
A 10-year-old male in 5th grade presents to the pediatric office with his mother complaining of itchy and red eyes for 1 day. The patient complains of watery drainage in both eyes, associated with repetitive itching. On physical exam, he has no fever or constitutional symptoms. His vision is normal, with no decrease in extraocular movements. The patient has a sibling that just started day care recently. He also has bilateral preauricular lymph nodes that are inflamed. What is the patient’s diagnosis? Viral conjunctivitis.
Mr. Clark, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about? Atenolol (Tenormin), a beta blocker for high blood pressure.
How would you describe the cervical lymphadenopathy associated with asymptomatic human immunodeficiency virus (HIV) infection? Nontender, mobile, and firm but not hard lymph nodes.
A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions Pseudomonas aeruginosa.
An eczematous skin reaction may result from: Penicillin.
Jill, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? Antihistamines.
Dan, age 57, has just been given a diagnosis of herpes zoster. He asks you about exposure to others. You tell him: He should stay away from children and pregnant women who have not had chickenpox.
. Martin, age 13, just started taking amoxicillin for otitis media. His mother said that he woke up this morning with a rash on his trunk. What is your first action? . Stop the amoxicillin.
Which of the following is not a modifiable risk factor? race
Which of the following is not a subjective finding? respiratory rate
What intervention would not be included in the definition of secondary health promotion? Computed tomography (CT) scan of the head for all car accident victims.
Which of the following refers to an aspect of a patient’s health that can be changed or affected by a health intervention? modifiable risk factor
Which of the following patients is health literate? A 62-year-old female who speaks the language of her provider, has Medicare for insurance, and can drive.
All of the following statements about the US Preventive Services Task Force (USPSTF) are true except? All of the recommendations made by the USPSTF are strong recommendations.
The OLD CARTS (onset, location, duration, character, aggravating/alleviating factors, radiation, timing, severity) mnemonic is best used in which part of your chart note? History of present illness.