Midterm Exam: NR569/ NR 569 (Latest 2024/ 2025 Update) Differential Diagnosis in Acute Care Practicum Review| Questions and Verified Answers| 100% Correct – Chamberlain
Midterm Exam: NR569/ NR 569 (Latest
2024/ 2025 Update) Differential Diagnosis in
Acute Care Practicum Review| Questions and
Verified Answers| 100% Correct –
Chamberlain
Q: Asthma Attack
Answer:
-An asthma attack is the sudden narrowing of the airways in re- sponse to a trigger. Asthma
attack triggers can include airborne irritants, respiratory illness, or strenuous exercise.
-During an asthma attack, airway muscles tighten, the airways swell and inflame, and excess
mucus is produced. This significantly narrows the airways, causing symptoms such as difficulty
breathing, chest pain, and wheezing.
Q: spontaneous pneumothorax
Answer:
Herpes zoster involves the reactivation of the varicella virus in the body.
Q: Pulmonary Embolism
Answer:
-blockage of an artery in the lungs. This is usually caused by a blood clot that forms in the leg,
known as deep vein thrombosis.
-Pulmonary embolism may be treated with blood thinners, medication, or surgical procedures.
-Symptoms of pulmonary embolism include chest pain, shortness of breath, and coughing. It may
be difficult to diagnose, because patients with asthma or a heart attack experience similar
symptoms. Risk factors of pulmonary embolism include heart disease, cancer, bed rest, smoking,
obesity, and pregnancy. Lowering the risk of clots forming in the body, lowers the risk of
forming a pulmonary embolism. Exercise, wearing compression stockings, and maintaining a
healthy weight may reduce the risk of forming clots in the legs.
Q: Acute Heart Failure
Answer:
-Right-sided heart failure is commonly caused by left-sided heart failure.
-Factors that increase risk for CHF include high blood pressure, coronary artery disease,
metabolic syndrome, diabetes, and structural abnormalities of the heart.
-Patients with CHF commonly experience symptoms such as fatigue and weakness, shortness of
breath, swelling of the lower limbs, decreased alertness, and a reduced ability to exercise.
Q: COPD exacerbation
Answer:
-airflow-limiting condition that affects the lungs. COPD
includes both emphysema and chronic bronchitis.
-Emphysema is a condition that affects the alveoli, the tiny air-filled pockets in the lungs
responsible for gas exchange and breathing. During emphysema, alveolar walls are broken down
causing alveolar air spaces to become permanently and ab- normally enlarged. Fewer alveolar
walls leads to less surface area for gas exchange to occur, limiting airflow.
-Chronic bronchitis is a condition that affects the bronchi and bronchioles, small tubes that allow
for the passage of air in and out of the lungs. During chronic bronchitis, the airways become
narrowed and blocked with mucus, limiting airflow.
Q: Acute gastritis
Answer:
Acute gastritis is characterized by inflammatory changes in the gastric mucosa. Generalized
epigastric discomfort (gnawing and burning) are common symptoms of acute gastritis.
-Symptoms of gastritis include feeling full after eating a few bites of food, nausea, bloating,
and/or lack of appetite. Black/tarry stools and/or vomiting can also be suggestive of gastritis.
Marisol reports feelings of fullness, bloating, and nausea. She also reports that she had one stool
that was black or tarry. She also has a history of H. pylori gastritis.
Patients with gastritis commonly present with previous H. pylori exposure, use of
NSAIDs, epigastric tenderness, a feeling of fullness with meals, and nausea.
Q: Cholecystitis
Answer:
Cholecystitis is inflammation of the gallbladder. Severe pain in the right upper quadrant or
epigastric pain along with nausea, vomiting, and fever are common symptoms of cholecystitis.
Q: Cholelithiasis
Answer:
Cholelithiasis is the presence of gallstones in the gallbladder. Although symptoms vary, common
symptoms include sudden, right upper quadrant or epigastric pain that radiates to the right
shoulder and nausea and vomiting.
Q: Gastroesophageal reflux disease (GERD)
Answer:
is caused by the inflammation of the esophagus due to reflux of gastric contents. Heartburn is a
common symptom of GERD, usually after eating and at night when lying down. Chest pain or
epigastric pain can be associated symptoms.
-Heartburn and/or reflux that occurs when lying down or after eating are common symptoms of
GERD. Epigastric pain is also a symptom of GERD. Marisol denies reflux symptoms or a sour
taste in her mouth, she describes her symptoms more as pain in the epigastric area. Tarry stools
would not be expected with GERD
Patients with GERD normally don’t have GI-bleeding
Q: Peptic ulcer disease
Answer:
characterized by ulcers in the lining of the stomach or duodenum. Epigastric pain, burning
stomach pain, bloating, belching, fatty food intolerance, heartburn, and nausea are commonly
reported symptoms of peptic ulcer disease.
-a gnawing or burning sensation after eating. It is common among patients taking NSAIDs.
Marisol reports a 2-year history of taking NSAIDS. She also had gastritis with Helicobacter
pylori (H. pylori) infection two years ago. H. pylori and the habitual use of NSAIDs are risk
factors for peptic ulcer disease. She also had a tarry stool this morning which is likely with PUD
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Life-Threatening Causes of Acute Dyspnea: Cardiac
Life-Threatening Causes of Acute Dyspnea: Metabolic
Life-Threatening Causes of Acute Dyspnea: Upper Airway
Life-Threatening Causes of Acute Dyspnea: Pulmonary
Life-Threatening Causes of Acute Dyspnea: Neurological
Life-Threatening Causes of Acute Dyspnea: Other Causes
Physical exam signs in patients presenting with dyspnea
Cyanosis, impending respiratory failure and/or depressed mental status
-Gas or air becomes trapped within the pleural space by a breach in the lung surface or chest wall.
-As air accumulates within the space, the lung compresses (collapses) the lung and causes impaired oxygenation or ventilation.
common conditions caused by a viral infection of the respiratory tissue. This leads to inflammation of one or more parts of the upper respiratory tract (sinuses, nasal mucosa, pharynx, and larynx). Specific manifestations of URIs are based on the location of infection and include sinusitis, rhinitis, pharyngitis, and laryngitis.
Common symptoms of URIs include stuffy or runny nose, sore throat, cough, difficulty swallowing, and hoarseness or loss of voice.
Chronic bronchitis is a long-term respiratory condition that affects the bronchi and bronchioles (small air passages) of the lungs.
During chronic bronchitis, the inner lining of the airway is significantly inflamed and excess mucus is produced, blocking airflow. Patients with chronic bronchitis often experience coughing, wheezing, shortness of breath, and fatigue.
Cigarette smoking is the most common cause of chronic bronchitis, though exposure to secondhand smoke and other airborne irritants may contribute to bronchitis symptoms.
ACE2 (angiotensin converting enzyme 2) receptor sits on the surface of an airway epithelial cell, one of the cells that lines the airway. It is this receptor that binds to spike (S) protein on SARS-CoV-2.
-Pneumonia is a lung infection characterized by coughing, fatigue, and difficulty breathing.
-Pneumonia is caused by a bacterial, viral, or fungal infection. In adults, bacteria are the most common cause of pneumonia. In response to the bacterial infection, the alveoli (tiny air sacs in the lungs) become inflamed and filled with fluid.
-Symptoms of pneumonia range in severity from mild to life-threatening. Patients may experience coughing with phlegm, difficulty breathing, chest pain, fatigue, confusion (especially in older patients), fever, chills, nausea, and vomiting.
-Risk factors for developing pneumonia include being under age 2 or over age 65, having a weakened immune system, smoking, having chronic lung or other diseases, and being hospitalized.
-Influenza is a contagious virus that infects the thin lining of the respiratory tract. Influenza virus infection (“flu”) can cause fever, headache, fatigue, and muscle aches, as well as cold-like symptoms such as runny nose and sore throat. Patients with the flu typically exhibit symptoms for two to five days.
-Though patients usually recover on their own, infants and older individuals are at a greater risk of developing flu complications such as pneumonia.
-An asthma attack is the sudden narrowing of the airways in response to a trigger. Asthma attack triggers can include airborne irritants, respiratory illness, or strenuous exercise.
-During an asthma attack, airway muscles tighten, the airways swell and inflame, and excess mucus is produced. This significantly narrows the airways, causing symptoms such as difficulty breathing, chest pain, and wheezing.
Herpes zoster involves the reactivation of the varicella virus in the body.
-blockage of an artery in the lungs. This is usually caused by a blood clot that forms in the leg, known as deep vein thrombosis.
-Pulmonary embolism may be treated with blood thinners, medication, or surgical procedures.
-Symptoms of pulmonary embolism include chest pain, shortness of breath, and coughing. It may be difficult to diagnose, because patients with asthma or a heart attack experience similar symptoms. Risk factors of pulmonary embolism include heart disease, cancer, bed rest, smoking, obesity, and pregnancy. Lowering the risk of clots forming in the body, lowers the risk of forming a pulmonary embolism. Exercise, wearing compression stockings, and maintaining a healthy weight may reduce the risk of forming clots in the legs.
-Right-sided heart failure is commonly caused by left-sided heart failure.
-Factors that increase risk for CHF include high blood pressure, coronary artery disease, metabolic syndrome, diabetes, and structural abnormalities of the heart.
-Patients with CHF commonly experience symptoms such as fatigue and weakness, shortness of breath, swelling of the lower limbs, decreased alertness, and a reduced ability to exercise.
-airflow-limiting condition that affects the lungs. COPD includes both emphysema and chronic bronchitis.
-Emphysema is a condition that affects the alveoli, the tiny air-filled pockets in the lungs responsible for gas exchange and breathing. During emphysema, alveolar walls are broken down causing alveolar air spaces to become permanently and abnormally enlarged. Fewer alveolar walls leads to less surface area for gas exchange to occur, limiting airflow.
-Chronic bronchitis is a condition that affects the bronchi and bronchioles, small tubes that allow for the passage of air in and out of the lungs. During chronic bronchitis, the airways become narrowed and blocked with mucus, limiting airflow.
Acute gastritis is characterized by inflammatory changes in the gastric mucosa. Generalized epigastric discomfort (gnawing and burning) are common symptoms of acute gastritis.
-Symptoms of gastritis include feeling full after eating a few bites of food, nausea, bloating, and/or lack of appetite. Black/tarry stools and/or vomiting can also be suggestive of gastritis. Marisol reports feelings of fullness, bloating, and nausea. She also reports that she had one stool that was black or tarry. She also has a history of H. pylori gastritis.
Patients with gastritis commonly present with previous H. pylori exposure, use of NSAIDs, epigastric tenderness, a feeling of fullness with meals, and nausea.
Cholecystitis is inflammation of the gallbladder. Severe pain in the right upper quadrant or epigastric pain along with nausea, vomiting, and fever are common symptoms of cholecystitis.
Cholelithiasis is the presence of gallstones in the gallbladder. Although symptoms vary, common symptoms include sudden, right upper quadrant or epigastric pain that radiates to the right shoulder and nausea and vomiting.
Gastroesophageal reflux disease (GERD)
is caused by the inflammation of the esophagus due to reflux of gastric contents. Heartburn is a common symptom of GERD, usually after eating and at night when lying down. Chest pain or epigastric pain can be associated symptoms.
-Heartburn and/or reflux that occurs when lying down or after eating are common symptoms of GERD. Epigastric pain is also a symptom of GERD. Marisol denies reflux symptoms or a sour taste in her mouth, she describes her symptoms more as pain in the epigastric area. Tarry stools would not be expected with GERD
Patients with GERD normally don’t have GI-bleeding
characterized by ulcers in the lining of the stomach or duodenum. Epigastric pain, burning stomach pain, bloating, belching, fatty food intolerance, heartburn, and nausea are commonly reported symptoms of peptic ulcer disease.
-a gnawing or burning sensation after eating. It is common among patients taking NSAIDs. Marisol reports a 2-year history of taking NSAIDS. She also had gastritis with Helicobacter pylori (H. pylori) infection two years ago. H. pylori and the habitual use of NSAIDs are risk factors for peptic ulcer disease. She also had a tarry stool this morning which is likely with PUD
a tear in the wall of the aorta through which blood flows in between the layers of the blood vessel wall. Symptoms include sudden, severe epigastric or upper back pain that radiates to the neck or down the back. Loss of consciousness and shortness of breath also are symptoms of aortic dissection.
refers to the abnormal narrowing of the esophageal lumen. Hallmark symptoms include dysphagia, hoarseness, reflux, unexpected weight loss, coughing, and drooling. Drooling is commonly associated with esophageal stricture.
occurs when a portion of the heart is deprived of oxygen due to blockage of a coronary artery. Symptoms include tightness or pain in the chest, epigastric area, neck, back, or arms, as well as fatigue, lightheadedness, arrhythmia, and anxiety.
Pancreatitis is inflammation of the pancreas. Epigastric pain, abdominal pain, nausea, and vomiting are commonly reported symptoms of pancreatitis.
Pericarditis refers to inflammation of the pericardium. Sharp, stabbing pain in the epigastric area, back, neck, or left shoulder are commonly reported symptoms of pericarditis.
associated with epigastric pain, difficulty swallowing, and reflux. Erosive esophagitis can lead to esophageal bleeding and is commonly associated with heavy alcohol use and NSAIDs. Patients with esophagitis commonly have dysphagia
characterized by intermittent burning, regurgitation, and substernal pain with typically some degree of dysphagia. Erosive esophagitis most often occurs as a result of prolonged GERD and must be definitively diagnosed by endoscopy.
What’s the main difference between gastritis and peptic ulcer disease?
Gastritis can progress to peptic ulcer disease when the inflammation of the stomach wall causes an irritation in the lining of the stomach. This irritation can lead to the formation of an ulcer. An endoscopy is required to confirm your diagnosis.
Gastritis and peptic ulcer disease have similar clinical presentations and etiology. In both conditions, damage to the gastrointestinal mucosal lining is often preceded by an Helicobacter pylori infection. Both disease processes are aggravated by the use of NSAIDs or caffeine and lessened by antacids. Given the similarities in presentation between gastritis and peptic ulcer disease, diagnostics are needed to confirm whether an ulcer has formed.
characterized by a lack of esophageal peristalsis and/or impaired relaxation of the lower esophageal sphincter (LES) during swallowing. Heartburn is a common symptom of Achalasia.
also called functional dyspepsia, is characterized by symptoms of indigestion with no obvious cause. Epigastric discomfort is a common symptom of this disorder.
characterized by heartburn and upper gastrointestinal symptoms, such as fullness after eating and early satiety.
Esophageal cancer is characterized by malignant cells within the esophagus. Although the symptoms of esophageal cancer vary and include heartburn, dysphagia is the more typical symptom.
A hiatal hernia is characterized by the prolapse of a portion of the stomach through the diaphragmatic esophageal hiatus. Although most individuals are asymptomatic, heartburn is a reported symptom.
Lifestyle Modification: Clothing, Weight loss, Symptom Journal, Waiting three hours after a meal before lying down and raising the head of the bed by 8 inches. avoiding large or high-fat meals not eating before bedtime eliminating alcohol consumption which can damage the mucosa due to acidity avoiding foods associated with GERD, such as caffeine, mints, chocolate, spicy and acidic foods, and carbonated beverages.
Pharmacologic Therapy: PPIs are the front-line and most commonly prescribed medication for the treatment of GERD and other acid-related disorders such as erosive esophagitis. Popular options include Omeprazole (Prilosec), lansoprazole (Prevacid), and Esomeprazole (Nexium).
severe or persistent dyspepsia, difficulty swallowing, unexplained weight loss, gastrointestinal bleeding, persistent or protracted vomiting, severe coughing spells, or palpable abdominal mass.
Characteristic:
Dry skin
Scaly, patchy
Where is it found?
Elbows, knees
Characteristic:
Burning
Pruritis
Where is it found?
Areas in contact with the irritant
Characteristic:
Raised truncal patch (“herald patch”)
Scaly plaques or papules, Christmas tree-shaped
Where is it found?
Scattered trunk and limbs
Characteristic:
Pain
Fluid-filled vesicles that crust over
Where is it found?
Segmentary rash; does not cross the midline of the body
Characteristic:
Pruritis is worse at night
Small erythematous papules
Where is it found?
Waist, webs of fingers, buttocks
Symptomatic treatment to reduce pruritus, fever, and discomfort associated with the condition.
Second generation antihistamines
Acetaminophen
Natural sun light exposure or phototherapy
Spontaneous resolution occurs within 6 to 12 weeks, recurrences are uncommon
Prevention
Vaccination for adults >50
Antiviral therapy:
Oral famciclovir (Famvir)
Oral valacyclovir (Valtrex)
Oral acyclovir (Zovirax)
Pain management:
Oral gabapentin (Neurontin)
Oral pregabalin (Lyrica)
Tricyclic antidepressants (doxepin, amitriptyline)
Topical capsaicin cream
Prevention and maintenance
Reduce triggers (if possible)
Baseline therapy of dryness with emollients
Pharmaceutical therapy
Non-steroid or steroid topicals
Oral antihistamines
AVOID the use of systemic corticosteroids
Patient Education/Counseling
Treatment and prevention of xerosis (dry skin)
Avoid taking long, hot showers and baths
Use soap only in skin body folds (axilla, buttocks, groin), otherwise avoid soap to other skin surfaces
After bathing, lightly pat the skin with a towel so that it remains damp but not wet
Apply lotion or hydrated to damp skin
Allergic/Contact Dermatitis tx
Treatment
Identify the causative substance and eliminate exposure
Pharmaceutical treatments: topical steroids, systemic antihistamines
Wet dressings or cloths soaked in Burrow’s solution for relief of pruritus
Systemic therapy with glucocorticoids indicated for severe cases or for rash on face or genitals
**Patient Education/Counseling**
Wear gloves or protective clothing in environments where exposure is possible
Wash area with soap and water and wash clothes that may be contaminated
Rash is not contagious (you cannot spread it to another area of the body or a person by touching the rash)
Avoid scratching to prevent secondary bacterial infections
Scabicide lotion or cream
Bedding, clothing, and towels need to be treated
Wash in hot water and dry in a hot dryer
Dry-clean
Seal in a plastic bag for at least 72 hours
Family members may need retreatment
Treatment
Small topical areas respond well to low to medium potency topical steroids
Larger areas may require topical and systemic steroid treatment tapered over 10-14 days
Patient teaching
The rash is not contagious. Touching the rash and touching elsewhere does not make it spread. The rash occurs only in areas where the oil of the rhus plant, urushiol, comes into direct contact with the skin.
Katja, a 27-year-old female, presents with a history of pruritic rash in between her fingers for 5 days that is not resolving. She denies a history of previous similar rash. She reports a similar rash along the waistband, but no rash is noted elsewhere. She reports no changes in detergents, soaps, or activities of daily living, however, she did travel to the coast last weekend and stayed at a motel but used her own toiletries. She also reports no recent illness and is healthy with no past medical history.
Which of the following is the most likely cause of her rash?
Scabies
Allergic contact dermatitis
Atopic dermatitis
Irritant contact dermatitis
scabies
Leah is a 17-year-old who presents to the office with a chief complaint of a red rash.
Contact dermatitis
herpes labialis/herpes simplex virus type 1 (HSV-1)
Diagnosis can be made clinically through the history and physical, however a viral culture can be done if needed for confirmation
Antivirals if initiated within 72 hours of the onset of symptoms can be beneficial
Acyclovir
Valacyclovir
Famciclovir
Viscous lidocaine may be used to reduce the pain associated with lesions
Can treat recurrent infections with varying strategies
Chronic suppressive therapy
Episodic therapy
Topical antiviral
Oral antivirals
Nail fungal infection
History
Rarely painful but may interfere with standing and walking with disease progression
Long history, possibly in other nails
Assess occupational and environmental risk factors
Common in the elderly and immunosuppressed patients
Exam
May involve any component of the nail unit
Nail is usually yellow-white, with yellow streaks
Nail is thin and crumbling and may separate from the nail bed
Bacterial infection of the finger involving the lateral nail fold
Exam
Assess for cellulitis and a possible abscess at the fingernail edges, along the nail folds
Acutely tender to touch
No systemic illness
History
Pain, erythema, and swelling
Inquire about occupational exposures
Inquire about a prior history of paronychia or MRSA risk factors
Assess whether the patient bites the fingernails (oral flora, anaerobes may be the source of infection)
Commonly caused by an ingrown nail
Which of the following depends on the prevalence of the disease?
The correct answer is positive predictive value. Predictive values depend on the prevalence of disease in the population whereas sensitivity and specificity are intrinsic properties of the test. Reliability refers to the consistency or stability of a measure.
A low pretest probability of disease may lead to which of the following?
The correct answer is low positive predictive value and more false-positive results. Positive predictive value increases with prevalence; therefore, a low prevalence value yields a low positive predictive value and implies a high false-positive rate. Negative predictive value decreases with prevalence, and sensitivity and specificity do not vary with prevalence.
The correct answer is false-negative test results due to a low negative predictive value. At the individual level, your clinical suspicion is equivalent to pre-test probability and high prevalence at the population level. Negative predictive value is inversely correlated with prevalence; therefore, your clinical suspicion translates to a low negative predictive value, suggesting a false-negative test result.
The correct answer is cannot be determined from this information. Without a pre-test probability the test result cannot be interpreted accurately.
The Positive Predictive Value (PPV) of a test refers to which of the following?
The correct answer is the proportion of patients with a positive test who have the disease.
The correct answer is 470/500. Specificity is the proportion of patients who test negative out of the total number of patients who do not have the disease; it is the number of true negatives overall negatives. In this example, 500/1000 patients have the disease. Of those 500 patients without the disease, 30 test positive, and 470 test negative.
what is the sensitivity of the Prostate Specific Antigen (PSA) for detecting prostate cancer?
# men with prostate cancer
# men with positive PSA
160
# men with negative PSA
40
total
200
The correct answer is 160/200. Sensitivity is the proportion of patients with the disease that have a positive result; it is the number of true positives divided by the total number of patients who have the disease.
PE
CT scan
RCT
population
Who is most most appropriate for focused assessment?
young guy with urine and penis issue (most stable)
Cardiac?
PE or MI?
a bacterial disease spread through the bite of an infected tick
Realize that you have biases and try to avoid them
When choosing history gathering questions you should?
Choose questions that gather a lot information, open ended and generalized
What’s obj and subj patient history?
1. Subjective data are symptoms felt by the patient while objective data is not felt by the patient.
physical findings or patient behaviors observed by the nurse, laboratory test results, and vital signs.
What are 5 symptoms of Crohn’s disease?
Diarrhea.
Fever.
Fatigue.
Abdominal pain and cramping.
Blood in your stool.
Mouth sores.
Reduced appetite and weight loss.
Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)
s a very common condition that causes diarrhoea and vomiting. It’s usually caused by a bacterial or viral tummy bug. It affects people of all ages, but is particularly common in young children. Most cases in children are caused by a virus called rotavirus.
Clears up quick
nausea and vomiting for more than 3 months =?
Gastroesophageal reflux disease (GERD)
Peptic ulcer disease.
A guy who’s an alcoholic in hospital with presents with left upper quadrant pain?
= acute pancreatitis
A young kid presents with RLQ pain n/v, what do you suspect?
appendicitis
A person with a URI 3 weeks prior, got antibiotics and now presents with a rash?
pityriasis rosea
Flat, discolored, circumscribed area
< 1 cm (10mm)
Change in color from skin color
Example: Freckle
Flat, non-palpable area of skin discoloration, larger than a macule
Irregular shaped macula > 1 cm (10mm)
Example: Vitiligo
Elevated or raised, firm, circumscribed area may be same or different color than the surrounding skin
<1 cm in size
Example: Raised nevus
Elevated or raised, firm, circumscribed area may be same or different color than the surrounding skin
>1 cm (10mm) in size
Aortic disection?
is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
A patient presents with vesicles on the left side only?
herpes (shingles)
wash all clothes and shoes immediately after your child has been outside. make sure your child does not touch a pet that might have been in contact with a poisonous plant. wash your child’s hands thoroughly
yeast infection
Common signs include: Tiny dents in your nails (called “nail pits”) White, yellow, or brown discoloration.
patient has itching between fingers worse at night?
Severe itching (pruritus), especially at night, is the earliest and most common symptom of scabies. A pimple-like (papular) itchy (pruritic) “scabies rash
Sensitivity: From the 50 patients, the test has only diagnosed 25. Therefore, its sensitivity is 25 divided by 50 or 50%.
Specificity: From the 50 healthy people, the test has correctly pointed out all 50. Therefore, its specificity is 50 divided by 50 or 100%.