6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS, Exams of Nursing

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6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS

6531 COMBINED MIDTERM AND FINAL REVIEW

QUESTIONS WITH COMPLETE SOLUTIONS

A health care provider in a clinic finds a patient in a room, unresponsive and pale. Which sign should be used to identify the need to initiate cardiopulmonary resuscitation (CPR)? Evaluation of peripheral perfusion and level of consciousness Obtaining a history of previous myocardial infarction Determination of uselessness or bradycardia Assessment of gasping breaths or not breathing CORRECT ANSWER Assessment of gasping breaths or not breathing An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient? Increase the dose of the thiazide medication Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment Prescribe a calcium channel blocker CORRECT ANSWER Admit to the hospital for evaluation and treatment A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms? Atrial fibrillation Anemia Extra systole Paroxysmal attacks CORRECT ANSWER Atrial fibrillation

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur? Aortic stenosis Tricuspid regurgitation Hypertrophic cardiomyopathy Mitral valve prolapse CORRECT ANSWER Hypertrophic cardiomyopathy A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Give the patient an oral beta blocker Transfer to the PCI-capable institution Administer heparin Initiate fibrinolytic treatment CORRECT ANSWER Initiate fibrinolytic treatment Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease are those with a history of (Select all that apply.) previous myocardial infarction. a low-density lipoprotein (LDL) level >190 mg/dL. diabetes and an LDL between 40 and 70 mg/dL. a 10-year risk score of 8% with an LDL of 80 mg/dL.

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS a 10-year risk score of 5% and an LDL of 165 mg/dL. CORRECT ANSWER previous myocardial infarction. a low-density lipoprotein (LDL) level >190 mg/dL. a 10-year risk score of 8% with an LDL of 80 mg/dL. A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for 30 minutes or more. What the does provider suspect as the cause for these symptoms? Buerger's disease Cauda equina syndrome Diabetic neuropathy Peripheral arterial disease CORRECT ANSWER Cauda equina syndrome Which are causes of secondary hypertension? (Select all that apply.) Oral contraceptives Isometic excercises NSAIDS Sleep apnea Increased salt intake CORRECT ANSWER Oral contraceptives NSAIDS Sleep apnea A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do? Reassure the patient that these findings are expected

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Continue to monitor the patient every 3 years Admit the patient to the hospital for evaluation and treatment Consult with cardiology to determine appropriate diagnostic tests CORRECT ANSWER Consult with cardiology to determine appropriate diagnostic tests A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action? Scheduling an MRI to evaluate for aortic disease Immediate referral to a thoracic surgeon US of the mass to determine size Ordering CT angiography CORRECT ANSWER US of the mass to determine size A patient is brought to an emergency department with symptoms of acute ST-segment elevations MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient? Give the patient an oral beta blocker Initiate fibrinolytic treatment Administer heparin Transfer to the PCI-capable institution CORRECT ANSWER Initiate fibrinolytic treatment A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient?

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels Order urinalysis, CBC, BUN and creatinine Refer to specialist for sleep study CORRECT ANSWER Order urinalysis, CBC, BUN and creatinine A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient? Statin therapy with clopidogrel Walking to the point of pain each day Daily aspirin therapy to prevent clotting Walking slowly for 15 to 20 minutes twice daily CORRECT ANSWER Walking to the point of pain each day An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minute. What will the provider do next? Order an electrocardiogram and exercise stress test Monitor the patient's heart rate while the patient is bearing down Evaluate the patient's orthostatic vital signs Reassure the patient that the symptoms are non-cardiac in origin CORRECT ANSWER Evaluate the patient's orthostatic vital signs The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrhythmia? Atrial flutter

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Ventricular fibrillation Atrial fibrillation Ventricular tachycardia CORRECT ANSWER Ventricular fibrillation A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the child emergency department. What initial intervention may be attempted in the clinic? Administration of intravenous adenosine Using a vagal maneuver or carotid massage Providing a loading dose of digoxin Giving a beta blocker CORRECT ANSWER Using a vagal maneuver or carotid massage Current American Heart Association (AHA) recommendations include: (Select all that apply.) Using a ratio of 2 rescue breaths to 30 compressions A compression depth of 1.5 inches or more on an adult A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths Rescue breaths given during 2 seconds to allow full chest rise CORRECT ANSWER Using a ratio of 2 rescue breaths to 30 compressions A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS nitroglycerin tablet which does not relieve the discomfort. What is the next action? Prescribe a calcium channel blocker medication Start aspirin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication Administer a second nitroglycerin tablet CORRECT ANSWER Give the patient a beta blocker medication A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient? No intervention is necessary for this patient Immediate open surgical repair of the aneurysm Endovascular stent grafting of the aneurysm Serial ultrasonographic surveillance of the aneurysm CORRECT ANSWER Serial ultrasonographic surveillance of the aneurysm Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Appropriately increased PTH and low or normal serum calcium Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Prolonged inappropriate secretion of PTH with subsequent hypercalcemia CORRECT ANSWER Inappropriate secretion of PTH along with hypercalcemia A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Hemoglobin A1C Random serum glucose C-peptide level Thyroid studies CORRECT ANSWER Hemoglobin A1C Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3-4) 0.2 uIU/L 4.2 uIU/L 0.4 uIU/L 2.4 uIU/L CORRECT ANSWER 0.2 uIU/L A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient? Radioiodine therapy Surgical resection of the thyroid gland Beta blocker medications Thionamide therapy CORRECT ANSWER Beta blocker medications A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? Avoidance of weight bearing exercises Annual monitoring of calcium, creatinine, and bone density Decreasing calcium and Vitamin D intake until values normal

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Parathyroidectomy CORRECT ANSWER Annual monitoring of calcium, creatinine, and bone density A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed? Serum calcitonin Radio nucleotide imaging Serum TSH level Thyroid ultrasound CORRECT ANSWER Thyroid ultrasound Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Prolonged inappropriate secretion of PTH with subsequent hypercalcemia Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Appropriately increased PTH and low or normal serum calcium CORRECT ANSWER Inappropriate secretion of PTH along with hypercalcemia What is important about increased PAI-1 levels in patients with metabolic syndrome? They cause increased insulin resistance. They predispose patients to dyslipidemia. They lower the risk of hypertension. They increase the risk of arterial thrombosis. CORRECT ANSWER They increase the risk of arterial thrombosis.

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria. Which initial action by the primary care provider is indicated for management of this patient? Consulting with a nephrologist Prescribing an antihypertensive medication Referring to an ophthalmologist Limiting protein intake CORRECT ANSWER Consulting with a nephrologist A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient? She will need lifelong medication. A thyroidectomy will be necessary. This condition may be transient. She should be referred to an endocrinologist. CORRECT ANSWER This condition may be transient. Which findings are symptoms of hyperparathyroidism? (Select all that apply.) Cognitive impairment Left ventricular hypertrophy Renal calculi Perioral paresthesias Chvostek's sign CORRECT ANSWER Cognitive impairment Left ventricular hypertrophy Renal calculi Which medication given for patients with metabolic syndrome helps to lower PAI- 1 levels?

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Aspirin Niacin Atorvastatin Metformin CORRECT ANSWER Metformin A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known? Giving a rapid-acting carbohydrate Performing a hemoglobin A1C Dipstick urinalysis for ketones Injection of rapid-acting insulin CORRECT ANSWER Giving a rapid-acting carbohydrate A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral diabetes medications. When explaining this change in therapy, the provider will tell the patient: that strict diet and exercise measures may be relaxed with insulin therapy. it is necessary because the patient cannot comply with the previous regimen. this is because of the natural progression of the disease. the use of insulin therapy may be temporary. CORRECT ANSWER this is because of the natural progression of the disease. A patient develops a dry, non-productive cough and is diagnosed with bronchitis. Several days later, the cough becomes

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS productive with mucoid sputum. What may be prescribed to help with symptoms? Bronchodilator treatment Mucokinetic agents Antitussive medication Antibiotic therapy CORRECT ANSWER Antitussive medication A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no signs of increased respiratory effort. Which diagnostic test will the provider perform initially? Chest radiograph Complete blood count Computerized tomography Spirometry CORRECT ANSWER Complete blood count A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend? Administering two more doses of albuterol Taking an oral corticosteroid Coming to the clinic for evaluation Going to the emergency department CORRECT ANSWER Administering two more doses of albuterol

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this patient? The infant should have an influenza vaccine now with a booster in 1 month The infant should be given prophylactic antiviral medications The rest of the family and all close contacts should have the influenza vaccine The infant should have the live attenuated influenza vaccine (LAIV) CORRECT ANSWER The rest of the family and all close contacts should have the influenza vaccine A patient reports coughing up a small amount of blood after a week of cough and fever. The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient's symptoms? Thromboembolism Infection Malignancy Lung abscess CORRECT ANSWER Infection An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient's dyspnea? Opioid medications Anxiolytic drugs Supplemental oxygen Breathing exercises CORRECT ANSWER Breathing exercises

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient? Arterial blood gases ventilation/perfusion scan Spirometry Blood cultures CORRECT ANSWER Spirometry A patient with hemoptysis and no other symptoms has a normal chest radiograph, CT, and fiberoptic bronch studies. What is the next action in managing this patient? Observation Refer to specialist Surgical intervention Prophylactic ABX CORRECT ANSWER Observation Which clinical sign is especially worrisome in a patient with a pulmonary embolism? TachycardiaAsw Dyspnea Hypotension Abnormal lung sounds CORRECT ANSWER Hypotension A patient has chronic chest pain that occurs after meals and the provider suspects gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor and after 2 months the patient reports improvement in symptoms. What is the next action in treating this patient? Schedule an upper endoscopy

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Continue the proton pump inhibitor Refer the patient to a gastroenterologist Order esophageal pH monitoring CORRECT ANSWER PPI A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend's nitroglycerin during one episode. What is the most likely cause of this chest pain? Pleural pain Cardiac pain Aortic dissection pain Esophageal pain CORRECT ANSWER Esophageal pain A patient who has a central line develops respiratory compromise. What is the initial intervention for this patient? Obtaining cultures and starting antibiotics Lung ultrasonography to determine the cause Prompt removal of the central line Rapid assessment and resuscitation CORRECT ANSWER Rapid assessment and resuscitation A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates. Based on these findings, which organism is the most likely cause of this patient's pneumonia? S. pneumonia

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS A virus Mycoplasma Tuberculosis CORRECT ANSWER Mycoplasma A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next? Recommend an NSAID Prescribe an antibiotic Refer to a cardiologist Order a chest radiograph CORRECT ANSWER Recommend an NSAID A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks after no improvement continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient? Increasing the dose of the antibiotics Open lung biopsy Performing diagnostic bronchoscopy Administration of the pneumonia vaccine CORRECT ANSWER Performing a diagnostic broncho A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient?

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS A respiratory fluoroquinolone antibiotic Empiric treatment with a macrolide antibiotic Hospitalization for intravenous antibiotics A B-lactam antibiotic plus a fluoroquinolone CORRECT ANSWER Empiric treatment with a macrolide antibiotic Which are causes of pleural effusions? (Select all that apply.) Bronchiectasis Breast Cancer Dehydration Congestive Heart failure Allergies CORRECT ANSWER Bronchiectasis Breast Cancer Congestive Heart failure An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient? Pertussis vaccine booster Azithromycin daily for 5 days Isolation if paroxysmal cough develops Symptomatic care only CORRECT ANSWER Azithromycin daily for 5 days Which method of treatment is used for traumatic pneumothorax? Placement of a small-bore catheter Observation for spontaneous resolution Needle aspiration of the pneumothorax Tube thoracostomy CORRECT ANSWER Tube thoracostomy

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS An adult develops chronic cough with episodes of wheezing and shortness of breath. The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms? Spirometry Allergy Testing Methacholine Challenge test Peak expiratory flow rate CORRECT ANSWER Spirometry A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help reduce the duration of symptoms in this patient? Trimethoprim-sulfamethoxazole Clindamycin Azithromycin Oseltamivir CORRECT ANSWER Oseltamivir A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism? D-dimer CT angiography Arterial blood gases Electrocardiogram CORRECT ANSWER CT angiography

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially? Perform a nasal swab for RT-PCR assay Administer LAIV influenza vaccine Observe for improvement or worsening for 24 hours Begin treatment with an antiviral medication CORRECT ANSWER Perform a nasal swab for RT-PCR assay A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings? Pulmonary infection Congestive heart failure Pulmonary embolus Hepatic disease CORRECT ANSWER CHF A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. The patient's lungs are clear and oxygen saturations are 97% on room air. What will the provider recommend? Symptomatic treatment with close follow up in clinic Referral to a specialist for evaluation and treatment Admission to the hospital for treatment of complications

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Empiric antibiotics to treat a possible secondary infection CORRECT ANSWER Symptomatic treatment with close follow up in clinic A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient? Administer three more nebulizer treatments and reassess Give epinephrine injections and monitor response Admit to the hospital with specialist consultation Prescribe an oral corticosteroid medication CORRECT ANSWER Admit to the hospital with specialist consultation A patient with a smoking history of 35 pack years’ reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated? Coagulation studies Computerized tomography Fiberoptic bronchoscopy Needle biopsy CORRECT ANSWER Computerized tomography A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism? CT angiography

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS D-dimer Arterial blood gases Electrocardiogram CORRECT ANSWER CT angiography A patient develops a pulmonary embolism after surgery and shows signs of right-sided heart failure. Which drug will be administered to this patient? Low molecular heparin Warfarin Tissue plasminogen activator Unfractionated heparin CORRECT ANSWER TPA A patient develops a dry, nonproductive cough and is diagnosed with bronchitis. Several days later, the cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms? Antibiotic therapy Bronchodilator treatment Mucokinetic agents Antitussive medication CORRECT ANSWER antitussive A patient suffers a penetrating injury to one eye caused by scissors. The provider notes a single laceration away from the iris that involves the anterior but not the posterior segment. What is the prognosis for this injury? CORRECT ANSWER Because the posterior segment is not involved, the prognosis is good A patient reports bilateral reports burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient's

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely? Allergic Bacterial Chemical viral CORRECT ANSWER Allergic A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient's pupils. What does this finding indicate? Probable benign, physiologic anisocoria A relative afferent pupillary defect Likely underlying neurological abnormality Indication of a difference in intraocular pressure CORRECT ANSWER Probable benign, physiologic anisocoria Which patients should be referred immediately to an ophthalmologist after eye injury and initial treatment? (Select all that apply.) A patient who was sprayed by lawn chemicals A patient with irrigation secondary to wood dust A patient who works in a metal fabrication shop A patient with a full-thickness corneal laceration A patient with a corneal abrasion CORRECT ANSWER A patient who was sprayed by lawn chemicals A patient who works in a metal fabrication shop A patient with a full-thickness corneal laceration A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma. The examination reveals a

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS deep red, confluent hemorrhage in the conjunctiva of that eye. What is the most likely treatment for this condition? Prescribe ophthalmic antibiotic drops Reassure the patient that this will resolve Refer to an ophthalmologist Order lubricating drops or ointments CORRECT ANSWER Reassure the patient that this will resolve A child has a localized nodule on one eyelid which is warm, tender, and erythematous. On examination, the provider notes clear conjunctivae and no discharge. What is the recommended treatment? Warm compress and massage of the lesion Surgical incision and drainage Referral to ophthalmologist Systemic antibiotics CORRECT ANSWER Warm compress and massage of the lesion An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend? Warm compress Nasolacrimal duct probing Systemic antibiotics Antibiotic eye drops CORRECT ANSWER Warm compress During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the significance of this finding?

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Ocular disease requiring referral Potential infection in the "red" eye Normal physiologic variant Potential vision loss in one eye CORRECT ANSWER Ocular disease requiring referral A child sustains an ocular injury in which a shard of glass from a bottle penetrated into the eye wall. The emergency department provider notes that the shard has remained in the eye. Which best describes this type of injury? Intraocular foreign body Penetrating eye injury Ruptured globe injury Perforating eye injury CORRECT ANSWER Intraocular foreign body A patient has dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially? Incision and drainage Topical antibiotic ointment Lacrimal bypass surgery Eyelid scrubs with baby shampoo CORRECT ANSWER I&D A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion? Blepharitis Chalazion meibomian

6531 COMBINED MIDTERM AND FINAL REVIEW QUESTIONS WITH COMPLETE SOLUTIONS Hordeolum CORRECT ANSWER Hordeolum A patient who has an inflamed pterygia lesion has been using loteprednol topical steroid drops for 7 days. The patient shows no improvement in symptoms. What is the next course of action? Prescribe a systemic corticosteroid Consult with an opthamologist Refer the patient to the emergency department Continue the medication for 7 more days CORRECT ANSWER Consult with an opthamologist A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner's next step? Application of topical fluorescein dye Administration of antibiotic eye drops Irrigation of the eye with normal saline Instillation of cyclopegic eye drops CORRECT ANSWER Application of topical fluorescein dye A patient who has a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated? Artificial tears and cool compresses Topical antibiotic eye drops Antihistamine-vasoconstrictor drops