Gender Dysphoria and Transgender Health, Exams of Nursing

Download Gender Dysphoria and Transgender Health and more Exams Nursing in PDF only on Docsity! 2 Chapter 1: The Evolving Landscape of Collaborative Practice Test Bank Multiple Choice 1. Which assessments of care providers are performed as part of the Value Based Purchasing initiative? Select all that apply. a. Appraising costs per case of care for Medicare patients b. Assessing patients’ satisfaction with hospital care c. Evaluating available evidence to guide clinical care guidelines d. Monitoring mortality rates of all patients with pneumonia e. Requiring advanced IT standards and minimum cash reserves ANS: A, B, D Value Based Purchasing looks at five domain areas of processes of care, including efficiency of care (cost per case), experience of care (patient satisfaction measures), and outcomes of care (mortality rates for certain conditions. Evaluation of evidence to guide clinical care is part of evidence-based practice. The requirements for IT standards and financial status are part of Accountable Care Organization standards. REF: Value Based Purchasing 2. What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients? a. Associations with area hospitals b. Costs of ambulatory care c. Ease of access to care d. The ratio of providers to patients ANS: C As part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access to care, walk-in settings and the ability to be seen within 30 minutes, and care that is close to home. Associations with hospitals, costs of care, and the ratio of providers to patients were not part of these results. REF: The New Look of Primary Care 3. A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? a. Bonuses based on achievement of benchmarks Buttaro: Primary Care, A Collaborative Practice, 5th Ed. b. Care coordination for chronic diseases c. Standards for minimum cash reserves d. Strict requirements for financial reporting ANS: A A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings bonuses based on achievement of benchmarks for quality measures and expenditures. Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial reporting. REF: Accountable Care Organizations 2 Chapter 3: Translating Research Into Clinical Practice Test Bank Multiple Choice 1. Which is the most appropriate research design for a Level III research study? a. Epidemiological studies b. Experimental design c. Qualitative studies d. Randomized clinical trials ANS: B The experimental design is the most appropriate design for a Level III study. Epidemiological studies are appropriate for Level II studies. Qualitative designs are useful for Level I studies. Randomized clinical trials are used for Level IV studies. REF: Level III Research/Experimental Design 2. What is the purpose of clinical research trials in the spectrum of translational research? a. Adoption of interventions and clinical practices into routine clinical care b. Determination of the basis of disease and various treatment options c. Examination of safety and effectiveness of various interventions d. Exploration of fundamental mechanisms of biology, disease, or behavior ANS: C Clinical research trials are concerned with determining the safety and effectiveness of interventions. Adoption of interventions and practices is part of clinical implementation. Determination of the basis of disease and treatment options is part of the pre-clinical research phase. Exploration of the fundamental mechanisms of biology, disease, or behavior is part of the basic research stage. REF: Translational Science Spectrum 3. What is the purpose of Level II research? a. To define characteristics of interest of groups of patients b. To demonstrate the effectiveness of an intervention or treatment c. To describe relationships among characteristics or variables d. To evaluate the nature of relationships between two variables ANS: C Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Level II research is concerned with describing the relationships among characteristics or variables. Level I research is conducted to define the characteristics of groups of patients. Level II research evaluates the nature of the relationships between variables. Level IV research is conducted to demonstrate the effectiveness of interventions or treatments. REF: Level II Research 2 Chapter 4: The Patient, the Provider, and Primary Care: An Integrated Perspective Test Bank Multiple Choice 1. A patient takes glucosamine chondroitin to help control osteoarthritis pain. Which medications, taken in conjunction with this medication, are of concern? a. Anticholinergic drugs b. Beta blocker medications c. Blood-thinning agents d. Narcotic analgesics ANS: C Glucosamine chondroitin can prolong bleeding if taken with other blood-thinning agents. It does not have anticholinergic effects, cardiac effects or analgesic effects. REF: Alternative Therapies for Common Chronic Conditions/Joint Pain 2. The provider learns that a patient is taking herbal supplements for a variety of reasons. What is an important point to discuss with this patient about taking such supplements? a. Because they are not FDA approved, they are not safe b. Dietary supplements are safer than most prescription medications c. Many supplements lack clear clinical evidence of efficacy d. Supplements should not be taken with prescription medications ANS: C Many dietary supplements lack clinical evidence to support their use. Even though they are not FDA approved, federal law mandates that the products are safe and cannot make misleading claims about use. Supplements are not necessarily safer than prescription drugs. Supplements may be taken with prescription medications as long as the effects, side effects, and drug interactions are known. REF: Alternative Therapies for Common Chronic Conditions 3. Which dietary supplements have shown some effectiveness in reducing blood pressure in patients with hypertension? Select all that apply. a. Chromium picolinate b. Cinnamon c. CoQ10 Buttaro: Primary Care, A Collaborative Practice, 5th Ed. b. Identifying appropriate specialists for referral c. Recommending routine screenings d. Reminding providers about immunizations e. Transmitting clinical dataabout patients ANS: A, C, D, E Patient registries are used to help manage patients at risk and include alerting providers about medication interactions, recommending routine screenings, reminders for immunizations, and transmitting clinical data. They are not used to identify or recommend providers or specialists. REF: Chronic Care Model/Clinical Information Systems 2 Chapter 6: Health Literacy, Health Care Disparities, and Culturally Responsive Primary Care Test Bank Multiple Choice 1. A primary care provider administers the ―Newest Vital Sign‖ health literacy test to a patient newly diagnosed with a chronic disease. What information is gained by administering this test? a. Ability to calculate data, along with general knowledge about health b. Ease of using technology and understanding of graphic data c. Reading comprehension and reception of oral communication d. Understanding of and ability to discuss health care concerns ANS: A The ―Newest Vital Sign‖ tests asks patients to look at information on an ice cream container label and answer questions that evaluate ability to calculate caloric data and to grasp general knowledge about food allergies. It does not test understanding of technology or directly measure reading comprehension. It does not assess oral communication. The ―Ask Me 3‖ tool teaches patients to ask three primary questions about their health care and management. REF: Health Literacy Assessment 2. A female patient who is from the Middle East schedules an appointment in a primary care office. To provide culturally responsive care, what will the clinic personnel do when meeting this patient for the first time? a. Ensure that she is seen by a female provider b. Include a male family member in discussions about health care c. Inquire about the patient’s beliefs about health and treatment d. Research middle eastern cultural beliefs about health care ANS: C It is important not to make assumptions about beliefs and practices associated with health care and to ask the patient about these. While certain practices are common in some cultural and ethnic groups, assuming that all members of those groups follow those norms is not culturally responsive. REF: Address Cultural Variations Among Diverse Patient Groups 3. What is the main reason for using the REALM-SF instrument to evaluate health literacy? a. It assesses numeracy skills. Buttaro: Primary Care, A Collaborative Practice, 5th Ed. b. It enhances patient-provider communication. c. It evaluates medical word recognition. d. It measures technology knowledge. ANS: C The REALM-SF is an easy and fast tool that measures medical word recognition. It does not evaluate numeracy. The ―Ask Me 3‖ tool enhances patient-provider communication. This tool does not evaluate understanding of technology. REF: Health Literacy Assessment Chapter 9: Adolescent Issues Test Bank Multiple Choice 1. Which behavior is most characteristic of early adolescence? a. Arguing with parents and teachers b. Assimilating adult roles and thinking c. Exhibiting fatigue more frequently d. Experimenting with sex and risky behaviors ANS: A Early adolescents challenge authority, experience wide mood swings, reject the ideation of childhood, and can be argumentative and disobedient. Middle adolescents experience fatigue and begin experimenting with sex and risky behaviors. Late adolescents begin to assimilate adult roles. REF: Introduction 2. What is the initial sign of puberty in the adolescent male? a. Deepening of the voice b. Elongation of the penis c. Nocturnal emissions d. Testicular enlargement ANS: D Testicular enlargement is the initial sign of puberty in adolescent males. Penile growth and nocturnal emissions occur later as does deepening of the voice. REF: Physical Development 3. A parent reports that an adolescent child does well in school but seems to consistently make poor decisions about activities with friends. What will the practitioner recommend as an approach to help the adolescent make better decisions? a. Correcting the adolescent’s decisions and judgments b. Listening without making suggestions about choices c. Making decisions for the adolescent to provide guidance d. Providing factual information about appropriate behavior ANS: B Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Test Bank 2 Listening without correcting is the best approach to help adolescents learn to make good decisions. Correcting the decisions, making decisions for the adolescent, or giving information that is unsolicited are not recommended. REF: Cognitive Development Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 10: LGBTQ Patient Care Test Bank Multiple Choice 1. Which is the most important factor limiting access to health care for sexual and gender minorities? a. Lack of familial support for SGM members b. Laws prohibiting full marriage equality c. Risky coping behaviors among SGM members d. Social stigma about being in this population ANS: B Since most people get health insurance through their employer or their spouse s employer, states which do not allow full marriage equality limit access to health care for LGBTQ people. The other causes are important, but this is the leading cause. REF: Introduction 2. What is the medical diagnostic term used to identify transgender patients? a. Gender dysphoria b. Gender expression disorder c. Gender identity disorder d. Gender role unconformity ANS: A Gender dysphoria is the term used to identify transgender patients in order to justify the medical necessity of treatments for transgender patients. It replaces the previous ―gender identity disorder‖ designation. REF: Access to Care Test Bank 2 Chapter 12: Lactation Guidance Test Bank Multiple Choice 1. An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell the mother? a. To decrease the frequency of breastfeeding b. To supplement feedings with extra water c. To switch to formula until the bilirubin level drops d. To use a breast pump to increase her milk supply ANS: D Infants with suboptimal breastfeeding can have starvation jaundice and mothers should be encouraged to increase the frequency of breastfeeding and should be offered a breast pump to increase milk supply. It is not recommended to supplement with water or sugar water or to switch to formula. REF: Physiologic Jaundice 2. The mother of a 3-day-old newborn reports that her infant nurses every 4 hours during the day and sleeps 6 hours at night. What will the provider recommend? a. Awakening the baby every 3 hours to nurse b. Continuing this schedule until the infant is 6 months old c. Ensuring that her infant nurses for 15 to 20 minutes each time d. Pumping her breasts to maintain her milk supply ANS: A Newborn infants should nurse 8 to 12 times daily and mothers should be encouraged to awaken a sleepy baby to nurse every 3 hours or more often. The feedings will gradually space out as the infant is older. REF: The First Few Days 3. A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth, and breast tenderness. What will the provider recommend? a. Ice packs and decreased frequency of nursing b. Ice packsand increased frequency of nursing c. Warm packs and decreased frequency of nursing d. Warm packsand increased frequency of nursing Buttaro: Primary Care, A Collaborative Practice, 5th Ed. ANS: D This mother has symptoms of mastitis. She should be encouraged to use warm packs for comfort and to increase the frequency of nursing to relieve the pressure. REF: Mastitis Test Bank 2 Chapter 13: Aging and Common Geriatric Syndromes Test Bank Multiple Choice 1. When prescribing medications to an 80-year-old patient, the provider will a. begin with higher doses and decrease according to the patient’s response. b. consult the Beers list to help identify potentially problematic drugs. c. ensure that the patient does not take more than five concurrent medications. d. review all patient medications at the annual health maintenance visit. ANS: B The Beers list provides a list of potentially inappropriate medications in all patients age 65 and older and helps minimize drug-related problems in this age group. Older patients should be started on lower doses with gradual increase of doses depending on response and side effects. Patients who take five or more drugs are at increased risk for problems of polypharmacy, but many will need to take more than five drugs; providers must monitor their response more closely. Medications should be reviewed at all visits, not just annually. REF: Polypharmacy/Consequences of Polypharmacy/Management 2. An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. She appears somewhat confused, according to her daughter, who is concerned that she is developing dementia. The provider learns that the woman still drives, volunteers at the local hospital, and attends a book club with several friends once a month. What is the initial step in evaluating this patient? a. Obtain a CBC, serum electrolytes, BUN, and glucose b. Ordering a CBC, serum ferritin, and TIBC c. Referring the patient to a dietician for nutritional evaluation d. Referring the patient to a neurologist for evaluation for AD ANS: A Patients with weight loss, confusion, and lethargy are often dehydrated and this should be evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently leading an active life, so the likelihood that recent symptoms are related to AD, although this may be evaluated if dehydration is ruled out. Anemia would be a consideration when dehydration is ruled out. Referrals are not necessary unless initial evaluations suggest that malnutrition or AD is present. REF: Dehydration/Pathophysiology/Clinical Presentation/Physical Examination Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Select all that apply. a. A directive to avoid calling 911 at the time of death b. A specific list of treatments the patient does not want c. How much information to give various family members d. The level of sedation versus alertness the patient desires e. The people designated to make care decisions for the patient ANS: C, D, E The Five Wishes approach addresses the type of care a patient wants as a disease progresses and is less defensive than the traditional advance directive which indicates the type of care a patient does not want. Calling 911 may be done without requiring resuscitation if the patient has an appropriate advanced directive in place. REF: Advance Care Planning Test Bank 2 Chapter 15: Obesity and Weight Management Test Bank Multiple Choice 1. A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess for complications of obesity in this patient based on this finding? a. Electrocardiography b. Gallbladder ultrasonography c. Mammography d. Polysomnography ANS: D Women with a neck circumference greater than 16 cm have an increased risk of obstructive sleep apnea and should have polysomnography to assess for this complication. The other tests may be necessary for obese patients, but are not specific to this finding. REF: Physical Examination/Diagnostics 2. Which medications are associated with weight gain? Select all that apply. a. Antibiotics b. Antidepressants c. Antihistamines d. Insulin analogs e. Seizure medications ANS: B, C, D, E Antidepressants, antihistamines, insulin and insulin analogs, and seizure medications are all associated with weight gain. Antibiotics are not associated with weight gain. REF: Pharmaceuticals Associated with Weight Gain Test Bank 2 Chapter 16: Lifestyle Management Test Bank Multiple Choice 1. A 60-year-old patient who leads a sedentary lifestyle has expressed an interest in beginning an aerobic exercise program. What will the provider include when counseling this patient about this program? a. Begin with a 45 to 60 minute workout b. Include a 1 to 2 minute warm up before exercise c. Maintain a heart rate between 80 and 128 beats per minute d. Stretching should be performed prior to activity ANS: D The heart rate should be kept between 50% and 80% of the maximum heart rate (220 minus the patient’s age = 160), which is 80 to 128 beats per minute. Patients who are not conditioned should begin with a 20 minute workout; conditioned individuals may increase up to 60 minutes. The warm up should be 3 to 5 minutes and longer if it is cold. Stretching is performed after the activity when the muscles are warm. REF: Exercise 2. Routine screening blood tests at an annual physical exam reveal a fasting glucose level of 125 mg/dL and a hemoglobin A1C of 6.2%. What will the provider do, based on these results? a. Evaluate the patient for impaired glucose tolerance b. Reassure the patient that these are normal values c. Suggest that the patient begin an exercise program d. Tell the patient that these results indicate diabetes ANS: A The fasting blood glucose level is normal, but the HgA1C indicates impaired glucose tolerance. If the HgA1C were greater than 6.4%, the patient would be diagnosed with diabetes. Until the results are evaluated, suggestions for treatment are not indicated. REF: Diabetes 3. The primary care provider is screening a patient using the CAGE criteria. What will the provider include in this assessment? Select all that apply. a. Number of times per week eaten in restaurants Buttaro: Primary Care, A Collaborative Practice, 5th Ed. a. A series of two herpes zoster vaccinations b. A single dose of herpes zoster vaccine c. No herpes zoster vaccine is necessary d. Prophylactic vaccination if exposed to chicken pox ANS: B All patients 50 years and older should have a single dose of herpes zoster vaccine regardless of previous herpes zoster infection. REF: Herpes Zoster Vaccine Test Bank 2 Chapter 18: Principles of Occupational and Environmental Health in Primary Care Test Bank Multiple Choice 1. A patient who has a history of working around asbestos and silica fibers is concerned about developing lung disease. The primary care provider determines that the patient has a previous history of asthma as a child and currently has frequent episodes of bronchitis. A physical examination is normal and pulmonary function tests and radiographs are negative. What action is correct? a. Reassure the patient about the normal findings b. Refer the patient to an occupational health specialist c. Request a workplace environmental assessment d. Suggest that the patient follow up with a pulmonologist ANS: B Patients with environmental exposure may not have symptoms or positive findings. Because this patient reports frequent bronchitis, this should be followed up with an occupational health specialist who can evaluate the degree of exposure and perform further testing. Normal findings are not necessarily reassuring. The occupational specialist may request an environmental assessment. Pulmonologists are not trained in occupational health. REF: Occupational Respiratory Diseases 2. During a pre-placement screening for a person hired for a job requiring heavy lifting, a primary care provider notes that the new employee has environmental allergies, a history of GERD, recurrent eczema, a previous history of an ankle fracture, and normal lower back strength and flexibility. A urine drug screen is negative. What will be included in the report to the employer? Select all that apply. a. GERD history b. History of allergies and eczema c. History of ankle fracture d. Lower back screening results e. Urine drug screening results ANS: D, E Only findings related to the ability of the individual to perform position requirements for the job are included in the report. Other findings should not be included, even though they may need to be addressed. REF: Pre-Placement Health Evaluation Buttaro: Primary Care, A Collaborative Practice, 5th Ed. t . Chapter 19: College Health Test Bank Multiple Choice 1. A female freshman college student tells the primary care provider at the student health center that she has a history of anorexia nervosa that has been well-controlled for several years. What will the provider recommend for this student? a. Dietary counseling b. Participation in sports c. Regular weight assessments d. Stress management strategies ANS: D Students with previous eating disorders may regress when stressed, so stress management is essential. Unless she begins to regress, dietary counseling is not indicated. Many who participate in sports will develop eating disorders in order to control weight. It is not necessary to evaluate weight regularly. REF: Eating Disorders and Weight Management 2. A female college student seeks information about emergency contraception. What is the most important part of the assessment of this patient? a. Cultural considerations for use of contraception b. Feelings of guilt about a possible pregnancy c. Possible concerns about confidentiality d. The female’s sense of control in sexual situations ANS: D Because college women are at greater risk for sexual violence and assault, a request for emergency contraception must be followed by an evaluation of possible rape or assault. The other considerations may be part of the assessment, but are not as important as determining whether a rape has occurred. REF: Reproductive, Substance, and Safety Issues Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 21: Presurgical Clearance Test Bank Multiple Choice 1. Which factors determine which diagnostic tests should be performed in a presurgical clearance evaluation? Select all that apply. a. Patient’s age b. Patient’s comorbidities c. Previous surgeries d. Surgeon’s preference e. Type of anesthetic agent planned ANS: A, B, D, E The patient’s age and comorbidities, surgeon preference, and the type of anesthetic planned al determine which presurgical diagnostic tests will be performed. The patient’s previous surgeries do not determine presurgical testing. REF: Diagnostics 2. Which patient should have pulmonary function testing as part of the presurgical exam? a. A patient older than 60 years of age b. A patient undergoing major intra-thoracic surgery c. A patient with a history of pneumonia in the last 2 years d. A patient with diabetes and morbid obesity ANS: B Any patient undergoing major thoracic surgery should have pulmonary function testing. Age over 60 years, a history of pneumonia, and diabetes and obesity do not require pulmonary function testing unless there is comorbid COPD. REF: Table 21-1: Tests for Presurgical Clearance Chapter 22: Preparticipation Sports Physical Test Bank Multiple Choice 1. During a pre-participation sports physical, the examiner notes a difference in strength of the patient’s radial and femoral pulses with the femoral pulses being weaker. What will the provider do? a. Evaluate for orthostatic hypotension b. Obtain Doppler studies of lower extremity circulation c. Reassure the patient that this is a normal finding d. Refer the patient for a cardiologic exam ANS: D Differences in strength between radial and femoral pulses may indicate coarctation of the aorta and should be evaluated by a cardiologist. This finding does not indicate orthostatic hypotension. The likelihood of decreased circulation is low in a young athlete. REF: Physical Examination 2. An overweight adolescent who takes metformin has type 2 diabetes with a HgA1c of 8.5% and asks about sports participation. What will the provider recommend? a. Losing weight prior to initiating sports participation b. Participation in strenuous sports to help with weight loss c. Referral to the endocrinologist for sports clearance d. Switching to insulin therapy prior to participation ANS: C Patients with poorly controlled diabetes should be referred to a specialist prior to clearance for sports participation. This patient has an elevated HgA1C, indicating poor control. The endocrinologist may suggest the other options, but the primary care provider should not clear this patient for participation in sports. REF: Medical Clearance 3. A high-school adolescent is being screened for fitness before participating in sports. The adolescent has a normal examination and the examiner notes S1 and S2 heart sounds without murmur, normal blood pressure, and equal pulses. The parent reports that the adolescent’s father has a history or Wolff-Parkinson-White syndrome, which has been treated. What will the provider do? a. Clear the adolescent to play sports Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Test Bank 2 b. Perfor an electrocardiogram c. Refer the adolescent to a cardiologist d. Tell the adolescent that sports are not allowed ANS: C A positive family history of Wolff-Parkinson-White syndrome requires physician consultation or referral before medical clearance can be given. The adolescent has a normal heart rate and physical exam, so the ECG may not yield significant or useful results. The examiner cannot clear the adolescent without consulting with a specialist. The adolescent may be cleared for sports by the specialist. REF: Medical Clearance Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Test Bank 2 a. Breathlessness with minimal activity or eating b. Pausing to breathe while attempting to talk c. Repetitive, spasmodic coughing at night d. Wheezing after exposure to a trigger ANS: B Inability to speak a full sentence without pausing to breathe indicates severe bronchospasm. Breathlessness, repetitive and spasmodic coughing, and wheezing are all common signs of bronchospasm and do not necessarily indicate severe bronchospasm. REF: Acute Bronchospasm/Clinical Presentation Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 25: Anaphylaxis Test Bank Multiple Choice 1. A child with no previous history of asthma is brought to the emergency department with wheezing, stridor, and shortness of breath. When the child is started on oxygen and given a nebulized bronchodilator treatment, the treatment team notes a wheal and flare rash on the child’s trunk. What medication will be given immediately? a. Inhaled racemic epinephrine b. Intramuscular epinephrine c. Intravenous diphenhydramine d. Intravenous ranitidine ANS: B The patient has signs of anaphylaxis and should be given IM or SC epinephrine immediately as first-line therapy, with this repeated every 5 to 20 minutes as needed to prevent cardiovascular shock. Inhaled epinephrine is used for acute upper airway bronchospasm. Diphenhydramine and ranitidine are given as second-line treatment after epinephrine is administered or for mild, non- life-threatening allergic reactions. REF: Anaphylaxis/Management 2. A man self-administers epinephrine using an Epi-Pen after experiencing a bee sting and developing angioedema and wheezing. What should the man do next? a. Obtain transport to an emergency department immediately b. Repeat the epinephrine dose if needed and notify a physician of the episode c. Resume normal activity if symptom free after 30 to 60 minutes d. Take oral diphenhydramine and report any symptoms to a provider ANS: A The man has a history of anaphylaxis and experienced symptoms after contact with a trigger. The Epi-Pen should be used immediately, but does not prevent the need for follow up in an emergency department for close observation, since continued reaction to the allergen can occur for 6 to 8 hours. The epinephrine dose may be given if needed before emergency personnel arrive, but a second dose is not sufficient to prevent ongoing reaction to the allergen. REF: Anaphylaxis/Management/Education and Health Promotion Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 26: Bites and Stings Test Bank Multiple Choice 1. A patient is seen in the emergency department after experiencing a spider bite. The spider is in a jar and is less than one inch in size, yellow-brown, and has a violin-shaped marking on its back. Depending on the patient’s symptoms, which treatments and diagnostic evaluations may be ordered? Select all that apply. a. Airway management b. An acute abdominal series c. Antivenom therapy d. CBC, BUN, electrolytes, and creatinine e. Coagulation studies f. Tetanus prophylaxis ANS: D, E, F The spider is a brown recluse. If the patient exhibits systemic symptoms, laboratory workup, including CBC, BUN, creatinine, electrolytes, and coagulation studies should be performed. Tetanus prophylaxis is given. Airway management, an acute abdominal series, and antivenom therapy are used for black widow spider bites. REF: Spider Bites/Definition and Epidemiology/Diagnostics/Initial Stabilization and Management 2. A child experiences a snake bite while camping and is seen in the emergency department. The child’s parents are not able to identify the type of snake. An inspection of the site reveals two puncture wounds on the child’s arm with no swel ing or erythema at the site. The child has normal vital signs. Which treatment is indicated? a. Administering antivenom and observing the child for 24 to 48 hours b. Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours c. Performing a type and cross match of the child’s blood d. Referral to a surgeon for incision and suction of the wound ANS: B The child does not have immediate symptoms of envenomation, since there is no swelling or erythema. Because symptoms may be delayed, and the type of snake is unknown, the child should be observed in an ED or hospital for 12 hours after providing wound care and tetanus prophylaxis. Antivenom is not indicated unless envenomation occurs. Type and cross match is done if envenomation is severe. Incision and suction of the sound is not recommended. REF: Buttaro: Primary Care, A Collaborative Practice, 5th Ed. 3. Which cardiac arrhythmia in an unstable patient requires unsynchronized shocks, or defibrillation? a. Atrial fibrillation b. Atrial flutter c. Monomorphic ventricular tachycardia d. Polymorphic ventricular tachycardia ANS: D Polymorphic ventricular tachycardia should be treated as ventricular fibrillation with unsynchronized shocks. The other arrhythmias are treated with synchronized cardioversion. REF: Box 27-1: Cardioversion and defibrillation of unstable patients with tachycardia Test Bank 2 Chapter 28: Cardiac Arrest Test Bank Multiple Choice 1. Current American Heart Association (AHA) recommendations include: Select all that apply. a. A compression depth of 1½ inches or more on an adult b. A rate of 100 compressions per minute at a minimum c. Rescue breaths given during 2 seconds to allow full chest rise d. Untrained rescuers giving compressions without breaths e. Using a ratio of 2 rescue breaths to 30 compressions ANS: B, D, E The AHA recommends compression rates of at least 100 compressions per minute at a ratio of 2 breaths for every 30 compressions. Untrained rescuers are encouraged to provide chest compressions only. The depth of compressions in adults should be at least 2 inches. Rescue breaths are given over 1 second with full chest rise. REF: Cardiac Arrest/Physical Examination 2. 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? a. Atrial fibrillation b. Atrial flutter c. Ventricular fibrillation d. Ventricular tachycardia ANS: C Most victims of cardiac arrest are in ventricular fibrillation, so the AHA considers early defibrillation the most effective treatment for adult victims of cardiac arrest. The other arrhythmias are not usually present in cardiac arrest and are treated with synchronized cardioversion REF: Cardiac Arrest/Initial Stabilization and Management 3. 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)? a. Assessment of gasping breaths or not breathing b. Determination of pulselessness or bradycardia c. Evaluation of peripheral perfusion and level of consciousness Buttaro: Primary Care, A Collaborative Practice, 5th Ed. d. Obtaining a history of previous myocardial infarction ANS: A The AHA recommends initiating CPR if the victim in not breathing or has gasping breaths. Determination of a pulse in an arrest situation can be problematic and the search for a pulse should not delay chest compressions if the patient is gasping for breath or not breathing. Evaluation of peripheral perfusion and LOC is not part of the initial assessment and not used to indicate the need for CPR. A medical history may be obtained after resuscitation is in progress. REF: Cardiac Arrest/Physical Examination Test Bank 2 Chapter 30: Electrical Injuries Test Bank Multiple Choice 1. What is true about electrical injuries? Select all that apply. a. Alternating current causes tetanic skeletal muscle contractions. b. Direct current is more dangerous than alternating current. c. Electrical injury causes more tissue necrosis in nerves than other tissues. d. Lightning is less lethal because the duration of electrical strike is short. e. Low-voltage contact has no potential to be lethal. ANS: A, C, D Alternating current tends to be more lethal than direct current because it causes tetanic muscle contractions. Electrical injury affects nerves more than other tissues because nerve tissue has the least resistance to direct flow and is most easily damaged. Lightning, although it has a voltage of 10 million to 2 billion volts, has a short duration of contact. Alternating current is more dangerous than direct current. Low-voltage contact has the potential to be lethal. REF: Pathophysiology 2. An adolescent male has an electrical injury from a high-voltage wire after climbing a tree. Which initial diagnostic test is necessary? a. 12-lead electrocardiogram b. Cervical spine radiography c. Complete blood count and electrolytes d. Creatine kinase and myoglobin level ANS: A An early essential assessment in all patients with electrical injury is a 12-lead ECG to assess arrhythmias and conduction disturbances. The other labs are part of the initial workup, but not a priority over the ECG. A C-spine radiograph is done if cervical injury is suspected. REF: Physical Examination/Diagnostics Test Bank 2 Chapter 31: Environmental Allergies Test Bank Multiple Choice 1. When performing diagnostic tests to determine which environmental allergens cause symptoms in an atopic patient, which aspects of scratch testing are preferable to other methods? Select all that apply. a. It has a lower potential for anaphylaxis. b. It is more sensitive. c. It is safer. d. It produces more rapid results. e. It requires a stepwise approach. ANS: A, C, D Scratch testing involves scratching the surface of the skin. This method has a lower potential for anaphylaxis, is safer, and has more rapid results. It is not as sensitive as the intradermal method, which requires a stepwise approach. REF: Environmental Allergies/Diagnostics 2. Which immunoglobulin is responsible for initiating the allergic cascade in susceptible individuals who are exposed to allergens? a. IgG b. IgA c. IgM d. IgE ANS: D While IgA, IgG, and IgM are produced to appropriately protect the body, circulating levels of IgE are responsible for the atopic reaction. REF: Environmental Allergies/Pathophysiology 3. Which food allergies in children may beoutgrown in the first decadeof life? Select all that apply. a. Egg allergy b. Fish allergy c. Milk allergy d. Nut allergy Buttaro: Primary Care, A Collaborative Practice, 5th Ed. e. Shell fish allergy ANS: A, C Both egg and milk allergy may be outgrown within the first decade of life. Fish, nut, and shell fish allergies are more common in adults and have a higher incidence of lifetime allergy. REF: Food Allergies/Definition and Epidemiology Test Bank 2 Chapter 33: Hypotension Test Bank Multiple Choice 1. A young adult patient is being treated for hypertension and is noted to have a resting blood pressure of 135/88 mm Hg just after finishing a meal. After standing, the patient has a blood pressure of 115/70 mm Hg. What is the likely cause of this change in blood pressure? a. A hyperglycemic episode b. Antihypertensive medications c. Neurogenic orthostatic hypotension d. Postpriandal hypotension ANS: B Medications to treat hypertension may cause orthostatic hypotension. Hypoglycemia may cause hypotension. Neurogenic orthostatic hypotension is less likely. Postpriandal hypotension occurs in elderly patients. REF: Pathophysiology 2. An elderly patient who has orthostatic hypotension secondary to antihypertensive medications is noted to have a drop in systolic blood pressure of 25 mm Hg. Which intervention is important for this patient? a. Administration of intravenous fluids b. Close monitoring cardiorespiratory status c. Initiation of a fall risk protocol d. Withholding antihypertensive medications ANS: C A reduction of systolic blood pressure >20 mm Hg is a risk factor for falls in the elderly, so a fall risk protocol should be initiated. Unless the patient is dehydrated, IV fluids are not recommended. Close monitoring of CR status will not prevent falls. Withholding antihypertensive medications often worsens orthostatic hypotension. REF: Diagnostics/Management 3. An older patient develops orthostatic hypotension secondary to an antihypertensive medication and asks what measures can be taken to minimize this condition. What will the provider recommend? Select all that apply. Buttaro: Primary Care, A Collaborative Practice, 5th Ed. a. Crossing the legs when standing up b. Custom-fitted elastic stockings c. Discontinuation of the medication d. Increased physical activity e. Performing the Valsalva maneuver ANS: A, B, D Measures such as crossing the legs when standing, wearing custom-fitted elastic stockings, and increasing physical activity may all help prevent orthostatic hypotension symptoms. Discontinuation of the medication may make the condition worse. Performing the Valsalva maneuver will increase intrathoracic pressure and should be avoided. REF: Management Test Bank 2 Chapter 34: Poisoning Test Bank Multiple Choice 1. A patient who ingested a bottle of acetaminophen tablets is brought to the emergency department. Which treatment is indicated? a. Flumazenil b. N-acetylcysteine c. Naloxone d. Supportive care only ANS: B N-acetylcysteine is used as an antidote for acetaminophen overdose. Flumazenil is used to treat benzodiazepine overdose. Naloxone is given for opioid overdose. REF: Poisoning/Initial Stabilization and Management 2. Several groups of college students arrive in the emergency department reporting severe gastrointestinal symptoms after leaving a fraternity party. After stabilizing these patients, a priority for the emergency department personnel is to a. contact the fraternity to determine whether others are affected. b. isolate the patients to prevent spread of infection. c. notify the local health department about this outbreak. d. obtain histories from the patients about illicit drug use. ANS: A Providers must be alert to situations in which a number of people present with similar symptoms within a short time, suggesting a common source of poisoning. This lowered threshold of suspicion requires action to prevent additional casualties, so the providers should contact the fraternity. If an infectious cause is determined, isolation may be required, but an investigation of the common source is paramount. After the situation is stabilized, the health department should be notified. Because the symptoms appeared in a cluster of patients who all attended the same party, questioning them about illicit drug use is a lower priority than determining risk to others. REF: Poisoning/Clinical Presentation 3. What is the first priority in emergency management of a biological terrorism attack? a. Basic life support Buttaro: Primary Care, A Collaborative Practice, 5th Ed. b. Perform a thorough gynecological exam and obtain cultures c. Question the patient about the events surrounding the assault d. Refer the patient to the emergency department for a forensic examination ANS: D If a patient has been sexually assaulted within the past 5 days, and especially if within the previous 72 hours, the provider should defer a physical examination and refer the patient to the ED for a forensic examination. It is not necessary to notify the police unless the victim is a child, elderly, or disabled. The provider should not perform the exam – a forensic exam ensures that standard protocol is followed and appropriate evidence is obtained. Retelling the story of the assault may be traumatizing to the patient, so this should be left to providers performing the forensic exam. REF: Sexual Assault/Physical Examination Test Bank 2 Chapter 36: Syncope Test Bank Multiple Choice 1. Which tests are indicated as part of the initial evaluation for women of childbearing age who report syncope? Select all that apply. a. 12-lead electrocardiogram b. Cardiac enzyme levels c. Complete blood count d. Electroencephalogram e. Serum glucose testing ANS: A, C, E Initial evaluation for all patients reporting syncope should include a standard 12-lead ECG. Women of childbearing age should have a CBC, serum pregnancy test, and serum glucose testing. Cardiac enzyme levels are obtained if the patient has cardiac risk factors. EEG is performed only if there is a concern for seizure disorder. REF: Syncope/Diagnostics 2. A healthy 20-year-old patient reports having had 1 or 2 episodes of syncope without loss of consciousness. Which is the most likely type of syncope in this patient? a. Cardiac b. Neurogenic c. Orthostatic hypotensive d. Reflex syncope ANS: D Neurally mediated or reflex syncope is the most common cause of syncope and is primarily seen in young adults. Cardiac, neurogenic, and orthostatic syncope are generally seen in older adults. REF: Syncope/Pathophysiology 3. An elderly patient reports experiencing syncope each morning when getting out of bed. Which assessment will the health care provider perform first to evaluate this patient’s symptoms? a. Cardiac enzyme levels b. Electroencephalogram Buttaro: Primary Care, A Collaborative Practice, 5th Ed. c. Fasting blood glucose d. Orthostatic blood pressures ANS: D Orthostatic blood pressures should be measured first since this patient reports problems associated with rising from a supine position. The other tests are performed as part of the diagnostic workup only if indicated by associated symptoms or suspected causes. REF: Syncope/Physical Examination Test Bank 2 Chapter 38: Examination of the Skin and Approach to Diagnosis of Skin Disorders Test Bank Multiple Choice 1. When examining a patient’s skin, a practitioner uses dermoscopy in order to Select all that apply. a. accentuate changes in color of pathologic lesions by fluorescence. b. assess changes in pigmentation throughout various lesions. c. determine whether lesion borders are regular or irregular. d. differentiate fluid masses from cystic masses in the epidermis. e. visualize skin fissures, hair follicles, and pores in lesions. ANS: B, C, E Dermoscopy is used to visualize the epidermis and superficial dermis and can reveal changes in pigmentation throughout lesions, whether borders are regular or irregular, and the various fissures, follicles, and pores present in lesions. The Wood’s light, or black light, is used to fluoresce lesions to accentuate changes in color. A direct light source is useful for differentiating fluid masses from cystic masses. REF: Physical Examination 2. A primary care provider is performing a Tzanck test to evaluate possible herpes simplex lesions. To attain accurate results, the provider will a. blanch the lesions while examining them with a magnifying glass. b. gently scrape the lesions with a scalpel onto a slide. c. perform a gram stain of exudate from the lesions. d. remove the top ofthe vesicles and obtain fluid from the lesions. ANS: D The Tzanck test requires removing the tops from vesicular lesions in order to obtain fresh fluid from the base of the lesions. Blanching of blue to red lesions under a microscope helps to evaluate whether blood is in the capillaries of the lesions. Scraping lesions onto a slide is done to evaluate the presence of hyphae and spores common with candidiasis or fungal infections. Gram staining is performed to distinguish gram-positive from gram-negative organisms in suspected bacterial infections. REF: Box 38-1: Skin Examination Technique Test Bank 2 Chapter 39: Surgical Office Procedures Test Bank Multiple Choice 1. A provider is preparing to administer electrocautery to a patient who has several seborrheic keratoses. The patient tells the provider that he has a pacemaker. Which action is correct? a. Administer the electrocautery per the usual protocol b. Apply electrocautery in short burst at low voltage c. Refer the patient to a dermatologist for removal d. Suggest another method for removal of the lesions ANS: B Patients with pacemakers or implantable cardioverter-defibrillators may receive electrocautery if appropriate precautions, such as lower voltage and shorter bursts are taken. It is not necessary to suggest another method or to refer to a dermatologist. REF: Electrocautery 2. A patient has molluscum contagiosum and the provider elects to use cryosurgery to remove the lesions. How will the provider administer this procedure? a. Apply one freeze-thaw cycle to each lesion b. Apply two or more freeze-thaw cycles to each lesion c. Apply until the freeze spreads laterally 1 mm from the lesion edges d. Apply until the freeze spreads laterally 4 mm from the lesion edges ANS: A For molluscum contagiosum, one freeze-thaw cycle is usually sufficient. Two freeze-thaw cycles are generally required for thicker, more keratotic lesions. The freeze should spread laterally 3 to 4 mm from the edge of the lesions. REF: Cryosurgery 3. Which type of office surgical procedure warrants sterile technique? a. Curettage b. Punch biopsy c. Scissor excision d. Shave biopsy ANS: B Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Punch biopsy requires sterile technique. The other procedures require cleaning with alcohol and clean technique with universal precautions. REF: Biopsy Test Bank 2 Chapter 41: Screening for Skin Cancer Test Bank Multiple Choice 1. Curing a total body skin examination for skin cancer, the provider notes a raised, shiny, slightly pigmented lesion on the patient’s nose. What will the provider do? a. Consult with a dermatologist about possible melanoma b. Reassure the patient that this is a benign lesion c. Refer the patient for possible electrodessication and curettage d. Tell the patient this is likely a squamous cell carcinoma ANS: C This lesion is characteristic of basal cell carcinoma, which is treated with electrodessication and curettage. Melanoma lesions are usually asymmetric lesions with irregular borders, variable coloration, >6 mm diameter, which are elevated; these should be referred immediately. All suspicious lesions should be biopsied; until the results are known, the provider should not reassure the patient that the lesion is benign. Squamous cell carcinoma is roughened, scaling, and bleeds easily. REF: Physical Examination/Management 2. What is the initial approach when obtaining a biopsy of a potential malignant melanoma lesion? a. Excisional biopsy b. Punch biopsy c. Shave biopsy d. Wide excision ANS: A A suspected malignant melanoma lesion should be biopsied with excisional biopsy; if diagnosed, a wide excision should follow. Punch and shave biopsy procedures are appropriate for diagnostic evaluation of NMSC lesions. REF: Diagnostics Test Bank 2 Chapter 42: Acne Vulgaris Test Bank Multiple Choice 1. A patient has acne and the provider notes lesions on half of the face, some nodules, and two scarred areas. Which treatment will be prescribed? a. Oral clindamycin for 6 to 8 weeks b. Oral isotretinoin c. Topical benzoyl peroxide and clindamycin d. Topical erythromycin ANS: C This patient has moderate acne, based on symptoms of lesions on half of the face with nodules and a few scars. A combination of topical benzoyl peroxide and clindamycin is recommended. Oral antibiotics are reserved for severe cases. Oral isotretinoin is used only for recalcitrant cases which are severe and have not responded to other treatments. Topical antibiotics should be used as monotherapy. REF: Acne Vulgaris/Pathophysiology/Management 2. When counseling a patient with rosacea about management of this condition, the provider may recommend Select all that apply. a. applying a topical steroid. b. avoiding makeup. c. avoiding oil-based products. d. eliminating spicy foods. e. exposing the skin to sun. f. using topical antibiotics. ANS: C, D, F Patients with rosacea should avoid oil-based products and eliminate spicy foods, alcohol, and hot fluids. Topical antibiotics may be used if pustules are present. Topical steroids are not recommended. Patients do not need to avoid makeup and should avoid the sun. REF: Rosacea 3. A provider is considering an oral contraceptive medication to treat acne in an adolescent female. Which is an important consideration when prescribing this drug? a. A progesterone-only contraceptive is most beneficial for treating acne. Buttaro: Primary Care, A Collaborative Practice, 5th Ed. b. Combined oral contraceptives are effective for non-inflammatory acne only. c. Oralcontraceptives are effective because of their androgen enhancing effects. d. Yaz, Ortho Tri-Cyclen, and Estrostep are approved for acne treatment. ANS: D Three oral contraceptives have a labeled use for acne treatment: Yaz, Ortho Tri-Cyclen, and Estrostep. Progesterone-only contraceptives may worsen acne. Combined oral contraceptives are effective in reducing inflammatory and non-inflammatory acne. Oral contraceptives are effective because of their antiandrogen effects, since androgen induces sebum production. REF: Acne Vulgaris/Management Test Bank 2 Chapter 44: Animal and Human Bites Test Bank Multiple Choice 1. Which type of bite is generally closed by delayed primary closure? Select all that apply. a. Bites to the face b. Bites to the hand c. Deep puncture wounds d. Dog bites on an arm e. Wounds 8 hours old ANS: B, C, E Cat and human bites, deep puncture wounds, clinically infected wounds, wounds more than 6 to 12 hours old, and bites to the hand should be left open and closed by delayed primary closure. A bite to the face is closed by primary closure. Dog bites do not require delayed or secondary closure. REF: Management 2. A patient has been bitten by a dog and has sustained several puncture wounds near the thumb of one hand. The patient is able to move all fingers and the bleeding has stopped. What is the correct treatment for this patient? a. Begin rabies and tetanus prophylaxis and bandage the wound b. Clean the wound thoroughly and order a topical antibiotic c. Obtain a physician consultation for evaluation and treatment d. Prescribe oralantibiotics and have the patient follow up in a few days ANS: C Any animal bites on the face or hand require physician consultation because of the increased risk for osteomyelitis, tendinitis, and septic arthritis. The other interventions may or may not be appropriate, but must be decided by the consulting physician. REF: Definition and Epidemiology/Physician Consultation 3. A patient has sustained a human bite on his hand during a fist fight. Which is especially concerning with this type of bite injury? a. Possible exposure to rabies virus b. Potential septic arthritis or osteomyelitis Buttaro: Primary Care, A Collaborative Practice, 5th Ed. c. Sepsis from Capnocytophaga canimorsus infection d. Transmission of human immunodeficiency virus ANS: B Clenched-fist injury, or ―fight bite,‖ has a high complication rate from the high penetrating force with the potential for osteomyelitis, tendinitis, and septic arthritis. Humans do not transmit rabies unless infected, which is highly unlikely. Humans do not transmit C. canimorsus. HIV transmission is potential, but the risk is extremely low. REF: Definition and Epidemiology/Pathophysiology Test Bank 2 Chapter 45: Bullous Pemphigoid Test Bank Multiple Choice 1. An elderly adult patient with bullous pemphigoid is prescribed oral prednisone and hydroxyzine to manage symptoms. Which medication side effect is of immediate concern for this patient? a. Osteoporosis b. Pruritis c. Sedation d. Weight gain ANS: C Older patients should take hydroxyzine cautiously because of the risks of sedation. Osteoporosis and weight gain are long-term effects of prednisone and not of immediate concern. Hydroxyzine is given to treat pruritus. REF: Management 2. A patient is newly diagnosed with bullous pemphigoid and has moderate to severe itching. The provider orders a topical corticosteroid will discuss which potential complication with this patient? a. Bone marrow suppression b. Developing systemic lesions c. Secondary infection d. Spread of disease to others ANS: C Topical corticosteroids and excessive rubbing and trauma to skin increase the risk of secondary infections. Bone marrow suppression is a side effect of immunosuppressive therapy. Systemic lesions are not likely; patients may develop systemic infection if secondary infection occurs. The disease is not contagious. REF: Patient and Family Education 3. When assisting with a skin biopsy of a patient suspected of having bullous pemphigoid lesions, the practitioner will a. avoid contact with the infected lesions. b. elicit a positive Nikolsky sign to confirm the diagnosis. c. perform direct immunofluorescence microscopy. Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 47: Cellulitis Test Bank Multiple Choice 1. A patient with a purulent skin and soft tissue infection (SSTI). A history reveals a previous MRSA infection in a family member. The clinician performs an incision and drainage of the lesion and sends a sample to the lab for culture. What is the next step in treating this patient? a. Apply moist heat until symptoms resolve b. Begin treatment with amoxicillin-clavulanate c. Prescribe oral clindamycin d. Wait for culture results before ordering an antibiotic ANS: C Because of a history of exposure to MRSA, the patient is likely to be colonized and should be treated accordingly. Small lesions may be treated with moist heat, but the likelihood of MRSA requires treatment. Amoxicillin-clavulanate is not effective for MRSA. Treatment should be started empirically. REF: Clinical Presentation/Management 2. A previously healthy patient has an area of inflammation on one leg which has well- demarcated borders and the presence of lymphangitic streaking. Based on these symptoms, what is the initial treatment for this infection? a. Amoxicillin-clavulanate b. Clindamycin c. Doxycycline d. Sulfamethoxazole-trimethoprim ANS: A This patient has symptoms consistent with erysipelas, which is commonly caused by staphylococcal or streptococcal bacteria. These may be treated empirically with a penicillinase- resistant penicillin. Clindamycin, doxycycline, and sulfamethoxazole-trimethoprim are used for methicillin-resistant staphylococcus aureus infections. REF: Clinical Presentation/Management 3. A child has vesiculopustular lesions around the nose and mouth with areas of honey-colored crusts. The provider notes a few similar lesions on the child’s hands and legs. Which treatment is appropriate for this child? a. Amoxicillin-clavulanate Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Test Bank 2 b. Culture and sensitivity of the lesions c. Sulfamethoxazole-trimethoprim d. Topical antiseptic ointment ANS: A This child has symptoms of impetigo which has spread to the hands and legs. A systemic penicillinase-resistant penicillin is recommended. It is not necessary to obtain a culture since this can be treated empirically in most cases. MRSA is unlikely, so sulfamethoxazole-trimethoprim is not indicated. Oral antibiotics, not topical antiseptics, are the treatment of choice. REF: Clinical Presentation/Management Chapter 48: Contact Dermatitis Test Bank Multiple Choice 1. A child has irritant contact dermatitis with lesions on the extremities and face. Which treatment is recommended for this patient? a. Antihistamines b. Medium- to high-potency topical corticosteroids c. Oral corticosteroids d. Topical calcineurin inhibitors ANS: C When periorbital regions or more than 20% of the body surface area is involved, the use of an oral steroid is appropriate. Antihistamines produce relaxation and improve sleep, but do not reduce the pruritus associated with contact dermatitis. Topical calcineurin inhibitors may be used in place of topical steroids, but oral steroids are indicated in this instance. REF: Management 2. A patient who has been exposed to poison ivy presents with inflammation and a vesicular rash on one arm. The provider recommends a topical steroid, but the next day the patient calls to report similar lesions appearing on the face. What will the provider tell this patient? a. The rash is spreading through self-inoculation. b. The vesicles may continue to develop for up to 2 weeks. c. The rash may spread over the next 8 weeks. d. The patient must have been re-exposed to the irritant. ANS: B Exposure to poison ivy resin results in vesicles and bullae that develop for up to 2 weeks. Once the resin is washed off, no further spread occurs. With insufficient treatment, the rash may persist, but not spread, for up to 8 weeks. REF: Clinical Presentation and Physical Examination Buttaro: Primary Care, A Collaborative Practice, 5th Ed. d. Topical medications will significantly shorten the healing time. ANS: C Topical medications may alleviate discomfort, but do not shorten healing time. Oral antivirals may help shorten healing, but are not necessary as treatment, since the disease is usually self- limiting. Salicylic acid should not be used because it can erode the skin. REF: Primary Herpes Labialis Test Bank 2 Chapter 51: Dermatitis Medicamentosa Test Bank Multiple Choice 1. A patient is taking a sulfonamide antibiotic and develops a rash that begins peeling. Which type of rash is suspected? a. Erythema multiforme b. Stevens-Johnson c. Urticaria d. Wheal and flare ANS: B The Stevens-Johnson syndrome rash typically peels in sheets. Erythema multiforme, urticaria, and wheal and flare rashes do not peel. REF: Complications 2. A child is brought to a clinic with a sudden onset of rash after taking an antibiotic for 2 days. The provider notes all over wheals with pruritis, which the parent reports seem to come and go. Which action is correct? a. Admit the child to the hospital for treatment and observation b. Prescribe an oral antihistamine and follow up in 1 to 2 days c. Reassure the parent that the rash will eventually subside d. Suggest trying cool compresses and tepid baths at home ANS: A Urticarial lesions are pruritic and often ―move.‖ The more sudden and explosive the appearance of the urticaria, the more likely that anaphylaxis may occur, so the child should be hospitalized for treatment and observation. Oral antihistamines, cool compresses, and tepid baths may be used, but the child should not be sent home. REF: Differential Diagnosis 3. Which types of medications are associated with urticarial type rashes? Select all that apply. a. ACE inhibitors b. Erythromycin c. NSAIDs d. Penicillins e. Phenothiazines Buttaro: Primary Care, A Collaborative Practice, 5th Ed. ANS: B, C, D Erythromycin, NSAIDs, and cillins are associated with urticaria. ACE inhibitors tend to cause angioedema. Phenothiazines are associated with photosensitivity. REF: Table 51-1: Skin Reactions Buttaro: Primary Care, A Collaborative Practice, 5th Ed. mmmm Bleach baths and intranasal mupirocin have been shown to reduce bacterial superinfections of the skin. Frequent bathing with soap and water may increase flare-ups and increase the risk for superinfections. Oral and topical antibiotic prophylaxis are not recommended. REF: Complications Test Bank 2 Chapter 54: Fungal Infections (Superficial) Test Bank Multiple Choice 1. Which medication will the provider prescribe as first-line therapy to treat tinea capitis? a. Oral griseofulvin b. Oral ketoconazol c. Topical clotrimazole d. Topical tolnaftate ANS: A Systemic antifungal medications are used for widespread tinea and always with infections that involve the nails or scalp. Oral ketoconazole should be avoided due to risks of hepatotoxicity and serious drug interactions. REF: Dermatophyte Infections/Management 2. When collecting a specimen to determine a diagnosis of tinea corporis, the provider will scrape which portion of the lesion? a. The active, leading border b. The area of central clearing c. The erythematous plaque d. The papular lesions ANS: A The key to a reliable KOH preparation is properly obtaining an adequate specimen by scraping the active, leading border of a lesion. The other areas do not yield a reliable specimen. REF: Dermatophyte Infections/Diagnostics 3. When evaluating scalp lesions in a patient suspected of having tinea capitis, the provider uses a Wood’s lamp and is unable to elicit fluorescence. What is the significance of this finding? a. The patient does not have tinea capitis. b. The patient is less likely to have tinea capitis. c. The patient is positive for tinea capitis. d. The patient may have tinea capitis. ANS: D Buttaro: Primary Care, A Collaborative Practice, 5th Ed. mmmm Although some fungal species causing tinea capitis fluoresce with a Wood’s lamp, Trichophyton tonsurans, the most common cause or tinea capitis, does not fluoresce, so lack of fluorescence does not rule out the infection, make it less likely, or diagnose it. REF: Dermatophyte Infections/Diagnostics Buttaro: Primary Care, A Collaborative Practice, 5th Ed. Chapter 56: Hidradenitis Suppurativa (Acne Inversa) Test Bank Multiple Choice 1. Which medications may be used as part of the treatment for a patient with hidradenitis suppurativa? Select all that apply. a. Chemotherapy b. Erythromycin c. Infliximab d. Isotretinoin e. Prednisone ANS: B, C, D, E Hidradenitis suppurativa is not malignant and chemotherapy is not used. Erythromycin, infliximab, isotretinoin, and prednisone are all used. REF: Hidradenitis Suppurativa/Management 2. A female patient is diagnosed with hidradenitis suppurativa and has multiple areas of swelling, pain, and erythema, along with several abscesses in the right femoral area. When counseling the patient about this disorder, the practitioner will include which information? a. Antibiotic therapy is effective in clearing up the lesions. b. It is often progressive with relapses and permanent scarring. c. The condition is precipitated by depilatories and deodorants. d. The lesions are infective and the disease may be transmitted to others. ANS: B Although lesions may be treated with antibiotics, other medications, and drainage, the disease is often progressive, with relapses and permanent scarring. Deodorants and depilatories are not implicated as a cause. The disease is not transmitted to others, although the organisms may cause other infections in other people. REF: Hidradenitis Suppurativa/Management/Patient Education Buttaro: Primary Care, A Collaborative Practice, 5th Ed. mmmm Chapter 57: Hyperhidrosis Test Bank Multiple Choice 1. A patient is newly diagnosed with hyperhidrosis with excessive sweating on the palms and soles. What will the provider recommend to treat this condition? a. Aluminum chloride hexahydrate b. Liposuction of sweat glands c. Oral anticholinergic agents d. Thoracic endoscopic surgery ANS: A Topical aluminum chloride hexahydrate is used initially for excessive perspiration on hands, feet, and in the axillae. Liposuction is performed on axillary glands. Oral anticholinergics may be used, but the initial treatment is the topical preparation. Thoracic endoscopic surgery may be used if other treatments fail. REF: Management 2. A patient has excessive sweating of the palms, soles, and axillae. The provider understands that this presentation is often due to which cause? a. Anxiety b. Hormones c. Hypoglycemia d. Medications ANS: A Localized excessive sweating is usually due to anxiety, heat, or is idiopathic, while more generalized excessive sweating may be due to underlying conditions. REF: Clinical Presentation 3. A patient reports generalized excessive sweating and states that night sweats are present. Which diagnostic test is a priority for this patient to determine the underlying cause? a. Blood pressure evaluation b. Fasting blood glucose c. Purified protein derivative test d. Thyroid function tests ANS: C Buttaro: Primary Care, A Collaborative Practice, 5th Ed. When night sweats are present, a PPD is done to exclude tuberculosis. Blood pressure evaluation is performed if pheochromocytoma is suspected. Fasting blood glucose and thyroid testing will be performed to exclude thyroid disease and diabetes. Since night sweats are common with TB, this test has priority. REF: Physical Examination/Diagnostics and Differential Diagnosis