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NURS 6501 ADVANCED PATHOPHYSIOLOGY WALDEN UNIVERSITY MIDTERM EXAM ACTUAL EXAM AND PRACTICE EXAM TEST BANK ACCURATE AND VERIFIED QUESTIONS WITH DETAILED ANSWERS GRADED A.pdf
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Mr. Wayne is a 42-year-old male who has hypertension and was recently diagnosed with mixed hyperlipidemia. He has been trying lifestyle changes for three months and his medications include lisinopril 10mg daily and one multivitamin daily. He comes into the office today to review his labs. His BP is 130/80, HR 90, BMI 34.8. His exam is unremarkable except for mild non-pitting edema to the ankles bilaterally. The nurse practitioner knows that, as part of the metabolic derangement, which of the following conditions is often observed in the early stages of development of Type 2 Diabetes Mellitus and often before abnormalities in the blood glucose are seen? A. Hyperlipidemia B. Retinopathy C. Atherosclerosis D - ANSWER✔✔Hyperlipidemia A 36 year old female presents to the clinic with a history of fatigue for the past few months. She admits to mild constipation that is not troublesome for her. She reports a 5 lb weight gain over the past 6 months, which she attributes to living a more sedentary life due to her fatigue. Her thyroid does not seem enlarged, although her face is slightly puffy. The remainder of her exam is unremarkable. The nurse
practitioner orders thyroid function studies, which show an elevated Thyroid Stimulating Hormone (TSH). What is the most likely diagnosis? A. Grave's disease B. Addison's disease C. D. Hypothyroidism - ANSWER✔✔Hypothyroidism Mrs. Patterson, a 62-year-old female, presents to the clinic to review lab results. Her only complaint is fatigue. Which two laboratory results would lead the Nurse Practitioner to suspect primary hyperparathyroidism? A. Hypercalcemia and hypophosphatemia B. Elevated Vitamin D level and Hypocalcemia C. D. Hyperkalemia and hypophosphatemia - ANSWER✔✔A. Hypercalcemia and hypophosphetemia A 55-year-old male had a fasting blood glucose level of 160 mg/dL 1 month ago. Today, his fasting glucose level is 140 mg/dL. He has a history of HTN that is controlled with an ACE inhibitor. He has no other medical problems. He is 5'11" and weighs 215 lbs. His father had DM, but the family history is otherwise noncontributory. This patient is asymptomatic, and his physical examination is unremarkable. What is the most likely diagnosis? A. Maturity Onset Diabetes of the Young (MODY)
B. Addison's disease C. D. Cushing's syndrome - ANSWER✔✔C. type 2 diabetes A 13-year-old male has been drinking large quantities of fluids and has an insatiable appetite, even for a teenager. However, he is losing weight and has become more tired and listless over the past month. A complete blood count is normal, but he is found to have a fasting serum glucose of 175 mg/dL. A diagnosis of type 1 diabetes is made. What is the probable inheritance pattern of his underlying disease? A. Autosomal dominant B. C. X-linked recessive D. Autosomal recessive - ANSWER✔✔B. Multifactorial Ms. Jackson, a 45 y/o female, complains of fatigue, weight gain, lack of concentration, and swelling for almost one year. The Nurse Practitioner thinks the patient could have hypothyroidism based on her clinical presentation. Which lab values would help to confirm Ms. Jackson's diagnosis of hypothyroidism? A. B. Increased TSH and increased T C. Decreased TSH and increased total T D. Decreased TSH and decreased free T4 - ANSWER✔✔A. increased tsh and decreased free t
Mr. Mann, age 50, presents to the Emergency Department with his wife for complaints of palpitations, feeling of panic with shakiness, headache, nausea for the past two hours. Upon arrival BP is 210/105. His medical history is significant for GERD and HTN. He takes Prilosec OTC daily and lisinopril 10mg daily. He has no known medication allergies. His family history includes HTN and cardiovascular disease in father, osteoporosis, anxiety, and HTN in mother, and breast cancer in only sister. His wife states the patient did this a couple of weeks ago on two different occasions, but the symptoms went away in just one or two minutes. His physical exam reveals mild diaphoresis, epigastric tenderness, and generalized trembling. What diagnosis does this patient's presentation most closely represent? A. Myxedema Coma B. Addison's Disease C. Thyrotoxicosis D. - ANSWER✔✔D. pheochromocytoma A 72-year-old male is brought to the ED in a coma. He was delivered to the ED from a nursing home and was reported by the nursing home staff to have had a seizure that lasted less than 1 minute. He was subsequently confused and soon thereafter entered a comatose state. His medical history is significant for Type II DM requiring insulin, HTN, and mild CHF. In the ED, the patient is very lethargic and responds only to painful stimuli. His vital signs are stable. The list of differential diagnoses that can cause seizure and coma. What is the most important diagnostic study to do immediately? A. Serum toxicology B. CT head without contrast
C. CT head with contrast D. - ANSWER✔✔D. serum glucose A 2-year-old child who recently immigrated to the United States has failure to thrive. The child is short, with course facial features, a protruding tongue, and an umbilical hernia. Profound mental retardation is apparent as the child matures. These findings are best explained by a lack of: A. Somatostatin B. Cortisol C D. Norepinephrine - ANSWER✔✔C. thyroxine A 36-year-old female presents to the clinic with a history of fatigue for the past few months. She does not have any other complaints. After a thorough medical history, she admits to mild constipation that is not troublesome for her. She reports a 5 lb weight gain over the past 6 months, which she attributes to living a more sedentary life of late due to her fatigue and lethargy. Her physical examination is unremarkable; her thyroid does not seem enlarged, although her face is slightly puffy. You order thyroid function studies, which show an elevated Thyroid Stimulating Hormone (TSH). What is the diagnosis? A. B. Grave's disease C. Addison's Disease D. Cushing's syndrome - ANSWER✔✔A. Hashimoto's thyroiditis
A 35-year-old female brings her 13-year-old son to the clinic reporting that he has developed some strange behaviors. She reports he cannot leave the house to go to school each morning without reorganizing his bookshelf and brushes his teeth 3 times before bed. She also expresses frustration that if daily plans change, he becomes tearful and hostile. You suspect that this child may have: A. post-traumatic stress disorder B C. depression D. social anxiety disorder - ANSWER✔✔B. OCD A 45-year-old male presents to the clinic with a chief complaint of a daily chronic, episodic headache for the past 7 weeks. He reports that he has been experiencing insomnia due to the symptoms which are waking him up at night. He reports that they last anywhere from 15 minutes to 3 hours. What is the most likely diagnosis? A. brain tumor B. migraine headache C. tension headache D. - ANSWER✔✔D A 44-year-old male injection drug user is admitted with a 1 day history of increasing headache and high fever. Head computed tomography (CT) does not reveal a mass lesion or midline shift. A lumbar puncture
is performed; the cerebral spinal fluid (CSF) protein concentration is increased, but the glucose level is decreased. Which of the following infectious agents is most likely to account for these findings? A. Mycobacterium B. C. Toxoplasma gondii D. Herpes simplex virus - ANSWER✔✔B A 66-year-old female presents after a transient episode of visual loss in her right eye. She reports that she had right sided headaches for several months, for which she takes ibuprofen, with some relief. On physical examination, she has tenderness over her scalp in the left temporal region and complains that her jaw "get tired with chewing." Neurological examination is normal with no focal deficits. Vital signs are as follows: temperature=101.1, pulse=72, RR=16, BP=140/82. What is the most likely diagnosis? A. B. Migraine headache C. Tension headache D. Cluster headache - ANSWER✔✔A A 4-year-old girl has been irritable for the past 2 days. She has not received her vaccinations. She has a temperature of 39.1 C. A lumbar puncture is performed, and the CSF shows numerous neutrophils, a slightly increased protein level, and a decreased glucose concentration. A gram stain of the CSF is most likely to show:
A. L. Monocytogenes B. N. meningitis C. D. S. pyogenes - ANSWER✔✔C A 26-year-old woman is examined by a neurologist for decreased vision in her left eye. Clinical history reveals an episode of weakness several months earlier, which she attributed to job stress and fatigue. The neurological examination reveals mild residual weakness in her right lower extremity. The spinal fluid tap reveals increased IgG levels with prominent oligoclonal bands in the CSF. A brain MRI scan reveal small, scattered, o.5 cm areas consistent with demyelination, mostly located in periventricular white matter. What should the nurse practitioner tell the patient? A. B. No further neurological problems will be experienced C. This disease can be passed on to children D. Further debilitation and death will occur within 5 years - ANSWER✔✔A A previously healthy nurse practitioner student has headaches for several weeks. She has increasing malaise. A head CT scan shows no abnormalities. A lumbar puncture yields clear, colorless CSF with normal glucose and minimally elevated protein levels. A few lymphocytes are present, but no neutrophils. A CSF gram stain is negative as is the India ink preparation. Her condition gradually improves over the next several months. Serum serologic test are most likely to reveal an elevated titer of antibodies to:
A. Toxoplasma gondii B. C. Listeria monocytogenes D. Neisseria meningitis - ANSWER✔✔B A 35-year-old female has been experiencing muscular weakness for several weeks. When she drives her automobile for long distances, she notices difficulty keeping her eyes open because her eyelids droop, and she experiences double vision. While working at her job as a secretary, these problems get worse as the day progresses. Which of the following laboratory test findings is most likely to be present in this patient? A. Increased serum creatine kinase level B. Elevated serum antinuclear antibody level C. D. Increased cerebrospinal fluid IgG protein concentration - ANSWER✔✔C A 40-year-old man complains to the nurse practitioner of severe stabbing pains behind his left eye for the past two days. They are accompanied by some nasal congestion and rhinorrhea, which is clear in color. The patient denies pharyngitis and fever. Which of the following conditions is most likely? A. Migraine headache with aura B. Cranial neuralgia C. Tic douloureux
After falling in the bathtub and striking her head, a 78-year-old female becomes increasingly somnolent. A day later, a head computed tomography (CT) scan demonstrates an accumulation of fluid beneath the dura, compressing the left cerebral hemisphere. What is the best term for this fluid collection? A. Hematoma B. Petechia C. Hematuria D. Ecchymosis - ANSWER✔✔A A 35 year old American Indian male presents to the clinic today complaining of abdominal pain in the RUQ that has persisted for over 24 hours. After running some tests, the patient is diagnosed with cholelithiasis. Based on what you know about the formation of gallstones, what would you expect to be the pathology behind this diagnosis? A.Decreased muscular wall motility B.Chronic inflammation of the gallbladder C.Presence of a foreign body D.Excessive bile that is saturated with cholesterol - ANSWER✔✔D.
A 4-year-old child appears listless for the last week. He complains of pain when he is picked up by his mother, and he is irritable when touching his arms or legs. Several large ecchymotic lesions have appeared on his right thigh and left shoulder. A complete blood count reveals a HgB=10.2, Hct=30.5%, MCV=96fL, platelet count of 45,000/ML, and WBC count of 13,990/ML. Examination of the peripheral blood smear reveals numerous blasts. The blasts lack peroxidase-positive granules but do contain periodic acid-Schiff (PAS)-positive aggregates and stain positively for TdT. Flow cytometry shows the phenotype of blasts to be CD19+, CD3-, and sIg-. What is the most likely diagnosis? A. Acute lymphoblastic leukemia (ALL) B. Chronic lymphocytic leukemia (CLL) C. Acute myelogenous leukemia (AML) D. Chronic myelogenous leukemia (CML) - ANSWER✔✔Acute lymphblastic leukemia A 3-year-old child of Italian ancestry presents with failure to thrive. Physical examination indicates hepatosplenomegaly. His hemoglobin concentration is 6 g/dL, and the peripheral blood smear reveals severely hypochromic microcytic red cells. Total serum iron level is normal. The reticulocyte count is 10%. Hemoglobin electrophoresis shows very little hemoglobin A. A radiograph of the skull shows maxillofacial deformities. What is the principle cause of anemia and other abnormalities in this patient? A. Reduced synthesis of hemoglobin F B. Reduced red blood cell survival from imbalance in the production of alpha and beta globin chains
C. Relative deficiency of vitamin B D. Increased fragility of the erythrocyte membrane - ANSWER✔✔Reduced synthesis of hemoglobin F A 68-year-old previously healthy female has been feeling increasingly tired and weak for several months. She states that she has had black, tarry stools for several weeks. She is found to be anemic with a hemoglobin concentration of 9.3g/dL. The peripheral blood smear reveals microcytic and hypochromic blood cells. Which of the following conditions should be suspected as the most likely of her condition as indicated by the peripheral blood smear? A. Aplastic anemia B. Beta thalassemia C. Gastrointestinal blood loss D. Pernicious anemia - ANSWER✔✔Gastrointestinal blood loss A 76-year-old female notices that small, pinpoint to blotchy areas of superficial hemorrhage have appeared on her gums and on the skin of her arms and legs over several weeks. She is found to have a normal prothrombin time(PT) and partial thromboplastin time (PTT). Her CBC shows hemoglobin concentration of 12.7 g/dL, hematocrit of 37.2%. MCV of 80 fL/red cell, platelet count of 276,000/microliter, and WBC of 5600/microliter. Her template bleeding time is 3 minutes. Her fibrinogen level is normal, and there are no fibrin split products detectable. Which of the following conditions best explain these findings?
A. Chronic renal failure B. Macronodular cirrhosis C. Vitamin B12 deficiency D. Vitamin C deficiency - ANSWER✔✔Vitamin C deficiency A young adult patient has just been diagnosed with Von Willebrand disease. Which of the following statements should you make to advise the patient of potential consequences of this disease? A. You may need an allogeneic bone marrow transplant B. You may have excessive bleeding following tooth extraction C. A splenectomy may be necessary to control the disease D. Expect increasing difficulties with joint mobility - ANSWER✔✔You may have excessive bleeding following tooth extraction Low dose aspirin is commonly used to reduce the risk of arterial thrombosis in patients who have suffered a myocardial infarction. Which one of the following steps in homeostasis is inhibited by aspirin? A. Synthesis of von Willebrand factor B. Aggregation of platelets C. Activation of factor Xa
D. Synthesis of antithrombin III - ANSWER✔✔Aggregation of platelets A 24-year-old presents to the office with fatigue. On physical exam, the NP notices that she ispale with the following vital signs: HR 112, BP 98/64, resp 20, O2 sats 99%. Her CBC shows: WBC6,000, Hemoglobin 9.6, Hematocrit 30.2, MCV is decreased at 76. What is the mostly likely causeof this patient's anemia? A. Iron deficiency anemia caused by menstruation B. Beta Thalassemia of genetic origin C. Pernicious anemia caused by dietary deficiency D. Folate deficiency caused by alcoholism - ANSWER✔✔Iron deficiency anemia caused by menstruation A 65-year-old female presents to your office complaining of fatigue. She has a long of rheumatoid arthritis. A CBC reveals the following: Hgb=11.6 g/dL, Hct=34.8%, MCV=87 fL/red cell, platelet count of 268,000/microliter, and WBC count of 6800/microliter. The serum haptoglobin level is normal, and the serum iron concentration is 20 micrograms/dL. The total iron binding capacity is 195 micrograms/dL, and the percent saturation is 10.2. The serum ferritin concentration is 317 ng/mL. No fibrin split products are detected. The reticulocyte concentration is 1.1%. What is the most likely diagnosis? A. Beta- thalassemia major B. Anemia of chronic disease
C. Acute blood loss anemia D. Iron deficiency anemia - ANSWER✔✔Anemia of chronic disease A 14-year-old male presents with high fever for ten days. Physical examination reveals scattered petechial hemorrhages but is negative for enlargement of the liver or spleen or lymph nodes. Bone marrow examination does not show any abnormal cells. The complete blood count (CBC) demonstrates a hemoglobin concentration (HgB) of 13.2 g/dL, hematocrit (Hct) of 38.9%, mean cell volume (MCV) of 93 fL, platelet count of 175,000/microliter, and white blood cell (WBC) count of 1850/microliter, with the differential count showing 1 segmented neutrophil, 98 lymphocytes, and 1 monocyte per 100 WBCs. What is the most likely cause of these findings? A. Overwhelming bacterial infection B. Acute lymphocytic (or lymphoblastic) leukemia C. Acute myeloid leukemia D. Aplastic anemia - ANSWER✔✔Overwhelming bacterial infection A 31-year-old male has a history of chronic anemia and painful crises with joint and abdominal pain. A head computed tomography (CT) scan reveals several small remote infarctions. During one of these acute crises, he is admitted with severe dyspnea. A CBC is performed. Which of the following morphologic findings for RBCs is most likely to be seen on the peripheral blood smear?
A. Tear drop cells B. Schistocytes C. Sickle cells D. Spherocytes - ANSWER✔✔Sickle cells A 50-year-old male has a blood pressure of 160/95 mm Hg. If this condition remains untreated for years, which of the following cardiovascular alterations will be seen on a transthoracic echocardiogram and ECG? A. Left Ventricular Hypertrophy B. Left Ventricular Atrophy C. Left Atrial Atrophy D. Right Ventricular Hypertrophy - ANSWER✔✔Left ventricular hypertrophy A 65-year-old male with longstanding uncontrolled HTN presents to the office for evaluation of syncope. His vital signs are temperature=98.3, Pulse=85, RR=17, BP=165/85. Physical examination reveals a fourth heart sound and a 4/6 crescendo-decrescendo murmur heard at the right upper sternal border with radiation to the carotid arteries. His ECG reveals enlarged QRS waves, consistent with left ventricular hypertrophy. What is the most likely cause of his syncopal episodes? A. Mitral regurgitation
B. Mitral Stenosis C. Aortic regurgitation D. Aortic stenosis - ANSWER✔✔Aortic stenosis A 63-year-old female presents to the emergency room with sudden onset of severe chest and back pain. She describes the pain as sharp and different from her anginal pain. Her past medical history is positive for HTN X 20 years. VS: HR 105, BP 160/105, RR 17. On physical examination, the NP notices that her pedal and radial pulses are not equal. What is the most likely cause of her chest pain? A. Unstable angina B. Aortic dissection C. Prinzmetal angina D. Acute myocardial infarction - ANSWER✔✔Aortic dissection A 45-year-old male collapsed suddenly while playing basketball. Bystander CPR and defibrillation was performed using an automatic external defibrillator or AED. When EMS arrived, the gentleman was awake and alert. The recorded rhythm strip on the AED shows tachycardia with AV dissociation (rate, approximately 220 bpm). Which arrhythmia induced his arrest? A. Nonsustained supraventricular tachycardia B. Sustained wide complex atrial tachycardia
C. Wide complex ventricular tachycardia D. Narrow complex ventricular tachycardia - ANSWER✔✔Wide complex tachycardia A 44-year-old previously healthy male presents to the office complaining of increasing dyspnea on exertion and exercise intolerance over the last six months. The NP order a chest XRAY and transthoracic echocardiogram. The chest XRAY shows an enlarged heart and mild pulmonary edema. The echocardiogram reveals four-chamber cardiac dilation with an ejection fraction of 30% and mitral and tricuspid valve regurgitation. The patient is referred to the cardiologist who orders a CAT scan of the coronary arteries which is negative for obstructive coronary artery disease. What is the most likely underlying cause of the dyspnea? A. Idiopathic dilated cardiomyopathy B. Rheumatic heart disease C. Hemochromatosis D. Chagas disease - ANSWER✔✔Idiopathic dilated cardiomyopathy A 72-year-old female with a known cardiac history of coronary artery disease presents to the emergency room following a syncopal episode. She received a stent to the right coronary artery in 2017 and was noted to have an ejection fraction of 40% at that time. A 12 lead ECG reveals a regular rhythm with a rate of 35. What is the most likely cause of her bradycardia?
A. Blocked pathway at or below the AV node B. Blocked pathway at or below the SA node C. Reentry pathway at or near the SA node D. Reentry pathway at or near the AV node - ANSWER✔✔Blocked pathway at or below the AV node A 43-year-old female is ten years post prosthetic aortic valve replacement secondary to infective endocarditis. Which of the following valvular conditions would be an expected finding? A. Paravalvular leak B. Aortic stenosis C. Aortic valve embolization D. Aortic regurgitation - ANSWER✔✔Aortic stenosis A 50-year-old male is admitted an acute myocardial infarction. His ejection fraction is noted to be 30%. He develops shortness of breath and his physical exam reveals crackles bilaterally. The bedside CXR indicates pulmonary edema. Which of the following best describes the pathological cause of the edema? A. Increased hydrostatic pressure B. Decreased plasma osmotic pressure C. Increased cardiac output
D. Decreased central venous pressure - ANSWER✔✔Increased hydrostatic pressure The direction of blood flow and the clinical severity of symptoms in Tetralogy of Fallot is determined primarily by the: A. Presence of an atrial septal defect B. Diameter of the tricuspid valve C. Size of the left ventricle D. Degree of pulmonary stenosis - ANSWER✔✔Degree of Pulmonary stenosis A 36-year-old female presents to the ED with the chief complaint of acute SOB and anxiety that started suddenly 2 to 3 hours ago while she was working around the house. She denies chest pain. Her PMH is unremarkable. She takes oral contraceptives, but no other medications. Vital signs are temperature=99.1, RR=34, BP=148/90, pulse=100. Oxygen saturation is 94% on room air. Laboratory tests reveal WBC=7.1, Hgb=12.2, Hct=37.3, Na+=138, K+=4.7, Cl=109, HCO3=25, BUN=14, Cr=0.9, glucose=106. ABGs are obtained and reveal pH=7.52, HCO3=20, PaCO2=26, PaO2=70. CXR and ECG are normal. What type of acid base disorder does the patient suffer from? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis
D. Metabolic acidosis - ANSWER✔✔Respiratory alkalosis A 65-year-old male is brought for care by his wife because of headache, nausea, and fatigue. PMH is significant for small cell carcinoma of the lung diagnosed approximately 2 years ago. He also has a history of TIA (6 years ago) and mild CHF. Vital signs are as follow: temperature=99.8F, RR=18, BP=140/88, pulse=76. On examination, he is awake but somewhat lethargic. Physical examination is unremarkable. Laboratory tests reveal the following: WBC=8.3, Hgb/Hct=10.2/30.7, glucose=106, serum Na+=121 mEq/L, K+=4.3, BUN/Cr= 7.0/0.4. What is the most likely diagnosis? A. Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) B. Diabetic ketoacidosis C. Diabetes Insipidus D. Compensated diastolic congestive heart failure - ANSWER✔✔SIADH Leo is a 40-year-old male who presents to the clinic with complaints of shortness of breath while doing yard work. He states he has had worsening of the shortness of breath throughout the summer. He states when he was younger, he had shortness of breath and coughed a lot at night. He was given an inhaler for a few years, but he hasn't had any trouble since he was about nine years old. Which findings are most suggestive of a diagnosis of asthma? A. Dry cough during exam, respiratory rate of 20 breaths/minute, and wheezing upon auscultation of posterior lower lung lobes.
B. Dry cough noted during the exam, Sp02=96%, FEV1 <80% predicted, and FEV1 increased 15% after administration of a short-acting bronchodilator. C. Bilateral wheezing noted on auscultation, Sp02=95%, and heart rate of 86 D. Pale, boggy nasal turbinates, dry cough, FEV1 <80% predicted and FEV1 increased 5% after administration of a short-acting broncho - ANSWER✔✔Dry cough noted during exam, Sp02=96%, FEV1 <80% predicted, and FEV1 increased 15% after administration of short acting bronchodilator. Which of the following symptoms is generally NOT considered a typical finding in someone with active tuberculosis infection? A. Weight loss B. Fever in the morning C. Night sweats D. Hemoptysis - ANSWER✔✔Fever in the morning A 43-year-old female presents to the clinic with a 2-day history of cough and fever. She states that she has felt tired for the past couple of weeks. Past medical history is unremarkable. On physical examination, she appears ill and has a persistent cough, productive of purulent sputum. She has crackles in her right posterior chest. BP=126/74, pulse=80, RR=24, temperature 102.2. WBC count is 14,000/mm3. What diagnostic test should be done first?
A. Sputum culture B. CT chest C. Bronchoscopy D. Chest Xray - ANSWER✔✔Chest X-RAY Which of the following findings is expected with restrictive lung disease? A. Decreased expansion of the lung B. Increased lung tissue compliance C. Over inflation of the lung alveoli D. Increased lung volumes - ANSWER✔✔Decreased expansion of the lung A 55-year-old female presents to the clinic because she is "sick and tired" of this cough she has had for 5 years, and it is getting worse. The cough is often productive of watery mucus. She complains of worsening dyspnea on exertion and cannot climb a flight of stairs without taking a rest. She denies chest pain, paroxysmal nocturnal dyspnea, fevers, chills, and weight loss. PMH is significant for HTN and a 35 pack-year history of cigarette smoking. Vital signs are as follow: temperature=99.0, pulse=75, RR=21, BP=158/82. Physical examination reveals an obese woman in no acute distress. On lung auscultation, there are coarse breath sounds bilaterally, but no wheezes or crackles. Chest radiograph is significant for a flattened diaphragm. What is the most likely diagnosis?
B. Asthma C. Cor Pulmonale D. Bronchitis - ANSWER✔✔COPD Two weeks after an 80-year-old female with Staphylococcus aureus pneumonia received a course of antibiotic therapy she returns to the clinic complaining of ongoing fever. She states the productive cough has resolved. A chest radiograph reveals a 3 cm, rounded density in the right lower lobe whose liquefied contents form a central air-fluid level. There are no surrounding infiltrates. What is the most likely cause of the chest Xray results? A. Abscess formation B. Recurrent pneumonia C. Pulmonary fibrosis D. Development of COPD - ANSWER✔✔Abscess formation A 66-year-old male is brought to the clinic with complaining of productive cough, fever, and chills for the past 2 days. The patient lives with his wife and is retired. PMH is significant for DM, for which he takes insulin; CHF, with an ejection fraction of 40%; and a history of renal insufficiency. He is alert and oriented. There is no history of smoking or alcohol use. On physical examination, he has crackles in the left lower lung. Cardiovascular examination is normal. Vital signs are temperature=103.3, BP=130/64,
Pulse=128, RR=24. Oxygen saturation on room air is 97%. CXR shows infiltrates and consolidation in the left lower lobe of the lung. Laboratory test results show WBC=15, Hct=36, Na=142, glucose=167, BUN=36, Cr=1.5. What is the most likely diagnosis? A. Asthma B. Bronchitis C. Hospital acquired pneumonia D. Community acquired pneumonia - ANSWER✔✔Community acquired pneumonia A 70-year-old male has undergone an open cholecystectomy. Aggressive pulmonary toileting is necessary in the post-operative period because older adults have: A. Decreased residual capacity B. Increased vital capacity C. Increased alveolar surface area D. Decreased chest wall compliance - ANSWER✔✔Decreased chest wall compliance Which of the following elevated lab values on a CBC would indicate Macrocytosis? A. Mean corpuscular volume