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A patient with a family history of amyotrophic lateral sclerosis (ALS) begins to have symptoms that include asymmetric weakness in the arms and difficulty walking. The neurologist recognizes these symptoms as characteristic of involvement of which portion of the nervous system? Lower motor neurons The spouse of a patient newly diagnosed with amyotrophic lateral sclerosis (ALS) asks about long-term care. What will the provider include when teaching the family about this disease? Preventing malnutrition is a key element in care. Which symptoms may occur with Bell's palsy? Select all that apply. Alteration in taste, Drooling, Tinnitus Exclusively breastfed infant starting solids… Iron supplementation 1 mg/kg/day. Sickle cell with fever and cough… Immediate ED evaluation; rule out sepsis/pneumonia. ITP with platelets 60,000… Observe; no activity restrictions unless <20 K. Lead elevation—follow-up? Environmental remediation + repeat testing. Older adult pruritus without skin findings… Order CBC, CMP, thyroid panel. Polymyalgia rheumatica initial dose… Prednisone 60 mg daily if giant-cell arteritis suspected. Bilateral shoulder pain with stiffness… Order ESR and CRP. Prolonged aPTT, normal PT… Factor VIII or IX deficiency. Macrocytic anemia with beefy tongue … Low Hgb, elevated MCV (B12 deficiency). Cancer patient with back pain, neurologic signs… Start steroids—suspect spinal cord compression. Implanted radioactive isotope… Brachytherapy. Reluctant to take opioids… Add stool softener and counseling; reassure about tolerance. Palpitations, Afib 120 bpm… Rate control—beta blocker. Suspect pheochromocytoma… Order plasma metanephrines. Erectile dysfunction + cardiovascular evaluation… Evaluate for CAD prior to PDE-5 inhibitor. A nurse plans to perform a painful procedure on an infant — what additional comfort method is evidence- based? Non-nutritive sucking and oral sucrose are evidence-based for neonatal pain relief. What is the benefit of early palliative care discussions in chronic illness management? Early palliative care promotes wellness, quality of life, and dignity by addressing physical, psychological, and spiritual needs —improving outcomes and satisfaction. What is the first priority in a bioterrorism event? protect self and prevent further exposure (remove clothing, irrigate skin 15–30 min). Safety and containment come before diagnosis or treatment
How do you interpret delayed hand preference in a 9-month-old infant? Persistent unilateral hand preference before 12 months suggests possible motor deficit (e.g., hemiparesis); needs full neuro and developmental evaluation What defines dermoscopy and what can it reveal during a skin exam? Dermoscopy is a non-invasive magnified light examination that reveals pigment pattern, vascular structures, and border regularity to differentiate benign vs malignant lesions. What is the difference in radiation types — brachytherapy vs external beam? Brachytherapy = radioactive source placed inside/near tumor; external beam = radiation delivered from outside the body. Brachytherapy limits exposure to surrounding tissue A 30-month-old with sickle cell has received one pneumococcal vaccine — what is the next preventive step? Give PPSV23 ≥ 8 weeks after PCV13 and ensure prophylactic penicillin until age 5; continue annual influenza vaccine. What is the definition of ulcerative skin reaction post-antibiotic — how to differentiate Stevens-Johnson? Stevens-Johnson presents with mucosal involvement and <10 % BSA detachment following drug exposure (e.g., sulfa, anticonvulsants) What clinical signs would lead to diagnosis of endometrial cancer in postmenopausal women? Postmenopausal vaginal bleeding, obesity, hypertension, and nulliparity are hallmark indicators requiring biopsy What is the treatment of dyspareunia caused by endometriosis? Combined oral contraceptives (COCs) — continuous or cyclic use to suppress ovulation and reduce pelvic inflammation. Which vasculitis has small vessel involvement and rash? Henoch–Schönlein Purpura (IgA vasculitis): palpable purpura on lower extremities, joint pain, abdominal pain. What causes dysmenorrhea in young women? Prostaglandin-mediated uterine contractions lead to cramping; NSAIDs are first-line therapy A 17-year-old reports past assault — what reporting is mandated? Providers are mandated reporters for minors; must report sexual assault or abuse per state law, ensure safety, and provide trauma-informed care What therapy is first-line for fibromyalgia with point tenderness? Aerobic exercise, sleep hygiene, and low- dose amitriptyline or SNRIs (duloxetine) for symptom relief A patient with ADHD who worsens on stimulant meds — what should be evaluated? Reassess for comorbid anxiety, sleep disorder, or substance use; consider dose-related irritability or need for non-stimulant A patient has fluctuating neck mass for weeks — what is the best diagnostic next step? Ultrasound of neck soft tissue to differentiate cystic vs solid lesion before biopsy A 35-year-old patient reports suddenly experiencing an asymmetric smile along with drooping and tearing in one eye. The patient has a history of a recent viral illness but is otherwise healthy. During the exam, the provider notes that there is unilateral full-face paralysis on the right side. What is the initial intervention for this patient? Prescribe oral prednisolone. What is recommended to prevent ophthalmic complications in patients with Bell's palsy? Lubricating eye drops
A patient reports paroxysms of burning, shock-like pain on both sides of the face usually triggered by chewing or talking. The provider suspects trigeminal neuralgia. Based on these presenting symptoms, what testing is indicated? Magnetic resonance imaging A patient with trigeminal neuralgia has tried several medication regimens to control pain without success. What is the next step in management for this condition? Referral to a neurosurgeon A patient is diagnosed with trigeminal neuralgia and reports having paroxysms several times each day. What is the initial treatment for this patient? A high dose of carbamazepine with subsequent titration downward A patient develops a gait disorder and the patient's spouse reports noticing recent personality changes. The provider suspects a brain lesion. Which evaluation is especially important in the initial physical examination? Examination of the optic fundi Which is the preferred treatment for primary brain tumors? Surgical resection A patient is diagnosed with panic disorder and begins taking a selective serotonin reuptake inhibitor medication. Six weeks later, the patient reports little relief from symptoms. What will the provider do next to manage this patient? Refer to a mental health provider. Which medication are useful in treating both obsessive-compulsive disorder and PTSD? Select all that apply. Selective serotonin reuptake inhibitors/Serotonin-norepinephrine reuptake inhibitors/Tricyclic antidepressants A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider determines that these symptoms occur in relation to many events and concerns. What other things will the provider question this patient about? Headaches and bowel habits A patient is seen in clinic 2 weeks after the death of a parent. The patient reports feelings of sadness and hopelessness and a feeling that the parent is still present, even to the point of hearing the parent's voice at times. What will the provider determine from these findings? These are normal grief responses. A college student is brought to clinic by a parent who is concerned about increasingly bizarre behavior and poor school performance. The provider notes difficulty engaging the patient in an organized conversation. The patient denies any concerns about behavior. What will the provider do initially to manage this patient's symptoms? Begin treatment with lithium or lamotrigine. A patient is seen frequently over a 9-month period with somatic complaints that are not related to physical disease. The primary provider notes that the patient has had a 15% weight loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the provider that the patient seems tired all the time and is irritable with other family members. What will the provider do initially? Perform a suicide risk assessment. A patient is brought to the emergency department who is experiencing disorientation, confusion, and fever. The patient describes visual and auditory hallucinations. The patient's spouse states that the patient had several drinks 12 hours prior to passing out. A blood alcohol level is 0.2%. What is the recommended treatment? Benzodiazepines A college student is brought to the emergency department by a roommate who is concerned about symptoms of extreme restlessness, nausea, and vomiting. The provider notes elevations of the pulse and blood pressure and pupillary dilation, along with hyperactive bowel sounds. The provider suspects withdrawal from which substance? Opioids
A 17-year-old male is brought to the clinic by a parent who is concerned that the patient has become more isolated and withdrawn and expresses suspicions that his teachers hate him and want him to fail. What will the provider tell this parent? The adolescent should be evaluated by a psychiatrist. A young male patient is reported to be more withdrawn from his peers than usual and has dropped out of college and quit his job within the last 5 months. The parent is concerned that the patient may have schizophrenia because a maternal uncle has the disease. What will the provider do next? Ask about the patient's speech and thinking patterns. Which are considered "negative" symptoms of schizophrenia? Select all that apply. Impaired self-care Poor school performance, Withdrawing from peers. When prescribing medications to an 80-year-old patient, the provider will consult the Beers list to help identify potentially problematic drugs. 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? Obtain a CBC, serum electrolytes, BUN, and glucose. The practitioner is establishing a plan for routine health maintenance for a new female client who is 80 years old. The client has never smoked and has been in good health. What will the practitioner include in routine care for this patient? Pneumovax vaccine if not previously given/ Yearly influenza vaccine. A previously healthy 30-year-old patient is brought to the emergency department with signs of stroke. Diagnostic testing determines an ongoing ischemic cause. The patient's spouse reports that symptoms began approximately 2 hours prior to transport. What is the recommended treatment? Tissue plasminogen activator (tPA) administration An elderly patient is brought to the emergency department after being found on the floor after a fall. The patient has unilateral sagging of the face, marked slurring of the speech, and paralysis on one side of the body. The patient's blood pressure is 220/190 mm Hg. What is the likely treatment for this patient? Neurosurgical consultation A patient exhibits visual field defect, ataxia, and dysarthria and complains of a mild headache. A family member reports that the symptoms began several hours prior. An examination reveals normal range of motion of the neck. What type of cerebrovascular event is most likely? Ischemic stroke A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient's symptoms? Lewy body dementia A patient with Alzheimer's disease (AD) is taking donepezil to treat cognitive symptoms. The patient's son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? Encourage activity and exercise. An elderly patient has symptoms of depression and the patient's daughter asks about possible Alzheimer's disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? Prescribe a trial of an antidepressant medication.
A patient is in the induction phase of chemotherapy just after diagnosis of cancer. Which prophylactic measures will help prevent tumor lysis syndrome? Select all that apply. Initiation of allopurinol Intravenous fluids of 3000 mL/day Rasburicase administration A patient is determined to have an unknown primary carcinoma after a metastatic lesion is found in the lymph nodes. A blood test reveals that the patient has microcytic anemia. Which diagnostic test will the provider consider next to help determine the primary tumor? Endoscopic evaluation of the upper and lower GI tract A female patient is diagnosed with unknown primary carcinoma (UPC) after a metastatic squamous cell carcinoma is found. She asks the provider for an estimate about survival. What is the median survival rate for this type of UPC? 24 months A woman has carcinomas confined to axillary nodes. A mammogram is normal. What is the next step in managing this patient? Evaluate HER-2 and estrogen and progesterone receptors. A patient with cancer is expected to require long-term pain medication to manage cancer pain. Which agent will be best for this patient? Morphine A patient with breast cancer has been symptom-free for 6 months and reports a new onset of lower back pain rated as an 8 on a 1 to 10 pain rating scale to the primary provider. What is most important when evaluating this patient's pain? Obtaining an MRI of the spinal cord A patient with cancer is reluctant to take an opioid agonist medication because of the side effects. What will the primary care provider recommend? Taking a stool softener with the opioid A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is a possible treatment for this patient? Pituitary tumor resection A patient has new-onset hypertension with a systolic blood pressure of 180 mm Hg. Which test will the provider order to diagnose this patient? Fractionated metanephrine levels A patient has unexplained weight loss, and the provider notes increased skin pigmentation on light-exposed skin folds along with darkened palmar creases. Which laboratory tests will the provider order? Serum ACTH Serum electrolytes TB skin testing A young adult woman is unable to conceive after trying to get pregnant for over 6 months. The woman reports having had irregular periods since the onset of menarche. The provider notes that the woman is overweight, has acanthosis nigricans, and an excess hair distribution. What does the provider suspect as the most likely primary cause of these symptoms? Polycystic ovarian syndrome A woman who has hirsutism with acne, and oligomenorrhea will most likely be treated with which medication to control these symptoms? Norgestimate When prescribing BCP do not prescribe with History of thromboembolic disorders (blood clots, stroke) An obese adolescent female patient reports irregular periods and excessive acne. The provider notes an increased amount of hair on her upper back, shoulders, and upper abdomen. What will the provider do, based on these findings? Refer to an endocrinologist for evaluation.
A patient is in the emergency department with confusion and fatigue and a corrected serum calcium concentration is 10.8 mg/dL. What is the initial treatment for this patient prior to admission to the inpatient unit? Rapid administration of intravenous normal saline A patient carpal spasm when a blood pressure cuff is inflated. Which diagnostic testing will the provider consider evaluating the cause of this finding? Magnesium and vitamin D A patient has low serum calcium associated with low serum albumin. What is the recommended treatment for this patient? Correction of other serum electrolytes A patient with normal renal function has a potassium level of 6.0 mEq/L. Which underlying cause is possible in this patient? Adrenocortical deficiency A hospitalized patient with renal failure is accidently given parenteral potassium and has a potassium level of 7.0 mEq/L. An ECG reveals a normal QRS interval. What is the initial recommended treatment for this patient? Insulin and glucose infusion A patient has a serum potassium level of 3 mEq/L and a normal blood pressure. Which test should be performed initially to assist with the differential diagnosis? Serum bicarbonate A patient has euvolemic hyponatremia secondary to chronic syndrome of inappropriate antidiuretic hormone (SIADH) and is hospitalized for fluid replacement. When preparing to discharge the patient home, what will be included in teaching? Limiting fluids to 500 mL/day for several days An elderly patient who is taking a thiazide diuretic has been ill with nausea and vomiting and is brought to the emergency department for evaluation. An assessment reveals oliguria, hypotension, and tachycardia and serum sodium is 118 mEq/L. What is the treatment? Emergency volume repletion with 3% NaCl. A high school athlete is brought to the emergency department after collapsing during outdoor practice on a hot day. The patient is weak, irritable, and confused. Serum sodium is 152 mEq/L and has dry mucous membranes and tachycardia. What is the initial approach to rehydration in this patient? Intravenous fluid resuscitation with an isotonic solution A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient? Annual monitoring of calcium, creatinine, and bone density Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? Inappropriate secretion of PTH along with hypercalcemia Which findings are symptoms of hyperparathyroidism? Cognitive impairment Left ventricular hypertrophy Renal calculi. A female calls the provider to report having unprotected sexual intercourse approximately 4 days prior. Which regimen will the provider recommend? Ulipristal Acetate taken one time. Methotrexate for ectopic pregnancy—teaching? No sex, alcohol, or folic acid for 3 months. Dyspareunia after menopause… Topical estrogen.
A postmenopausal woman reports unilateral breast pain that she describes as sharp and burning and localized to one area. A breast examination reveals no dimpling, discharge, or masses. Which diagnostic test will the provider order? Bilateral mammography A female patient is identified as having the BRCA mutation and she asks which intervention will reduce her risk of breast cancer the most? What will the provider tell her? Prophylactic mastectomy and oophorectomy A woman with chronic pelvic pain most likely has a gynecological cause for her symptoms. Which treatment will the provider recommend initially? Oral contraceptives
Which underlying causes are related to chronic pelvic pain in women? Faulty posture Interstitial cystitis Physical abuse A patient with primary dysmenorrhea has taken NSAIDs and COX-2 inhibitors without getting relief from symptoms. What will the provider suggest? A combined oral contraceptive A 35-year-old woman without a previous history of dysmenorrhea reports lower pelvic pain and irregular bleeding between periods. What is the initial action in managing this patient? Performing an abdominal, pelvic, and rectovaginal examination An adolescent female reports crampy pelvic pain radiating to the back, sacrum, and inner thighs during the first 2 days of each menstrual period, associated with nausea and loose tools. She asks about what causes these symptoms. What will the provider tell her? Excess prostaglandins, vasopressin will cause these symptoms. A previously healthy 22-year-old female reports pain in the rectovaginal area that occurs with sexual intercourse. What is the most likely cause of this patient's discomfort? Endometriosis A perimenopausal woman reports a recent onset of moderate to severe pain with sexual intercourse. Which treatment will the provider prescribe initially to treat this pain? Topical estrogen A woman asks about her risk of ovarian cancer. To best assess risk in this patient, what will the provider do first? Obtain a 3-generation family history. A postmenopausal woman who is overweight and who has hyperlipidemia, and a history of infertility develops vaginal bleeding and reports a feeling of pelvic pressure. The provider suspects a genital tract cancer and refers the patient for diagnostic evaluation. What is the likely cause of this woman's symptoms? Endometrial cancer A woman who has had routine Pap tests all of her adult life has an abnormal Pap. What will the provider tell her about this result? Colposcopy with biopsy is necessary. Which are risk factors for pelvic inflammatory disease? Select all that apply. Age under 25 years Cigarette smoking Vaginal douching. A sexually active female has symptoms of PID with fever. Cultures are pending. For outpatient treatment, what will the provider order? Rocephin, doxycycline, and metronidazole A female patient reports cramping, dysuria, low back pain, and nausea. A dipstick urinalysis is normal, and a pregnancy test is negative. What will the provider do next? Obtain vaginal secretions for testing. A female patient reports vulvar pruritus and dyspareunia. The provider notes white papules on the vulva with thinning of the epithelium. What condition does the provider suspect? Lichen sclerosis A sexually active young female reports vaginal discharge and moderate vulvovaginal irritation. The examination reveals a white, non-inflammatory discharge adhering to the vaginal walls, clue cells on microscopic examination and a positive KOH whiff test. What will the provider do next? Prescribe metronidazole 500 mg for 7 days.
A couple who has been trying to conceive for over 9 months asks the provider about artificial reproductive therapy. When discussing risks and benefits associated with these methods, what will the provider include? Select all that apply. Higher rates of pregnancy-induced hypertension Increased premature births More frequent multiple gestations. A provider is caring for a couple who are trying to conceive. To most accurately evaluate ovulation and luteal surge in the woman, what test will the provider recommend or perform? Urinary luteal hormone home kit In order to help prevent unplanned pregnancies, which group of providers may make the most impact by providing contraceptive counseling to women? Primary care providers An adolescent female calls a primary care clinic to report that she has missed two periods and is having morning nausea and vomiting. What will the provider suggest? Coming to the clinic for pregnancy testing A provider sees a woman who has just learned she is pregnant with an unplanned pregnancy. What is an initial step in helping this woman make decisions about his pregnancy? Actively listen to the woman's concerns and questions A female patient has lower abdominal pain, nausea, and vomiting and reports missing a period 3 weeks prior. The patient reports using an intrauterine device for contraception. A serum B-hCG is 1500 mIU/mL. What will the provider do, based on these findings? Perform a transvaginal ultrasound. A patient is determined to have a non-ruptured ectopic pregnancy within 1 week of a missed period. Which treatment will the specialist order? Methotrexatenursing A patient has received methotrexate therapy for treatment of an ectopic pregnancy. What will the provider include when teaching this patient about this therapy? Select all that apply. Avoid sexual intercourse for 3 months Do not consume alcohol for at least 3 months Refrain from taking vitamins containing folic acid. A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks gestation. How will this be recorded as her G/TPAL in her electronic medical record? G4P: A pregnant woman reports not having had any vaccinations as a child but requests vaccines during her pregnancy. Which vaccines may be given? Select all that apply. HPV Inactivated influenza Varicella A pregnant woman who is overweight has no previous history of hypertension or diabetes. Her initial screening exam reveals a blood pressure of 140/90 and a fasting blood glucose of 128 mg/dL. What will the practitioner do? Monitor blood pressure and fasting blood glucose closely. An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell the mother? To use a breast pump to increase her milk supply
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? Awakening the baby every 3 hours to nurse A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth, and breast tenderness. What will the provider recommend? Warm packs and increased frequency of nursing A 20 kg child has iron-deficiency anemia and will begin taking an oral iron preparation. What will the provider teach the child's parents about administration of this medication? The correct dose is 30 mg twice daily. A 60-year-old female patient has recently lost weight and a physical examination reveals a beefy-red, sore tongue, with no neurological findings. Based on these clinical findings, what will the provider anticipate finding in the laboratory data? Low hemoglobin and elevated MCV A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present? Decreased hematocrit. A patient is suspected of having leukemia and the provider orders biochemical studies and a bone marrow aspirate and biopsy. The results include WBCs greater than 200,000 cells/mm3 normal RBCs, hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase. Which test will the provider order to confirm a diagnosis in this patient? Philadelphia chromosome test A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a WBC of 30,000 cells/mm3 and near normal RBC and platelet counts. What will the provider do next to manage this patient? Refer to a specialist for a bone marrow aspirate and biopsy. A patient with acute myelogenous leukemia (AML) who has a high white blood cell count and diffuse lymphadenopathy is hospitalized during the induction phase of chemotherapy. What monitoring and interventions are critical to assess for complications during this phase of care for this patient? Select all that apply. Administration of sodium bicarbonate and allopurinol Daily renal function and chemistry values Meticulous assessment of hydration status A patient reports a neck mass that has been present off and on for 5 or 6 weeks which varies in size. The provider palpates a lymph node measuring 1.25 cm. Which test will provide proper histologic diagnosis for this patient? Lymph node biopsy Which types of lymphomas typically have an aggressive presentation? Select all that apply. Adult T cell leukemia-lymphoma Burkitt lymphoma Diffuse large B cell lymphoma. A 30-year-old male patient is diagnosed with Hodgkin lymphoma. Initial lab work reveals a WBC of 20 × 109/L, hemoglobin of 10.1 gm/dL, a serum albumin of 45 gm/dL, and lymphopenia of 0.5 × 109/L. Staging studies identify stage III disease. What is this patient's prognostic score? 4 A 70-year-old patient reports frequent infections, shortness of breath, fatigue, and palpitations. An exam reveals pallor and petechiae. The provider orders a peripheral blood smear and bone marrow biopsy. Which findings are consistent with a diagnosis of myelodysplasia? Select all that apply.
A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks about a family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both had post-surgical complications related to bleeding. Based on this history, which diagnosis is possible? Hemophilia A patient is noted to have prolonged bleeding after an intravenous needle is removed. A subsequent laboratory test reveals a prolonged activated partial thromboplastin (aPTT) time with a normal prothrombin time (PT). Based on this result, the provider may suspect alteration in function of which factor? Factor VIII
- A patient has type 1 Von Willebrand disease (vWD). What treatment is generally effective to prevent and treat bleeding episodes in this patient? Desmopressin A patient with systemic lupus erythematosus (SLE) has frequent symptoms and has been taking prednisone for each episode. The provider plans to start hydroxychloroquine, and the patient asks why this medication is necessary. What will the provider tell this patient about this medication? It is effective in reducing disease flares and for tapering steroids. A patient with systemic lupus erythematosus (SLE) develops end-stage renal disease. Because of the underlying SLE, what treatment is recommended for this patient? Kidney transplantation Which laboratory tests may help distinguish systemic lupus erythematosus (SLE) from other systemic rheumatologic disorders? Serum complements levels Which is a distinctive finding in patients who have Churg-Strauss syndrome (CSS)? Increased eosinophils A patient has a palpable purpural rash. This finding is most consistent with small-vessel vasculitis. A child has a high fever, bilateral conjunctivitis, and a desquamating rash and is presumed to have a vasculitic disease. What is the likely treatment for this child? Aspirin and intravenous immunoglobulin A 60-year-old patient reports new onset of bilateral shoulder pain with morning stiffness lasting approximately one hour. Which will be included in initial diagnostic testing for this patient? Select all that apply. ESR and CRP Liver function tests Protein electrophoresis A patient who is taking prednisolone 20 mg daily to treat polymyalgia rheumatica, reports blurred vision. What will the provider do? Increase the prednisolone dose to 60 mg daily. A patient is diagnosed with polymyalgia rheumatica with giant cell arteritis. Which dose of prednisolone will be given initially? 60 mg daily Which are symptoms of rheumatoid arthritis that distinguish it from osteoarthritis? Select all that apply. Extra-articular inflammatory signs Morning stiffness of at least one hour Symmetric tender, swollen joints A patient is diagnosed with rheumatoid arthritis after a review of systems, confirmatory lab tests, and synovial fluid analysis. What will the provide order initially to treat this patient? Disease-modifying anti-rheumatic drugs
A patient has swelling and tenderness in the small joints of both hands and reports several weeks of malaise and fatigue. A RF test is negative. What will the primary care provider do next? Order radiographic tests, a CBC, and acute-phase reactant levels. A pregnant woman tests positive for HIV infection. What will the provider recommend? Treatment with highly active antiretroviral therapy A homeless patient who has HIV infection has been on antiretroviral therapy (ART) for 18 months and has had normal CD4 counts and viral loads for past year. What will the provider recommend? Continue monitoring viral load and CD4 counts every 3 to 4 months. Which patients with documented HIV infection may be classified has having acquired immunodeficiency syndrome (AIDS)? Select all that apply. A patient with a CD4 cell counts of 150/mm A patient with esophageal candidiasis A patient with tuberculosis. A patient reports the sudden onset of pain, redness, and swelling in one knee joint along with a no fever. The provider elicits exquisite pain with manipulation of the joint and notes no decrease in pain when the joint is at rest. Which is the likely cause of this arthritis? Bacterial infection An adolescent patient reports pain and swelling in various joints on the right side that comes and goes and occurs in the knee, elbow, wrist, and ankle. A physical examination reveals tenosynovitis and a maculopapular rash. Which diagnostic tests will be most helpful in determining a diagnosis in this patient? Cultures of the urethra, pharynx, cervix, and rectum A patient has marked swelling of a shoulder joint with erythema and severe pain. The provider suspects a bacterial cause. Which culture will be most helpful to determine the cause of these symptoms? Synovial fluid culture A 45-year-old patient has mild osteoarthritis in both knees and asks about non-pharmacologic therapies. What will the provider recommend? Aerobic exercise A patient who has osteoarthritis in the carpometacarpal joints of both thumbs asks about corticosteroid injections to treat symptoms. What will the provider tell this patient about this therapy? This treatment may cause a temporary increase in pain, warmth, and redness. A 50-year-old woman reports pain in one knee upon awakening each morning that goes away later in the morning. A knee radiograph is negative for pathology and serum inflammatory markers are normal. What will the provider tell this patient? To take acetaminophen 1 gram three times daily for pain A 3-year-old child has marked pain in one leg localized to the upper tibia with refusal to bear weight. The child has a high fever and a toxic appearance. Which type of osteomyelitis is most likely? Hematogenous osteomyelitis A 50-year-old patient with diabetes mellitus has a low-grade fever and pain on one foot. The provider notes erythema and swelling at the site along with several superficial skin ulcers without necrosis and suspects osteomyelitis. Which type of diagnostic study will the provider order? Plain radiograph of the foot A patient has osteomyelitis related to vascular insufficiency. Which initial consultation is necessary? Surgical consultation
An infant has atopic dermatitis and seborrheic dermatitis with lesions on the forehead and along the scalp line. Which is correct when prescribing a corticosteroid medication to treat this condition? Initiate treatment with 0.1% triamcinolone acetonide (Kenalog lotion) When recommending an over-the-counter topical medication to treat a dermatologic condition, which instruction to the patient is important to enhance absorption of the drug? Place an occlusive dressing over the medication. A provider is prescribing a topical dermatologic medication for a patient who has open lesions on a hairy area of the body. Which vehicle type will the provider choose when prescribing this medication? Gel Which type of bite is generally closed by delayed primary closure? Select all that apply. Bites to the hand Deep puncture wounds Wounds 8 hours old 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? Obtain a physician consultation for evaluation and treatment. A patient has sustained a human bite on his hand during a fist fight. Which is especially concerning with this type of bite injury? Potential septic arthritis, tendinitis, or osteomyelitis A patient comes to the clinic after being splashed by boiling water while cooking. The patient has partial thickness burns on both forearms, the neck, and the chin. What will the provider do? Refer the patient to the emergency department. A patient suffers chemical burns on both arms after a spill at work. What is the initial action by the providers in the emergency department? Remove the offending chemical and garments. A patient with well-localized vitiligo is referred to a dermatologist for treatment. What will the initial treatment be? Twice-daily application of a mid-potency steroid cream A parent reports the appearance of areas of depigmented skin on a child which has spread rapidly. The provider notes asymmetrically patterned tri-colored, macules in a dermatomal distribution. What type of vitiligo does the provider suspect? Segmented vitiligo A patient who is diagnosed with vitiligo asks the provider what can be done to minimize the contrast between depigmented and normal skin. What will the provider recommend? Applying a cosmetic cover-up or tanning cream 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? Prescribe oral clindamycin. 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? Amoxicillin-clavulanate 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? Amoxicillin-clavulanate
A child has irritant contact dermatitis with lesions on the extremities and face. Which treatment is recommended for this patient? Oral corticosteroids 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? The vesicles may continue to develop for up to 2 weeks. A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize the episodes. What will the provider recommend as first-line treatment? Acyclovir A patient who has never had an outbreak of oral lesions reports a burning sensation on the oral mucosa and then develops multiple painful round vesicles at the site. A Tzanck culture confirms HSV-1 infection. What will the provider tell the patient about this condition? The initial episode is usually the most severe. A patient who has had lesions for several days is diagnosed with primary herpes labialis and asks about using a topical medication. What will the provider tell this patient? Topical medications can have an impact on pain and discomfort. A patient is taking a sulfonamide antibiotic and develops a rash that begins peeling. Which type of rash is suspected? Stevens-Johnson 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? Admit the child to the hospital for treatment and observation. Which types of medications are associated with urticarial type rashes? Select all that apply. Erythromycin NSAIDs Penicillins A patient who has chronically dry skin who has been using emollients and moisturizers reports an uneven diamond pattern and redness on the lower legs and arms. What will the provider recommend? Referral to a dermatologist When counseling a patient who has dry skin about ways to minimize exacerbations, what will the provider include? Select all that apply. Eat soups and stews frequently Take tepid-water baths Use fragrance-free detergents. Which medication will the provider prescribe as first-line therapy to treat tinea capitis? Oral griseofulvin When collecting a specimen to determine a diagnosis of tinea corporis, the provider will scrape which portion of the lesion? The active, leading border 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? The patient may have tinea capitis. Which is the primary symptom causing discomfort in patients with atopic dermatitis? Pruritus
