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A wide range of medical symptoms and clinical manifestations across various conditions, including negative symptoms, cognitive symptoms, lower and upper urinary tract infections, bile salt deficiencies, health promotion, gastritis, respiratory and cardiac disorders, skin conditions, immune system responses, sleep apnea, pancreatic insufficiency, stress ulcers, candidiasis, sarcomas, pain in cancer, musculoskeletal injuries, amino acid metabolism, erythrocyte life span, glaucoma, heart murmurs, pulmonary defense mechanisms, kidney stones, pancreatic enzymes, and cell structures involved in dna formation. Detailed information on the clinical presentation and pathophysiology of these medical conditions, which could be useful for healthcare professionals, medical students, and lifelong learners interested in understanding the signs and symptoms associated with different diseases and disorders.
Typology: Exams
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What part of the body do we typically see symptoms from autonomic neuropathy in type 1 diabetes? - ...ANSWER...GI: decreased esophageal motility, gastroporesis and delayed gastric emptying Symptoms of hypoglycemia (6) - ...ANSWER...tachycardia, palpitations, diaphoresis, tremors, pallor and arousal anxiety What do we teach diabetics about how to avoid hypoglycemia? - ...ANSWER...don't skip meals, take meds appropriately and pay attention to carbs Cause of primary hyperparathyroidism - ...ANSWER...parathyroid tumor cause of secondary hyperparathyroidism - ...ANSWER...increased PTH secretion in response to hypocalcemia What typically accompanies hypercalcemia - ...ANSWER...hypophosphatemia
Main symptom of hypercalcemia - ...ANSWER...osteoporosis in distal 1/3rd of the radius Risk factors of hypoparathyroidism (4) - ...ANSWER...Alcoholics, malabsorption, increased renal clearance of mag, chemo drugs Symptoms of hypocalcemia (8) - ...ANSWER...dry skin, loss of body and scalp hair, hypoplasia of teeth, ridges on nails, cataracts, basal ganglia calcifications, bone deformities and bowing of long bones Another term for hypercortisolism - ...ANSWER...cushings syndrome Main characteristics of cushings syndrome - ...ANSWER...buffalo hump, moon face and truncal obesity What is the biggest signal of adrenal crisis? - ...ANSWER...Hypotension What can cause adrenal crisis? - ...ANSWER...Improper weaning off glucocorticoid meds key symptoms associated with parkinson's disease (5) - ...ANSWER...shuffling gait, dysphagia, resting tremor, postural disturbance and dysarthia Risk factors for MS (3) - ...ANSWER...smoking, vit D deficiency and epstein-barr virus what kind of disease is MS - ...ANSWER...demyelinating
characteristics of cluster headache - ...ANSWER...unilateral trigeminal distribution of severe pain with ipsilateral manefistations symptoms of cluster headache (3) - ...ANSWER...tearing on affected side, ptosis of ipsilateral eye and congestion of nasal mucosa Where does pain refer to in cluster headaches (2) - ...ANSWER...midface and teeth characteristics of a migraine - ...ANSWER...unilateral, throbbing pain that worsens with activity Symptoms of migraine headache (3) - ...ANSWER...N/V, photophobia and phonophobia What type of migraine is most common - ...ANSWER...migraine without an aura Characteristics of tension headache - ...ANSWER...bilateral headache that feels like a tight band around the head what type of headache is the most common - ...ANSWER...tension What cranial nerve is associated with bells palsy - ...ANSWER...cranial nerve VII What cranial nerve is associated with trigeminal neuralgia - ...ANSWER...cranial nerve V
Symptoms of bells palsy - ...ANSWER...asymmetry and inability to close eye, smile or frown on affected side Symptoms of trigeminal neuralgia - ...ANSWER...severe sharp stabbing pain that worsens with chewing symptoms of bacterial meningitis or meningial irritation - ...ANSWER...severe throbbing headache, severe photophobia, nuchual rigidity and positive kernig/brudinski Result of infarct in the ACA - ...ANSWER...motor contralateral paralysis or paresis that is greater in the foot and thigh result of basal artery infarct - ...ANSWER...loss of vibratory sense, sense of position with dysmetria, loss of two-point discrimination, impaired rapid alternating movement causes of rosacea (5) - ...ANSWER...chronic sun exposure/damage, alcohol/hot beverage consumption, hormones, mites (demodex folliculorum) and mental stress/anxiety Most aggressive skin cancer - ...ANSWER...melanoma Which of the following is true regarding a complicated urinary tract infection? - ...ANSWER...Can be caused by a structural urinary tract disorder Which of the following is a risk factor for the development of a urinary tract infection (UTI)? - ...ANSWER...Pregnancy
A symptom of a lower urinary tract infection includes: - ...ANSWER...urgency Women are at a higher risk for the development of a UTI because of having a shorter urethra. - ...ANSWER...true Which of the following can help to prevent a UTI? - ...ANSWER...Increase water consumption Uncomplicated UTI - ...ANSWER...Occurs in the normal urinary tract Responds well to short course of antibiotic therapy Simple cystitis in non-pregnant women without any urologic abnormalities Complicated UTI - ...ANSWER...UTI extends beyond the bladder Caused by structural or functional urinary tract abnormalities or untreated UTI Infants and older adults affected Associated with: indwelling catheters, renal calculi, diabetes, pregnancy A 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new information reported is that she recently had sexual intercourse with a new male partner. The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs, nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results, the patient can be diagnosed with: - ...ANSWER...cystitis
J.S. is an 80 - year-old patient who resides in a local nursing home. He recently became confused and then fell while ambulating to the bathroom three days ago. Because of his confusion and fall, he was transferred to the acute care facility for evaluation and treatment. Lab work revealed that the patient was very dehydrated with hypernatremia identified and appropriate intravenous fluids started. Cystitis was also identified from the urinalysis. He was also noted to have red and excoriated skin between the buttocks and inner thighs due to urinary frequency and dribbling. To help with skin healing and to prevent further urine leakage, an indwelling catheter was inserted. Two days after the catheter was placed, the patient spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense, foul odor was noted in the urine. On examination of the flank area, the patient yelled out when touched. A urine c - ...ANSWER...pyelonephritis Identify the major risk factor J.S. has that is associated with pyelonephritis: - ...ANSWER...indwelling foley catheter The urinalysis of a patient with a complicated UTI will show WBCs and casts - ...ANSWER...true Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria are gram negative because of the presence of: - ...ANSWER...nitrites A 21-year-old patient reports to the primary care clinic complaining of urinary urgency, frequency and burning. She also reports a small amount of vaginal discharge that contains an odor. It is likely that the NP will perform a vaginal exam at this visit. - ...ANSWER...true
The NP would know that the patient most likely has an uncomplicated UTI because: - ...ANSWER...The UTI responds well to a short course of antibiotic therapy. A common organism that causes a urinary tract infection include: - ...ANSWER...Staphylococcus saprophyticus. E coli The purpose of straining in BPH is to overcome the obstruction encountered during urination. - ...ANSWER...true The peripheral zone of the prostate is the largest zone. - ...ANSWER...true On a digital rectal exam to assess the quality of the prostate, the NP would be concerned with which of the following findings? - ...ANSWER...hard nodule There is a significant risk for men with benign prostatic hyperplasia (BPH) to develop cellular mutations that lead to prostate cancer. - ...ANSWER...false The patient most often develops symptoms of BPH when: - ...ANSWER...The prostatic urethra becomes obstructed. Irritative symptoms - ...ANSWER...urinary frequency nocturia urgency that results from bladder hypertrophy and dysfunction obstructive symptoms - ...ANSWER...incomplete emptying post-void dribbling
The action of a 5-Alpha-reductase inhibitor causes: - ...ANSWER...Shrinkage of the prostate gland. Men who have BPH are prone to developing a UTI because: - ...ANSWER...Stagnated urine in the bladder promotes bacterial growth. The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation. - ...ANSWER...true The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply. - ...ANSWER...true The location of the characteristic hyperplastic nodules of BPH is: - ...ANSWER...In the periurethral zone. The type of stone that forms due to a urinary tract infection is:
A 45-year-old male presents to the primary care office with right flank pain that he describes as unremitting; he also reports nausea and vomiting. The NP performs an exam and observes him writhing in pain on the exam table with the inability to find a comfortable position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and revealed 1+ blood. Urine microscopy also revealed 10-20 RBCs per high- power field (hpf). A kidney stone is suspected. The patient reports no prior history of a kidney stone. After providing the patient an analgesic, where the patient reported mild relief, the NP had the patient transferred to the emergency room for intravenous fluids, pain management and further work-up for the kidney stone. Upon follow-up in the office a week later, the patient reported that he was diagnosed with - ...ANSWER...adequate hydration balanced diet Lithotripsy is an invasive procedure used to break up the stone
At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone. - ...ANSWER...true Which of the following actions will relax the detrusor muscle of the bladder? - ...ANSWER...Activation of Beta-2 receptors by the sympathetic nervous system. The relay station in the brain that plays a major role in regulating micturition is: - ...ANSWER...Pontine micturition center. The location of the internal sphincter is under the urogenital diaphragm. - ...ANSWER...false (located in the bladder) When the bladder is empty, the detrusor muscle relaxes, and the internal and external sphincters constrict. - ...ANSWER...true The levator ani muscle plays a major role in constriction of the external sphincter. - ...ANSWER...true stress incontinence - ...ANSWER...leakage of urine with activity Increased intra-abdominal pressure causes leaking because there is no resistance to counteract the intra-abdominal pressure urge incontinence - ...ANSWER...leakage of urine with sensation of need to urinate Detrusor muscle hyperactivity leads to urine leakage
neurogenic incontinence - ...ANSWER...unimpeded urine leakage Neurological lesions alter nervous system impulses that innervate the detrusor muscle. The result is decreased bladder compliance and decreased sphincter tone overflow incontinence - ...ANSWER...leakage of urine is associated with urgency, frequency, dribbling, and hesitancy Leakage is due to retained urine in the bladder that leads to over-distention A 54-year-old female reports to the primary care office with complaints of frequent urination. She reports that she is "leaking" urine several times a day, especially when she coughs, sneezes, or lifts a heavy object. She indicates that she has not experienced any dysuria or any urgency. The NP looked at the patient's previous urine culture obtained approximately 1 month ago and determined that it was negative. Other than her urinary complaints, she is in otherwise good health. BP 128/76; HR 78 bpm; T 98.6; Ht. 5'4"; Wt: 180lbs.; BMI 30.9. The NP performs a physical exam and all findings are normal. The urinalysis obtained was negative as well. Based on patient's symptoms and negative physical exam, she has a typical
A sphincter malfunction that prevents urine from flowing out of the bladder would most likely result in: - ...ANSWER...overflow incontinence The major cause of stress incontinence in women is hypermobility of the external sphincter. - ...ANSWER...true The pathophysiology of neurogenic bladder is: - ...ANSWER...Lesions alter nervous system impulses that innervate the detrusor muscle to decrease bladder compliance and decreased sphincter tone. Involuntary loss of urine caused by dementia or immobility is known as: - ...ANSWER...functional incontinence Which of the following is considered be a transient cause of urinary incontinence? - ...ANSWER...UTI A pre-renal cause of acute renal failure is: - ...ANSWER...hypotension One of the first pathophysiological responses to the decreased GFR in acute renal failure is: - ...ANSWER...Activation of the renin-angiotensin-aldosterone system. One of the major markers for glomerular filtration rate is creatinine. - ...ANSWER...true Pre-renal is the most common cause of acute renal failure. The most common cause of acute renal failure is due to a pre- renal failure. - ...ANSWER...true Acute renal failure - ...ANSWER...Oliguria (< 30ml/hr).
Increased blood urea nitrogen (BUN) and creatinine. Fluid and electrolyte abnormalities. Pre-renal - ...ANSWER...sudden and severe drop in blood pressure or interruption of blood flow to the kidneys from severe injury or illness Intra-renal - ...ANSWER...direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply Post-renal - ...ANSWER...sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury In post-renal failure, the damage occurs in the collecting duct.
The result of vitamin D deficiency results in: - ...ANSWER...hypocalcemia The number one cause of end-stage renal disease is diabetes mellitus and hypertension combined. - ...ANSWER...true Stage III kidney disease is signified when the GFR drops below 60. - ...ANSWER...true Which of the following is a complication of decreased GFR? - ...ANSWER...anemia The anemia seen in renal failure is due to the lack or iron. - ...ANSWER...false (Anemia occurs because there is a reduced production of erythropoietin which is responsible for triggering the production of RBCs rather than the lack of iron or a decrease in the RBCs) stage 1 - ...ANSWER...There is kidney damage with normal or elevated GFR (90-120) Stage 2 - ...ANSWER...There is kidney damage with mild decrease in GFR (60-89) stage 3 - ...ANSWER...There is a moderate decrease in GFR (30-59) stage 4 - ...ANSWER...There is a severe decrease in GFR (15-
stage 5 - ...ANSWER...Kidney failure- End-stage renal disease (<15 dialysis)
Need dialysis with these symptoms - ...ANSWER...Metabolic acidosis. Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. Hyperkalemia by itself is not an indication for dialysis. Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). Fluid volume overload that is not responsive to diuretics. Uremic symptoms due to nitrogenous wastes in the blood stream. The decision to begin dialysis is guided by the patient's symptoms rather than GFR. - ...ANSWER...true Diuretic therapy is used in Stage IV kidney failures to stimulate kidney function. - ...ANSWER...false (diuretics used for stages 1-111 and dialysis for 4 and 5) The major acid/base disturbance in renal failure is: - ...ANSWER...metabolic acidosis Dietary management of a patient with CKD includes: - ...ANSWER...low potassium, low sodium, and low phosphate The Monoamine Deficiency Theory states that the underlying basis of depression is low levels of serotonin, norepinephrine and dopamine. - ...ANSWER...true Dysthymia is a persistent depressive disorder used to describe milder symptoms of depression that happen over longer periods of time. - ...ANSWER...true
Despite the different classifications, all antidepressant medications are equally effective in reducing the major symptoms of major depressive disorder. - ...ANSWER...true Selective Serotonin Reuptake Inhibitors are the most common antidepressants prescribed. - ...ANSWER...true Electroconvulsive Therapy (ECT) is no longer used as a treatment of major depressive disorder (MDD). - ...ANSWER...false (Still used) Post-partum depression - ...ANSWER...after childbirth, a mother's depressed mood (hormonal change accompanies) atypical depression - ...ANSWER...improved mood when exposed to pleasurable or positive events A 42-year-old female presents to the primary care clinic with a three- month history of "feeling low", poor energy, inability to concentrate and irritability. She is concerned about her loss of interest in her usual social activities of walking with her friends and participating in her sewing group. She is especially concerned about her recent 15-pound weight gain. Other reported symptoms are frequent headaches, difficulty getting out of bed in the morning, and feeling worthless. She denies suicide ideation. She reports a family history of depression (mother and sister) and denies any consumption of drugs and alcohol. She is divorced and has a grown son who lives approximately one hour away but rarely sees because of his work schedule. The patient is interested in knowing if her symptoms are related to depression.
Upon initial evaluation, the NP considers if the patient meets the criteria for MDD by consulting the DS - ...ANSWER...Depressed mood Fatigue/loss of energy Loss of interest/Anhedonia Feeling worthless or having excessive guilt Insomnia or hypersomnia Poor concentration Recurrent thoughts of death, suicide, a suicide plan or attempt Psychomotor agitation or retardation A strong social network has been proven to lead to a better outcome for individuals with MDD. - ...ANSWER...true Amitriptyline (Elavil) is an alpha-agonist that increases synaptic concentration of serotonin and/or norepinephrine. - ...ANSWER...false (Amitriptyline is a tricyclic anti- depressant) Which of the following symptoms would prompt the NP to refer the patient to a psychiatrist? - ...ANSWER...Psychotic symptoms. Suicide ideation. Patient's request. Selective Serotonin Reuptake Inhibitors (SSRIs) block the reabsorption or inhibits the reuptake of serotonin that allows for more of it in the synaptic cleft. - ...ANSWER...true Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) drugs increase levels of serotonin and norepinephrine in the brain by promoting their reuptake by nerves. - ...ANSWER...false
(SNRIs block or delay serotonin and norepinephrine in the brain) A mood disorder is a mental illness that causes the individual to have dramatic shifts in emotions, mood and energy levels. - ...ANSWER...true Individuals with family members who have bipolar disorder are ten times more likely to also have it. - ...ANSWER...true Unipolar depression is characterized by extreme anxiety and hallucinations. - ...ANSWER...false (same symptoms as MDD) Which of the following can trigger a bipolar mood disorder? - ...ANSWER...Selective Serotonin Reuptake Inhibitors. (SSRIs) Stimulant drugs. Changes in circadian rhythm. Life stressors. During a manic phase, the individual will experience a low self-esteem. - ...ANSWER...false (high self-esteem) Bipolar 1 - ...ANSWER...More severe One or more manic or mixed episodes leading to: Serious problems Hospitalization Psychotic features Bipolar 2 - ...ANSWER...One or more hypomanic episodes ( days or more), and no maniaOne or more major depressive episodes (2 weeks or more)
Cyclothymia - ...ANSWER...Alternating between hypomanic symptoms, and mild or moderate depressive moods, like Bipolar II Less severe, higher functioning Examine the following case and identify the symptoms to determine if the diagnosis is Bipolar 1, Bipolar 2 or Cyclothymia. A man calls the primary care office to report concern about his wife exhibiting bizarre behavior. He reports that she has had little sleep over the past week as she has been engaged in excessive cleaning and calling family members throughout the night. Without his knowledge, she came home two days ago after having purchased an expensive sports car and plans to drive it to Las Vegas next weekend. She indicates that one of the casinos there needs her help decorating for the upcoming 4th of July. Her spouse tells the primary care provider that she has become obsessed with going to Las Vegas since seeing a commercial about the 4th of July events advertised. What is the best diagnosis for his wife? - ...ANSWER...Bipolar 1 In a mixed episode, the individual experiences symptoms of depression and mania simultaneously. - ...ANSWER...true In rapid cycling, the individual has 4 or more episodes of depression and mania within one year. - ...ANSWER...true Lithium is best at treating both manic and depressive episodes. - ...ANSWER...false (only manic)
Talk therapy and cognitive behavioral therapy are not helpful in treating the manic episodes of bipolar disorder. - ...ANSWER...true Major depression is required to be present in order to diagnose Bipolar 1 and Bipolar 2 disorder. - ...ANSWER...false (Major depression may be present in both but not required for diagnosis) Benzodiazepines are drugs that reduce depression associated with the individual's anxiety. - ...ANSWER...false (psychoactive drugs that reduce anxiety by providing calming effect on individual) Generalized Anxiety Disorder (GAD) is episodic in nature that is brought on by stressful situation - ...ANSWER...false (GAD is characterized by excessive, persistent, unreasonable anxiety about everyday situations) Psychotherapy helps the individual to think and act in different ways to deal with stressful situation - ...ANSWER...true Cognitive behavioral therapy has major advantages over medications in the long-term treatment of anxiety - ...ANSWER...true Physical manifestations can also be associated with Generalized Anxiety Disorder - ...ANSWER...true B. R. is a 20-year-old college student who reports feeling anxious "about everything", restlessness and irritability. She reports no significant past medical or mental health history.
She states that her anxiety started about 6 months ago when she decided to change her major to pre-med and complete an application to participate in a summer pre-med preparation program. During an open house meeting with the medical school academic advisors attended by all students applying for the summer program, she learned that only 50 students would be selected out of 450 applications to participate in the summer program. Despite wanting to enter the summer program, she felt that she would be unable to cope with the pressure associated with a short summer program or the rejection if she was not selected. She told the NP that she did not feel "good enough" to be selected as she compared herself to the other applicants. She said that - ...ANSWER...Generalized anxiety disorder J.J. is a 44-year-old male who works as a department head for a Fortune-500 company that is down-sizing due to economic reasons. Top level management has announced that there will be restructuring of the company where many of the management roles will be consolidated. Some department head positions will be eliminated altogether. Each department head has been given the task of developing a presentation to provide an overview of their department specifically sharing data to demonstrate productivity and the meeting of company initiatives. From the moment J.J. read the email outlining the presentation requirements, he started to feel fearful of the possibility of losing his job. On the day of delivering the presentation, all department heads were present with top-level management. As he listened to the other department heads deliver their presentations, he began to feel nausea. He even noticed his heart pounding. When it - ...ANSWER...Panic attack
R.D. is a 34-year-old female who is engaged to be married in one month. This will be her second marriage. She has been divorced for three years. Her fiancé, who has never been married, has invited his parents to town to meet their soon- to
Monitoring the panic attacks using a diary can be an effective component of psychotherapy. - ...ANSWER...true More men than women seem to be affected by schizophrenia with onset in the mid-twenties. - ...ANSWER...true In the prodromal phase of schizophrenia, Individuals become hyperactive and outgoing. - ...ANSWER...false (become withdrawn) Which of the following would be considered a negative symptom of schizophrenia? - ...ANSWER...flat affect The cognitive symptoms of schizophrenia are subtle and may only be detected when specific tests are performed. - ...ANSWER...true Catatonic behavior involves bizarre movements, posture, and responsiveness. - ...ANSWER...true postitive symptoms - ...ANSWER...Delusions: are thing that the individual feels strong about that they refuse to change their mind even if there is evidence against their stance: delusion of control-some outside force is controlling their actions Delusion of reference: insignificant remarks are directed at them Hallucinations: any type of sensation that is not actually there (visual) of auditory-hearing things that are not there. Disorganized speech: word salad- a random juggling of words or phrases.
Disorganized behavior: bizarre behavior that is out of context to the situation with no purpose (wearing a heavy coat in the summer). Catatonic behavior: bizarre movements, posture, and responsiveness; stupor and unresponsive to moving. Negative symptoms - ...ANSWER...Decreased emotions/Loss of interests: Flat affect: does not respond to an emotion or reaction that would seem appropriate to the situation Alogia: lack of content in the speech Avolition: a decrease in motivation to complete certain goals cognitive symptoms - ...ANSWER...Memory Ability to learn new things Understanding Symptoms are subtle and may only be detected when specific tests are performed. For example, the individual may not be able to keep up with several tasks at once. Prodromal phase - ...ANSWER...become withdrawn and spend most time alone active phase - ...ANSWER...more severe symptoms like delusions, hallucinations, disorganized speech or behavior or catatonic behavior residual phase - ...ANSWER...cognitive symptoms not being able to concentrate or becoming withdrawn E.M. is a 21-year-old man that presents to the primary clinic accompanied by his mother. He is a freshman in college but came home last week telling his mother that he 1. blank
because 2. blank. His mother called her son's roommate to obtain further information about her son's behavior. The roommate reports that E.M. has 3. blank over the last week because he 4. blank. He also insists that the rival fraternity's president has had his dorm room bugged and that his 5. blank. At the primary care office, E.M. just 6. blank and 7. blank. - ...ANSWER...1. dropped out