gcu nur643E week 8 final exam 2021
• A 62-year-old woman, who has been coming to you for 3 years, has a recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?
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Add a fourth medicine
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Refer to nephrology
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Get a CT scan
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Listen closely to her abdomen
• Question Points: 0.0 / 3.0
• Mrs. Jaeger is a 67–year-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered?
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Endometrial cancer
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Hormone replacement therapy
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Uterine or cervical polyps
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All of these
• Question Points: 0.0 / 3.0
• A 73-year-old retired accountant presents to your office for her annual examination. She has incontinence of urine when she coughs or sneezes. She takes several medications for control of hypertension and diabetes. You use the DIAPERS mnemonic to assess the cause of her incontinence. All of the following are items represented by the mnemonic except for:
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Atrophic vaginitis
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Depression
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Pharmaceuticals
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Restricted mobility
• Question Points: 3.0 / 3.0
• A 58-year-old gardener presents to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?
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Actinic keratosis
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Seborrheic keratosis
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Basal cell carcinoma
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Squamous cell carcinoma
• Question Points: 3.0 / 3.0
• A patient presents to you because she is experiencing a tremor only when she reaches for things. This becomes worse as she nears the “target.” When you ask her to hold out her hands, no tremor is apparent. What type of tremor does this most likely represent?
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Intention tremor
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Postural tremor
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Resting tremor
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Intention tremor
• Question Points: 0.0 / 3.0
• A 77-year-old retired bus driver presents to your clinic for a physical examination at his wife’s request. He has recently been losing weight and has felt very fatigued. He has had no chest pain, shortness of breath, nausea, vomiting, or fever. His past medical history includes arthritis and colon cancer, for which he had surgery. He has been married for more than 40 years. He denies any tobacco or drug use and has not had alcohol in more than 40 years. His parents both died of cancer in their 60s. On examination, his vital signs are normal. His head, cardiac, and pulmonary examinations are unremarkable. On abdominal examination, you hear normal bowel sounds, but when you palpate his liver it is abnormal. His rectal examination is positive for occult blood.
What further abnormality of the liver was likely found on examination?
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Smooth, large, non-tender liver
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Soft, sharp, liver edge
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Elongated right lobe
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Irregular, large liver
• Question Points: 3.0 / 3.0
• A 32-year-old attorney presents to your office for her second prenatal visit. She has had two previous pregnancies with uneventful prenatal care and vaginal deliveries. Her only problem was that with each pregnancy she gained 50 lbs (23 kg) and had difficulty losing the weight afterward. She has no complaints today. Looking at her chart, you see she is currently 10 weeks pregnant and that her prenatal weight was 130 lbs (59 kg). Her weight today is 134 lbs (60.9 kg). Her height is 5’4”, giving her a BMI of 22. Her blood pressure, pulse, and urine tests are unremarkable. The fetal heart tone is difficult to find but is located and is 150. While you give her first trimester education, you tell her how much weight you expect her to gain.
How much weight should this patient gain during pregnancy?
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Less than 15 pounds (less than 7 kg)
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15 to 25 pounds (7 to 11.5 kg)
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25 to 35 pounds (11.5 to 16 kg)
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30 to 40 pounds (12.5 to 18 kg)
• Question Points: 0.0 / 3.0
• Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?
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This is most likely due to lack of lubrication.
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This is most likely due to atrophic vaginitis.
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This is most likely due to pressure on an ovary.
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Psychosocial reasons may cause this condition.
• Question Points: 3.0 / 3.0
• You are speaking to an eighth-grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
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A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
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A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
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A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
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A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution
• Question Points: 3.0 / 3.0
• You are examining an elderly man and notice the following: decreased vibration sense in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and diminished abdominal reflexes. Which of these is abnormal?
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Decreased vibration sense
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Diminished gag reflex
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Diminished right patellar reflex compared to the left
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Diminished abdominal reflexes
• Question Points: 0.0 / 3.0
• You are assessing an infant and notice that his nares flare, he has a soft grunt with each breath, and the skin between his ribs is pulled inward with inhalation. What is the significance of these findings?
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These are indicative of a CNS process.
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These are indicative of respiratory distress.
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These are indicative of muscular dystrophy.
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These are frequently accompanied by stridor.
• Question Points: 3.0 / 3.0
• Jacob, a 33-year-old presents with fluid filled lesions on neck. On examination multiple small pustules and vesicles grouped together are seen on erythematous base.
What is most likely?
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Herpes Simplex Virus
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Contact dermatitis
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Actinic keratosis
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Sebaceous hyperplasia
• Question Points: 3.0 / 3.0
• A 76-year-old retired farmer presents to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for more than 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer, and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees, and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable, and his fecal occult blood test is negative. His prostate is slightly enlarged, but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.
What condition that typically causes abdominal pain best describes his symptoms and signs
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Acute diverticulitis
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Acute cholecystitis
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Acute appendicitis
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Mesenteric ischemia
• Question Points: 3.0 / 3.0
• Which of the following booster immunizations is recommended in the older adult population?
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Tdap
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Diphtheria
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Measles
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Mumps
• Question Points: 0.0 / 3.0
• A 72-year-old teacher presents to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum, there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?
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Stage 1
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Stage 2
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Stage 3
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Stage 4
• Question Points: 3.0 / 3.0
• A 21-year-old receptionist presents to your clinic complaining of frequent diarrhea. She states that the stools are very loose and there is some cramping beforehand. She states this has occurred on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool. Occasionally, she has periods of constipation, but that is rare. She thinks the diarrhea is much worse when she is nervous. Her past medical history is not significant. She is single and a junior in college majoring in accounting. She smokes when she drinks alcohol but denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable.
What is most likely the etiology of her diarrhea?
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An infection
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Trauma
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Irritable bowel syndrome
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An endocrine disorder
• Question Points: 3.0 / 3.0
• A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?
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A palpable “notch” along its edge
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The inability to push your fingers between the mass and the costal margin
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The presence of normal tympany over this area
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The ability to push your fingers medial and deep to the mass
• Question Points: 0.0 / 3.0
• Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn’t blanch. What would you tell her regarding her rash?
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It is likely to be related to her lupus.
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It is likely to be related to an exposure to a chemical.
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It is likely to be related to an allergic reaction.
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It should not cause any problems.
• Question Points: 0.0 / 3.0
• An elderly woman with a history of coronary bypass presents in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?
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Malingering
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Neuropathy
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Ischemia
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Physical abuse
• Question Points: 3.0 / 3.0
• A 26-year-old sports store manager presents to your clinic complaining of severe right-sided abdominal pain for 12 hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was last night and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant. His rectal, inguinal, prostate, penile, and testicular examinations are normal.
What is the most likely cause of his pain?
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Acute appendicitis
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Acute mechanical intestinal obstruction
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Acute cholecystitis
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Mesenteric ischemia
• Question Points: 3.0 / 3.0
• A 30-year-old paralegal analyst presents to your clinic complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination, she appears healthy and has unremarkable vital signs. On examination of the perineum, there are no lesions noted. On palpation of the inguinal nodes, there is no lymphadenopathy. On speculum examination, a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells).
What type of vaginitis best describes her findings?
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Trichomonas vaginitis
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Candida vaginitis
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Bacterial vaginosis
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Atrophic vaginitis
• Question Points: 0.0 / 3.0
• Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline that is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
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Sigmoid mass
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Tumor in the abdominal wall
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Hernia
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Enlarged bladder
• Question Points: 0.0 / 3.0
• Which of the following brief screening measures is useful in assessing memory?
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Three-item recall
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Serial 7s
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Spelling “world” backward
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Copying intersecting pentagrams
• Question Points: 0.0 / 3.0
• A 36-year-old security officer presents to your clinic complaining of a painless mass in his scrotum. He found it 3 days ago during a testicular self-examination. He has had no burning with urination and no pain during sexual intercourse. He denies any weight loss, weight gain, fever, or night sweats. His past medical history is notable for high blood pressure. He is married and has three healthy children. He denies using illegal drugs, smokes two to three cigars a week, and drinks six to eight alcoholic beverages per week. His mother is in good health and his father had high blood pressure and coronary artery disease. On physical examination, he appears anxious but in no pain. His vital signs are unremarkable. On visualization of his penis, he is circumcised and has no lesions. His inguinal region has no lymphadenopathy. Palpation of his scrotum shows a soft cystic-like lesion measuring 2 cm over his right testicle. There is no difficulty getting a gloved finger through either inguinal ring. With weight bearing there are no bulges. His prostate examination is unremarkable.
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Hydrocele
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Scrotal hernia
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Testicular tumor
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Varicocele
• Question Points: 0.0 / 3.0
• Claire’s daughter brings her in today after Claire fell at her home. Which assessments are indicated at this time?
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Orthostatic vital signs
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Review of her medications
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Assessment of gait and balance
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All of these
• Question Points: 3.0 / 3.0
• Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant. Now, he hesitates to walk, because any motion makes the pain much worse. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely causing pain in this region?
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Peptic ulcer
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Cholecystitis
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Pancreatitis
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Appendicitis
• Question Points: 0.0 / 3.0
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