UTA 5220 Modules 3-4

ch 17

A patient reports spontaneous discharge from her left nipple. How would you determine if the discharge was from one or multiple ducts?

A. Order an ultrasound.

B. Order a mammogram.

C. Compress the nipple and examine with a magnifying glass.

D. Depress the nipple into the well behind the areola and observe discharge.

Compress the nipple and examine with a magnifying glass.

Mrs. Harris presents to your office with a complaint of a red rash on her breast suggestive of either Paget disease or eczema. Which is a distinguishing factor between these two problems?

A. The location of the lesion on the nipple.

B. The presence or absence of crust.

C. The response to cortisone

D. The pattern of fever

The response to cortisone

Mrs. Yates is a 58-year-old patient who presents to your office for her yearly physical examination. She asks you if she really needs to have mammograms. Which is a correct response?

Breast cancer mortality is reduced with mammography screening

Mrs. Ulman is a 56-year-old patient who presents to your office for her routine follow-up after having a mastectomy of the right breast 2 years ago. Which statement applies to your examination of this patient?

A. Swelling, thickening, and small lumps at the mastectomy site are expected.

B. The mastectomy site is inspected but not palpated because of pain.

C. If malignancy recurs, it may be at the scar site.

D. There is no need to examine the mastectomy site.

If malignancy recurs, it may be at the scar site.

Mrs. Yates is a 58-year-old patient who presents to your office for her yearly physical examination. She asks you how often a mammogram is recommended. The best response by the examiner is:

A. "every year."

B. "every 3 years."

C. "every 5 years."

D. "every year if you have a family history of cancer."

"every year."

Mrs. Venin brings her 18-year-old son in for a follow-up examination. You have examined him before due to his enlarged breast tissue, which has not resolved spontaneously. Which action is most appropriate?

A. Refer him to a surgeon for removal.

B. Explain that it may still resolve spontaneously.

C. Ask about history of sexual activity.

D. Ask about illicit or prescription drug use.

Ask about illicit or prescription drug use.

Mrs. Harold is a 37-year-old patient who presents for her yearly physical examination. Which statement made by Mrs. Harold would make the examiner suspect fibrocystic changes?

A. "I have a lump in my breast that is not tender."

B. "My right breast is larger than the left breast."

C. "My nipples are darker than before my baby was born."

D. "I feel lumps before my period."

"I feel lumps before my period."

Mrs. Black brings her 12-year-old daughter in with a complaint of a breast mass. On examination, you note unilateral breast enlargement with associated tenderness but no mass. Which action do you take?

A. Refer for mammogram.

B. Refer for biopsy.

C. Ask the mother about her own breast development.

D. Explain that this is an expected finding.

Explain that this is an expected finding.

Mrs. Newer brings her young child in for a yearly physical examination. On examination, you note a supernumerary nipple. For which other finding do you need to be alert?

A. Papillomatosis

B. Duct ectasia

C. Renal anomalies

D. Ambiguous sex organs

Renal anomalies

Mrs. Wolf is a 68-year-old patient who presents to your office with a complaint of breast mass. On examination, you note an irregular hard, fixed breast mass and an inverted nipple. Which of the following would you suspect?

A. Fibroadenoma

B. Intraductal papilloma

C. Fat necrosis

D. Carcinoma

Carcinoma

Mrs. Bower, a 56-year-old patient, presents for a yearly physical examination. On examination, you note a fixed mass in the left breast. Given this finding, which area would you palpate for sentinel nodes?

A. Supraclavicular fossa

B. Inner aspect of the upper arm

C. Posterior chest wall along the border of the scapula

D. Anterior chest wall along the pectoral muscles

Supraclavicular fossa

Mrs. Harmon brings her 16-year-old son in for a routine examination. On examination, you observe enlarged breast tissue. Which term is used to describe this finding?

A. Ballottement

B. Gynecomastia

C. Peritonitis

D. Phimosis

Gynecomastia

Mrs. Jones brings her newborn infant daughter in for a routine office visit. On examination, you express a clear to milky white fluid from the breast bud. Which term is used to describe this fluid?

A. Witch's milk

B. Witch hazel

C. Infant's milk

D. Neonate excretion

Witch's milk

What is the cause of a Peau d'orange appearance to the skin of the breast?

A. Vascular stasis

B. Destruction of stromal tissue

C. Infiltration with immune cells

D. Edema from blocked lymph drainage

Edema from blocked lymph drainage

Which is a similarity between fibroadenoma and fibrocystic disease?

A. Both involve fluid-filled cysts.

B. Both are usually tender to touch.

C. Both are nonmalignant breast problems.

D. Both fluctuate with the menstrual cycle.

Both are nonmalignant breast problems.

When examining a 34-year-old mother of two who is a new patient in for a routine physical, you notice that the right nipple is inverted. Which question would you immediately ask?

A. "Did you breast feed your children?"

B. "How long has your right nipple been inverted?"

C. "Is there any history of breast cancer in your family?"

D. "When was your last mammogram?"

"How long has your right nipple been inverted?"

Which are risk factors for breast cancer for a 43-year-old woman?

1. Mother died of breast cancer

2. Menarche at age 11

3. Early onset of menopause

4. 50-year-old sister currently has breast cancer

5. History of alcoholism

6. One child, a 7-year-old son

A. 1 and 4

B. 2, 3, and 6

C. 1, 2 and 3

D. All but 3

All but 3

The anterior axillary nodes are located:

along the lower border of the pectoralis major.

along the upper humerus.

high in the axilla.

outside the lateral axillary fold.

along the lower border of the pectoralis major.

The midaxillary nodes are:

A. easy to feel along the upper humerus.

B. along the lateral border of the scapula.

C. low in the axilla.

D. superficial and easy to palpate.

superficial and easy to palpate.

Mrs. Tucker brings her infant daughter in for a newborn visit. On examination, you are able to express a clear to milky white fluid from the breast bud. You explain to Mrs. Tucker that this is an expected finding for an infant at which age?

A. Up to 2 months

B. Up to 3 months

C. Up to 4 months

D. Up to 6 months

Up to 3 months

Mrs. Emilio is a 41-year-old patient who presents with a complaint of a breast mass. On examination, you note an inflammation of the sebaceous glands in the areola. Which term is used to identify this clinical finding?

A. Retention cysts

B. Galactorrhea

C. Fat necrosis

D. Papillomatosis

Retention cysts

While palpating the axilla, it is best to place the patient in a:

A. sitting position with the hands over the head.

B. sitting position with the arms flexed at the elbows.

C. supine position with the arms on the hips.

D. lateral position with the arms at the sides.

sitting position with the arms flexed at the elbows.

Ms. Darren is a 29-year-old patient who presents with a firm, irregular mass with an area of discoloration. Which of the following diagnoses is associated with these clinical findings?

A. Ductal carcinoma

B. Papillomatosis

C. Retention cyst

D. Fat necrosis

Fat necrosis

Which of the following is the correct position in which to place the patient for breast palpation?

A. Supine with the arms at the side and a pillow under the neck

B. Supine with the arms over the head and small pillow under the shoulder of the side being assessed

C. Left lateral position with the arm bent backward

D. Sitting slightly forward with the breasts hanging away from the chest with the hands on the hips

Supine with the arms over the head and small pillow under the shoulder of the side being assessed

Mr. Hortsman is a 69-year-old patient who presents to your office for routine follow-up. On examination, you observe gynecomastia. This may be secondary to:

A. a decrease in physical activity.

B. increased lactiferous duct glands.

C. lymphatic engorgement.

D. a decrease in testosterone.

a decrease in testosterone.

Mrs. Casey is a 68-year-old patient who presents for a yearly physical examination. While performing a breast examination, which finding is expected?

A. The breast tissue has multiple large firm lumps in it.

B. The breast tissue has a granular feel.

C. The tail of Spence is no longer definable.

D. The axillary lymph nodes are enlarged.

The breast tissue has a granular feel.

Mrs. Tucker is a 52-year-old patient who presents for her routine yearly physical examination. What do you call the nontender and nonsuppurative bumps seen on the areola?

A. Montgomery tubercles

B. Papilloma

C. Romberg macules

D. Retention cysts

Montgomery tubercles

A clear-to-yellow viscous nipple discharge that is associated with pregnancy is called:

A. priapism.

B. hypospadias.

C. varicocele.

D. colostrum.

colostrum.

Which is a nipple-related indication of possible breast malignancy?

A. Contraction

B. Retraction

C. Virchow striation

D. Telangiectasia

Retraction

Mrs. Ginley is a 43-year-old mother of a 7 year old and a 5 year old who presents to your office for a routine physical. On examination, you note galactorrhea. Which question is most pertinent to this situation?

A. Did you breast feed your children?

B. What medications do you take?

C. Has anyone in your family had Paget disease?

D. When was your last mammogram?

What medications do you take?

Mrs. Werner is a 30-year-old patient who presents to your office. After a thorough clinical examination, you diagnose mastitis. Which factor typically causes this clinical condition?

A. Ductal enlargement

B. Clogged milk duct

C. Supernumerary nipple

D. Malignant breast tumor

Clogged milk duct

A small nipple on the upper inner thigh is:

A. a clogged milk duct.

B. a malignant breast tumor.

C. a supernumerary nipple.

D. a ductal enlargement.

a supernumerary nipple.

When examining the breasts of a woman who is 7 ½ months pregnant, which finding would be a cause for concern?

A. Enlarged, flattened nipples

B. Coarse nodularity on palpation

C. Non-blanching vascular spiders on the upper chest

D. Pronounced unilateral venous network

Pronounced unilateral venous network

What is the purpose of doing a chest wall sweep as part of a breast examination?

A. To feel superficial lumps

B. To check for tenderness in the costal cartilages

C. To increase the visibility of surface vascularity

D. To outline the breast quadrants and the tail of Spence

To feel superficial lumps

When palpating for infraclavicular lymph nodes, which direction do you give the patient?

A. Turn your head toward the side being palpated; drop both your shoulders.

B. Turn your head away from the side being palpated and drop your shoulder on that side.

C. Turn your head toward the side being palpated and raise your shoulder on that side.

D. Turn your head away from the side being palpated and raise your shoulder on that side.

Turn your head toward the side being palpated and raise your shoulder on that side.

At what point in the menstrual cycle is a routine breast examination best done?

A. Mid cycle

B. A week before menses

C. During menses

D. A week after menses

A week after menses

CH 18

Mr. Jones is a 46-year-old patient-year-old patient who presents to your office with a complaint of fatigue. Which statement made by Mr. Jones suggests a potential risk for viral hepatitis A?

A. "I am a health care worker."

B. "I had a blood transfusion recently."

C. "I have renal failure and have hemodialysis three times a week."

D. "I have recently been overseas."

"I have recently been overseas."

The examiner auscultates a friction rub in the abdomen of the patient. This finding should make the examiner consider:

A. portal hypertension.

B. renal artery stenosis.

C. inflammation of the peritoneal surface.

D. mesentery artery hypertension.

inflammation of the peritoneal surface.

A hiatal hernia is best described as:

A.a protrusion of abdominal contents through a weakening in the abdominal wall.

B. a protrusion of the stomach through the esophageal hiatus of the diaphragm.

C. an ulcer in the mucosa of the stomach that herniates into the peritoneal cavity.

D. a herniation of the gallbladder into the cystic duct.

a protrusion of the stomach through the esophageal hiatus of the diaphragm.

An examiner may wish to use a bimanual technique for abdominal palpation when:

A. palpating superficial organs.

B. validating abdominal tenderness in the infant.

C. meeting muscle resistance while performing deep palpation.

D. determining the presence of excessive peritoneal fluid.

meeting muscle resistance while performing deep palpation.

Which finding indicates the possibility of liver disease in the neonate?

A. Absence of RLQ bowel sounds

B. Epigastric pulsation

C. Spider nevi

D. Cullen sign

Spider nevi

Mr. Walker is a 46-year-old patient who presents for a routine monthly appointment. You note that the midclavicular liver span is 18 cm. With palpation, you note that the liver is enlarged with a firm, nontender border. Which problem do these findings suggest?

A. Diverticulitis

B. Ulcerative colitis

C. Hepatitis

D. Cirrhosis

Cirrhosis

Mr. Goldstein is a 56-year-old patient who presents to your office. On examination, you are unable to palpate his liver or kidneys. Which technique will help assess tenderness to these organs?

A. Direct, continuous, firm pressure over the organ for several minutes

B. Percussion for tympany

C. Percussion for size

D. Indirect fist percussion

Indirect fist percussion

In which age group does abdominal palpation become easier and more accurate?

A. Young children

B. Adolescents

C. Young adults

D. Older adults

Older adults

Which is an expected finding related to bowel sounds in the neonate?

A. Present at birth

B. Present within 1-2 hours after birth

C. Present with initiation of first feeding

C. Present on passage of first meconium

Present within 1-2 hours after birth

When examining a newborn infant, which finding suggests a congenital anomaly?

A. The umbilical cord has one artery and one vein.

B. The umbilical cord is thick.

C. The umbilical cord is thin.

D. There is a small mass around the umbilicus.

The umbilical cord has one artery and one vein.

Another way to document rebound tenderness is to write positive "__________sign."

A. Blumberg

B. Striae

C. Cullen

D. Appley

Blumberg

When a patient complains of pain down the medial thigh to the knees, it is called the ____________ and may occur in response to a strangulated hernia.

A. Apley sign

B. Romberg-Howship sign

C. Balance sign

D. Cullen sign

Romberg-Howship sign

Ms. Jones reports to your clinic with complaints of crampy pain after eating ice cream. What would you suspect is the cause of this symptom?

A. An ulcer

B. Esophageal reflux

C. Lactose intolerance

D. A hiatal hernia

Lactose intolerance

An absence of bowel sounds in the right lower quadrant is referred to as the ________________ sign.

A. Cullen

B. Striae

C. Ballance

D. Dance

Dance

An abnormal accumulation of fluid within the peritoneal cavity is referred to as:

A. ascites.

B. ballance.

C. Cullen sign.

D. singultus

ascites

A bluish periumbilical discoloration known as ________ is indicative of intraabdominal bleeding.

A. Balance sign

B. Cullen sign

C. Appley sign

D. Romberg-Howship sign

Cullen sign

Mrs. Cody is 36 weeks pregnant. She tells the examiner she feels like her stomach muscle is splitting. A light protrusion of the abdomen midline is observed. This is recognized as:

A. abdominal dehiscence.

B. swelling of the abdominal aorta.

C. diastasis recti.

D. umbilical herniation.

diastasis recti.

In which patient would a slight pulsation in the epigastric area be considered a normal inspection finding?

A. A neonate

B. An obese patient

C. A patient with ascites

D. An older patient

A neonate

Mr. Yates is a 62-year-old patient who presents for monthly follow-up examination. You palpate an organ in the left costal margin. Which technique should you use to differentiate between an enlarged left kidney and an enlarged spleen?

A. Auscultation, listening for renal bruit

B. Auscultation, listening for abdominal friction rub

C. Palpation, using indirect fist palpation to assess for tenderness

D. Percussion, listening for dullness

Percussion, listening for dullness

A 44-year-old man presents with a complaint of lower left quadrant (LLQ) pain. Which approach would you use in examining his abdomen?

A. Place the patient in a 30-degree reclining position.

B. Begin with auscultation of the tender area.

C. Ask the patient to hold his breath as you examine the LLQ.

D. Examine all other areas of the abdomen before examing the tender area.

Examine all other areas of the abdomen before examing the tender area.

Mrs. Tate is going on vacation to a foreign country and wants to know what to do to decrease her change of experiencing "traveler's diarrhea." What should you tell her?

A. Avoid eating eggs.

B. Don't eat peeled fruits and vegetables.

C. Drink water only from drinking fountains.

D. Stay away from street vendor food.

Stay away from street vendor food.

Which factor is most closely associated with a decrease in liver size and hepatic blood flow?

A. Decline in cardiac output

B. Slowed metabolic rate

C. Decreased glomerular filtration rate

D. Advancing age

D. Advancing age or

Decline in cardiac output

Which technique is used to confirm the presence of abdominal ascites?

A. Auscultation of fluid movement within the abdominal cavity

B. Palpation of rebound tenderness

C. Palpation of pitting edema on the abdomen

D. Percussion of dullness over dependent areas of the abdomen

Percussion of dullness over dependent areas of the abdomen

A 5-week-old male infant is brought to the clinic with a 2-day history of projectile vomiting. For which finding should the examiner be particularly alert?

A. Abdominal pain with palpation

B. Palpation of a small, round RUQ mass

C. Auscultation of tinkering bowel sounds

D. Auscultation of a bruit over the renal artery

Palpation of a small, round RUQ mass

Mr. Goldberg is a 45-year-old patient who presents to your office. Which finding is indicative of peritoneal irritation or appendicitis?

A. Palpation of rebound tenderness

B. Percussion of shifting dullness over the abdomen

C. Auscultation of a bruit over the abdominal aorta

D. Percussion of dullness over the suprapubic area

Palpation of rebound tenderness

A 32-year-old woman tells the examiner that when she goes running, she dribbles urine. Which problem should the examiner consider?

A. Hydronephrosis

B. Renal abscess

C. Stress incontinence

D. Overflow incontinence

Stress incontinence

A 61-year-old man has a presenting complaint of frequent constipation. He tells the examiner that there has been a change in his bowel movement habits-he gets constipated easily, the stool is very "skinny-looking," and it is a different color than usual. He denies pain. Which disorder do these symptoms suggest?

A. Diverticulitis

B. Hepatitis B

C. Colon or rectal cancer

D. Pancreatitis

Colon or rectal cancer

You hear loud bowel sounds while standing next to the patient. You would document this as:

A. Ballance.

B. borborygmi.

C. striae.

D. Cullen sign.

borborygmi.

When assessing bowel sounds, how long should you auscultate before determining the bowl sounds are absent?

A. 2 minutes

B. 3 minutes

C. 4 minutes

D. 5 minutes

5 minutes

When percussing the abdomen, which is the predominant sound you expect?

A. Resonance

B. Hyperresonance

C. Tympany

D. Dullness

Tympany

Tympany is the predominant sound because air is present in the stomach and intestines.

A technique known as _________________________ is used to assess a free-floating object in the abdomen.

A. Ballance

B. striae

C. ballottement

D. Cullen sign

ballottement

Mr. Graham is a 56-year-old patient who presents to your office with a complaint of knifelike pain and epigastric tenderness. Knifelike pain may indicate:

A. ulcer.

B. liver/biliary disease.

C. aortic aneurysm.

D. pancreatitis.

pancreatitis.

Abdominal pain that has a colic quality may indicate:

A. ulcer.

B. renal stone.

C. aortic aneurysm.

D. pancreatitis.

renal stone.

Abdominal bruits may indicate:

A. renal stone.

B. pancreatitis.

C. ulcer.

D. aortic aneurysm.

aortic aneurysm.

Burning pain in the abdomen may indicate:

A. pancreatitis.

B. aortic aneurysm.

C. ulcer.

D. renal stone.

ulcer

Ms. Sanchez is a 16-year-old female adolescent. Her mother has recently died and she was told by her father to quit school so she could take care of her two younger brothers. Since her cultural value orientation is collateral, she will be most likely to:

run away to her aunt's house.

quit school and take care of her brothers.

continue in school until she graduates.

talk to her minister and follow his advice.

quit school and take care of her brothers.

Belief that individuals have little control over their own destinies represents which category of value orientation?

Activity orientation

Human nature orientation

Relational orientation

People-to-nature orientation

People-to-nature orientation

The people-to-nature orientation belief is characterized by human beings being subject to the environment with very little control over own destiny and that they are in harmony with nature. Answers a, b, and c are characterized by different beliefs.

Mrs. Towand is a 56-year-old patient who reports that she frequently has sores at the corners of her mouth. What type of nutritional deficiency should be considered?

Vitamin E

Protein

B vitamins

Fatty acid

B vitamins

Which laboratory test result is consistent with vitamin B12 deficiency anemia?

Normal hemoglobin

Normal hematocrit

Decreased transferrin

Increased serum iron

Increased serum iron

A history of an individual's food intake is important because it:

allows estimation of the adequacy of the diet.

identifies foods from the food pyramid.

compares the recommended dietary allowances to the USDA food pyramid.

compares diet and exercise.

allows estimation of the adequacy of the diet.

It is difficult to calculate the exact energy expenditure for a given activity for a specific individual due to variables such as:

height.

type of fat cells.

muscle mass and body weight.

dietary intake.

muscle mass and body weight.

Mrs. Casey is a 47-year-old patient who is evaluated in the clinic. Currently she is homeless and her diet is poor. You are concerned that she has a vitamin B12 deficiency. Which of the following foods would increase her vitamin B12 intake?

Milk or eggs

Green leafy vegetables

Enriched whole-grain bread

Citrus fruits

Milk or eggs

Milk and eggs are high in vitamin B12, as well as breast milk, infant formula, and animal foods only: milk, egg yolk, cheese, meat, poultry, fish. Green leafy vegetables and citrus fruits are high in vitamin C. Enriched whole-grain bread is high in multiple vitamins and minerals.

It is known that the metabolic rate increases after eating. How much of an increase occurs in the total energy expenditure of the body?

5%

7%

10%

12%

7%

Mrs. Harris brings her 14-year-old daughter to your office. After her examination, you explain to Mrs. Harris that her daughter is suffering from anorexia nervosa. Her lab work demonstrates that she does not have anemia. Which of the following is the rationale for this?

Abnormal levels of hemoglobin and hematocrit

Normal levels of iron and folate

Abnormal levels of AST and ALT

Normal levels of RDW and MCHC

Normal levels of iron and folate

Which serum albumin value (g/dL) is consistent with good adult nutrition?

1.2-1.8

2.0-2.5

2.6-3.1

3.4-5.4

3.4-5.4

Situation: Jack is a 43-year-old man who complains of a loss of energy, appetite, and weight. He states that he maintained his weight at 172 pounds until 9 months ago, when he started to rapidly lose weight. Jack is 5 feet 9 inches tall and currently weighs 142 pounds. He has a midarm muscle circumference of 255 mm.

Calculating Jack's desirable weight based on height, you determine that his ideal body weight (IBW) is:

145 pounds.

150 pounds.

160 pounds.

165 pounds.

160 pounds.

To calculate IBW for a male, start with 106 pounds for first 5 feet of height and add 6 pounds for each inch thereafter.

Situation: Jack is a 43-year-old man who complains of a loss of energy, appetite, and weight. He states that he maintained his weight at 172 pounds until 9 months ago when he started to rapidly lose weight. Jack is 5 feet 9 inches tall and currently weighs 142 pounds. He has a midarm muscle circumference of 255 mm.

At his current weight of 142 pounds, Jack's percent of IBW or desirable body weight is approximately:

98%.

95%.

89%.

86%.

89%.

Situation: Jack is a 43-year-old man who complains of a loss of energy, appetite, and weight. He states that he maintained his weight at 172 pounds until 9 months ago when he started to rapidly lose weight. Jack is 5 feet 9 inches tall and currently weighs 142 pounds. He has a midarm muscle circumference of 255 mm.

At his previous weight of 172 pounds, Jack's percent of IBW or desirable body weight was approximately:

120%.

115%.

108%.

104%.

108%.

To solve this problem, use the percent of desirable weight formula (current weight 100/desirable weight). 172 100/160=108.

Situation: Jack is a 43-year-old man who complains of a loss of energy, appetite, and weight. He states that he maintained his weight at 172 pounds until 9 months ago when he started to rapidly lose weight. Jack is 5 feet 9 inches tall and currently weighs 142 pounds. He has a midarm muscle circumference of 255 mm.

What is the significance of midarm muscle circumference?

Sensitive index of protein reserves

Estimates nutritional needs

Specific index of body fat

Sensitive index of energy reserves

Sensitive index of protein reserves

Situation: Jack is a 43-year-old man who complains of a loss of energy, appetite, and weight. He states that he maintained his weight at 172 pounds until 9 months ago when he started to rapidly lose weight. Jack is 5 feet 9 inches tall and currently weighs 142 pounds. He has a midarm muscle circumference of 255 mm.

According to these data, you determine that Jack's weight loss is:

insignificant.

insignificant, but sudden weight loss may be problematic.

significant and requires further investigation.

significant but no follow-up is necessary.

significant and requires further investigation.

A significant weight loss equals or exceeds 10% in a 6-month period. Jack has lost over 10% of his body weight, which requires further investigation. Use the percent of weight change formula to complete the math.

Which of the following factors influence the perception and interpretation of pain?

Sleep deprivation, previous pain experience, previous pain medications

Age, previous pain medications, sleep deprivation

Cultural background, previous pain medications, emotions

Emotions, sleep deprivation, age

Emotions, sleep deprivation, age

Ch 7.

Ms. Pammy is a 36-year-old woman who presents to your office with a complaint of depression. She is experiencing anger, fear, and sorrow. Which of the following regulates feelings of anger, fear, and sorrow?

Limbic system

Corpus callosum

Temporal lobes

Caudate nucleus

Limbic system

The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection). Reactions to emotions such as anger, love, hostility, and envy originate here, but the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe.

Disordered perceptions, decreased attention span, suspiciousness and fear with motor and sensory excitement are characteristics of which disorder?

Delirium

Dementia

Schizophrenia

Depression

Delirium

Delirium is impaired cognition, consciousness, mood and behavioral dysfunction of acute onset. Disordered perceptions, decreased attention span, suspiciousness and fear with motor and sensory excitement are objective characteristics found in delirium.

Mr. Yates is a 67-year-old patient who presents to your office with his son. Which of the following would best test Mr. Yates comprehension?

Ask him to count backward by 7's from 100.

Ask him to follow one- and two-step commands.

Ask him the meaning of "a stitch in time saves nine."

Ask him his name, the date, and the season.

Ask him to follow one- and two-step commands.

Mrs. Tucker presents to your office today for a follow-up appointment. She appears to fidget in her seat and with her hands. Which of the following would assess her attention span?

Are you usually this anxious?

I am going to ask you to name four items; do the best you can.

What does this phrase mean: "A stitch in time saves nine?"

Could you take this paper, fold it in half, and put it on the counter?

Could you take this paper, fold it in half, and put it on the counter?

Mr. Johnson presents to your office with a complaint of anxiety. Which area of the mental assessment corresponds to his complaint?

Cognitive abilities

Speech/language

Emotional stability

Appearance and behavior

Emotional stability

Mrs. Karon is a 46-year-old female patient who presents to your office for a physical. When you enter the room, her arms are folded tight and she will not look up to address you. Into which category of examination findings do these observations belong?

Cognitive abilities

Speech/language

Emotional stability

Appearance and behavior

Appearance and behavior

Mrs. Horter brings her 14-year-old son in with a complaint that he has a poor attention span. Which of the following examination categories is most reflective of attention span?

Cognitive abilities

Speech/language

Emotional stability

Appearance and behavior

Cognitive abilities

You administer the Isaac Set Test to evaluate mental function in a 78-year-old woman whose family reports apparent changes in her cognition. You would interpret a score in which range as indicative of dementia?

Over 40

26-30

15-25

14 or less

14 or less

The Isaac Set Test measures a patient's mental functioning. Their ability to respond demonstrates executive functioning, alertness, attention span, and recent memory. A score less than 15 is associated with dementia.

Which is a major difference between Alzheimer disease and vascular dementia?

Etiology

Degree of memory loss

Functional ability

Extent of personality disintegration

Etiology

Dementia is a chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years and usually related to structural diseases. Vascular dementia is a type of dementia related to acute or embolic strokes or cerebral hemorrhages due to hypertension. Up to 70% of Alzheimer dementia is caused by the presence of senile plaques, and neurofibrillary tangles with abnormal amyloid processing or deposits.

Which of the following actions would best evaluate the patient's judgment?

Ask the patient the meaning of the statement "A stitch in time saves nine."

Provide the patient with four unrelated words and ask the patient to remember them.

Ask the patient, "What do you plan to do after you are discharged from the hospital?"

Give the patient pencil and paper and ask him to write a paragraph about judgment.

Ask the patient, "What do you plan to do after you are discharged from the hospital?"

Mr. Gates is a 68-year-old man who is brought to your office by his daughter. Which of the following would demonstrate an evaluation of thought process and content?

Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed

Observing congruence of affect and speech

Inquiring about visual, auditory, or tactile hallucinations

Asking the patient a question such as "What would you do if you were in a theatre and saw a fire starting?"

Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed

Mr. Brooks is a 65-year-old patient who presents to your office with his daughter. The daughter states that her father has intact reading comprehension, impaired writing skills, and uses only nouns and verbs in speech. Which of the following best identifies this condition?

Wernicke aphasia

Broca aphasia

Dementia aphasia

Global aphasia

Broca aphasia

Broca aphasia is an expressive type of aphasia characteristic of intact reading comprehension, impaired writing skills, and uses only nouns and verbs in speech. Wernicke and Broca aphasia display different symptoms, and the patient's speech with dementia aphasia may be rambled, incoherent, disordered, or the patient struggles to find the right words.

Mr. Santos is a 78-year-old patient who presents to your office with his daughter. The daughter describes difficulties that include a sudden onset of cognitive impairment, illogical flow of ideas, and hallucinations. Which of the following best describes this condition?

Delirium

Alzheimer type dementia

Vascular type dementia

Anxiety disorder

Delirium