NR 511 Differential Diagnosis and Primary Care- Final Exam Review Questions and answers with 100% accuracy

Topics

GI Disorders

....

Ulcerative colitis

A 38-year-old male patient has recently had an ileostomy for ulcerative colitis. Which self-care measures should the clinician teach him about to relieve food blockage?

massage the peristomal area

Diverticulitis

Which of the following is true regarding diverticula

obesity is correlated

Left lower quadrant abdominal pain for 2 days, the pain started suddenly and then fever, chills, anorexia, nausea and painless bloody stools.

Acute diverticulitis

An 82-year-old female has been diagnosed with irritable bowel, chronic constipation, and diverticulosis following a colonoscopy. Which pharmacological agent should the clinician recommend?

bulk laxative

Which of the following is part of the treatment plan for the

patient with irritable bowel syndrome?

High fiber diet

A 35-year-old female patent is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical exam?

digital rectal exam, Sexual history, Pelvic exam

A 28-year-old patent is seen in the clinic with colicky abdominal pain, particularly with meals. She has

frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of

diverticulitis unlikely?

Her age

C. diff Definition and Risk factors

C. diff Symptoms

C. diff Diagnosis

C. diff Treatment

GERD pathophysiology

A 54-year-old female presents to your primary care office for routine reevaluation for gastroesophageal reflux disease (GERD). She has been treated with diet modifications and 6 weeks of omeprazole without improvement of her symptoms. What is the next step in the management of this patient's GERD?

Order an endoscopy (This is the next step in treatment in order to evaluate the etiology of the patient's

GERD and consider biopsy if necessary)

A 67-year-old female on multiple medications for chronic conditions was just diagnosed with gastroesophageal reflux disease (GERD). In teaching the patient about the disease, what medication should the clinician recommend that the patient refrain from using?

nonsteroidal anti-inflammatory drugs

The patient with gastro esophageal reflux disease (GERD)

should be instructed to eliminate which of these activities?

Weight lifting

A patient is seen with a sudden onset of flank pain

accompanied by nausea, vomiting, and diaphoresis, in addition to

nephrolithiasis, which of the following should be added to the list

of differential diagnoses?

Pancreatitis, peptic ulcer disease, diverticulitis, All of

the above

A patient is diagnosed with Giardia after a backpacking trip in

the mountains. Which of the following would be the appropriate

treatment?

Metrinidazole

A patient is seen in the clinic with right upper quadrant (RUQ)

pain that is radiating to the middle of the back. The clinician

suspects acute cholelithiasis. The clinician should expect which of

the following laboratory findings?

Elevated alkaline phosphatase

A patient is diagnosed with gastroesophageal reflux disease

(GERD), and his endoscopic report reveals the presence of

Barretts epithelium. Which of the following information should the

clinician include in the explanation of the pathology

This is a premalignant tissue, This tissue is resistant to

gastric acid, This tissue supports healing of the esophagus:

All of the above

which of the following dietary information should be given to a

patient with gastroesophageal reflux disease (GERD)

Eliminate coffee

Mark has necrotizing fasciitis of his left lower extremity.

Pressure on the skin reveals crepitus due

to gas production by which anaerobic bacteria?

Clostridium perfringens

A patient is diagnosed with GERD, the clinician knows that she misunderstands the teaching when she says:

stop smoking

eat smaller meals

-have a snack before retiring for bed.

a patient presents to the clinic with a dry cough, non smoker, for 5 weeks. the cough increases at night, he reports episodes of heartburn after meals. what should the differential include?

GERD

A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that "some foods get stuck" and she has been having "heartburn" at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis?

GERD

Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months for which he takes Tums with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information's would lead

you to believe that gastro esophageal reflux disease (GERD) is the cause of his pain?

He awakens at night coughing with a bad taste in his mouth

Which of the following dietary information's should be given to a patent with gastroesophageal

reflux disease (GERD)

Stop coffee

PUD

A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly for 2 weeks. He gets temporary relief from Alka Seltzer. The burning pain wakes him at night and radiates up into his chest. Which factor favors a diagnosis of gastric ulcer?

His use of Alka Seltzer

You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated with:

Infection by Helicobacter pylori (About 90% of cases of pepti

c ulcers have been found to be caused by

infection with the bacteria H pylori)

Peptic ulcer disease symptom Question of symptoms

Burning/nawing

PUD Treatement

PUD V GERD 1

PUD V GERD

A 52-year-old female is suspected of having a gastric ulcer and will undergo an Esophagogastroduodenoscopy (EGD). She is concerned because she heard that gastric ulcers can be malignant. How should the clinician respond?

About 95% of gastric ulcers are benign

A 72-year-old male patient presents to the clinic for his annual physical. He states that he is worried because he only has a bowel movement every three days. How should the clinician respond?

There is no such thing as a normal pattern of defecation

Rotavirus

Appendicitis

A 16 year old male presents to urgent care clinic with abdominal pain. The pain is constant and located in the periumbilical region shifting to the RLQ. N/V/D. Elevation in wbc and wbc in urine

Appendicitis

Rovsing's sign is associated with which of the following?

An acute abdomen, such as during a ruptured appendix

A 7-year-old male presents with his mother to the urgent care clinic complaining of abdominal pain. He started to complain of pain prior to going to bed; however, it has gotten progressively worse and is now preventing him from sleeping. He is nauseous but hasn't vomited and didn't eat dinner due to the pain. The patient appears pale and is complaining of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120, temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is

tender in the right lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 17.0. What is the patient's likely diagnosis?

Appendicitis (This is the clinical scenario typical for appendicitis)

gastroenteritis

A 26-year-old male recently returned from a camping trip with symptoms of acute gastroenteritis. He reports that he only ate vegetables from his garden that he canned prior to his outing. Which of the following pathogens might be causing his symptoms?

Clostridium botulinum

A 39 year old female reports a 10 year history of crohns disease. which of the following is true of crohns

disease?

obstructions, fissures are seen with disease progression

Initial laboratory testing for IBS may include:

abdominal imaging

A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives. Following this, she has diarrhea for a couple of days. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be?

Obtain a complete history

H. Pylori

A 42 year old male has been diagnosed with h pylori gastritis which was confirmed by urea breath test. The clinician has given the patient a prescription for a standard 14 day triple therapy regimen. Which is correct

regarding treatment?

Repeat test 4 weeks after therapy completion

What is the recommended treatment to eradicate h pylori

amox, clarythro and omeprazole

A clinician expects the patient to have gastroduodenal ulcer dt HPYLORI and plans to treat empirically

PPI

A patent is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses?

Pancreatitis

b. Peptic ulcer disease

Diverticulitis

d. All of the above

Diarrhea

A patent with complaints of diarrhea is seen. Which of the following should be included on the differential diagnosis list for a patent with diarrhea?

gastroenteritis, Lactase deficiency, Inflammatory bowel disease

Most common cause of travelers diarrhea

e.coli

a 25-year old male presents with abdominal cramping and diarrhea for 7 days. The clinician knows that stool samples are warranted in which of the following situations:

Consuming sushi

Which of the following is the least likely diagnosis for a patient with diarrhea?

GERD

A 30-year-old male presents to the clinic with intermittent diarrhea. He states the loose stools always occur within 30 minutes after taking antacids. How should the clinician respond?

Antacids may contain magnesium, which may cause diarrhea

A 29-year-old female just returned from Central America with traveler's diarrhea and presents to the clinic for evaluation. Which of the following is the best treatment?

supportive care

Giardia

Salmonella

Giardia vs Salmonella

splenic sequestration

Nausea is difficult to discern in a young child. What question should the clinician ask to determine if a child has nausea?

Are you hungry

To differentiate among the different diagnosis of inflammatory bowel disease, you look at the clients histological and radiologic images that show:

Crohns-Focal involvement of the colon with some skipped areas and sparing rectal mucosa.

Which of the following is the appropriate treatment for giardia

quin.hydr.

Anemia

Anemia Cont

What is the most common cause of anemia

c. iron deficiency anemia

Diagnostic tests Anemia results

Which of the following reflects the sickle cell anemia heritary?

Sickle cell is autosomal recessive

Gold standard for definitive diagnosis of sickle cell?

Hemoglobin electophoresis

Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after

you ask him about his diet?

Perform a fecal occult blood test

iron deficiency anemia1

iron deficiency anemia

Caroline, 65, is homeless and has iron deficiency anemia. She smokes and drinks when she can and has a

stomach ulcer. Which of the following is not one of her risk factors for iron deficiency anemia?

Smoking

Lorie, age 29, appears with the following signs: pale conjunctivae and nail beds, tachycardia, heart

murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect?

iron deficiency anemia

a 19 year old female was diagnosed with iron deficiency d/t menorrhia. What education should you

give?

Take on an empty stomach

A woman presents to your primary care office for an annual physical. She denies any complaints other

than having heavy menstrual bleeding which is something she has experienced her whole life. On

routing CBC evaluation, her hemoglobin is 11. Other values; dec ferritin, elevated total iron binding

compacity. mcv is 75. Which is the most likely cause of her anemia

iron deficiency anemia

Caroline, an older adult, is homeless and has iron deficiency anemia. She smokes and drinks when she can and has an ulcer. Which of the following is not one of the risk factors of iron deficiency anemia?

Smoking

Which is the best test to perform to spot an iron-deficiency anemia early before it progresses to full-blown anemia?

Ferritin

A 68-year-old man complains of lower abdominal pain, anorexia, extreme fatigue, an unintentional weight loss of 15 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. Which diagnosis should the NP consider?

Colon cancer

Retic Count

In which of the following circumstances is the reticulocyte count elevated?

Acute blood loss

MCV

Sherri's blood work returns with a decreased mean corpuscular volume (MCV) and a decreased

mean corpuscular hemoglobin concentration (MCHC). What should you do next?

Order a serum iron level, a total iron-binding capacity level, and a serum ferritin level

Your client Shirley has an elevated mean corpuscular volume (MCV). What should you be considering in

terms of diagnosis?

Liver disease

normocytic anemia is defend as anemia associated with normally sized RBCs, what is the MCV

MCV=81-99

(macrocytic equal or greater than 100fL)

megaloblastic anemia

Macrocytic normochromic anemias are caused by

A defciency of folic acid

Sideroblastic anemia

Which of the following diagnostic tests confirms sideroblastic anemia?

perusian blue stain

what will a cbc with differential reveal with pernicious anemia?

macrocytic and normochromic

microcytic anemia

What type of anemia is beta thalacemia minor

Micro

Macrocytic normochromic anemia are caused by

Deficiency of folic acid

Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a

microcytic hypochromic anemia. What should you do now at this visit?

Obtain a lead level