NSG 554 EXAM 4 V3 - PRIMARY CARE I
COMPREHENSIVE REVIEW.
QUESTIONS AND ANSWERS
1. A 65-year-old male presents with a new onset of a ‘curtain falling’ over his left eye that
lasted for 10 minutes before resolving. He has a history of hypertension and smoking. What is
the most likely diagnosis?
A. Amaurosis fugax (TIA)
B. Retinal detachment
C. Acute angle-closure glaucoma
D. Optic neuritis
Answer: A
Conceptual Explanation: Amaurosis fugax is a transient monocular vision loss often
described as a curtain falling, typically caused by an embolus from the carotid artery,
signifying a TIA.
2. When evaluating a patient for Rheumatoid Arthritis (RA), which of the following lab
findings is the most specific for the diagnosis?
A. Positive Rheumatoid Factor (RF)
,B. Elevated Erythrocyte Sedimentation Rate (ESR)
C. Anti-cyclic citrullinated peptide (Anti-CCP) antibodies
D. Elevated C-reactive protein (CRP)
Answer: C
Conceptual Explanation: While RF is sensitive, Anti-CCP is highly specific (up to 95%) for
Rheumatoid Arthritis and can predict the progression to erosive joint disease.
3. A 28-year-old female presents with fatigue and a sore tongue. Her labs show Hemoglobin
10.2 g/dL, MCV 112 fL, and elevated homocysteine and methylmalonic acid (MMA) levels.
What is the diagnosis?
A. Iron deficiency anemia
B. Folic acid deficiency
C. Anemia of chronic disease
D. Vitamin B12 deficiency
Answer: D
Conceptual Explanation: Elevated MMA is specific to B12 deficiency; in folate deficiency,
only homocysteine is elevated, not MMA.
4. In the management of a patient with a new diagnosis of Parkinson’s Disease, which
physical exam finding is considered a ‘cardinal’ sign?
A. Bradykinesia
, B. Intention tremor
C. Hyperreflexia
D. Ataxia
Answer: A
Conceptual Explanation: The cardinal signs of Parkinson’s include bradykinesia, resting
tremor (pill-rolling), rigidity, and postural instability.
5. A patient presents with a painful, swollen first metatarsophalangeal (MTP) joint. A joint
aspiration reveals negatively birefringent needle-shaped crystals. What is the first-line
treatment for this acute flare?
A. Indomethacin (NSAID)
B. Probenecid
C. Allopurinol
D. Febuxostat
Answer: A
Conceptual Explanation: Acute gout flares are treated with NSAIDs, colchicine, or
steroids. Urate-lowering therapies like Allopurinol should not be started during an acute
flare.
COMPREHENSIVE REVIEW.
QUESTIONS AND ANSWERS
1. A 65-year-old male presents with a new onset of a ‘curtain falling’ over his left eye that
lasted for 10 minutes before resolving. He has a history of hypertension and smoking. What is
the most likely diagnosis?
A. Amaurosis fugax (TIA)
B. Retinal detachment
C. Acute angle-closure glaucoma
D. Optic neuritis
Answer: A
Conceptual Explanation: Amaurosis fugax is a transient monocular vision loss often
described as a curtain falling, typically caused by an embolus from the carotid artery,
signifying a TIA.
2. When evaluating a patient for Rheumatoid Arthritis (RA), which of the following lab
findings is the most specific for the diagnosis?
A. Positive Rheumatoid Factor (RF)
,B. Elevated Erythrocyte Sedimentation Rate (ESR)
C. Anti-cyclic citrullinated peptide (Anti-CCP) antibodies
D. Elevated C-reactive protein (CRP)
Answer: C
Conceptual Explanation: While RF is sensitive, Anti-CCP is highly specific (up to 95%) for
Rheumatoid Arthritis and can predict the progression to erosive joint disease.
3. A 28-year-old female presents with fatigue and a sore tongue. Her labs show Hemoglobin
10.2 g/dL, MCV 112 fL, and elevated homocysteine and methylmalonic acid (MMA) levels.
What is the diagnosis?
A. Iron deficiency anemia
B. Folic acid deficiency
C. Anemia of chronic disease
D. Vitamin B12 deficiency
Answer: D
Conceptual Explanation: Elevated MMA is specific to B12 deficiency; in folate deficiency,
only homocysteine is elevated, not MMA.
4. In the management of a patient with a new diagnosis of Parkinson’s Disease, which
physical exam finding is considered a ‘cardinal’ sign?
A. Bradykinesia
, B. Intention tremor
C. Hyperreflexia
D. Ataxia
Answer: A
Conceptual Explanation: The cardinal signs of Parkinson’s include bradykinesia, resting
tremor (pill-rolling), rigidity, and postural instability.
5. A patient presents with a painful, swollen first metatarsophalangeal (MTP) joint. A joint
aspiration reveals negatively birefringent needle-shaped crystals. What is the first-line
treatment for this acute flare?
A. Indomethacin (NSAID)
B. Probenecid
C. Allopurinol
D. Febuxostat
Answer: A
Conceptual Explanation: Acute gout flares are treated with NSAIDs, colchicine, or
steroids. Urate-lowering therapies like Allopurinol should not be started during an acute
flare.
