Final Diagnostics Exam

Final Diagnostic: Sprained ankle 1-1 What is the most common presentation of a client with a sprained ankle? A. Point tenderness over a ligament, ecchymoses, edema, and pain B. General achiness, reddened skin, and no edema C. Bony deformity, no edema, and cool skin D. Crepitus, ecchymoses, severe pain, and no point Tenderness Testicular torsion 1-3 Which of the following is a urological emergency? A. Testicular torsion B. Epididymitis C. Varicocele D. Hydrocele 14-28 Tommy, age 15, comes to the clinic in acute distress with “belly pain.” When obtaining his history, you find that he fell off his bike this morning and has vomited. Upon closer examination, you determine the belly pain to be left-sided groin pain, or pain in his left testicle. He is afebrile and reports no dysuria. You suspect A. testicular torsion. B. epididymitis. C. a hydrocele. D. a varicocele. 14-71 Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. You are trying to differentiate between epididymitis and testicular torsion. Which test to determine whether swelling is in the testis or the epididymis should be your first choice? A. X-ray B. Ultrasound C. Technetium scan D. Physical examination 14-84 Which of the following scrotal disorders is most common in adolescents? A. Acute epididymitis B. Testicular torsion C. Atrophic testes D. Scrotal edema Dementia 1-5 Your client Mrs. Jones, age 78, is brought to your primary care office by her son, James. He is describing recent changes in Mrs. Jones’s behavior and affect. You are trying to differentiate between depression and dementia. You know that A. the person with dementia usually tries to conceal memory problems. B. the person with depression has wide mood swings. C. dementia has a sudden onset. D. agitation always accompanies depression. Mr. Boyd, age 84, has dementia and is in a long-term care facility. His daughter and son-in-law are visiting. As they get ready to leave and begin to say good-bye, Mr. Boyd grabs his daughter’s arm and begins to cry, saying “Don’t leave me here. I will die in this place.” As she leaves the room, his daughter is visibly upset and asks you if she should visit again soon because it has so upset her father. The best reply for you to make is A. “You might try telephoning next time instead of visiting. Your father will know that you are thinking of him then.” B. “I will give you the number of the social worker. She will be able to arrange a team conference and family meeting.” D. “He needs time to adjust to this new setting. Perhaps it might be easier on you all if you just didn’t visit for a few days.” 1-58 What is the most common cause of progressive dementia in persons older than 55? A. Alzheimer ’ s disease B. Vascular disease C. Huntington ’ s disease D. Parkinson ’ s disease 3-66 Jan’s mother has Alzheimer’s disease. She tells you that her mother’s recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, “Is this as bad as it gets?” You tell her that her mother is in which stage of the disease? A. Stage 1 B. Stage 2 C. Stage 3 C. “This is a very upsetting time for all of you. However, it is important that you continue to visit regularly. For now, I will go in and sit with your father for a little while.” D. Stage 4 7-23 Which medication should be avoided in clients with Alzheimer ’ s disease who have concurrent vascular dementia or vascular risk factors? A. Acetycholinesterase inhibitors like donepezil (Aricept) B. N -methyl-d-aspartate (NMDA) receptor antagonists C. Anxiolytics like bupirone (Buspar) D. Atypical antipsychotics like risperidone (Risperdal) 6-19 Mary is caring for her 83-year-old father at home. He has dementia and is unsteady on his feet. You recommend that Mary A. put her father in a nursing home so that she can have a life of her own. B. take in another elderly person so that her father can have company. C. get information on home safety and community resources. D. lock her father’s bedroom door at night so that he will not wander into the street. 6-118 Mr. Green is a vigorous 70-year-old who comes for early assessment of dementia. He wants to “work ” to keep up his mental capacities. You counsel that he should A. make sure he gets enough rest because cells need time to regenerate as a result of the stress of the aging process. B. begin taking a calcium supplement. C. consider a hobby that challenges his mental capacity, like building model ships or airplanes. D. play bridge (or any group card game) several times a week. 7-24 Dave, age 76, is brought in by his wife, who states that within the past 2 days Dave has become agitated and restless, has had few lucid moments, slept very poorly last night, and can remember only recent events. Of the following differential diagnoses, which seems the most logical from this brief history? A. Depression B. Dementia C. Delirium D. Schizophrenia 7-49 Clients with senile dementia of the Alzheimer’ s type often die of A. pneumonia. B. suicide. C. pressure sores. D. malnutrition. 7-69 Lynne, age 72, presents for the first time with her daughter. Her daughter describes some recent disturbing facts about her mother. How can you differentiate between depression and dementia? A. You might be able to pinpoint the onset of dementia, but the onset of depression is difficult to identify. B. A depressed person has wide mood swings, whereas a person with dementia demonstrates apathetic behavior. D. The person with dementia has a poor self-image, whereas the person with depression does not have a change in self-image. 7-70 Grace, age 82, has Alzheimer ’ s disease. Her daughter states that she is agitated, has time disorientation, and wanders during the afternoon and evening hours. How do you describe this behavior? A. Alzheimer’s dementia B. Sundowning C. Deficits of the Alzheimer’s type D. Senile dementia 7-100 Sophie is 82 and scores 25 on the Mini- Mental State Examination (MMSE). What is your initial thought? A. Normal for age B. Depression C. Early Alzheimer ’ s disease D. Late Alzheimer ’ s disease 7-112 What are the two most common causes of dementia in older adults? A. Polypharmacy and nutritional disorders B. Alzheimer’s disease and vascular disorders C. Metabolic disorders and space-occupying lesions D. Infections affecting the brain and polypharmacy Depression 3-43 Which of the following statements is true about the older adult? A. Older adults are at an increased risk for depression. B. Depression is a normal part of aging. C. The person with dementia tries to hide problems concerning his or her memory, whereas the person with depression complains about memory. C. Depression may just be the emotion felt when a spouse is grieving the loss of a loved one. D. Most antidepressive drugs do not work without psychotherapy on older adults. 3-81 Which individuals does the U.S. Preventive Services Task Force (USPSTF) recommend screening for depression? A. Adults who are experiencing gender issues B. Adults who have already tried unsuccessfully to commit suicide C. All adults D. If a provider suspects depression, the individual should be referred to a specialist rather than screening in the primary care office 4-89 Joyce, who experienced some transient emotional disturbances around her third postpartum day, is just now feeling like herself again after about 2 weeks. It is most likely that Joyce experienced A. maternity or “baby” blues. B. postpartum depression. C. postpartum psychosis. D. postpartum anxiety disorder. 6-9 Jane comes to your office shortly after the death of her husband of 40 years. You should be concerned if she expresses complaints of A. waves or periods of depression. B. loss of appetite. C. crying when she talks with friends. D. extreme guilt. 6-69 As you speak with Melissa and her mother, you ascertain more signs and symptoms that contribute to a clinical picture of depression. These include A. sad, discouraged, irritable mood and feelings of Loneliness. B. going on a spending spree. C. obsessively exercising. D. constant hand washing. 6-73 In counseling Melissa on dealing with her depression, you are aware of the successful strategies in managing a depressive illness. Apart from pharmacological interventions, some suggested strategies include A. an exercise regimen; more exposure to daylight; rethinking one’s situation. B. stressing the importance of rest. C. doing complete blood work on Melissa and recommending a multivitamin and vitamin E. D. recommending St. John’s wort, an herbal remedy, because Melissa does not want to take antidepressants. 6-108 You see a 19-year-old college student, Melissa, who is listless and speaks in monosyllabic language. Her affect is flat. Her mother has brought her to your primary care office because she is concerned about her. You know that risk factors for depression include which of the following? A. Being a college student B. Believing oneself to be incapable, helpless, a victim, or hopeless C. Having the summer free from school D. Not having a car or transportation available 7-86 Which of the following symptoms related to memory indicates depression rather than delirium or dementia in the older adult? A. Inability to concentrate, with psychomotor agitation or retardation B. Impaired memory, especially of recent events C. Inability to learn new material D. Difficulty with long-term memory 7-108 Major depression occurs most often in which of the following conditions? A. Parkinson ’ s disease B. Alzheimer ’ s disease C. Myocardial infarction D. Stroke