6531 Final Deck 2 Exam with complete solutions

Sharon, age 29, is pregnant for the first time. She complains of nasal stuffiness and occasional epistaxis. What do you do? A. Order lab tests, such as a CBC with differential, hemoglobin and hematocrit B. Prescribe an antihistamine C. You do nothing except for client teaching D. Refer the client to an ear, nose and throat specialist - Answer- C. You do nothing except for client teaching - Can occur with pregnancy because of increased vascularization in the upper respiratory tract David, age 32, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? A. Prescribe nasal steroids and oral decongestants B. Prescribe antibiotic eardrops C. Prescribe systemic eardrops D. Refer David to an ear, nose, and throat specialist - Answer- A. Prescribe nasal steroids and oral decongestants A sexual history of oral-genital contact in a client presenting with pharyngitis is significant when which of the following organisms is suspected? A. Escherichia coli B. Haemophilus influenzae C. Neisseria gonorrhoeae D. Streptococcus pneumoniae - Answer- C. Neisseria gonorrhoeae - Neisseria gonorrhoeae pharyngitis is a common sexually transmitted disease The most common cause of sensoineural hearing loss is A. Trauma B. Tympanic membrane sclerosis and scarring C. Otosclerosis D. Presbycusis - Answer- D. Presbycusis How do you describe the cervical lymphadenopathy associated with asymptomatic HIV infection? A. Movable, discrete, soft, and nontender lymph nodes B. Enlarged, warm, tender, firm, but freely movable lymph nodes C. Hard, unilateral, nontender, and fixed lymph nodes D. Firm but not hard, nontender, and mobile lymph nodes - Answer- D. Firm but not hard, nontender, and mobile lymph nodes You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergeny room. Which of the following symptoms would indicate that an airway obstruction is imminent? A. Reddened face B. Screaming C. Grabbing her throat D. Stridor - Answer- D. Stridor Purulent matter in the anterior chamber of the eye is called A. Hyphema B. Hypopyon C. Anisocoria D. Pterygium - Answer- B. Hypopyon A 42 year old stockbroker comes to your office for evaluation of a pulsating headache over the left temporal region and he rates the pain as an 8 on a scale of 1-10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent headaches for many years but not as severe and they are usually relieved by over the counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headaache? A. Tension B. Migraine C. Cluster D. Temporal arteritis - Answer- B. Migraine The trachea deviates toward the affected side in all of the following except A. Aortic aneurysm B. Unilateral thyroid lobe enlargement C. Large atelectasis D. Pneumothorax - Answer- C. Large atelectasis Matthew, age 52, has allergic rhinitis and would like some medicine to relieve his symptoms. He is taking cimetidine (Tagamet) for gastroesophageal reflux disease. Which medication would you not order? A. A first-generation antihistamine B. A second-generation antihistamine C. A decongestant D. A topical nasal corticosteroid - Answer- B. A second-generation antihistamine Jessica, an 8 year old third grader is broght to the office by her grandmother, who is the child's babysitter. She has complained of fever and sore throat for the past 2 days. Five other children in her class have been sick with sore throats. She denies difficulty swallowing and has been drinking fluids but has no appetite. ROS reveals that she has clear nasal drainage, hoarseness, and nonproductive cough. She denies vomiting but has had mild diarrhea. On examination she has a temperature of 101.5 F, 3+ erythematous tonsils, and palpable, tender cervical lymph nodes. Based on these findings, what is the most likely diagnosis? A. Mono B. Sinusitis C. Strep pharyingitis D. Viral pharyngitis - Answer- D. Viral pharyngitis Marcia, age 4, is brought into the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102 F but no pharyngeal erythema or cough. What do you suspect? A. Epiglottitis B. Group A beta-hemolytic streptococcal infection pharyngitis C. Tonsillitis D. Diphtheria - Answer- A. Epiglottitis You note a completely split uvula in Noi, a 42 year old Asian. What is your next course of action? A. Do nothing B. Refer Noi to a specialist C. Perform a throat culture D. Order a CBC - Answer- A. Do nothing Claude, age 78, is being treated with timolol maleate (Timoptic) drops for his chronic open-angle glaucoma. While performing a new client history and physical, you note that he is taking other medications. Which medication would you be most concerned about? A. Apsirin therapy as prophylaxis for heart attack B. Ranitidine (Zantac) for gastroesophageal reflux disease C. Alprazolam (Xanax), an anxiolytic for anxiety D. Atenolol (Tenormin), a beta blocker for high blood pressure - Answer- D. Atenolol (Tenormin), a beta blocker for high blood pressure Harry, age 69, has had Meniere's disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo? A. A labyrinthectomy B. Pharmacological therapy C. A vestibular neurectomy D. Wearing an earplug in the ear with the most hearing loss - Answer- C. A vestibular neurectomy A 65 year old man presents complaining of left sided deep, throbbing headache along with mild fatigue. On examination the client has a tender, tortuous temporal artery. You suspect temporal arteritis. How do you confirm your diagnosis? A. MRI fo the head B. Erythrocyte sedimentation rate (ESR) C. EEG D. Otoscopy - Answer- B. Erythrocyte sedimentation rate (ESR) Marty has a hordeolum in his right eye. You suspect that the offending organism is A. Herpes simplex virus B. Staphylococcus C. Candida albicans D. Escherichia coli - Answer- B. Staphylococcus The most common offending allergens causing allergic rhinitis are A. Pollens of grasses, trees and weeds B. Fungi C. Animal allergens D. Food sensitivity - Answer- A. Pollens of grasses, trees, and weeds Cydney, age 7, is complaining that she feels as though something is stuck in her ear. What action is contraindicated? A. Inspecting the ear canal with an otoscope B. Using a small suction device to try to remove the object C. Flushing the ear with water D. Instilling several drops of mineral oil in the ear - Answer- C. Flushing the ear with water June, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthus. She is concerned that they may be cancerous skin lesions. You tell her they are probably A. Xanthelasmas B. Pingueculae C. The result of arcus senilis D. Actinic keratoses - Answer- A. Xanthelasmas Mavis is 70 years old and wonders if she can donate her corneas when she dies. How do you respond? A. "As long as you don't have any chronic illness, you corneas may be harvested." B. "They will use corneas only from persons younger than age 65." C. "What makes you feel like you are dying?" D. "Don't think about such terrible things now." - Answer- B. "They will use corneas only from persons younger than age 65." Manny, age 16, was hit in the eye with a baseball. He developed pain in the eye, decreased visual acuity, and injection of the globe. You confirm the diagnosis of hyphema by finding blood in the anterior chamber. What treatment would you recommend while Manny is waiting to see the ophthalmologist? A. Apply bilateral eye patches B. Have Manny lie flat C. Refer him to an ophthalmologist within a week D. Make sure Manny is able to be awakened every 30 minutes - Answer- A. Apply bilateral eye patches Judy, age 67, complains of a sudden onset of impaired vision, severe eye pain, vomiting, and a headache. You diagnose the following condition and refer for urgent treatment A. Cataracts B. Macular degeneration C. Presbyopia D. Acute glaucoma - Answer- D. Acute glaucoma Which of the following refractive errors in vision is a result of the natural loss of accomodative capacity with age? A. Presbyopia B. Hyperopia C. Myopia D. Astigmatism - Answer- A. Presbyopia The leading cause of blindness in persons age 20-60 in the United States is A. Macular degeneration B. Glaucoma C. Diabetic retinopathy D. Trauma - Answer- C. Diabetic retinopathy A 62 year old obese woman comes in today 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 will awake at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements. She does not drink or smoke. 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 OB negative. What is the most likely diagnosis? A. Esophageal varices B. Esophageal cancer C. Gastroesophageal reflux disease (GERD) D. Peptic ulcer disease - Answer- C. Gastroesophageal reflux disease (GERD) Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect? A. Acute otitis media B. Chronic otitis media C. External otitis D. Temporomandibular joint syndrome - Answer- C. External otitis Barbara, age 72, states that she was told she had atrophic macular degeneration and asks you if there is any treatment. How do you respond? A. "No, but 5 years from the time of the first symptoms, the process usually stops." B. "Yes, there is a surgical procedure that will cure this." C. "If we start medications now, they may prevent any further damage." D. "Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can help you adjust to the visual loss." - Answer- D. "Unfortunately, there is no effective treatment, but I can refer you to a rehabilitation agency that can help you adjust to the visual loss." Natasha, age 4, has amblyopia. How do you respond when her mother asks about treatment? A. "We'll wait until she's 7 years old before starting treatment." B. "Treatment needs to be started now. We'll cover her 'bad' eye." C. "Treatment needs to be started now. We'll cover her 'good' eye." D. "No treatment is necessary. She'll outgrow this." - Answer- C. "Treatment needs to be started now. We'll cover her 'good' eye." When Judith, age 15, asks you to explain the 20/50 vision in her right eye, you respond A. "You can see at 20ft with your left eye what the normal person can see at 50ft." B. "You can see at 20ft with your right eye what the normal person can see at 50ft." C. "You can see at 50ft with your right eye what the normal person can see at 20ft." D. "You can see at 50ft with the left eye what the normal person can see at 20ft." - Answer- B. "You can see at 20ft with your right eye what the normal person can see at 50ft." - If vision is greater than 20/30, refer the client to an ophthalmologist or optometrist Risk factors for oral cancers include A. A family history, poor dental habits, and use of alcohol B. Obesity, sedentary lifestyle, and chewing tobacco C. A history of diabetes, smoking, and a high fat intake D. Smokine, use of alcohol, and chewing tobacco - Answer- D. Smoking, use of alcohol, and chewing tobacco When you are assessing the internal structure of the eye, absence of a red reflex may indicate A. A cataract or a hemorrhage into the vitreous humor B. Acute iritis C. Nothing, this is a normal finding in older adults D. Diabetes or long-standing hypertension - Answer- A. A cataract or a hemorrhage into the vitreous humor The immediate goal of myringotomy and tube placement in a child with recurrent episodes of totis media is to A. Prevent future infections B. Have an open access to the middle ear for irrigation and instillation of antibiotics C. Allow removal of suppurative or mucoid material D. Relieve pain - Answer- C. Allow removal of suppurative or mucoid material A 22 year old client who plays in a rock band complains that he finds it difficult to understand his fellow musicians at the end of a night of performing, a problem that is compounded by the noisy environment of the "club." These symptoms are most characteristic of which of the following? A. Sensorineural loss B. Conductive loss C. Tinnitus D. Vertigo - Answer- A. Sensorineural loss With a chronic allergy, a client's nasal mucosa appear A. Swollen and red B. Swollen, boggy, pale and gra