Exam (elaborations) CMN 577

1. A 62-year-old female presents to your clinic with new onset of muscle weakness, muscle cramps, and increased fatigue. The patient states that she also has increased urinary output since she has been prescribed Lasix (furosemide) for a recent diagnosis of CHF. What is the best clinical diagnosis for this patient according to her medical history? - ANSHyponatremia B. Hyperkalemia C. Hypocalcemia D. Hypokalemia* Rationale: Hypokalemia is a common side effect of loop diuretics (i.e. Lasix). Signs and symptoms of mild to moderate hypokalemia include fatigue, muscle cramps and weakness. 1. A 72-year-old female complains of shortness of breath, nonproductive cough, weight gain in the last 2 weeks, and dyspnea with exertion. On auscultation, you hear fine crackles and no wheezes. She most likely has: - ANSChronic Bronchitis B. R sided heart failure C. L sided heart failure* D. Atrial Fibrillation Rationale: The most common symptoms of Left heart failure are shortness of breath, dyspnea with exertion, and nonproductive cough. Crackles represent fluid collection in the alveoli. Fluid retention causes rapid weight gain. Symptoms of R sided heart failure include edema, ascites, hepatic congestion, decreased appetite and nausea. 1. Knowing that treatment for deep vein thrombosis (DVT) involves the administration of anticoagulants, which of the following patients can be safely treated for DVT in the outpatient setting? - ANSan 80-year-old woman who weighs 42 kg B. a 22-year-old man who had an appendectomy 2 days ago C. a 32-year-old woman with peptic ulcer disease D. a 55-year-old man with lung cancer in remission* Most patients with DVT may be treated in the outpatient setting. However, there are multiple contraindications to outpatient treatment, most involving increased bleeding risk, including: active peptic ulcer disease, recent surgery, and weight <55 kg for males and <45 kg for females. Lung cancer or any other cancer that does not involve brain metastases is not a contraindication for outpatient treatment. 10. A 15-year old sexually active patient comes into your clinic for a wellness exam. What screenings are NOT appropriate to perform on this patient? - ANSCervical cancer* B. Hypertension C. Depression/anxiety D. Obesity Rationale: According to the USPSTF guidelines you do not start cytology screening until a female is 21 years old and then every 3 years if cytology is normal. 10. A 3-year-old child presents to your clinic with a history of bilateral AOM. She was treated with Amoxicillin within the past 28 days. The mother states the child is not sleeping at night and is tugging at his right ear. On exam you note there is decreased motility with pneumatic otoscopy to the right tympanic membrane. There is pus behind the TM, and it is reddened and retracted. The left TM is pearly white with a good cone of light. Boney landmarks are visible. How would you treat today? - ANSAmoxicillin B. Augmentin * C. Rocephin D. Omnicef A bulging TM and middle ear effusion by pneumatic otoscopy or tympanometry must both be present to diagnose. If patient has taken amoxicillin in the past 30 days use Augmentin ES due to the assumed presence of the beta lactase. Augmentin is PCN with a beta lactam ring. 10. All of the following can help reduce the risk of adolescents developing STIs except: - ANSa monogamous sexual relationship with one partner B. the use of a condom C. abstinence D. birth control Abstinence, a monogamous sexual relationship with one partner, and proper condom use has shown to reduce the risk of adolescents developing sexually transmitted infections. On the other hand, birth control only helps to prevent pregnancy and does not offer any protection against STIs. 11. A 57-year-old female comes into the clinic with complaints of hot flashes and vaginal dryness. She is a smoker and has hypertension. When giving her hormone replacement options, the NP informs her best option is: - ANSOral estrogen B. Oral estrogen with progesterone C. Estradiol injections D. Transdermal estrogen*