Primary Care I - Final Exam Review
Which of following statements best captures the importance of employing diagnostic
reasoning?
1. A systematic approach to diagnosis can reduce errors in all healthcare environments
2. Diagnostic reasoning forces providers to quickly narrow their differential
E. Emergency room care is often rushed and diagnostic reasoning slows the thinking
process
4. Diagnostic reasoning involves use of a comprehensive ROS and physical exam - 1. A
systematic approch to diagnosis can reduce errors in all healthcare environments
The essential difference between a diagnostic framework and a differential is that:
1. Diagnostic frameworks are symptom based, differential are patient based
2. Diagnostic frameworks require a greater understanding of illness scripts
3. Diagnostic frameworks are ranked in order of likelihood
4. Diagnostic frameworks are only necessary when the presenting symptoms are vague
- 1. Diagnostic frameworks are symptom based, differential are patient based
Ideally, to rule in a diagnosis, the better test would be:
1. The least expensive test
2. The test with the largest negative likelihood ratio
3. The test with a positive predictive value of 1
4. The test with the largest positive likelihood ratio - 4. The test with the largest positive
likelihood ratio
A patient with polyarticular joint pain, fatigue, malaise and ulnar deviation of the
metacarpal joints. Which blood test is most specific for this disease?
1. Anticyclic Citrullinated Peptide (Anti-CCP)
2. Rheumatoid Factor (RF)
3. Anti double strength DNA (Anti-DS DNA)
4. Antinuclear antibody (ANA) - 1. Anti-CCP
In most autoimmune diseases, the best use of an ESR and CRP is?
1. Monitoring the progression of a disease and the effectiveness of a medication
2. As the initial screening tool
3. Ruling in an infectious process
4. Establishing the presence of an autoimmune disease - 1. Monitoring the progression
for disease and the effectiveness of a medication
A key feature differentiating osteoarthritis from rheumatoid arthritis is:
1. Monoarticular vs. polyarticular
,2. Obesity vs. underweight
3. Pain after use vs. pain after immobility
4. Acute vs. chronic onset - 3. Pain after use vs. pain after immobility
A major difference between NSAIDS and DMARDS is that:
1. NSAIDS are more effective in smaller joints, DMARDS are more effective in larger
joints
2. DMARDS can restore lost function, NSAIDS cannot restore lost function
3. DMARDS provide much more pain control
4. DMARDS slow the progression of the disease, NSAIDS do not - 4. DMARDS slow
the progression of the disease, NSAIDS do not
Which principle should guide diagnosis of an autoimmune disease?
1. Always maintain a suspicion of autoimmune disease
2. Included a screening CBC with any patient with joint pain
3. Autoimmune disease can be ruled out if there are not arthralgias (joint pain)
4. Refer any joint pain to ortho or rheumatology - 1. Always maintain a suspicion of
autoimmune disease
A young child is diagnosed with CF. The parents are concerned that any other children
they have will also be born with CF. The practitioner explains that CF is an autosomal
recessive inherited disease and that any future children:
1. Is much more likely to have this condition if they are male
2. Will have a 25% chance of inheriting the disease
3. Is very unlikely to have this condition because it is extremely rare
4. Will have a 50% chance of inheritance - 2. Will have a 25% chance of inheriting the
disease
A major concern when a patient is taking a biological disease modifying anti rheumatic
drug is:
1. Immunosuppression
2. Thrombocytopenia
3. Toxic dermatological reactions
4. Treatment resistance to high blood pressure - 1. Immunosuppression
What is the best example of polymorphism?
1. Inheritance and environment play equal roles in the emergence of a trait
2. Eye color is a result of several different genes
3. X-linked recessive conditions result in males with the phenotype of the condition
4. An ethnic population metabolizes a medication more slowly than the population at
large - 4. An ethnic population metabolizes a medication more slowly than the
population at large
In which genetic inheritance, can the likelihood of a disease be decreased with
preventative measures?
1. Multi factorial
, 2. Chromosomal translocation
3. Polygenic
4. Replication errors - 1. Multi factorial
What is the main principle to follow when prescribing antibiotics?
1. Use the narrowest spectrum that is effective for the infection
2. Use the broadest spectrum for infants and toddlers
3. Always have patients return for a test of cure
4. Prescribe to be given as frequently as possible to maintain serum levels - 1. Use the
narrowest spectrum that is effective for the infection
First line treatment for Lymes Disease includes:
1. Doxycycline
2. Tetracycline and prednisone
3. Rocephin
4. Penicillin - 1. Doxycycline
Before treating a patient for a sore throat and rapid strep positive test, the NP asks
about medication allergies. The patient reports that they experienced hives (wheals)
after taking PCN. In considering the allergic reaction, the NP would most safely
prescribe:
1. A first generation cephalosporin
2. A fluoroquinolone
3. A macrolide
4. Augmentin - 3. A macrolide
Dry eye disease, or keratoconjunctivitis is of diagnostic importance because of its
association with:
1. Autoimmune disease
2. Substance addiction
3. Retinal detachment
4. Macular degeneration - 1. Autoimmune disease
A patient presents with the following signs and symptoms: gradual onset of low-grade
fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy.
Based on these signs and symptoms which of the following should be included in the
differential?
1. Influenza
2. Candidiasis
3. Mononucleosis
4. Herpes zoster - 3. Mononucleosis
A patient reports nasal congestion, and facial pain that is worse when they bend forward
and with pain on palpation over the maxillary sinuses. What additional finding would
cause you to consider prescribing and antibiotic?
1. Fever of 101
Which of following statements best captures the importance of employing diagnostic
reasoning?
1. A systematic approach to diagnosis can reduce errors in all healthcare environments
2. Diagnostic reasoning forces providers to quickly narrow their differential
E. Emergency room care is often rushed and diagnostic reasoning slows the thinking
process
4. Diagnostic reasoning involves use of a comprehensive ROS and physical exam - 1. A
systematic approch to diagnosis can reduce errors in all healthcare environments
The essential difference between a diagnostic framework and a differential is that:
1. Diagnostic frameworks are symptom based, differential are patient based
2. Diagnostic frameworks require a greater understanding of illness scripts
3. Diagnostic frameworks are ranked in order of likelihood
4. Diagnostic frameworks are only necessary when the presenting symptoms are vague
- 1. Diagnostic frameworks are symptom based, differential are patient based
Ideally, to rule in a diagnosis, the better test would be:
1. The least expensive test
2. The test with the largest negative likelihood ratio
3. The test with a positive predictive value of 1
4. The test with the largest positive likelihood ratio - 4. The test with the largest positive
likelihood ratio
A patient with polyarticular joint pain, fatigue, malaise and ulnar deviation of the
metacarpal joints. Which blood test is most specific for this disease?
1. Anticyclic Citrullinated Peptide (Anti-CCP)
2. Rheumatoid Factor (RF)
3. Anti double strength DNA (Anti-DS DNA)
4. Antinuclear antibody (ANA) - 1. Anti-CCP
In most autoimmune diseases, the best use of an ESR and CRP is?
1. Monitoring the progression of a disease and the effectiveness of a medication
2. As the initial screening tool
3. Ruling in an infectious process
4. Establishing the presence of an autoimmune disease - 1. Monitoring the progression
for disease and the effectiveness of a medication
A key feature differentiating osteoarthritis from rheumatoid arthritis is:
1. Monoarticular vs. polyarticular
,2. Obesity vs. underweight
3. Pain after use vs. pain after immobility
4. Acute vs. chronic onset - 3. Pain after use vs. pain after immobility
A major difference between NSAIDS and DMARDS is that:
1. NSAIDS are more effective in smaller joints, DMARDS are more effective in larger
joints
2. DMARDS can restore lost function, NSAIDS cannot restore lost function
3. DMARDS provide much more pain control
4. DMARDS slow the progression of the disease, NSAIDS do not - 4. DMARDS slow
the progression of the disease, NSAIDS do not
Which principle should guide diagnosis of an autoimmune disease?
1. Always maintain a suspicion of autoimmune disease
2. Included a screening CBC with any patient with joint pain
3. Autoimmune disease can be ruled out if there are not arthralgias (joint pain)
4. Refer any joint pain to ortho or rheumatology - 1. Always maintain a suspicion of
autoimmune disease
A young child is diagnosed with CF. The parents are concerned that any other children
they have will also be born with CF. The practitioner explains that CF is an autosomal
recessive inherited disease and that any future children:
1. Is much more likely to have this condition if they are male
2. Will have a 25% chance of inheriting the disease
3. Is very unlikely to have this condition because it is extremely rare
4. Will have a 50% chance of inheritance - 2. Will have a 25% chance of inheriting the
disease
A major concern when a patient is taking a biological disease modifying anti rheumatic
drug is:
1. Immunosuppression
2. Thrombocytopenia
3. Toxic dermatological reactions
4. Treatment resistance to high blood pressure - 1. Immunosuppression
What is the best example of polymorphism?
1. Inheritance and environment play equal roles in the emergence of a trait
2. Eye color is a result of several different genes
3. X-linked recessive conditions result in males with the phenotype of the condition
4. An ethnic population metabolizes a medication more slowly than the population at
large - 4. An ethnic population metabolizes a medication more slowly than the
population at large
In which genetic inheritance, can the likelihood of a disease be decreased with
preventative measures?
1. Multi factorial
, 2. Chromosomal translocation
3. Polygenic
4. Replication errors - 1. Multi factorial
What is the main principle to follow when prescribing antibiotics?
1. Use the narrowest spectrum that is effective for the infection
2. Use the broadest spectrum for infants and toddlers
3. Always have patients return for a test of cure
4. Prescribe to be given as frequently as possible to maintain serum levels - 1. Use the
narrowest spectrum that is effective for the infection
First line treatment for Lymes Disease includes:
1. Doxycycline
2. Tetracycline and prednisone
3. Rocephin
4. Penicillin - 1. Doxycycline
Before treating a patient for a sore throat and rapid strep positive test, the NP asks
about medication allergies. The patient reports that they experienced hives (wheals)
after taking PCN. In considering the allergic reaction, the NP would most safely
prescribe:
1. A first generation cephalosporin
2. A fluoroquinolone
3. A macrolide
4. Augmentin - 3. A macrolide
Dry eye disease, or keratoconjunctivitis is of diagnostic importance because of its
association with:
1. Autoimmune disease
2. Substance addiction
3. Retinal detachment
4. Macular degeneration - 1. Autoimmune disease
A patient presents with the following signs and symptoms: gradual onset of low-grade
fever, marked fatigue, severe sore throat, and posterior cervical lymphadenopathy.
Based on these signs and symptoms which of the following should be included in the
differential?
1. Influenza
2. Candidiasis
3. Mononucleosis
4. Herpes zoster - 3. Mononucleosis
A patient reports nasal congestion, and facial pain that is worse when they bend forward
and with pain on palpation over the maxillary sinuses. What additional finding would
cause you to consider prescribing and antibiotic?
1. Fever of 101
