CMN 577 - FINAL EXAM REVIEW QUESTIONS jj jj jj jj jj jj
AND ANSWERS (VERIFIED AND UPDATE
jj jj jj jj jj
2026/2027 jj
1. Knowing that treatment for deep vein thrombosis (DVT) involves administration of j j j j j j j j j j j j j j j j j j j j
j j anticoagulants, which of the following patients can be safely treated for DVT in the outpatient jj jj jj jj jj jj jj jj jj jj jj jj jj jj
setting?
jj
A. an 80-year-old woman who weighs 42 kg
jj jj jj jj jj jj
B. a 22-year-old man who had an appendectomy 2 days ago
jj jj jj jj jj jj jj jj jj
C. a 32-year-old woman with peptic ulcer disease
jj jj jj jj jj jj
D. a 55-year-old man with lung cancer in remission
jj jj jj jj jj jj jj
Most patients with DVT may be treated in the outpatient setting. However, there are multiple contraindications to outpatient
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
treatment, most involving increased bleeding risk, including: active peptic ulcer disease, recent surgery, and weight <55 kg for males
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
and <45 kg for females. Lung cancer or any other cancer that does not involve brain metastases is not a contraindication for outpatient
jj jj j jj j j j j j j j j j j j j j j j j j j j
treatment.
jj
Leavitt, A.D., & Minichiello, T. (2019). Disorders of Hemostasis, Thrombosis, & Antithrombotic Therapy. In M.A. Papadakis & S.J.
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
McPhee (Eds.), Current medical diagnosis and treatment 2019 (pp. 577-588). New York: McGraw-Hill Education.
jj jj jj jj jj jj jj jj jj jj jj jj jj jj
2. The nurse practitioner is examining a 65-year-old man with a history of type 2 diabetes mellitus and a
j j j j j j j j j j j j j j j j j
jj complaint of cramping pain in his calves when walking. The patient reports the pain is alleviated with rest
j j j j j j j j j j j j j j j j jj
but returns when the patient must walk again. The nurse practitioner expects to find all of the following on
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj j
exam consistent with the diagnosis of peripheral artery disease, except:
j j j j j j j j j j
A. weak or absent dorsalis pedis pulses jj jj jj jj jj
B. large ulcerations at the medial ankles jj jj jj jj jj
C. bruits over the femoral arteries jj jj jj jj
D. an ABI of 0.6 jj jj jj
Peripheral artery disease (PAD) causes intermittent claudication, pulses in the lower extremities to be faint or absent, may cause
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
bruits over the larger arteries, and usually results in an ABI of less than 0.9 (normal is 0.9-1.2). PAD can also cause ischemic and
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
arterial ulcers; however, these are generally found in the toes and feet. Large ulcers near the ankles are characteristic of venous ulcers and
jj j j j j j j j j j j j j j j j j j j j j j jj
chronic venous insufficiency.
jj jj jj
Gasper, W.J., Rapp, J.H., & Johnson, M.D. (2019). Blood Vessel & Lymphatic Disorders. In M.A. Papadakis & S.J. McPhee (Eds.),
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
Current medical diagnosis and treatment 2019 (pp. 483-501). New York: McGraw-Hill Education.
jj jj jj jj jj jj jj jj jj jj jj jj
3. A 43-year-old female presents with complaints of weight gain, constipation, memory fog, and fatigue.
jj jj jj jj jj jj jj jj jj jj jj jj jj
jj Her labs reveal a TSH of 6.7 and Free T4 of 5. Your plan for this patient includes:
j j j j j j j j j j j j j j j j j j
A. Her labs are within normal range, and no treatment is needed.
jj jj jj jj jj jj jj jj jj jj
B. Start her on Synthroid at 1.6mcg/kg/day and recheck labs in 4-6 weeks.
jj jj jj jj jj jj jj jj jj jj jj
,C. Instruct her to take her Synthroid on a full stomach for best absorption.
jj jj jj jj jj jj jj jj jj jj jj jj
D. Start her on Synthroid at 0.8mcg/kg/day and recheck labs in 2 weeks.
jj jj jj jj jj jj jj jj jj jj jj
Normal TSH values are 0.4-4 mIU/L and normal FreeT4 is 10-27pmlol/L. This patient has both the symptoms and lab values for
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
hypothyroidism. Synthroid (synthetic levothyroxine) is the first line medication for hypothyroidism and starting dose is 1.6mcg/kg/day
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
based on ideal body weight. TSH and Free T4 should be rechecked every 4-6 weeks until euthyroid and normal lab values should
jj jj jj jj jj j j jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
be obtained within 1-2 months of starting therapy.
jj jj jj jj jj jj jj jj
Fitzgerald, P.A. (2019). Endocrine Disorders. In M.A. Papadakis & S.J. Mcphee (Eds.), Current medical diagnosis and treatment 2019
j j jj jj j j jj jj jj j j jj j jj jj jj j
(pp.1134-1137). New York: McGraw-Hill Education.
jj jj jj jj jj
,4. Cigarette smoking may falsely increase the levels of: jj jj jj jj jj jj jj
A. gamma-glutamyl transpeptidase jj
B. sodium and potassium concentrations jj jj jj
C. hepatic enzymes jj
D. serum protein electrophoresis jj jj
Cigarette smoking may increase hepatic enzymes which in turn will reduce the levels of substances metabolized by the liver such as
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
theophylline.
jj
Online: https://accessmedicine-mhmedical-
jj
com.libproxy.usouthal.edu/content.aspx?bookid=2957§ionid=249389479#1175378669
5. A 75-year-old female patient who is healthy and active reports that she has recently been having trouble
j j j j j j j j j j j j j j j jj
getting to the bathroom on time to urinate and also has some leaks when she sneezes or coughs. She
j j j j j j j j j j j j j j j j j jj j
reports having to wear an incontinence pad daily. She is very independent and is embarrassed and
j j j j j j j j j j j j j j jj jj
jworried that this is going to affect her lifestyle. As her provider, your best next steps for this patient would
jj j j jj j jj jj j j jj jj j jj jj j jj jj jj jj
jj be:
A. Refer her to urology, her symptoms will only get worse and she will more than likely need surgery
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
B. Suggest bladder training and pelvic floor muscle exercises (Kegel’s) to decrease incidences of stress
jj jj jj jj jj jj jj jj jj jj jj jj jj
and urge incontinence
jj jj jj
C. Prescribe an antimuscarinic agent such as oxybutynin immediately j j j j j j j
D. Schedule the patient for insertion of a pessary jj jj jj jj jj jj jj
For women with mixed stress/urge incontinence, pelvic floor muscle exercises can be effective for decreasing this problem. The other
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
choices are more invasive and would not be first-line conservative treatments.
jj jj jj jj jj jj jj jj jj jj jj
Harper, G. M., Johnston, C. B., & Landefeld, C. S. (2019). Geriatric Disorders. In M. A. Papadakis, & S. J. McPhee, Current Medical
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
Diagnosis and Treatment (pp. 65-67). McGraw-Hill Education.
jj jj jj jj jj jj jj
6. A 40-year-old female waitress presents to the clinic complaining of pain, burning, and tingling in her
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
jj hands and fingers. She reports the symptoms are most bothersome at night. The NP has
j j j j j j j j j j j j j j j j j j j j j j j j j j j j
j j carpal tunnel syndrome as a differential diagnosis. All of the following are used to rule in or out this
j j jj jj jj jj jj jj jj j jj jj j jj jj jj jj jj jj
diagnosis EXCEPT:
jj jj
A. Tinel test jj
B. Phalen test jj
C. Spurling test jj
D. Carpal compression test j j
A Tinel or Phalen sign may be positive. A Tinel sign is tingling or shock like pain on volar wrist percussion. The Phalen sign is pain or
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
paresthesia in the distribution of the median nerve when the patient flexes both wrists to 90 degrees for 60 seconds. The carpal
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
compression test, in which numbness and tingling are induced by the direct application of pressure over the carpal tunnel, may be
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
more sensitive and specific than the Tinel and Phalen tests.
jj jj jj jj jj jj jj jj jj jj
Papadakis, M. A., McPhee, S. J. (2019). Sports medicine & outpatient orthopedics. In A. Luke, & C. B. Ma (Eds.), Current Medical
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
jj Diagnosis and Treatment 2019 (p. 1704). New York: McGraw-Hill Education.
jj jj jj jj jj jj jj jj jj
7. A 66-year-old Hispanic female presents with a two-year history of detrusor overactivity or “urge
j j j j j j j jj j j j j j
jj incontinence. She has been treated by a physical therapist with bladder training therapy for j j j j j j j j j j j j j j j j j j j j j j j j j j
j j one year, buts fail to provide appropriate relief. The next possible treatment would be:
j j jj jj jj jj jj jj jj jj jj jj jj jj
, A. Tolterodine 1-2 mg orally 2x daily jj jj jj jj jj
B. Oxybutynin 2.5 – 5mg orally 2-3x daily jj jj jj jj jj jj
C. Refer to OB/Gyn for a pessary fitting jj jj jj jj jj jj
D. All of the above jj jj jj
Antimuscarinic agents such as tolterodine or oxybutynin may provide additional benefit in stress incontinence issues. These
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
medications must be used with caution due to the side effects of dry mouth, urine retention, and delirium. A pessary may also be of
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
additional benefit but should be prescribed only by providers who are experienced in the selection, placement, and
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
management of these devices.
jj jj jj jj
Harper G, & Johnston C, & Landefeld C (2021). Overview: geriatric disorders. Papadakis M.A., & McPhee S.J., & Rabow
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
M.W.(Eds.),
jj Current Medical Diagnosis & Treatment 2021. McGraw-Hill. https://accessmedicine-mhmedical-
jj jj jj jj jj jj jj jj
com.libproxy.usouthal.edu/content.aspx?bookid=2957§ionid=249362728
8. A 23-year-old male patient presents to the clinic with complaints of fever, irritative voiding symptoms,
jj jj jj jj jj jj jj jj jj jj jj jj jj jj
jj and perineal/suprapubic pain for 2 days. Onexam, the CBC shows leukocytosis and a left shift. UA is
j j j j j j j j j j j j j j j j j j
jj positive for pyuria andbacteriuria. There isnoCVA tenderness or painful scrotal enlargement. The NP
j j j j j j j j j j j j j j j
jj suspects the patient has which of the following diagnosis? jj jj jj jj jj jj jj jj
A. Acute Bacterial Prostatitis jj jj
B. Chronic Bacterial Prostatitis j j
C. Acute Epididymitis jj
D. Prostatodynia
Acute Bacterial Prostatitis presents with fever, irritative voiding symptoms, perineal and/or suprapubic pain, and a positive UA.
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
Chronic bacterial prostatitis does not present with fever or a positive UA. Acute epididymitis will present with painful scrotal
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
j swelling due to enlargement of the epididymitis. Prostatodynia is a noninflammatory disorder presenting with a normal UA and
j jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
no fever (Papadakis & McPhee, 2019, p. 970-973).
jj jj jj jj jj jj jj jj
Papadakis, M.A., McPhee, S.J. (2019). Urologic Disorders. In M.V., Wang, T.J., Walsh, & T.D.,
j j j j j j j j j j j j j
Chi (Eds.), Current medical diagnosis & treatment (58th ed., pp. 970 - 973). United States of America: McGraw-Hill Education.
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
9. A 24-year-old female who identifies as a lesbian, presents for her annual wellness visit. She has multiple
j j j j j j j j j j j j j j j jj
j j female sexual partners. She did not receive the HPV vaccine and has not had a cervical
j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j
j j cancer screening since she was 21 years old. Which of the following is not recommended in the treatment
jj j j j j j j j j j j j j j j j j
plan for this patient?
j jj jj jj
A. HPV vaccination series jj jj
B. Papanicolaou (PAP) smear with HPV co-testing jj jj jj jj jj
C. Chlamydia trachomatis and Neisseria gonorrhea testing jj jj jj jj jj
D. Screen for Intimate Partner Violence (IPV) j j jj j j
Chlamydial infections were higher in 14- to 24-year-old women who reported same-sex behavior when compared with exclusively
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
heterosexual women. Untreated chlamydial infection places a woman’s future fertility at risk due to potential tubal occlusion. Some
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
women who have a chlamydia infection do not have symptoms. Secondary sequelae of chlamydia include intra-abdominal
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
abscesses, chronic pain, and the need for multiple surgeries. Regardless of sexual orientation, the CDC recommends
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
annual Chlamydia trachomatis (and Neisseria gonorrheae) screening from the age of first sexual activity to the age of 25 years for
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
all women. Compared to heterosexual women, lesbians and bisexual women have higher exposure to violence throughout their
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
lifetimes. The lifetime prevalence of sexual assault may be as high as 85%. It is essential to screen all women for IPV but especially
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
those in the LGBTQ community due to these alarming statistics. The primary prevention of cervical cancer is essential. All females
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
between the ages of 12 and 26 years should receive the HPV vaccine series even if they never have been or plan to be sexually
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
active with men. HPV is transmitted sexually between lesbian or heterosexual partners. The rate of HPV immunization among
jj jj jj j j jj jj jj jj jj jj jj jj jj jj jj jj jj jj
AND ANSWERS (VERIFIED AND UPDATE
jj jj jj jj jj
2026/2027 jj
1. Knowing that treatment for deep vein thrombosis (DVT) involves administration of j j j j j j j j j j j j j j j j j j j j
j j anticoagulants, which of the following patients can be safely treated for DVT in the outpatient jj jj jj jj jj jj jj jj jj jj jj jj jj jj
setting?
jj
A. an 80-year-old woman who weighs 42 kg
jj jj jj jj jj jj
B. a 22-year-old man who had an appendectomy 2 days ago
jj jj jj jj jj jj jj jj jj
C. a 32-year-old woman with peptic ulcer disease
jj jj jj jj jj jj
D. a 55-year-old man with lung cancer in remission
jj jj jj jj jj jj jj
Most patients with DVT may be treated in the outpatient setting. However, there are multiple contraindications to outpatient
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
treatment, most involving increased bleeding risk, including: active peptic ulcer disease, recent surgery, and weight <55 kg for males
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
and <45 kg for females. Lung cancer or any other cancer that does not involve brain metastases is not a contraindication for outpatient
jj jj j jj j j j j j j j j j j j j j j j j j j j
treatment.
jj
Leavitt, A.D., & Minichiello, T. (2019). Disorders of Hemostasis, Thrombosis, & Antithrombotic Therapy. In M.A. Papadakis & S.J.
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
McPhee (Eds.), Current medical diagnosis and treatment 2019 (pp. 577-588). New York: McGraw-Hill Education.
jj jj jj jj jj jj jj jj jj jj jj jj jj jj
2. The nurse practitioner is examining a 65-year-old man with a history of type 2 diabetes mellitus and a
j j j j j j j j j j j j j j j j j
jj complaint of cramping pain in his calves when walking. The patient reports the pain is alleviated with rest
j j j j j j j j j j j j j j j j jj
but returns when the patient must walk again. The nurse practitioner expects to find all of the following on
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj j
exam consistent with the diagnosis of peripheral artery disease, except:
j j j j j j j j j j
A. weak or absent dorsalis pedis pulses jj jj jj jj jj
B. large ulcerations at the medial ankles jj jj jj jj jj
C. bruits over the femoral arteries jj jj jj jj
D. an ABI of 0.6 jj jj jj
Peripheral artery disease (PAD) causes intermittent claudication, pulses in the lower extremities to be faint or absent, may cause
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
bruits over the larger arteries, and usually results in an ABI of less than 0.9 (normal is 0.9-1.2). PAD can also cause ischemic and
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
arterial ulcers; however, these are generally found in the toes and feet. Large ulcers near the ankles are characteristic of venous ulcers and
jj j j j j j j j j j j j j j j j j j j j j j jj
chronic venous insufficiency.
jj jj jj
Gasper, W.J., Rapp, J.H., & Johnson, M.D. (2019). Blood Vessel & Lymphatic Disorders. In M.A. Papadakis & S.J. McPhee (Eds.),
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
Current medical diagnosis and treatment 2019 (pp. 483-501). New York: McGraw-Hill Education.
jj jj jj jj jj jj jj jj jj jj jj jj
3. A 43-year-old female presents with complaints of weight gain, constipation, memory fog, and fatigue.
jj jj jj jj jj jj jj jj jj jj jj jj jj
jj Her labs reveal a TSH of 6.7 and Free T4 of 5. Your plan for this patient includes:
j j j j j j j j j j j j j j j j j j
A. Her labs are within normal range, and no treatment is needed.
jj jj jj jj jj jj jj jj jj jj
B. Start her on Synthroid at 1.6mcg/kg/day and recheck labs in 4-6 weeks.
jj jj jj jj jj jj jj jj jj jj jj
,C. Instruct her to take her Synthroid on a full stomach for best absorption.
jj jj jj jj jj jj jj jj jj jj jj jj
D. Start her on Synthroid at 0.8mcg/kg/day and recheck labs in 2 weeks.
jj jj jj jj jj jj jj jj jj jj jj
Normal TSH values are 0.4-4 mIU/L and normal FreeT4 is 10-27pmlol/L. This patient has both the symptoms and lab values for
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
hypothyroidism. Synthroid (synthetic levothyroxine) is the first line medication for hypothyroidism and starting dose is 1.6mcg/kg/day
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
based on ideal body weight. TSH and Free T4 should be rechecked every 4-6 weeks until euthyroid and normal lab values should
jj jj jj jj jj j j jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
be obtained within 1-2 months of starting therapy.
jj jj jj jj jj jj jj jj
Fitzgerald, P.A. (2019). Endocrine Disorders. In M.A. Papadakis & S.J. Mcphee (Eds.), Current medical diagnosis and treatment 2019
j j jj jj j j jj jj jj j j jj j jj jj jj j
(pp.1134-1137). New York: McGraw-Hill Education.
jj jj jj jj jj
,4. Cigarette smoking may falsely increase the levels of: jj jj jj jj jj jj jj
A. gamma-glutamyl transpeptidase jj
B. sodium and potassium concentrations jj jj jj
C. hepatic enzymes jj
D. serum protein electrophoresis jj jj
Cigarette smoking may increase hepatic enzymes which in turn will reduce the levels of substances metabolized by the liver such as
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
theophylline.
jj
Online: https://accessmedicine-mhmedical-
jj
com.libproxy.usouthal.edu/content.aspx?bookid=2957§ionid=249389479#1175378669
5. A 75-year-old female patient who is healthy and active reports that she has recently been having trouble
j j j j j j j j j j j j j j j jj
getting to the bathroom on time to urinate and also has some leaks when she sneezes or coughs. She
j j j j j j j j j j j j j j j j j jj j
reports having to wear an incontinence pad daily. She is very independent and is embarrassed and
j j j j j j j j j j j j j j jj jj
jworried that this is going to affect her lifestyle. As her provider, your best next steps for this patient would
jj j j jj j jj jj j j jj jj j jj jj j jj jj jj jj
jj be:
A. Refer her to urology, her symptoms will only get worse and she will more than likely need surgery
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
B. Suggest bladder training and pelvic floor muscle exercises (Kegel’s) to decrease incidences of stress
jj jj jj jj jj jj jj jj jj jj jj jj jj
and urge incontinence
jj jj jj
C. Prescribe an antimuscarinic agent such as oxybutynin immediately j j j j j j j
D. Schedule the patient for insertion of a pessary jj jj jj jj jj jj jj
For women with mixed stress/urge incontinence, pelvic floor muscle exercises can be effective for decreasing this problem. The other
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
choices are more invasive and would not be first-line conservative treatments.
jj jj jj jj jj jj jj jj jj jj jj
Harper, G. M., Johnston, C. B., & Landefeld, C. S. (2019). Geriatric Disorders. In M. A. Papadakis, & S. J. McPhee, Current Medical
jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj jj
Diagnosis and Treatment (pp. 65-67). McGraw-Hill Education.
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6. A 40-year-old female waitress presents to the clinic complaining of pain, burning, and tingling in her
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jj hands and fingers. She reports the symptoms are most bothersome at night. The NP has
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j j carpal tunnel syndrome as a differential diagnosis. All of the following are used to rule in or out this
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diagnosis EXCEPT:
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A. Tinel test jj
B. Phalen test jj
C. Spurling test jj
D. Carpal compression test j j
A Tinel or Phalen sign may be positive. A Tinel sign is tingling or shock like pain on volar wrist percussion. The Phalen sign is pain or
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paresthesia in the distribution of the median nerve when the patient flexes both wrists to 90 degrees for 60 seconds. The carpal
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compression test, in which numbness and tingling are induced by the direct application of pressure over the carpal tunnel, may be
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more sensitive and specific than the Tinel and Phalen tests.
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Papadakis, M. A., McPhee, S. J. (2019). Sports medicine & outpatient orthopedics. In A. Luke, & C. B. Ma (Eds.), Current Medical
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jj Diagnosis and Treatment 2019 (p. 1704). New York: McGraw-Hill Education.
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7. A 66-year-old Hispanic female presents with a two-year history of detrusor overactivity or “urge
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jj incontinence. She has been treated by a physical therapist with bladder training therapy for j j j j j j j j j j j j j j j j j j j j j j j j j j
j j one year, buts fail to provide appropriate relief. The next possible treatment would be:
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, A. Tolterodine 1-2 mg orally 2x daily jj jj jj jj jj
B. Oxybutynin 2.5 – 5mg orally 2-3x daily jj jj jj jj jj jj
C. Refer to OB/Gyn for a pessary fitting jj jj jj jj jj jj
D. All of the above jj jj jj
Antimuscarinic agents such as tolterodine or oxybutynin may provide additional benefit in stress incontinence issues. These
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medications must be used with caution due to the side effects of dry mouth, urine retention, and delirium. A pessary may also be of
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additional benefit but should be prescribed only by providers who are experienced in the selection, placement, and
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management of these devices.
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Harper G, & Johnston C, & Landefeld C (2021). Overview: geriatric disorders. Papadakis M.A., & McPhee S.J., & Rabow
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M.W.(Eds.),
jj Current Medical Diagnosis & Treatment 2021. McGraw-Hill. https://accessmedicine-mhmedical-
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com.libproxy.usouthal.edu/content.aspx?bookid=2957§ionid=249362728
8. A 23-year-old male patient presents to the clinic with complaints of fever, irritative voiding symptoms,
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jj and perineal/suprapubic pain for 2 days. Onexam, the CBC shows leukocytosis and a left shift. UA is
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jj positive for pyuria andbacteriuria. There isnoCVA tenderness or painful scrotal enlargement. The NP
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jj suspects the patient has which of the following diagnosis? jj jj jj jj jj jj jj jj
A. Acute Bacterial Prostatitis jj jj
B. Chronic Bacterial Prostatitis j j
C. Acute Epididymitis jj
D. Prostatodynia
Acute Bacterial Prostatitis presents with fever, irritative voiding symptoms, perineal and/or suprapubic pain, and a positive UA.
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Chronic bacterial prostatitis does not present with fever or a positive UA. Acute epididymitis will present with painful scrotal
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j swelling due to enlargement of the epididymitis. Prostatodynia is a noninflammatory disorder presenting with a normal UA and
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no fever (Papadakis & McPhee, 2019, p. 970-973).
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Papadakis, M.A., McPhee, S.J. (2019). Urologic Disorders. In M.V., Wang, T.J., Walsh, & T.D.,
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Chi (Eds.), Current medical diagnosis & treatment (58th ed., pp. 970 - 973). United States of America: McGraw-Hill Education.
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9. A 24-year-old female who identifies as a lesbian, presents for her annual wellness visit. She has multiple
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j j female sexual partners. She did not receive the HPV vaccine and has not had a cervical
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j j cancer screening since she was 21 years old. Which of the following is not recommended in the treatment
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plan for this patient?
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A. HPV vaccination series jj jj
B. Papanicolaou (PAP) smear with HPV co-testing jj jj jj jj jj
C. Chlamydia trachomatis and Neisseria gonorrhea testing jj jj jj jj jj
D. Screen for Intimate Partner Violence (IPV) j j jj j j
Chlamydial infections were higher in 14- to 24-year-old women who reported same-sex behavior when compared with exclusively
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heterosexual women. Untreated chlamydial infection places a woman’s future fertility at risk due to potential tubal occlusion. Some
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women who have a chlamydia infection do not have symptoms. Secondary sequelae of chlamydia include intra-abdominal
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abscesses, chronic pain, and the need for multiple surgeries. Regardless of sexual orientation, the CDC recommends
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annual Chlamydia trachomatis (and Neisseria gonorrheae) screening from the age of first sexual activity to the age of 25 years for
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all women. Compared to heterosexual women, lesbians and bisexual women have higher exposure to violence throughout their
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lifetimes. The lifetime prevalence of sexual assault may be as high as 85%. It is essential to screen all women for IPV but especially
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those in the LGBTQ community due to these alarming statistics. The primary prevention of cervical cancer is essential. All females
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between the ages of 12 and 26 years should receive the HPV vaccine series even if they never have been or plan to be sexually
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active with men. HPV is transmitted sexually between lesbian or heterosexual partners. The rate of HPV immunization among
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