N675 Acute and Episodic Exam 1 Questions and Answers

N675 Acute and Episodic Exam 1

A health care provider in a clinic finds a patient in a room, unresponsive and pale.

Which sign should be used to identify the need to initiate cardiopulmonary resuscitation (CPR)?

Evaluation of peripheral perfusion and level of consciousness Obtaining a history of previous myocardial infarction Determination of pulselessness or bradycardia Assessment of gasping breaths or not breathing An African-American patient who is being treated with a thiazide diuretic for chronic hypertension reports blurred vision and shortness of breath. The provider notes a blood pressure of 185/115. What is the recommended action for this patient?

Increase the dose of the thiazide medication Add a beta blocker to the patient's regimen Admit to the hospital for evaluation and treatment Prescribe a calcium channel blocker https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms?

Atrial fibrillation Anemia Extrasystole Paroxysmal attacks A patient has a cardiac murmur that peaks in midsystole and is best heard along the left sternal border. The provider determines that the murmur decreases in intensity when the patient changes from standing to squatting and increases in intensity with the Valsalva maneuver. Which cause will the provider suspect for this murmur?

Aortic stenosis Tricuspid regurgitation Hypertrophic cardiomyopathy Mitral valve prolapse A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?

Give the patient an oral beta blocker Transfer to the PCI-capable institution

Administer heparin Initiate fibrinolytic treatment Patients who meet the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease are those with a history of (Select all that apply.) previous myocardial infarction. a low-density lipoprotein (LDL) level >190 mg/dL. diabetes and an LDL between 40 and 70 mg/dL. a 10 year risk score of 8% with an LDL of 80 mg/dL. a 10 year risk score of 5% and an LDL of 165 mg/dL. a low-density lipoprotein (LDL) level >190 mg/dL. a 10 year risk score of 8% with an LDL of 80 mg/dL. A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for 30 minutes or more. What the does provider suspect as the cause for these symptoms?

Buerger's disease Cauda equina syndrome Diabetic neuropathy Peripheral arterial disease Which are causes of secondary hypertension? (Select all that apply.)

Oral contraceptives Isometic excercises NSAIDS Sleep apnea Increased salt intake NSAIDS Sleep apnea https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A young female patient has known mitral valve prolapse. During a routine health maintenance exam, the provider notes an apical systolic murmur and a midsystolic click on auscultation. The patient denies chest pain, syncope, or palpitations. What will the provider do?

Reassure the patient that these findings are expected Continue to monitor the patient every 3 years Admit the patient to the hospital for evaluation and treatment Consult with cardiology to determine appropriate diagnostic tests A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action?

Scheduling an MRI to evaluate for aortic disease Immediate referral to a thoracic surgeon US of the mass to determine size Ordering CT angiography

A patient is brought to an emergency department with symptoms of acute ST-segment elevations MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?

Give the patient an oral beta blocker Initiate fibrinolytic treatment Administer heparin Transfer to the PCI-capable institution A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not take any medications. What will the provider do next to evaluate this patient?

Continue to monitor blood pressure at each health maintenance visit Assess serum cortisol levels Order urinalysis, CBC, BUN and creatinine Refer to specialist for sleep study A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help with relief of symptoms in this patient?

Statin therapy with clopidogrel Walking to the point of pain each day Daily aspirin therapy to prevent clotting Walking slowly for 15 to 20 minutes twice daily An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minute. What will the provider do next?

Order an electrocardiogram and exercise stress test Monitor the patient's heart rate while the patient is bearing down Evaluate the patient's orthostatic vital signs Reassure the patient that the symptoms are non-cardiac in origin The AHA recommends early CPR and AED use for adult victims of cardiac arrest outside of a hospital setting because most victims have which arrhythmia?

Atrial flutter Ventricular fibrillation Atrial fibrillation Ventricular tachycardia https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the child emergency department. What initial intervention may be attempted in the clinic?

Administration of intravenous adenosine Using a vagal maneuver or carotid massage

Providing a loading dose of digoxin Giving a beta blocker Current American Heart Association (AHA) recommendations include: (Select all that apply.)

Using a ratio of 2 rescue breaths to 30 compressions A compression depth of 1.5 inches or more on an adult A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths Rescue breaths given during 2 seconds to allow full chest rise A rate of 100 compressions per minute at a minimum Untrained rescuers giving compressions without breaths A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action?

Prescribe a calcium channel blocker medication Start aspirin therapy and refer the patient to a cardiologist Give the patient a beta blocker medication Administer a second nitroglycerin tablet A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has poorly-controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient?

No intervention is necessary for this patient Immediate open surgical repair of the aneurysm Endovascular stent grafting of the aneurysm Serial ultrasonographic surveillance of the aneurysm Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?

Appropriately increased PTH and low or normal serum calcium Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Prolonged inappropriate secretion of PTH with subsequent hypercalcemia A patient who is obese has recurrent urinary tract infections and reports feeling tired most of the time. What initial diagnostic test will the provider order in the clinic at this visit?

Hemoglobin A1C Random serum glucose C-peptide level Thyroid studies https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism? (normal TSH is 0.3-4) 0.2 uIU/L 4.2 uIU/L 0.4 uIU/L 2.4 uIU/L A 20-year-old female patient with tachycardia and weight loss but no optic symptoms has the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?

Radioiodine therapy Surgical resection of the thyroid gland Beta blocker medications Thionamide therapy A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient?

Avoidance of weight bearing exercises Annual monitoring of calcium, creatinine, and bone density Decreasing calcium and Vitamin D intake until values normal Parathyroidectomy A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?

Serum calcitonin Radionucleotide imaging Serum TSH level Thyroid ultrasound Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?

Prolonged inappropriate secretion of PTH with subsequent hypercalcemia Inappropriate secretion of PTH along with hypercalcemia Appropriately high PTH along with hypocalcemia Appropriately increased PTH and low or normal serum calcium What is important about increased PAI-1 levels in patients with metabolic syndrome?

They cause increased insulin resistance.

They predispose patients to dyslipidemia.

They lower the risk of hypertension.

They increase the risk of arterial thrombosis. https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient who has diabetes has a blood pressure of 140/90 mm Hg and albuminuria.

Which initial action by the primary care provider is indicated for management of this patient?

Consulting with a nephrologist Prescribing an antihypertensive medication Referring to an ophthalmologist Limiting protein intake A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the provider tell this patient?

She will need lifelong medication.

A thyroidectomy will be necessary.

This condition may be transient.

She should be referred to an endocrinologist.

Which findings are symptoms of hyperparathyroidism? (Select all that apply.)

Cognitive impairment Left ventricular hypertrophy Renal calculi Perioral paresthesias Chvostek's sign Left ventricular hypertrophy Renal calculi Which medication given for patients with metabolic syndrome helps to lower PAI-1 levels?

Aspirin Niacin Atorvastatin Metformin A patient recently diagnosed with type 1 diabetes mellitus is in clinic for a follow-up evaluation. The provider notes that the patient appears confused and irritable and is sweating and shaking. What intervention will the provider expect to perform once the point of care blood glucose level is known?

Giving a rapid-acting carbohydrate Performing a hemoglobin A1C Dipstick urinalysis for ketones Injection of rapid-acting insulin https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient with type 2 diabetes mellitus becomes insulin dependent after a year of therapy with oral diabetes medications. When explaining this change in therapy, the provider will tell the patient: that strict diet and exercise measures may be relaxed with insulin therapy.

it is necessary because the patient cannot comply with the previous regimen. this is because of the natural progression of the disease. the use of insulin therapy may be temporary.

A patient develops a dry, non-productive cough and is diagnosed with bronchitis.

Several days later, the cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?

Bronchodilator treatment Mucokinetic agents Antitussive medication Antibiotic therapy A young adult patient without a previous history of lung disease has an increased respiratory rate and reports a feeling of "not getting enough air." The provider auscultates clear breath sounds and notes no signs of increased respiratory effort.

Which diagnostic test will the provider perform initially?

Chest radiograph Complete blood count Computerized tomography Spirometry A patient who has asthma calls the provider to report having a peak flow measure of 75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid medication twice daily. What will the provider recommend?

Administering two more doses of albuterol Taking an oral corticosteroid Coming to the clinic for evaluation Going to the emergency department https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

The parent of a 4-month-old infant who has had an episode of bronchiolitis asks the provider if the infant may have an influenza vaccine. What will the provider tell this patient?

The infant should have an influenza vaccine now with a booster in 1 month The infant should be given prophylactic antiviral medications The rest of the family and all close contacts should have the influenza vaccine The infant should have the live attenuated influenza vaccine (LAIV) A patient reports coughing up a small amount of blood after a week of cough and fever.

The patient has been previously healthy and does not smoke or work around pollutants or irritants. What will the provider suspect as the most likely cause of this patient's symptoms?

Thromboembolism Infection Malignancy

Lung abscess An older patient with COPD is experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no history of pulmonary hypertension or congestive heart failure. What will the provider order to help manage this patient's dyspnea?

Opioid medications Anxiolytic drugs Supplemental oxygen Breathing exercises A patient reports shortness of breath with activity and exhibits increased work of breathing with prolonged expirations. Which diagnostic test will the provider order to confirm a diagnosis in this patient?

Arterial blood gases ventilation/perfusion scan Spirometry Blood cultures https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient with hemoptysis and no other symptoms has a normal chest radiograph, CT, and fiberoptic bronch studies. What is the next action in managing this patient?

Observation Refer to specialist Surgical intervention Prophylactic ABX Which clinical sign is especially worrisome in a patient with a pulmonary embolism?

TachycardiaAsw Dyspnea Hypotension Abnormal lung sounds A patient has chronic chest pain that occurs after meals and the provider suspects gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor and after 2 months the patient reports improvement in symptoms. What is the next action in treating this patient?

Schedule an upper endoscopy Continue the proton pump inhibitor Refer the patient to a gastroenterologist Order esophageal pH monitoring A patient comes to an emergency department with chest pain. The patient describes the pain is sharp and stabbing and reports that it has been present for several weeks. Upon questioning, the examiner determines that the pain is worse after eating. The patient reports getting relief after taking a friend's nitroglycerin during one episode. What is the most likely cause of this chest pain?

Pleural pain Cardiac pain Aortic dissection pain Esophageal pain https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient who has a central line develops respiratory compromise. What is the initial intervention for this patient?

Obtaining cultures and starting antibiotics Lung ultrasonography to determine the cause Prompt removal of the central line Rapid assessment and resuscitation A patient has a cough and fever and the provider auscultates rales in both lungs that do not clear with cough. The patient reports having a headache and sore throat prior to the onset of coughing. A chest radiograph shows patchy, nonhomogeneous infiltrates.

Based on these findings, which organism is the most likely cause of this patient's pneumonia?

S. pneumonia A virus Mycoplasma Tuberculosis A high school athlete reports recent onset of chest pain that is aggravated by deep breathing and lifting. A 12-lead electrocardiogram in the clinic is normal. The examiner notes localized pain near the sternum that increases with pressure. What will the provider do next?

Recommend an NSAID Prescribe an antibiotic Refer to a cardiologist Order a chest radiograph A patient who was initially treated as an outpatient for pneumonia and then hospitalized for two weeks after no improvement continues to show no improvement after several antibiotic regimens have been attempted. What is the next step in managing this patient?

Increasing the dose of the antibiotics Open lung biopsy Performing diagnostic bronchoscopy Administration of the pneumonia vaccine https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A young adult, previously healthy clinic patient has symptoms of pneumonia including high fever and cough. Auscultation reveals rales in the left lower lobe. A chest

radiograph is normal. The patient is unable to expectorate sputum. Which treatment is recommended for this patient?

A respiratory fluoroquinolone antibiotic Empiric treatment with a macrolide antibiotic Hospitalization for intravenous antibiotics A B-lactam antibiotic plus a fluoroquinolone Which are causes of pleural effusions? (Select all that apply.)

Bronchiectasis Breast Cancer Dehydration Congestive Heart failure Allergies Breast Cancer Congestive Heart failure https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

An adult patient who had pertussis immunizations as a child is exposed to pertussis and develops a runny nose, low-grade fever, and upper respiratory illness symptoms without a paroxysmal cough. What is recommended for this patient?

Pertussis vaccine booster Azithromycin daily for 5 days Isolation if paroxysmal cough develops Symptomatic care only Which method of treatment is used for traumatic pneumothorax?

Placement of a small-bore catheter Observation for spontaneous resolution Needle aspiration of the pneumothorax Tube thoracostomy An adult develops chronic cough with episodes of wheezing and shortness of breath.

The provider performs chest radiography and other tests and rules out infection, upper respiratory, and gastroesophageal causes. Which test will the provider order initially to evaluate the possibility of asthma as the cause of these symptoms?

Spirometry Allergy Testing Methacholine Challenge test Peak expiratory flow rate A patient develops acute bronchitis and is diagnosed as having influenza. Which medication will help reduce the duration of symptoms in this patient?

Trimethoprim-sulfamethoxazole Clindamycin Azithromycin Oseltamivir

A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism?

D-dimer CT angiography Arterial blood gases Electrocardiogram https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A 65-year-old patient who has not had an influenza vaccine is exposed to influenza and comes to the clinic the following day with fever and watery, red eyes. What will the provider do initially?

Perform a nasal swab for RT-PCR assay Administer LAIV influenza vaccine Observe for improvement or worsening for 24 hours Begin treatment with an antiviral medication A patient complains of shortness of breath when in a recumbent position and reports coughing and pain associated with inspiration. The provider notes distended neck veins during the exam. What is the likely cause of these findings?

Pulmonary infection Congestive heart failure Pulmonary embolus Hepatic disease A previously healthy patient develops influenza which is confirmed by RT-PCR testing and begins taking an antiviral medication. The next day, the patient reports increased fever and cough without respiratory distress. The patient's lungs are clear and oxygen saturations are 97% on room air. What will the provider recommend?

Symptomatic treatment with close follow up in clinic Referral to a specialist for evaluation and treatment Admission to the hospital for treatment of complications Empiric antibiotics to treat a possible secondary infection A patient is seen in clinic for an asthma exacerbation. The provider administers three nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient?

Administer three more nebulizer treatments and reassess Give epinephrine injections and monitor response Admit to the hospital with specialist consultation

Prescribe an oral corticosteroid medication https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient with a smoking history of 35 pack years reports having a chronic cough with recent symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in the right upper lobe. Which diagnostic test is indicated?

Coagulation studies Computerized tomography Fiberoptic bronchoscopy Needle biopsy A patient who has undergone surgical immobilization for a femur fracture reports dyspnea and chest pain associated with inspiration. The patient has a heart rate of 120 beats per minute. Which diagnostic test will confirm the presence of a pulmonary embolism?

CT angiography D-dimer Arterial blood gases Electrocardiogram A patient develops a pulmonary embolism after surgery and shows signs of right-sided heart failure. Which drug will be administered to this patient?

Low molecular heparin Warfarin Tissue plasminogen activator Unfractionated heparin https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient develops a dry, nonproductive cough and is diagnosed with bronchitis. Several days later, the cough becomes productive with mucoid sputum. What may be prescribed to help with symptoms?

Antibiotic therapy Bronchodilator treatment Mucokinetic agents Antitussive medication A patient suffers a penetrating injury to one eye caused by scissors. The provider notes a single laceration away from the iris that involves the anterior but not the posterior segment. What is the prognosis for this injury? Correct answer- Because the posterior segment is not involved, the prognosis is good A patient reports bilateral reports burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient's eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely?

Allergic Bacterial Chemical viral A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient's pupils. What does this finding indicate?

Probable benign, physiologic anisocoria A relative afferent pupillary defect Likely underlying neurological abnormality Indication of a difference in intraocular pressure https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

Which patients should be referred immediately to an ophthalmologist after eye injury and initial treatment? (Select all that apply.)

A patient who was sprayed by lawn chemicals A patient with irrigation secondary to wood dust A patient who works in a metal fabrication shop A patient with a full-thickness corneal laceration A patient with a corneal abrasion A patient who works in a metal fabrication shop A patient with a full-thickness corneal laceration A patient comes to clinic with diffuse erythema in one eye without pain or history of trauma. The examination reveals a deep red, confluent hemorrhage in the conjunctiva of that eye. What is the most likely treatment for this condition?

Prescribe ophthalmic antibiotic drops Reassure the patient that this will resolve Refer to an ophthalmologist Order lubricating drops or ointments A child has a localized nodule on one eyelid which is warm, tender, and erythematous.

On examination, the provider notes clear conjunctivae and no discharge. What is the recommended treatment?

Warm compress and massage of the lesion Surgical incision and drainage Referral to ophthalmologist Systemic antibiotics An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend?

Warm compress Nasolacrimal duct probing Systemic antibiotics

Antibiotic eye drops During an eye examination, the provider notes a red light reflex in one eye but not the other. What is the significance of this finding?

Ocular disease requiring referral Potential infection in the "red" eye Normal physiologic variant Potential vision loss in one eye https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A child sustains an ocular injury in which a shard of glass from a bottle penetrated into the eye wall. The emergency department provider notes that the shard has remained in the eye. Which best describes this type of injury?

Intraocular foreign body Penetrating eye injury Ruptured globe injury Perforating eye injury A patient has dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially?

Incision and drainage Topical antibiotic ointment Lacrimal bypass surgery Eyelid scrubs with baby shampoo A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion?

Blepharitis Chalazion meibomian Hordeolum https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient who has an inflamed pterygia lesion has been using loteprednol topical steroid drops for 7 days. The patient shows no improvement in symptoms. What is the next course of action?

Prescribe a systemic corticosteroid Consult with an opthamologist Refer the patient to the emergency department Continue the medication for 7 more days A patient who works in a furniture manufacturing shop reports a sudden onset of severe eye pain while sanding a piece of wood and now has copious tearing, redness, and light

sensitivity in the affected eye. On examination, the conjunctiva appears injected, but no foreign body is visualized. What is the practitioner's next step?

Application of topical fluorescein dye Administration of antibiotic eye drops Irrigation of the eye with normal saline Instillation of cyclopegic eye drops A patient who has a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated?

Artificial tears and cool compresses Topical antibiotic eye drops Antihistamine-vasoconstrictor drops Topical corticosteroid drops https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient has an elevated, yellowish-white lesion adjacent to the cornea at the 3 o'clock position of the right eye. The provider notes pinkish inflammation with dilated blood vessels surrounding the lesion. What will the provider tell the patient about this lesion?

UVB eye protection is especially important Artificial tear drops are contraindicated Spontaneous bleeding is likely Visine may be used for symptomatic relief A patient reports has been using artificial tears for comfort because of burning and itching in both eyes, but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins with clear conjunctivae. What is the recommended treatment?

Compresses, lid scrubs, and antibiotic ointment A patient with allergic conjunctivitis who has been using a topical antihistaminevasoconstrictor medication reports worsening symptoms. What is the provider's next step in managing this patient's symptoms?

Consider prescribing a topical mast cell stabilizer Prescribe a non-sedating oral antihistamine Refer the patient to an ophthalmologist for further care Determine the duration of treatment with this medication A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this patient?

Refer the patient to an otolaryngologist Prescribe antibiotic ear drops Insert a wick into the ear canal Irrigate the ear canal to remove the discharge

Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media? (Select all that apply.)

Tugging on ears Difficulty sleeping Poor hearing Level of cooperation Appetite Difficulty sleeping Appetite https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis?

Otitis media with effusion Acute otitis externa Acute otitis media Chronic otitis externa A patient has nasal congestion, fever, purulent nasal discharge, headache, and facial pain and begins treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the patient continues to have purulent discharge, congestion, and facial pain without fever. What is the next course of action for this patient?

A trial of azithromycin A CT scan of the paranasal sinuses A second course of amoxicillin-clavulanate A referral to an otolaryngologist A provider is recommending a cerumenolytic for a patient who has chronic cerumen buildup. The provider notes that the patient has dry skin in the ear canal. Which preparation is FDA approved for this use?

Mineral oil Liquid docusate sodium Carbamide peroxide Hydrogen peroxide A patient complains of otalgia and difficulty hearing from one ear. The provider performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient's tympanic membrane. What is the initial action?

Irrigate the canal with normal saline Ask the patient about previous problems with that ear Use a curette to attempt to dislodge the mass Prescribe a ceruminolytic agent for that ear A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A healthcare provider at the game notes

bleeding from the child's nose and displacement of the septum. What is the most important intervention at this time?

Immobilize the child's head and call 911 Apply ice to the injured site to prevent airway occlusion Turn the child's head to the side to prevent aspiration of blood Place nasal packing in both nares to stop the bleeding A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient?

Intranasal steroids Oral antihistamines Antihistamine spray Intranasal cromolyn Surgery to reduce the nasal fracture A patient has been taking amoxicillin for treatment of a dental abscess. In a follow-up visit, the provider notes edema of the eyelids and conjunctivae. What is the next action?

Hospitalize the patient for an endodontist consultation Suggest using warm compresses to the eyes for comfort Recommend follow up with a dentist in 2-3 days Prescribe amoxicillin clavulanate for 10-14 days https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary at this time?

Urgent drainage of the mass CT scan of facial structures Ice packs to reduce facial swelling Surgery to reduce the nasal fracture A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation?

Standards for minimum cash reserves Care coordination for chronic diseases Strict requirements for financial reporting Bonuses based on achievement of benchmarks A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical lymphadenopathy. What will the provider do next to manage this patient's symptoms?

Refer to to an otolaryngologist Prescribe empiric penicillin Perform a rapid antigen detection test Order an antistreptolysin O titer

A patient has gingival inflammation with several areas of ulceration and a small amount of purulent discharge. What is required to diagnose this condition?

Culture and sensitivity Microscopic exam of oral scrapings Tzanck smear Physical examination https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

An alert, irritable 12-month-old child is brought to the emergency department by a parent who reports that the child fell into a coffee table. The child has epistaxis, periorbital ecchymosis, and nasal edema. Nares are patent and the examiner palpates instability and point tenderness of the nasal septum. The orbital structures appear intact. What is an urgent action for this patient?

Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial antibiotic therapy?

A 36 month old with fever of 38C, mild otalgia, and red, non- bulging ™ A 6 month old with fever of 39.2C, poor sleep and appetite and bulging ™ A 5 year old with fever of 38.0 C, severe otalgia, and red, bulging ™ A 4 year old, afebrile child with bilateral otorrhea Which are potential complications of chronic or recurrent sinusitis?

Orbital infection Osteomyelitis Meningitis Osteomyelitis Meningitis A patient with allergic rhinitis develops acute sinusitis and begins treatment with an antibiotic. Which measure may help with symptomatic relief for patients with underlying allergic rhinitis?

Intranasal steroids Topical decongestants Oral mucolytics Saline solution rinses https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues w/o discharge. Which is the initial course of action by the provider?

A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with the diagnosis?

Which physical examination finding suggests viral rather than bacterial parotitis?

Clear discharge from Stensen's duct Unilateral edema of parotid glands Gradual reduction in saliva production Enlargement and pain of affected glands A screening audiogram on a patient is abnormal. Which test may the primary provider perform next to further evaluate the cause of this finding?

Pure tone audiogram Impedance audiometry Tympanogram Speech reception test A patient has recurrent epistaxis without localized signs of irritation. Which laboratory tests may be performed to evaluate this condition? (Select all that apply.)

BUN and creatinine CBC with platelets PT/INR PT and PTT Liver function tests PT/INR PT and PTT Which assessments of care providers are performed as part of the Value Based Purchasing initiative? (Select all that apply.)

Appraising costs per case of care for Medicare patients Requiring advanced IT standards and minimum cash reserves Evaluating available evidence to guide clinical care guidelines Monitoring mortality rates of all patients with pneumonia Assessing patients' satisfaction with hospital care Monitoring mortality rates of all patients with pneumonia Assessing patients' satisfaction with hospital care A patient who has acute suppurative parotitis has been taking amoxicillin- clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin resistant S. aureus. Which other measure may be helpful?

Topical corticosteroid Discouraging chewing gum Cool compresses Surgical drainage Which symptoms may occur with vestibular neuritis? (Select all that apply.)

Hearing loss Fever N/V Disequilibrium

Tinnitus Fever N/V Disequilibrium Tinnitus An adult patient is seen in clinic with fever, sore throat, and dysphagia. Which diagnostic test will the provider order to confirm a diagnosis of epiglottitis?

Lateral neck film Blood cultures Fiberoptic nasopharyngoscopy Complete blood count A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly inflamed and the tympanic membrane is not involved. Which medication will be ordered?

Cipro HC Neomycin Vinegar and alcohol Fluconazole https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient is in the emergency department with unilateral epistaxis that continues to bleed after 15 minutes of pressure on the anterior septum and application of a topical nasal decongestant. The provider is unable to visualize the site of the bleeding. What is the next measure for this patient?

Nasal Packing Electrocautery Chemical cautery Petrolatum ointment A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth.

The provider notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these symptoms?

Herpes simplex virus Bacterial infection Candida albicans Human papilloma virus A primary care provider notes painless, hard lesions on a patient's external ears that expel a white crystalline substance when pressed. What diagnostic test is indicated?

Uric acid chemical profile Rheumatoid factor Endocrine studies Biopsy of the lesions

A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient?

Clear the blood with suction to identify site of bleeding Have the patient sit up straight and tilt the head forward Apply firm, continuous pressure to the nostrils Assess airway safety and vital signs A pediatric patient has otalgia, fever of 38.8° C, and a recent history of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the correct action?

Treat empirically with amoxicillin 80-90 mg/kg/day Remove the cerumen and visualize the tympanic membrane Recommend symptomatic treatment for fever and pain Perform a tympanogram on the right ear https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A school age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year. The child's parent asks the provider if the child needs a tonsillectomy.

What will the provider tell this parent?

If there is one more episode in the next 6 months, a tonsillectomy is necessary Current recommendations do not support tonsillectomy for this child.

The child should have radiographic studies to evaluate the need for tonsillectomy Tonsillectomy is recommended based on this child's history An adult patient has epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications?

Dexamethasone Chloramphenicol Metronidazole Clindamycin The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient?

Obtain an immediate consultation with an otolaryngologist Administer empiric intravenous antibiotics and steroids Have the child lie down and administer high-flow, humidified oxygen Perform a thorough examination of the oropharynx Which are risk factors for developing otitis externa? (Select all that apply.)

Cooler, low-humidity environments Exposure to someone with otitis externa Having underlying diabetes mellitus Vigorous external canal hygiene Use of earplugs and hearing aids

Tugging on ears Appetite An adolescent has fever, chills, and a severe sore throat. On exam, the provider notes foul smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue. What will the primary care provider do?

Refer the patient to an otolaryngologist Prescribe empiric oral antibiotics Evaluate for possible epiglottitis Perform a rapid strep and throat culture What was an important finding of the Advisory Board survey of 2014 about primary care preferences of patients?

Costs of ambulatory care Associations with area hospitals The ratio of providers to patients Ease of access to care Which are risk factors for developing hearing loss caused by presbycusis? (Select all that apply.)

High blood pressure Diabetes Smoking GERD Liver disease https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most likely cause of these symptoms?

Infectious mononucleosis Group A streptococcus Allergic pharyngitis Viral pharyngitis A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient's vital signs are normal. What is the most likely diagnosis for this patient?

Acute sinusitis Viral rhinitis Chronic sinusitis Allergic rhinitis A patient reports ear pain after being hit in the head with a baseball. The provider notes a perforated tympanic membrane. What is the recommended treatment?

Refer the patient to an otolaryngologist for evaluation Correct answer- refer

A patient is diagnosed with peritonsillar abscess and will be hospitalized for intravenous antibiotics. What additional treatment will be required?

Needle aspiration of the abscess During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of one ear auricle and suspects skin cancer. What will the provider tell the patient about this lesion?

Immediate surgery is recommended This is most likely malignant A biopsy should be performed It is benign and will not need intervention To reduce adverse events associated with care transitions, the Centers for Medicare and Medicaid Service have implemented which policy?

Reduction of payments for patients readmitted within 30 days after discharge Mandates for communication among primary caregivers and hospitalists Penalties for failure to perform medication reconciliations at time of discharge Requirements for written discharge instructions for patients and caregivers discharge What are factors associated with acute suppurative parotitis? (Select all that apply.)

DM Allergies Hypervolemia Radiotherapy Anticholinergic medications https://www.stuvia.com/doc/1463621/n675-acute-and-episodic-exam-1-questions-and-answers

Which approaches are among those recommended by the Agency for Healthcare Research and Quality to improve health literacy in patients? (Select all that apply.)

Supplementing teaching with visual aids Highlighting no more than 7 key points Empowering patients and families Giving written handouts for all teaching Repeating the instructions A patient who has acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin-resistant S. aureus. Which other measure may be helpful?

Cool compresses Topical corticosteroids Surgical drainage Discouraging chewing gum

A patient reports tooth pain in a lower molar and the provider notes a mobile tooth with erythema and edema of the surrounding tissues without discharge. Which is the initial course of action by the provider?

Refer to an oral surgeon for emergency surgery Perform an incision and drainage of the edematous tissue Recommend oral antiseptic rinses and follow up in one week Prescribe amoxicillin and refer to a dentist in 2-3 days

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