KAPLAN MN568 2018 March Unit 8 Exam Latest

MN568   Primary Care Across the Span
Unit 8 Exam
Question 1                         
The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
Question options:
 
a)
 
“I’ll take my pill at least 30 minutes before breakfast.”
 
b)
 
“I’ll take my Glucotrol before bedtime.”
 
c)
 
“It is important to take my medication right after I eat.”
 
d)
 
“Since I only like to eat two meals a day, I can take the pill between my meals.”
Question 2                         
Urine-free cortisol is one of four diagnostic tests recommended for Cushing’s syndrome.
Question options:
                a) True
                b) False
Question 3                         
A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?
Question options:
 
a)
 
Sinus bradycardia
 
b)
 
Atrial fibrillation
 
c)
 
Supraventricular tachycardia
 
d)
 
U waves
Question 4                         
One of the most frequent presenting signs/symptoms of osteoporosis is:
Question options:
 
a)
 
Goiter
 
b)
 
Abnormal serum calcium
 
c)
 
Elevated urine biochemical markers
 
d)
 
Bony fracture
Question 5                         
After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?
Question options:
 
a)
 
Suggest she use a heating pad to improve circulation.
 
b)
 
Refer to a podiatrist for a foot care treatment plan.
 
c)
 
Send her for acupuncture treatments.
 
d)
 
All of the above
Question 6                         
Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis?
Question options:
 
a)
 
Bone alkaline phosphatase levels
 
b)
 
Urinary N-telopeptide assay
 
c)
 
Bone mass density measurement by densitometry
 
d)
 
Magnetic resonance imaging
Question 7                         
You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient?
Question options:
 
a)
 
1
 
b)
 
2
 
c)
 
3
 
d)
 
4
 
e)
 
5
Question 8                         
Which of the following is diagnostic for diabetes mellitus?
Question options:
 
a)
 
A1C 7.0 on one occasion
 
b)
 
Fasting blood sugar (FBS) of 100 mg/dL on two occasions
 
c)
 
Random plasma glucose greater than or equal to 200 in a person with symptoms of hyperglycemia
 
 
d)
 
Two-hour post-load plasma glucose of 300 mg/dL on one occasion
Question 9                         
Fruit juice with added sugar is the treatment of choice for anyone experiencing hypoglycemia.
Question options:
                a) True
                b) False
Question 10                       
Osteoarthritis is primarily a noninflammatory condition.
Question options:
                a) True
                b) False
Question 11                       
Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?
Question options:
 
a)
 
Taking bisphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs.
 
b)
 
There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying.
 
c)
 
This class of drugs can be taken at any time of the day without regard to meals.
 
d)
 
None of the above
Question 12                       
A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?
Question options:
 
a)
 
Serum calcium
 
b)
 
TSH
 
c)
 
Electrolytes
 
d)
 
Urine specific gravity
Question 13                       
Which of the following are common signs of type 2 DM?
Question options:
 
a)
 
Anorexia
 
b)
 
Recurrent yeast infection
 
c)
 
Weight gain
 
d)
 
Elevated HDL cholesterol
Question 14                       
The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
Question options:
 
a)
 
Apprehension sign
 
b)
 
Bulge sign
 
c)
 
Thumb sign
 
d)
 
None of the above
Question 15                       
The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
Question options:
 
a)
 
Overweight
 
b)
 
Mild obesity
 
c)
 
Moderate obesity
 
d)
 
Morbid obesity
Question 16                       
A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods?
Question options:
 
a)
 
Rice
 
b)
 
Carrots
 
c)
 
Spinach
 
d)
 
Potatoes
Question 17                       
A BMI of 29 kg/m2 is considered obesity.
Question options:
                a) True
                b) False
Question 18                       
The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
Question options:
 
a)
 
High sensitivity thyroid-stimulating hormone (TSH) and free T4
 
b)
 
Free T4 and serum calcium
 
c)
 
Free T3 and T4
 
d)
 
TSH and thyroxin antibodies
Question 19                       
A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which of the following should be included in the differential diagnosis?
Question options:
 
a)
 
Anxiety disorder
 
b)
 
Pheochromocytoma
 
c)
 
Psychosis
 
d)
 
All of the above
Question 20                       
Which of the following statements concerning the musculoskeletal examination is true?
Question options:
 
a)
 
The uninvolved side should be examined initially and then compared to the involved side.
 
b)
 
The part of the body that is causing the patient pain should be examined first.
 
c)
 
When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain.
 
d)
 
Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.
Question 21                       
A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
Question options:
 
a)
 
“Control of glucose will help postpone or delay complications.”
 
b)
 
“Regularly checking blood sugar will help establish a routine.”
 
c)
 
“Monitoring glucose will promote a sense of control.”
 
d)
 
All of the above
Question 22                       
Which of the following medications can cause hyperglycemia?
Question options:
 
a)
 
Prednisone
 
b)
 
Metformin
 
c)
 
Synthroid
 
d)
 
Cephalexin
Question 23                       
A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes?
Question options:
 
a)
 
Reduces postprandial blood glucose
 
b)
 
Reduces triglycerides and increases high-density lipoprotein (HDL)
 
c)
 
Reduces total cholesterol
 
d)
 
All of the above
Question 24                       
Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
Question options:
 
a)
 
Ecchymosis, edema, and erythema over the lateral epicondyle
 
b)
 
Pain at the elbow with resisted movements at the wrist and forearm
 
c)
 
Inability to supinate and pronate the arm
 
d)
 
Inability to flex or extend the elbow against resistance
Question 25                       
Which of the following tests should you order to confirm Mr. W’s diagnosis?
Question options:
 
a)
 
Bone scan
 
b)
 
Computed tomography (CT) scan
 
c)
 
X-ray of the foot
 
d)
 
Culture of the ulcer
Question 26                       
Which stage of Paget’s disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
Question options:
 
a)
 
Lytic
 
b)
 
Mixed
 
c)
 
Sclerotic
 
d)
 
All of the above
Question 27                       
A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
Question options:
 
a)
 
Make an immediate referral for an orthopedic evaluation without further assessment.
 
b)
 
Tell her that it takes time for these bruises to improve, so she should be patient.
 
c)
 
Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint.
 
d)
 
Send her to the emergency room for reduction of this obvious wrist fracture.
Question 28                       
The presence of a positive rheumatoid factor is always indicative of rheumatoid arthritis.
Question options:
                a) True
                b) False
Question 29                       
The clinician should question the patient with suspected gout about use of which of these medications?
Question options:
 
a)
 
Low-dose aspirin
 
b)
 
Thiazide diuretics
 
c)
 
Ethambutol
 
d)
 
All of the above
Question 30                       
Jennifer is an 18-year-old who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
Question options:
 
a)
 
Posterior dislocations are more common than anterior dislocations.
 
b)
 
There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
 
c)
 
Recurrent dislocations are uncommon and would require great force to result in injury.
 
d)
 
Surgery is most commonly the treatment of choice.
Question 31                       
A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
Question options:
 
a)
 
No treatment at this time
 
b)
 
Diet and exercise for 6-week trial
 
c)
 
Diet, exercise, and oral medication
 
d)
 
Diet, exercise, and exogenous insulin
Question 32                       
The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?
Question options:
 
a)
 
Inability to bear weight immediately after the injury
 
b)
 
Development of marked ankle swelling and discoloration after the injury
 
c)
 
Crepitation with palpation or movement of the ankle
 
d)
 
All of the above
Question 33                       
Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis?
Question options:
 
a)
 
History of hypertension
 
b)
 
Her affected shoulder is also her dominant arm.
 
c)
 
Her history of diabetes mellitus
 
d)
 
Her work as a secretary predisposes her to repetitive motions.
Question 34                       
Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
Question options:
 
a)
 
Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel.
 
b)
 
Only people with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel.
 
c)
 
An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel.
 
d)
 
Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance.
Question 35                       
Which of the following statements concerning the treatment of fibromyalgia syndrome is true?
Question options:
 
a)
 
There is currently no cure for the disorder; however, patients should be made aware that symptom relief is possible.
 
b)
 
Treatment is directed toward controlling discomfort, improving sleep, and maintaining function.
 
c)
 
Fibromyalgia syndrome can be difficult to manage, requiring a variety of approaches and multiple medications.
 
d)
 
All of the above
Question 36                       
Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
 
Question options:
 
a)
 
Gastrocnemius weakness
 
b)
 
A reduced or absent ankle reflex
 
c)
 
Numbness in the lateral foot
 
d)
 
Paresthesia of the perineum and buttocks
Question 37                       
Which of the following is essential for diagnosing thyroid cancer?
Question options:
 
a)
 
Fine needle aspiration
 
b)
 
Thyroid ultrasound
 
c)
 
CT scan
 
d)
 
Magnetic resonance imaging
Question 38                       
Mr. W, 53 years old, is seen in the clinic with concerns about his left foot. He has a 40-year history of type 1 diabetes with “fairly good” control on twice-daily insulin. He denies injury but states that he tripped a few months ago and that his foot is sore when he walks. Physical examination reveals an edematous, erythremic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely diagnosis?
Question options:
 
a)
 
Fallen arch
 
b)
 
Arthritis
 
c)
 
Charcot joint
 
d)
 
Sprained ankle
Question 39                       
Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
Question options:
 
a)
 
The goal of treatment is to prevent flexion and extension movements of the wrist.
 
b)
 
Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position.
 
c)
 
Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection.
 
d)
 
All of the above
Question 40                       
Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
Question options:
 
a)
 
Morning stiffness and limited mobility of the lumbar spine
 
b)
 
Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
 
c)
 
Fever, chills, and elevated erythrocyte sedimentation rate
 
d)
 
Pathologic fractures, severe night pain, weight loss, and fatigue
Question 41                       
One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?
Question options:
 
a)
 
Bone
 
b)
 
Synovium
 
c)
 
Tendons
 
d)
 
Fascia
Question 42                       
The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which of the following data?
Question options:
 
a)
 
RAI prevents the peripheral conversion of T4 to T3.
 
b)
 
RAI binds free T4.
 
c)
 
RAI destroys thyroid tissue.
 
d)
 
RAI reduces freely circulating iodine.
Question 43                       
Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions?
Question options:
 
a)
 
Myxedema
 
b)
 
Thyrotoxicosis
 
c)
 
Cushing’s syndrome
 
d)
 
Pan-hypopituitarism
Question 44                       
Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?
Question options:
 
a)
 
Insulin
 
b)
 
Metformin
 
c)
 
Glucotrol
 
d)
 
Precose
Question 45                       
A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?
Question options:
 
a)
 
Ketoacidosis
 
b)
 
Cirrhosis
 
c)
 
Hypoglycemic episodes
 
d)
 
All of the above
Question 46                       
How often should the clinician examine the feet of a person with diabetes?
Question options:
 
a)
 
Once a year
 
b)
 
Every 6 months
 
c)
 
Every 3 months
 
d)
 
Every visit
Question 47                       
After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?
Question options:
 
a)
 
Elevated TSH
 
b)
 
Normal TSH
 
c)
 
Low TSH
 
d)
 
Undetectable TSH
Question 48                       
The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
Question options:
 
a)
 
“You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.”
 
b)
 
“You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication.”
 
c)
 
“You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.”
 
d)
 
“It is important to take NSAIDs on an empty stomach in order to increase absorption.”
Question 49                       
Which of the following statements is true concerning the management of the client with a herniated disc?
Question options:
 
a)
 
Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use.
 
b)
 
An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred.
 
c)
 
Intolerable pain for more than a 3-month period is an indication for surgical intervention.
 
d)
 
All of the above
Question 50                       
Metformin is the first line of pharmacologic treatment for type 2 DM.
Question options:
                a) True
                b) False