(Test Bank) Adult Geriatrics

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Test Bank for Adult Geriatrics, The downloadable file consists of 157 pages, and the total size of the file is 0.79 MB. Purchase now only for highly discounted price.

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Question : The major impact of the physiological changes that occur with aging is: Student Answer:Reduced physiological reserve Reduced homeostatic mechanisms Impaired immunological response All of the above Instructor Explanation:The major impact of all of these physiological changes can be highlighted with three primary points. First, there is a reduced physiological reserve of most body systems, particularly cardiac, respiratory, and renal. Second, there are reduced homeostatic mechanisms that fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance. Third, there is impaired immunological function: infection risk is greater, and autoimmune diseases are more prevalent. (Kennedy-Malone 3) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014- 01-14. VitalBook file. Points Received: 2 of 2 Comments: Question 2 .Question : Men have faster and more efficient biotransformation of drugs and this is thought to be due to: Student Answer:Less obesity rates than women Prostate enlargement Testosterone -582355588MultipleChoice1True 0-582355588MultipleChoice1 Less estrogen than women Instructor Explanation:Men have faster and more efficient biotransformation, presumably because of serum testosterone. Conditions of increased or decreased liver perfusion alter the overall level of the drug that is absorbed and how it is metabolized. (Kennedy-Malone 5) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014- 01-14. VitalBook file. Points Received: 2 of 2 Comments: Question 3 .Question : The cytochrome p system involves enzymes that are generally: Student Answer:Inhibited by drugs Induced by drugs Inhibited or induced by drugs Associated with decreased liver perfusion Instructor Explanation:Biotransformation occurs in all body tissues but primarily in the liver, where enzymatic activity (cytochrome P [CYP] system) alters and detoxifies the drug and prepares it for excretion. (Kennedy-Malone 5) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014-01-14. VitalBook file. Points Received: 2 of 2 Comments: -582355587MultipleChoice2True 0-582355587MultipleChoice2 -582355586MultipleChoice3TrueQuestion 4 .Question : Functional abilities are best assessed by: Student Answer:Self-report of function Observed assessment of function A comprehensive head-to-toe examination Family report of function Instructor Explanation:Two well-established tools used to evaluate function in older adults are the Katz Activities of Daily Living Scale (Katz et al., 1963) and the Lawton and Brody scale for Instrumental Activities of Daily Living (Lawton & Brody, 1969). It is important to be cautious about self-report of function (rather than direct observation of function) and to ask, “Do you …?” instead of “Can you …?” in order to determine if patients actually perform the activity. (Kennedy-Malone 40) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014- 01-14. VitalBook file. Points Received: 2 of 2 Comments: Question 5 .Question : Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data? Student Answer: Hemoglobin and Hematocrit Mean Corpuscular V olume (MCV) and Mean Corpuscular Hemoglobin (MCH) 0-582355586MultipleChoice3 -582355585MultipleChoice4True 0-582355585MultipleChoice4 Serum ferritin and serum iron Total iron binding capacity and transferrin saturation Instructor Explanation:RBC indices reveal an MCV (mean corpuscular volume/RBC size) that will be decreased to <80 fL in adults; MCH (mean corpuscular hemoglobin/RBC color) will show hypochromia or pale cells; RBC distribution width (RDW)/volume variation will be increased. (Kennedy-Malone page 519) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014-01-14. VitalBook file. Points Received: 0 of 2 Comments: Question 6 .Question : When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD): Student Answer: Hemoglobin <12 g/dl, MCV decreased, MCH decreased Hemoglobin >12 g/dl, MCV increased, MCH increased Hemoglobin <12 g/dl, MCV normal, MCH normal Hemoglobin >12 g/dl, MCV decreased, MCH increased Instructor Explanation:Hemoglobin (Hgb): <12 g/dL (120 g/L) women <13 g/dL (130 g/L) men Rarely <10 g/dL (100 g/L) Mean corpuscular volume: 80–96 mcm3 (normocytic) Mean corpuscular hemoglobin Normochromic (normal color) RBC distribution width: normal (Kennedy-Malone page 517) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014-01-14. VitalBook file. -582355584MultipleChoice5False 0-582355584MultipleChoice5 Points Received: 0 of 2 Comments: Question 7 .Question : The pathophysiological hallmark of ACD is: Student Answer:Depleted iron stores Impaired ability to use iron stores Chronic uncorrectable bleeding Reduced intestinal absorption of iron Instructor Explanation:The pathophysiological hallmark of ACD is a disregulation of iron homeostasis, characterized by an increased uptake and retention of iron within the cells of the reticuloendothelial system (liver/spleen), resulting in decreased RBC production. Essentially, iron is present but inaccessible for use in the production of Hgb with the erythrocytes (Bross et al., 2010). A shortened RBC survival is also a contributing factor to ACD. (Kennedy- Malone page 516-517) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014- 01-14. VitalBook file. Points Received: 0 of 2 Comments: Question 8 .Question : The main focus of treatment of patients with ACD is: Student Answer:Replenishing iron stores -582355583MultipleChoice6False 0-582355583MultipleChoice6 -582355582MultipleChoice7False 0-582355582MultipleChoice7 Providing for adequate nutrition high in iron Management of the underlying disorder Administration of monthly vitamin B 12 injections Instructor Explanation:Treatment: Treatment of ACD focuses on management of the underlying disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004). (Kennedy-Malone page 518) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014- 01-14. VitalBook file. Points Received: 2 of 2 Comments: Question 9 .Question : In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? Student Answer:Serum iron Total iron binding capacity Transferrin saturation Serum ferritin Instructor Explanation:Treatment: Treatment of ACD focuses on management of the underlying disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004). -582355581MultipleChoice8True 0-582355581MultipleChoice8 (Kennedy-Malone page 518) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014- 01-14. VitalBook file. Points Received: 2 of 2 Comments: Question 10 .Question : Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except: Student Answer:Sore throat Fever Weight loss Headache Instructor Explanation:Signal symptoms: The initial HIV infection is characterized by mononucleosis-like illness with fever, sore throat, lymphadenopathy, headache, and fatigue. A roseola-like rash may also develop. These initial symptoms are followed by an asymptomatic phase, which may last 10 years or more. Later, if untreated, lymphadenopathy, weight loss, myalgias, and diarrhea may develop (Cohen, Kuritzkes, & Sax, 2011). In advanced disease, malignancies and opportunistic infections occur. Co-infection with hepatitis B or C is common (25% to 30%) in IV drug users, so hepatitis symptoms may also appear (Centers for Disease Control and Prevention [CDC], 2010a). (Kennedy-Malone page 521) Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of Older Adults . F.A. Davis Company, 2014-01- 14. VitalBook file. Points Received: 0 of 2 -582355580MultipleChoice9True 0-582355580MultipleChoice9 Comments: Question 11 .Question : Essential parts of a health history include all of the following except: Student Answer: Chief complaint History of the present illness Current vital signs All of the above are essential history components Instructor Explanation:Vital signs are part of the physical examination portion of patient assessment, not part of the health history. Points Received: 2 of 2 Comments: Question 12 .Question : Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? Student Answer:Clinical practice guideline Clinical decision rule Clinical algorithm Clinical recommendation Instructor Clinical decision (or prediction) rules provide another support for clinical -582355579MultipleChoice10False 0-582355579MultipleChoice10 -582355578MultipleChoice11True 0-582355578MultipleChoice11 Explanation:reasoning. Clinical decision rules are evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain situations, settings, and/or patient characteristics. Goolsby page 7 Points Received: 2 of 2 Comments: Question 13 .Question : The first step in the genomic assessment of a patient is obtaining information regarding: Student Answer: Family history Environmental exposures Lifestyle and behaviors Current medications Instructor Explanation:A critical first step in genomic assessment, including assessment of risk, is the use of family history. Family history is considered the first genetic screen (Berry & Shooner 2004) and is a critical component of care because it reflects shared genetic susceptibilities, shared environment, and common behaviors (Yoon, Scheuner, & Khoury 2003). Goolsby page 18 Points Received: 2 of 2 Comments: Question 14 .Question : In autosomal recessive (AR) disorders, individuals need: Student Answer:Only one mutated gene on the sex chromosomes to acquire the disease -582355577MultipleChoice12True 0-582355577MultipleChoice12 -582355576MultipleChoice13True 0-582355576MultipleChoice13 Only one mutated gene to acquire the disease Two mutated genes to acquire the disease Two mutated genes to become carriers Instructor Explanation:In autosomal recessive (AR) disorders, the offspring inherits the condition by receiving one copy of the gene mutation from each of the parents. Autosomal recessive disorders must be inherited through both parents (Nussbaum et al. 2007). Individuals who have an AR disorder have two mutated genes, one on each locus of the chromosome. Parents of an affected person are called carriers because each carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. Goolsby page 28 Points Received: 0 of 2 Comments: Question 15 .Question : In AR disorders, carriers have: Student Answer:Two mutated genes; two from one parent that cause disease A mutation on a sex chromosome that causes a disease A single gene mutation that causes the disease One copy of a gene mutation but not the disease Instructor Explanation:Individuals who have an AR disorder have two mutated genes, one on each allele of the chromosome. Parents of an affected person are called carriers because each parent carries one copy of the mutation on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease. In pedigrees with an AR inheritance patterns, males and females will be equally affected because the gene mutation is on an autosome. Goolsby page 28 Points Received: 2 of 2 -582355575MultipleChoice14False 0-582355575MultipleChoice14 Comments: Question 16 .Question : A woman with an X-linked dominant disorder will: Student Answer: Not be affected by the disorder herself Transmit the disorder to 50% of her offspring (male or female) Not transmit the disorder to her daughters Transmit the disorder to only her daughters Instructor Explanation:Everyone born with an X-linked dominant disorder will be affected with the disease. Transmission of the disorder to the next generation varies by gender, however. A woman will transmit the mutation to 50% of all her offspring (male or female). Goolsby page 29 Points Received: 0 of 2 Comments: Question 17 .Question : According to the Genetic Information Nondiscrimination Act (GINA): Student Answer: Nurse Practitioners (NPs) should keep all genetic information of patients confidential NPs must obtain informed consent prior to genetic testing of all patients Employers cannot inquire about an employee’s genetic information -582355574MultipleChoice15True 0-582355574MultipleChoice15 -582355573MultipleChoice16False 0-582355573MultipleChoice16 All of the above Instructor Explanation:On May 21, 2008, President George W. Bush signed the Genetic Information Nondiscrimination Act (GINA) to protect Americans against discrimination based upon their genetic information when it comes to health insurance and employment, paving the way for patient personalized genetic medicine without fear of discrimination (National Human Genome Research Institute 2012). Goolsby page 43 Points Received: 2 of 2 Comments: Question 18 .Question : Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? Student Answer: Colon cancer in family member at age 70 Breast cancer in family member at age 75 Myocardial infarction in family member at age 35 All of the above Instructor Explanation:Early onset cancer syndromes, heart disease, or dementia are red flags that warrant further investigation regarding hereditary disorders. Goolsby page 36 Points Received: 0 of 2 Comments: Question 19 .Question : Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: -582355572MultipleChoice17True 0-582355572MultipleChoice17 -582355571MultipleChoice18False 0-582355571MultipleChoice18 Student Answer:Variable expressivity related to inherited disease Dysmorphic features related to genetic disease De novo mutations of genetic disease Different penetrant signs of genetic disease Instructor Explanation:Assessing for dysmorphic features may enable identification of certain syndromes or genetic or chromosomal disorders (Jorde, Carey, & Bamshad 2010; Prichard & Korf 2008). Dysmorphology is defined as “the study of abnormal physical development” (Jorde, Carey, & Bamshad 2010, 302). Goolsby page 37 Points Received: 2 of 2 Comments: Question 20 .Question : In order to provide a comprehensive genetic history of a patient, the NP should: Student Answer:Ask patients to complete a family history worksheet Seek out pathology reports related to the patient’s disorder Interview family members regarding genetic disorders All of the above Instructor Explanation:Asking the patient to complete a family history worksheet prior to the appointment saves time in the visit while offering the patient an opportunity to contribute to the collection of an accurate family history. Reviewing the family information can also help establish family rapport while verifying medical conditions in individual family members. If a hereditary condition is being considered but family medical information is unclear or unknown, requesting medical records and pathology or autopsy reports may be warranted. Goolsby page 32 -582355570MultipleChoice19True 0-582355570MultipleChoice19 1.Question : An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: Student Answer:Acoustic neuroma Cerumen impaction Otitis media Ménière’s disease Instructor Explanation:Elderly clients frequently present with complaints of hardened cerumen and decreased hearing resulting from cerumen impaction aggravated by hearing aid wear. (Goolsby 137-138) Conductive hearing loss is caused by a lesion involving the outer and middle ear to the level of the oval window. Various structural abnormalities, cerumen impaction, perforation of the tympanic membrane, middle ear fluid, damage to the ossicles from trauma or infection, otosclerosis, tympanosclerosis, cholesteatoma, middle ear tumors, temporal bone fractures, injuries related to trauma, and congenital problems are some of the causes. (Kennedy-Malone 170-171) Points Received: 2 of 2 Comments: Question 2 .Question : In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of: Student Answer:Bacterial sinusitis -580490446MultipleChoice1True 0-580490446MultipleChoice1 Allergic rhinitis Drug abuse Skull fracture Instructor Explanation:When examining the nose, assess the mucosa for integrity, color, moistness, and edema/lesions and the nasal septum for patency. The turbinates should be assessed for color and size. Pale, boggy turbinates suggest allergies; erythematous, swollen turbinates are often seen with infection. Any discharge should be noted. Clear, profuse discharge is often associated with allergies. (Goolsby 128-129) Patients with seasonal allergic rhinitis report rhinorrhea, sneezing, obstructed nasal passages, and pruritic eyes, nose, and oropharynx during the spring and fall. Patients with perennial allergic rhinitis have similar symptoms associated with exposure to environmental allergens typically in their homes. Physical examination may reveal a pale, boggy nasal mucosa, injected conjunctiva, enlarged turbinates, dark discoloration or bags under the eyes, and mouth breathing; absence of pale, boggy nasal mucosa does not rule out allergic rhinitis. (Kennedy-Malone 182-183) Points Received: 2 of 2 Comments: Question 3 .Question : A 45 year old patient presents with ‘sore throat’ and fever for one week. After a quick strep screen you determine the patient has Strep throat. You know that streptococcal pharyngitis should be treated with antibiotics to prevent complications and to shorten the course of disease. Which of the following antibiotics should be considered when a patient is allergic to Penicillin? Student Answer: Amoxicillin EES (erythromycin) -580490445MultipleChoice2True 0-580490445MultipleChoice2 Bicillin L-A Dicloxacillin Instructor Explanation:MedU Card #1 Points Received: 2 of 2 Comments: Question 4 .Question : Presbycusis is the hearing impairment that is associated with: Student Answer: Physiologic aging Ménière’s disease Cerumen impaction Herpes zoster Instructor Explanation:Presbycusis is an age-related cause of gradual sensorineural hearing loss and involves diminished hairy cell function within the cochlea as well as decreased elasticity of the TM. Although the changes associated with presbycusis often start in early adulthood, the decreased hearing acuity is usually not noticed until the individual is older than 65. (Goolsby 138) Because presbycusis is gradual and insidious, hearing loss may go unnoticed until it has progressed significantly. (Kennedy-Malone 170) Points Received: 2 of 2 Comments: -580490444MultipleChoice3True 0-580490444MultipleChoice3 -580490443MultipleChoice4True 0-580490443MultipleChoice4Question 5 .Question : Epistaxis can be a symptom of: Student Answer:Over-anticoagulation Hematologic malignancy Cocaine abuse All of the above Instructor Explanation:Cocaine abuse, which is more common than might be expected, frequently causes epistaxis. Hematologic disorders likely to cause bleeding include thrombocytopenia, leukemia, aplastic anemia, and hereditary coagulopathies. High doses of anticoagulants can cause epistaxis and bleeding from the gums. (Goolsby 142) Epistaxis results from a spontaneous rupture of a blood vessel in the nose, usually in the anterior septum in Kiesselbach's plexus (Nguyen, 2012). The bleeding may be secondary to local infections, systemic infections, drying of the nasal mucous membrane, trauma, arteriosclerosis, hypertension, or bleeding disorders. Trauma is usually the primary mechanism of disruption of the nasal mucosa. Posterior epistaxis can result in nausea and respiratory compromise. In older adults, nasal and paranasal tumors may be involved (Mäkitie, 2010). (Kennedy-Malone 168-169) Points Received: 2 of 2 Comments: Question 6 .Question : Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: Student Answer:Malignant melanoma -580490442MultipleChoice5True 0-580490442MultipleChoice5 Squamous cell carcinoma Aphthous ulceration Behcet’s syndrome Instructor Explanation:Most oral malignancies are painless until quite advanced, so patients are often unaware of the lesion unless the lip or anterior portion of the tongue is involved. The patient may become aware of the lesion if it bleeds. Squamous cell cancer lesions vary in appearance, from the reddened patches of erythroplakia to areas of induration/thickening, ulceration, or necrotic lesions. Lesions of malignant melanoma have varied pigmentation, including brown, blue, and black. Even lesions that appear flat and smooth may be nodular, indurated, or fixed to adjacent tissue on palpation. Even though patients with squamous cell malignancies often have a history of heavy alcohol and/or tobacco use or poor dentition, these are not risk factors for malignant melanoma. In Behcet’ s syndrome, the patient complains of recurrent episodes of oral lesions that are consistent with aphthous ulcers. The number of lesions ranges from one to several; the size of the ulcers varies from less than to greater than 1 cm. Like aphthous ulcers, the lesions are well defined, with a pale yellow or gray base surrounded by erythema. The majority of patients also develop lesions on the genitals and eyes. (Goolsby 153) Tobacco use and heavy alcohol consumption, alone or synergistically, are strongly related to the development of oral cancer. Pipe smoking and sun exposure have been implicated in lip cancer. Leukoplakia and erythroplasia are often precursors to oral cancer. Relationships between oral cancer and Epstein-Barr virus, HPV , herpes simplex virus, and immunodeficiency states also have been found (Stenson, 2011). (Kennedy-Malone 177). Points Received: 2 of 2 Comments: Question 7 .Question : A 26 year old patient presents with cough and general malaise for 3 days. They note that their eyes have been watering clear fluid and a ‘runny nose’ since yesterday. They note they ‘feel miserable’ and demand something to make them feel better. What -580490441MultipleChoice6True 0-580490441MultipleChoice6would be the best first plan of treatment? Student Answer: Saline nasal spray for congestion and acetaminophen as needed for pain. Z-pack (azithromycin) for infection and Cromolyn nasal for congestion Hydrococone/acetaminophen as needed for pain and Guaifensin for congestion Cephalexin for infection and Cromolyn ophthalmic for congestion Instructor Explanation:MedU Card #4 Points Received: 0 of 2 Comments: Question 8 .Question : Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? Student Answer:History of bright flash of light followed by significantly blurred vision History of transient and painless monocular loss of vision History of monocular severe eye pain, blurred vision, and ciliary flush All of the above Instructor Explanation:Amaurosis fugax is a monocular, transient loss of vision. It stems from transient ischemia of the retina and presents an important warning sign for impending stroke. Depending on the circumstances reported, the patient -580490440MultipleChoice7False 0-580490440MultipleChoice7 should be immediately referred to either a cardiovascular or neurological specialist. (Goolsby 108) Points Received: 2 of 2 Comments: Question 9 .Question : Dizziness that is described as "lightheaded" or, "like I'm going to faint," is usually caused by inadequate cerebral perfusion and is classified as? Student Answer: Presyncope Disequilibrium Vertigo Syncope Instructor Explanation:MedU Card #5 Points Received: 0 of 2 Comments: Question 10 .Question : It is important to not dilate the eye if ____ is suspected. Student Answer:Cataract Macular degeneration Acute closed-angle glaucoma -580490439MultipleChoice8True 0-580490439MultipleChoice8 -580490438MultipleChoice9False 0-580490438MultipleChoice9 Chronic open-angle glaucoma Instructor Explanation: If the patient has experienced sudden onset of eye pain, it is important not to dilate the eyes before determining whether acute closed-angle glaucoma is present because dilating the eye may increase the intraocular pressure. (Goolsby 108) Acute glaucoma, also known as angle-closure or narrow-angle glaucoma, is an obstruction to the outflow of aqueous humor from the posterior to the anterior chamber through the trabecular meshwork, canal of Schlemm, and associated structures. It results in an elevation of intraocular pressure, damaging the optic nerve and causing loss of peripheral vision, eye pain, and redness. This type of glaucoma is uncommon but may occur as a primary disease or secondary to other conditions and constitutes an ophthalmic emergency (Kennedy-Malone 161) Points Received: 2 of 2 Comments: Question 11 .Question : Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports occasional ‘dizziness’ that got better with change in position. He denies a recent history of URI or any history of headaches or migraines. What would the most likely diagnosis be? Student Answer: Vestibular neruitis Benign paroxysmal positional vertigo Vestibular migraine Benign hypertensive central vertigo Instructor Explanation:MedU Card #9 Points Received: 2 of 2 -580490437MultipleChoice10True 0-580490437MultipleChoice10 Comments: Question 12 .Question : Which of the following patients with vertigo would require neurologic imaging? Student Answer: A 68-year-old woman with a history of hypertension and sudden acute onset constant vertigo. She has right nystagmus that changes direction with gaze and that does not disappear when she focuses. A 45-year-old man with recurrent episodes of brief intense vertigo every time he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix-Hallpike maneuver. A 66-year-old man with recurrent episodes of vertigo associated with tinnitus and hearing loss. His head thrust test is positive. A 28-year-old otherwise well woman with new onset constant vertigo with no other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when her gaze is fixed. Instructor Explanation:MedU Card #11. There are multiple reasons to be concerned about a central lesion and possible infarct in this patient. Her age puts her at risk as does her hypertension. Her physical exam shows nystagmus that changes direction and that does not inhibit with focus. Both of these findings are consistent with a central lesion. She needs an urgent MRI. Points Received: 0 of 2 Comments: Question 13 .Question : A patient presents with eye redness, scant discharge, and a gritty -580490436MultipleChoice11True 0-580490436MultipleChoice11 -580490435MultipleChoice12False 0-580490435MultipleChoice12sensation. Your examination reveals the palpable preauricular nodes, which are most likely with: Student Answer:Bacterial conjunctivitis Allergic conjunctivitis Chemical conjunctivitis Viral conjunctivitis Instructor Explanation:Preauricular nodes are nonpalpable and nontender in allergic conjunctivitis, usually nonpalpable in bacterial conjunctivitis, and palpable in viral conjunctivitis. (Goolsby 112) Points Received: 2 of 2 Comments: Question 14 .Question : In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness? Student Answer:History of prior red-eye episodes Grossly visible corneal defect Exophthalmos Photophobia Instructor Explanation:Red flag warnings for eye redness include pain (not discomfort or irritation), decreased vision, profuse discharge, and corneal defect grossly visible. (Goolsby 112) Points Received: 2 of 2 Comments: -580490434MultipleChoice13True 0-580490434MultipleChoice13 Question 15 .Question : A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation? Student Answer:Bacterium Allergen Virus Fungi Instructor Explanation:Patients with seasonal allergic rhinitis report rhinorrhea, sneezing, obstructed nasal passages, and pruritic eyes, nose, and oropharynx during the spring and fall. Patients with perennial allergic rhinitis have similar symptoms associated with exposure to environmental allergens typically in their homes. Physical examination may reveal a pale, boggy nasal mucosa, injected conjunctiva, enlarged turbinates, dark discoloration or bags under the eyes, and mouth breathing; absence of pale, boggy nasal mucosa does not rule out allergic rhinitis. (Kennedy-Malone 182-183) Points Received: 2 of 2 Comments: Question 16 .Question : Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following? Student Answer: Sinus pain, increased vascular permeability, and -580490433MultipleChoice14True 0-580490433MultipleChoice14 -580490432MultipleChoice15True 0-580490432MultipleChoice15 bronchodilation Bronchospasm, vascular permeability, and vasodilatation Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction Vasodilatation, bronchodilation, and increased vascular permeability Instructor Explanation:Rhinitis may be either allergic or nonallergic. Allergic rhinitis results as a response of the nasal mucosa to airborne allergens in atopic genetically prone individuals. This response is mediated by the production of immunoglobulin E (IgE). IgE antibodies produced in response to the initial and subsequent exposure to allergens bind to the nasal mucosa. With repeated exposure, immediate type 1 hypersensitivity reactions may occur (Simoens & Laekeman, 2009). Antigen-specific T cells are activated through the lymphatic system in response to the antigen. The activated antigen-specific T cells activate B cells, and IgE is created in lymphoid tissue and at local tissue sites (Adelman, Casale, & Corren, 2002; Novak, 2009). The newly created antigen-specific IgE is released by plasma cells and binds to high-affinity IgE receptors located on the basophils and mast cells. This leads to the sensitization of the cells in the tissues of the nose, lung, or skin (Adelman et al., 2002; Cirillo, Pistorio, Tosca, & Ciprandi, 2009). IgE also binds with the antigen protein, beginning degranulation of the mast cells and basophils. These actions start the allergic cascade. Mediators are released as a result of the degranulation and include histamine, proteoglycans, enzymes, leukotrienes, cytokines, and many others. The chain in the release of mediators is responsible for the immediate and late phase responses of the cells. Histamine may be fully released within 30 minutes of degranulation, whereas cytokines may be released over many hours (Adelman et al., 2002; Derendorf & Meltzer, 2008). (Kennedy-Malone 181-182) Points Received: 2 of 2 Comments: Question 17 .Question : You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you -580490431MultipleChoice16True 0-580490431MultipleChoice16