The phrase usual and customary refers to:
Question 1The phrase usual and customary refers to:
The success rate of a specified procedure.
How charges for a service compares with charges made to other persons receiving similar services and supplies.
How an insurer evaluates the need for an ordered diagnostic test.
How much an insurer will charge to provide coverage.
Question 2Which of the following statements does not belong in the past medical history portion of your chart note?
Your patient has an allergy to penicillin.
Your patient had a cholecystectomy 3 years prior.
Your patient’s father passed away from lung cancer.
Your patient had lab work done at their last appointment; CBC was normal.
Question 3Which of the following statements about Medicaid is true?
Medicaid is a federal plan created to provide care for indigent persons.
Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration.
Medicaid is a program for the indigent financed jointly by the federal and state governments.
Medicaid pays for family planning services, dental care, and eyeglasses.
Question 4In relation to writing a patient encounter note, the acronym SOAP stands for which of the following?
Subjective, outward findings, assessment, plan.
Symptoms, objective findings, assessment, plan.
Subjective, objective, assessment, plan.
Symptoms, observations, assessment, plan.
Question 5The Affordable Care Act (ACA) which passed in 2010 has a number of provisions, including the establishment of health exchanges. The purpose of a health insurance exchange is to:
Reduce the overall out-of-pocket cost of health insurance to the consumer.
Reduce the number of consumer health claims to the insurer.
Require each state to sell health insurance policies to consumers.
Create an online marketplace for the sale and purchase of health insurance for consumers.
NR511 Differential Diagnosis and Primary Care
Week 2 Quiz
Question 1 The antibiotic of choice for recurrent acute otitis media (AOM) and/or treatment failure in children is:
Amoxicillin (Amoxil).
Azithromycin (Zithromax).
Prednisone (Deltasone).
Amoxicillin and potassium clavulanate (Augmentin).
Question 2 A 72-year-old male patient presents to the clinic for his annual physical. He states that he is worried because he only has a bowel movement every three days. How should the clinician respond?
“You should have at least three stools per week.”
“There is no such thing as a ‘normal’ pattern of defecation.”
“You should have two to three stools per day.”
“You should defecate once a day.”
Question 3 A 30-year-old male presents to the clinic with intermittent diarrhea. He is pretty sure that the antacids taken for heartburn are the cause since the loose stools always occur within 30 minutes after taking them. How should the clinician respond?
“Antacids contain caffeine, which decreases bowel transit time.”
“Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts that draw fluid into the bowel.”
“Antacids contain fructose, which may not be totally absorbed, resulting in fluid being drawn into the bowel.”
“Antacids contain sorbitol or mannitol, which are sugars that aren’t absorbed and can cause fluid to be drawn into the bowel.”
Question 4 A 21-year-old female patient presents to the clinic for pre-operative tonsillectomy clearance. She has heard about permanent taste changes after a tonsillectomy and is concerned. What should the clinician tell her?
“About half of the patients have some permanent alterations in the sense of taste.”
“Your ability to recognize sweet from salty taste will be altered for life.”
“You will have some alterations, but we’ll have to wait and see how you are affected personally.”
“You may notice a slight difference initially, but there are no lasting changes in taste.”
Question 5 A 29-year-old female just returned from Central America with traveler’sdiarrhea and presents to the clinic for evaluation. Which of the following is the best treatment?
Penicillin antibiotics.
Supportive care.
Gastric lavage.
Metronidazole (Flagyl).
NR511 Differential Diagnosis and Primary Care
Week 3 Quiz
Question 1Henry, 64 years old, is having difficulty getting rid of a corneal infection. He asks why. How do you respond?
“Systemic antibiotics have difficulty getting to that area of the eye.”
“Because the cornea doesn’t have a blood supply, an infection can’t be fought off as usual.”
“Because the infection was painless, it was not treated early enough.”
“We can’t determine the causative agent.”
Question 2A 22-year-old college student presents to your urgent care clinic complaining of a rash. She was recently on spring break and spent every night in the hot tub at her hotel. On physical exam, she has multiple small areas of 1- to 2-mm erythematous pustules that are present mostly where her bathing suit covered her buttocks. What is the most likely pathogen causing these lesions?
Staphylococcus aureus.
Streptococcus.
Pseudomonas aeruginosa.
Klebsiella.
Question 3A 3-year-old patient presents to your pediatric office with her mother. She has recently started in day care. Her mother noted slight perioral erythema on the right side of the patient’s mouth last night before bed. The patient awoke today with 3 small, superficial, honey-colored vesicles where the erythema was last night. The patient has no surrounding erythema presently. She had no difficulty eating this morning and is active and energetic and doesn’t appear lethargic or fatigued. She is also afebrile. How would you treat this child?
Oral Keflex for 7 days.
Topical compress with Burow solution and follow-up in 2 to 3 days.
Local debridement and topical compress with Burow solution and close follow-up.
Local debridement and mupirocin for 5 days.
Question 4A 20-year-old male presents to your office in the summer complaining of chest discoloration. He is a lifeguard and has been out in the sun without a shirt on for long periods of time. His physical exam shows small, flat, circular, hypopigmented macules on his chest that he states are mildly pruritic. What is the treatment of choice for this diagnosis?
Hydrocortisone cream 1%.
Oral fluconazole.
Selenium sulfide shampoo.
Ketoconazole shampoo.
Question 5Mary, age 82, presents with several eye problems. She states that her eyes are always dry and look “sunken in.” What do you suspect?
A detached retina.
Hypothyroidism.
Cushing syndrome.
Normal age-related changes.
NR511 Differential Diagnosis and Primary Care
WEEEK 4 MIDTERM EXAM
Question 1. Which of the following is a crucial element of developing a
guideline?
Creating a physician expert panel
Reviewing the literature with ratings of available evidence
Conducting an external review of a guideline
Developing evidence-based tables
Question 2. African American patients seem to have a negative reaction
to which of the following asthma medications?
Inhaled corticosteroids
Long-term beta-agonist bronchodilators
Leukotriene receptor agonists
Oral corticosteroids
Question 3. Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?
The tumor size cannot be evaluated; the cancer has not spread to the lymph nodes; and the distant spread cannot be evaluated.
The cancer is in situ; it is spreading into the lymph nodes,but the spread cannot be evaluated otherwise.
The cancer is less than 2 cm in size and has not spreadto the lymph nodes or other parts of the body.
The cancer is about 5 cm in size; nearby lymph nodes cannot be evaluated; and there is no evidence of distant
spreading.
Question 4. Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?
Meclizine
Diphenhydramine
Diamox
Promethazine
Question 5. Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and document this as a:
Filiform/digitate wart
Dysplastic cervical lesion
Condyloma acuminata
Koilocytosis
NR511 Differential Diagnosis and Primary Care
Week 5 Quiz
Question 1A 55-year-old female presents to the clinic with complaints of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, the clinician notes tenderness at the “anatomical snuffbox.” This finding most likely indicates which of the following?
Scaphoid fracture.
Ulnar styloid fracture.
Hamate fracture.
Radial head fracture.
Question 2A 28-year-old male presents to the clinic for follow-up from the emergency department, where he was seen for right forearm pain 3 days ago. He works as a carpenter and is right hand dominant. He states he was diagnosed with right forearm tendinitis and is not sure what this means. As part of teaching, the clinician explains that the condition is caused by inflammation of one or more of the tendons. Which of the following describes tendons?
The collagen fibers that connect muscle to bone.
The pouches of synovial fluid that cushion bone and other joint structures.
The ropelike bundles of collagen fibrils that connect bone to bone.
The fibrocartilaginous disks that separate bony surfaces.
Question 3A conservative approach is recommended in the initial approach to the management of low back pain. Which of the following would be an appropriate treatment plan for a 32-year-old obese male (BMI 33) diagnosed with an acute lumbar strain?
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Bedrest.
Surgery.
Epidural Steroid Injections (ESI).
Question 4A 10-year-old male presents to the clinic after jumping off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray demonstrates a fracture of the distal tibia, over the articular surface, through the epiphysis and physis. Based on the Salter-Harris classification of growth plate injuries, the clinician knows that this is a ______?
Salter-Harris V fracture.
Salter-Harris III fracture.
Salter-Harris IV fracture.
Salter-Harris II fracture.
Question 5A 48-year-old male presents with acute low back pain in the right that increases when standing and bending. Upon physical exam, lower extremity muscle strength is 5/5 and straigh leg raise test is negative. Which of the following is the most likely diagnosis?
Spondylolisthesis.
Osteoarthritis.
Muscle strain.
Herniated nucleus pulposus.
NR511 Differential Diagnosis and Primary Care
Week 6 Quiz
Question 1 The most common cause of hyperthyroidism is:
Graves disease.
A pituitary tumor.
Subacute thyroiditis.
A toxic uninodulargoiter.
Question 2 An elderly client presents with atrial fibrillation. Which of the following lab tests is important in forming the diagnosis?
Comprehensive metabolic panel (CMP).
Thyroid-stimulating hormone (TSH).
C-reactive protein (CRP).
Complete blood count (CBC).
Question 3 A client presents with clinical manifestations of hyperthyroidism. The differential diagnosis includes Graves disease and subacute thyroiditis. Which of the following findings is consistent with subacute thyroiditis?
A 24-hour radioactive iodine uptake (RAIU) demonstrating increased uptake.
A 24-hour radioactive iodine uptake (RAIU) demonstrating a “cold” nodule.
A 24-hour radioactive iodine uptake (RAIU) demonstrating decreased uptake.
A fine-needle aspiration is required for diagnosis of subacute thyroiditis.
Question 4 A 24-year-old female is preparing for radioactive iodine therapy to treat Graves disease. Which test must she undergo first?
Basal metabolism rate.
Lithium level.
Serum calcium.
Beta-human chorionic gonadotropin.
Question 5 Which of the following statements about hypothyroidism is not true?
The most common worldwide cause of hypothyroidism is iodine deficiency.
Lithium use is a risk factor for hypothyroidism.
The rate of hypothyroidism decreases with age.
The most common cause of autoimmune hypothyroidism is Hashimoto thyroiditis.
NR511 Differential Diagnosis and Primary Care
Week 7 Quiz
Question 1 A 32-year-old male appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. The nurse practitioner is trying to differentiate between epididymitis and testicular torsion. Which test should be the provider’s first choice?
Technetium scan.
X-ray.
Ultrasound.
Physical examination.
Question 2 A male patient presents to the clinic for evaluation of infertility. Subjectively, the patient complains of pain and fullness of the testes and states, “My testicles feel like a bag of worms.” On physical examination, the nurse practitioner notes tortuous veins posterior to and above the testes that extend up into the external inguinal ring. Based on the preceding assessment, the nurse practitioner refers the patient to urology with a diagnosis of:
Hydrocele.
Urethritis.
Varicocele.
Orchitis.
Question 3 A patient’s chief complaint is pain and heaviness in the scrotum. The nurse practitioner notes swelling of the testes, along with warm scrotal skin. Which of the following diagnoses is most probable?
Testicular torsion.
Orchitis.
Cryptorchidism.
Epididymitis.
Question 4 A 15-year-old male comes to the clinic in acute distress with “belly pain.” When obtaining his history, the nurse practitioner (NP) finds that he fell off his bike this morning and has vomited. Upon closer examination, the NP determines the belly pain to be left-sided groin pain or pain in his left testicle. He is afebrile and reports no dysuria. Which of the following diagnoses is most likely?
Testicular torsion.
Epididymitis.
Varicocele.
Hydrocele.
Question 5 A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being treated for a coagulopathy. Which of the following medications would be contraindicated?
Alprostadil (Caverject).
Topical testosterone (AndroGel).
Subcutaneous pellet testosterone (Testopel).
Sildenafil (Viagra).
NR511 Differential Diagnosis and Primary Care
WEEK 8 FINAL EXAM
Question 1 The most cost-e?ective screening test for determining HIV status is which of the following?
Western blot
Enzyme-linked immunosorbent assay
Venereal Disease Research Laboratory test
Viral load
Question 2. Which blood test is a nonspecific method and most helpful for evaluating the severity and course of an inflammatory process?
Erythrocyte sedimentation rate
White blood cell count
Polymorphonuclear cells
C-reactive protein (CRP)
Question 3. Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?
GABA
Acetylcholine
Dopamine
Serotonin
Question 4. Mrs. Thomas was seen in the o?ce 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 di?erentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
Ecchymosis, edema, and erythema over the lateral epicondyle
Pain at the elbow with resisted movements at the wrist and forearm
Inability to supinate and pronate the arm
Inability to flex or extend the elbow against resistance
Question 5. Which of the following statements concerning the musculoskeletal examination is true?
The uninvolved side should be examined initially and then compared to the involved side.
The part of the body that is causing the patient pain should be examined first.
When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid
causing pain.
Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.
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