A patient experiences a carpal spasm when a blood pressure cuff is inflated. Which
diagnostic
testing will the provider consider evaluating to determine the cause of this finding?
a. Calcitriol level
b. C-reactive protein
c. Magnesium and vitamin D
d. Protein electrophoresis
Give this one a try later!
, ANS: C
The Trousseau's sign indicates neuromuscular irritability, which occurs with
hypocalcemia.
Because hypomagnesemia and vitamin D deficiency may cause
hypocalcemia, these should
be evaluated to help determine a cause. Calcitriol levels are used to assess
hypercalcemia.
Inflammatory markers are not indicated. Protein electrophoresis is used in
the evaluation of
hypercalcemia.
A patient diagnosed 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
a. it is necessary because the patient cannot comply with the previous regimen.
b. that strict diet and exercise measures may be relaxed with insulin therapy.
c. the use of insulin therapy may be temporary.
d. this is because of the natural progression of the disease.
Give this one a try later!
ANS: D
Even after several years of therapy for type 2 DM well controlled with oral
diabetic
medications, diet, and exercise, the natural progression of the disease may
require patients to
become insulin dependent. Patients must understand that this does not
represent failure on
their part. Adding insulin may cause weight gain, so continuing lifestyle
measures is essential.
The addition of insulin is not temporary.
,When a patient reports experiencing chronic chest pain that occurs after meals, the
provider
suspects gastroesophageal reflux disease (GERD) and prescribes a proton pump
inhibitor.
After 2 months the patient reports improvement in symptoms. What is the next action
in
treating this patient?
a. Wean patient from proton pump inhibitor (PPI).
b. Order esophageal pH monitoring.
c. Refer the patient to a gastroenterologist.
d. Schedule an upper endoscopy.
Give this one a try later!
ANS: A
Often the effectiveness of treatment with a PPI is diagnostic and is equal to
or better than
more invasive and expensive testing. If the patient continues to show
improvement, the patient
is weaned off of the PPI. Most patients do well and there is no need to
order tests or refer for
evaluation. If patients do not do well, further testing is needed.
What intervention will the provider implement when prescribing medications to an
80-year-old patient?
a. Beginning with higher doses and decrease according to the patient's response
b. Consulting the Beers list to help identify potentially problematic drugs
c. Ensuring that the patient does not take more than five concurrent medications
d. Reviewing all patient medications at the annual health maintenance visit
Give this one a try later!
, ANS: B
The Beers list provides a list of potentially inappropriate medications in all
patients aged 65
and older and helps minimize drug-related problems in this age group.
Older patients should
be started on lower doses with gradual increase of doses depending on
response and side
effects. Patients who take five or more drugs are at increased risk for
problems of
polypharmacy, but many will need to take more than five drugs; providers
must monitor their
response more closely. Medications should be reviewed at all visits, not just
annually.
A patient with hemoptysis and no other symptoms has a normal chest radiograph
(CXR),
computed tomography (CT), and fiberoptic bronchoscopy studies. What is the next
action in
managing this patient?
a. Observation
b. Prophylactic antibiotics
c. Specialist consultation
d. Surgical intervention
Give this one a try later!
ANS: A
Patients with negative findings on CXR, CT, and bronchoscopy, with no risk
factors may be
observed for 3 years. Antibiotics are not indicated, since signs of infection
are not present.
Specialty consultation and surgery are not indicated.
diagnostic
testing will the provider consider evaluating to determine the cause of this finding?
a. Calcitriol level
b. C-reactive protein
c. Magnesium and vitamin D
d. Protein electrophoresis
Give this one a try later!
, ANS: C
The Trousseau's sign indicates neuromuscular irritability, which occurs with
hypocalcemia.
Because hypomagnesemia and vitamin D deficiency may cause
hypocalcemia, these should
be evaluated to help determine a cause. Calcitriol levels are used to assess
hypercalcemia.
Inflammatory markers are not indicated. Protein electrophoresis is used in
the evaluation of
hypercalcemia.
A patient diagnosed 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
a. it is necessary because the patient cannot comply with the previous regimen.
b. that strict diet and exercise measures may be relaxed with insulin therapy.
c. the use of insulin therapy may be temporary.
d. this is because of the natural progression of the disease.
Give this one a try later!
ANS: D
Even after several years of therapy for type 2 DM well controlled with oral
diabetic
medications, diet, and exercise, the natural progression of the disease may
require patients to
become insulin dependent. Patients must understand that this does not
represent failure on
their part. Adding insulin may cause weight gain, so continuing lifestyle
measures is essential.
The addition of insulin is not temporary.
,When a patient reports experiencing chronic chest pain that occurs after meals, the
provider
suspects gastroesophageal reflux disease (GERD) and prescribes a proton pump
inhibitor.
After 2 months the patient reports improvement in symptoms. What is the next action
in
treating this patient?
a. Wean patient from proton pump inhibitor (PPI).
b. Order esophageal pH monitoring.
c. Refer the patient to a gastroenterologist.
d. Schedule an upper endoscopy.
Give this one a try later!
ANS: A
Often the effectiveness of treatment with a PPI is diagnostic and is equal to
or better than
more invasive and expensive testing. If the patient continues to show
improvement, the patient
is weaned off of the PPI. Most patients do well and there is no need to
order tests or refer for
evaluation. If patients do not do well, further testing is needed.
What intervention will the provider implement when prescribing medications to an
80-year-old patient?
a. Beginning with higher doses and decrease according to the patient's response
b. Consulting the Beers list to help identify potentially problematic drugs
c. Ensuring that the patient does not take more than five concurrent medications
d. Reviewing all patient medications at the annual health maintenance visit
Give this one a try later!
, ANS: B
The Beers list provides a list of potentially inappropriate medications in all
patients aged 65
and older and helps minimize drug-related problems in this age group.
Older patients should
be started on lower doses with gradual increase of doses depending on
response and side
effects. Patients who take five or more drugs are at increased risk for
problems of
polypharmacy, but many will need to take more than five drugs; providers
must monitor their
response more closely. Medications should be reviewed at all visits, not just
annually.
A patient with hemoptysis and no other symptoms has a normal chest radiograph
(CXR),
computed tomography (CT), and fiberoptic bronchoscopy studies. What is the next
action in
managing this patient?
a. Observation
b. Prophylactic antibiotics
c. Specialist consultation
d. Surgical intervention
Give this one a try later!
ANS: A
Patients with negative findings on CXR, CT, and bronchoscopy, with no risk
factors may be
observed for 3 years. Antibiotics are not indicated, since signs of infection
are not present.
Specialty consultation and surgery are not indicated.
