Mod 3 MSN 621 practice Exam with
complete solutions latest version
A .30-year-old .woman .presents .with .complaints .of .abdominal .pain .and .diarrhea
.for .6 .months. .She .describes .her .pain .as .abdominal .cramps. .She .is .unable .to
.localize .her .pain. .She .states .it .is .intermittent, .rated .8/10 .at .its .worst .and .0/10
.currently. .She .says .her .pain .is .worse .right .before .she .has .a .bowel .movement
.and .relieves .after .having .a .bowel .movement. .She .denies .any .weight .loss,
.dietary .changes, .or .recent .travel. .She .describes .her .bowel .movements .as
.loose, .unformed .stools. .Given .the .patient's .most .likely .diagnosis, .which .of .the
.following .would .be .most .likely .in .this .patient? .- .CORRECT .ANSWER-Recent
.problems .with .increased .marital .stress
A .26-year-old .male .attended .a .picnic .two .days .ago .and .now .presents .with
.multiple .episodes .of .nonbloody, .watery .diarrhea .without .abdominal .pain. .He .is
.afebrile, .and .the .other .vital .signs .and .physical .exam .are .notable .for .signs .of
.moderate .dehydration. .Given .the .leading .cause .of .this .patient's .likely
.condition, .what .is .the .best .initial .treatment? .- .CORRECT .ANSWER-Oral
.rehydration
A .16-year-old .patient .is .hospitalized .for .bloody .diarrhea, .high .fever, .and
.abdominal .pain. .The .patient .recently .returned .from .a .week-long .vacation .to
.Mexico, .where .he .enjoyed .many .local .delicacies. .Complete .blood .count .and
.stool .cultures .are .pending, .and .empiric .treatment .for .the .suspected
.enterohemorrhagic .E.coli .O157: .H7 .diarrhea .is .started. .Which .of .the .following
.bacteria .are .part .of .this .patient's .differential, .given .his .clinical .constellation? .-
.CORRECT .ANSWER-Salmonella, .Shigella, .Yersinia, .Campylobacter
A .34-year-old .African-American .man .presents .with .severe .diarrhea .for .five
.days. .He .recalls .eating .scrambled .eggs .his .neighbor .bought .from .a .local .farm.
.Abdominal .bloating .and .cramps .began .about .one .day .after .eating .the .eggs,
.followed .by .watery .stools .about .every .two .hours .in .frequency. .He .denies .pain
.on .defecation .or .blood .or .mucus .in .the .stool. .He .denies .any .recent .travel
.history. .Vital .signs .are .heart .rate .110 .bpm, .blood .pressure .90/64 .mm .Hg, .and
.temperature .101 .°F .(38.3 .°C). .The .abdominal .exam .is .notable .for .diffuse
.tenderness .to .palpation .without .peritoneal .signs. .His .stool .is .negative .for
.blood .but .positive .for .white .blood .cells. .What .is .the .most .reasonable .empiric
.treatment? .- .CORRECT .ANSWER-Ciprofloxacin
, A .19-year-old .African-American .man .presents .with .four .days .of .diarrhea .and
.subjective .fever .for .one .day. .Watery .bowel .movements .occur .5 .to .6 .times .daily
.and, .on .one .occasion, .had .bloody .streaks. .He .has .sickle .cell .disease, .which .is
.controlled .with .hydroxyurea, .and .the .last .crisis .was .eight .months .ago. .He .is .a
.college .student .and .eats .chicken .nuggets .at .a .local .fast-food .place .multiple
.times .a .week .when .attending .school. .His .vital .signs .are .blood .pressure .of
.120/80 .mm .Hg, .pulse .rate .100/min, .and .a .temperature .of .101 .°F .(38.3 .°C). .The
.abdominal .exam .shows .no .tenderness .or .peritonitis. .Blood .work .shows .a .mild
.decrease .in .white .blood .cells .at .4500/microL .with .no .anemia. .Electrolytes .are
.within .the .normal .range. .What .is .the .most .likely .underlying .organism .and .the
.most .appropriate .treatment? .- .CORRECT .ANSWER-Non-typhoidal .Salmonella;
.ciprofloxacin
A .35-year-old .man .presents .with .3 .days .of .watery .diarrhea .after .a .trip .to .the
.Caribbean .10 .days .ago. .The .bowel .movements .have .not .been .bloody .or
.associated .with .pus, .occur .about .3 .to .6 .times .daily, .and .are .associated .with
.abdominal .cramps. .He .denies .fever, .nausea, .or .vomiting. .He .is .a .corporate
.office .manager, .and .since .he .needed .to .go .to .a .meeting, .he .took .some
.diphenoxylate .that .helped .his .symptoms .and .reduced .the .frequency .of .bowel
.movements .significantly. .On .physical .examination, .his .vital .signs .are
.temperature .37 .°C .(98.6 .°F), .pulse .rate .105 .beats/min, .respiration .16
.breaths/min, .and .blood .pressure .100/65 .mm .Hg. .Examinations .of .the .heart .and
.lungs .are .unremarkable, .apart .from .mild .tachycardia. .The .abdomen .is .soft .and
.not .tender. .What .is .the .next .most .appropriate .step .in .the .management .of .this
.patient? .- .CORRECT .ANSWER-Recommend .a .course .of .oral .rehydration .salt
.treatment.
A .34-year-old .African-American .man .presents .with .five .days .of .severe .diarrhea.
.Loose .stools, .bloating, .and .abdominal .cramps .started .two .days .after .he .ate
.chicken .nuggets .at .a .local .fast .food .joint. .Abdominal .cramps .are .felt .in .the
.whole .abdomen; .they .come .and .go, .lasting .20-30 .minutes .associated .with
.nausea. .He .does .not .have .pain .at .defecation .and .has .seen .no .blood .or .mucus
.in .the .stool. .He .denies .any .recent .travel .history. .On .exam, .heart .rate .is .110
.beats .per .minute, .blood .pressure .is .90/64 .mm .Hg, .and .temperature .of .101 .°F
.(38.3 .°C). .His .abdomen .is .diffusely .tender .to .palpation, .but .there .are .no
.peritoneal .signs. .His .stool .is .negative .for .blood .but .positive .for .white .blood
.cells. .Besides .exhibiting .severe .disease, .which .of .the .following .would .be .an
.indication .for .treatment? .- .CORRECT .ANSWER-Hemoglobinopathy
An .18-year-old .presents .with .nausea, .and .multiple .episodes .of .loose, .watery
.stools .that .began .yesterday, .one .day .after .she .entered .sub-Saharan .Africa .for
.a .camping .trip. .Vital .signs .are .temperature .102.2 .F .(39 .C), .heart .rate .98 .bpm,
.blood .pressure .100/80 .mm .Hg, .and .respiratory .rate .18 .breaths/min. .The
.physical .examination .is .normal. .Laboratory .tests .show .a .Hb .level .of .10.5 .g/dL,
.a .WBC .of .11000/mm3, .and .a .platelet .count .of .365,000/mm3. .Treatment .is
.initiated .for .traveler's .diarrhea. .Which .of .the .following .drugs .is .the .most
.suitable .for .her? .- .CORRECT .ANSWER-Loperamide, .with .a .single .oral .dose .of
.ciprofloxacin
complete solutions latest version
A .30-year-old .woman .presents .with .complaints .of .abdominal .pain .and .diarrhea
.for .6 .months. .She .describes .her .pain .as .abdominal .cramps. .She .is .unable .to
.localize .her .pain. .She .states .it .is .intermittent, .rated .8/10 .at .its .worst .and .0/10
.currently. .She .says .her .pain .is .worse .right .before .she .has .a .bowel .movement
.and .relieves .after .having .a .bowel .movement. .She .denies .any .weight .loss,
.dietary .changes, .or .recent .travel. .She .describes .her .bowel .movements .as
.loose, .unformed .stools. .Given .the .patient's .most .likely .diagnosis, .which .of .the
.following .would .be .most .likely .in .this .patient? .- .CORRECT .ANSWER-Recent
.problems .with .increased .marital .stress
A .26-year-old .male .attended .a .picnic .two .days .ago .and .now .presents .with
.multiple .episodes .of .nonbloody, .watery .diarrhea .without .abdominal .pain. .He .is
.afebrile, .and .the .other .vital .signs .and .physical .exam .are .notable .for .signs .of
.moderate .dehydration. .Given .the .leading .cause .of .this .patient's .likely
.condition, .what .is .the .best .initial .treatment? .- .CORRECT .ANSWER-Oral
.rehydration
A .16-year-old .patient .is .hospitalized .for .bloody .diarrhea, .high .fever, .and
.abdominal .pain. .The .patient .recently .returned .from .a .week-long .vacation .to
.Mexico, .where .he .enjoyed .many .local .delicacies. .Complete .blood .count .and
.stool .cultures .are .pending, .and .empiric .treatment .for .the .suspected
.enterohemorrhagic .E.coli .O157: .H7 .diarrhea .is .started. .Which .of .the .following
.bacteria .are .part .of .this .patient's .differential, .given .his .clinical .constellation? .-
.CORRECT .ANSWER-Salmonella, .Shigella, .Yersinia, .Campylobacter
A .34-year-old .African-American .man .presents .with .severe .diarrhea .for .five
.days. .He .recalls .eating .scrambled .eggs .his .neighbor .bought .from .a .local .farm.
.Abdominal .bloating .and .cramps .began .about .one .day .after .eating .the .eggs,
.followed .by .watery .stools .about .every .two .hours .in .frequency. .He .denies .pain
.on .defecation .or .blood .or .mucus .in .the .stool. .He .denies .any .recent .travel
.history. .Vital .signs .are .heart .rate .110 .bpm, .blood .pressure .90/64 .mm .Hg, .and
.temperature .101 .°F .(38.3 .°C). .The .abdominal .exam .is .notable .for .diffuse
.tenderness .to .palpation .without .peritoneal .signs. .His .stool .is .negative .for
.blood .but .positive .for .white .blood .cells. .What .is .the .most .reasonable .empiric
.treatment? .- .CORRECT .ANSWER-Ciprofloxacin
, A .19-year-old .African-American .man .presents .with .four .days .of .diarrhea .and
.subjective .fever .for .one .day. .Watery .bowel .movements .occur .5 .to .6 .times .daily
.and, .on .one .occasion, .had .bloody .streaks. .He .has .sickle .cell .disease, .which .is
.controlled .with .hydroxyurea, .and .the .last .crisis .was .eight .months .ago. .He .is .a
.college .student .and .eats .chicken .nuggets .at .a .local .fast-food .place .multiple
.times .a .week .when .attending .school. .His .vital .signs .are .blood .pressure .of
.120/80 .mm .Hg, .pulse .rate .100/min, .and .a .temperature .of .101 .°F .(38.3 .°C). .The
.abdominal .exam .shows .no .tenderness .or .peritonitis. .Blood .work .shows .a .mild
.decrease .in .white .blood .cells .at .4500/microL .with .no .anemia. .Electrolytes .are
.within .the .normal .range. .What .is .the .most .likely .underlying .organism .and .the
.most .appropriate .treatment? .- .CORRECT .ANSWER-Non-typhoidal .Salmonella;
.ciprofloxacin
A .35-year-old .man .presents .with .3 .days .of .watery .diarrhea .after .a .trip .to .the
.Caribbean .10 .days .ago. .The .bowel .movements .have .not .been .bloody .or
.associated .with .pus, .occur .about .3 .to .6 .times .daily, .and .are .associated .with
.abdominal .cramps. .He .denies .fever, .nausea, .or .vomiting. .He .is .a .corporate
.office .manager, .and .since .he .needed .to .go .to .a .meeting, .he .took .some
.diphenoxylate .that .helped .his .symptoms .and .reduced .the .frequency .of .bowel
.movements .significantly. .On .physical .examination, .his .vital .signs .are
.temperature .37 .°C .(98.6 .°F), .pulse .rate .105 .beats/min, .respiration .16
.breaths/min, .and .blood .pressure .100/65 .mm .Hg. .Examinations .of .the .heart .and
.lungs .are .unremarkable, .apart .from .mild .tachycardia. .The .abdomen .is .soft .and
.not .tender. .What .is .the .next .most .appropriate .step .in .the .management .of .this
.patient? .- .CORRECT .ANSWER-Recommend .a .course .of .oral .rehydration .salt
.treatment.
A .34-year-old .African-American .man .presents .with .five .days .of .severe .diarrhea.
.Loose .stools, .bloating, .and .abdominal .cramps .started .two .days .after .he .ate
.chicken .nuggets .at .a .local .fast .food .joint. .Abdominal .cramps .are .felt .in .the
.whole .abdomen; .they .come .and .go, .lasting .20-30 .minutes .associated .with
.nausea. .He .does .not .have .pain .at .defecation .and .has .seen .no .blood .or .mucus
.in .the .stool. .He .denies .any .recent .travel .history. .On .exam, .heart .rate .is .110
.beats .per .minute, .blood .pressure .is .90/64 .mm .Hg, .and .temperature .of .101 .°F
.(38.3 .°C). .His .abdomen .is .diffusely .tender .to .palpation, .but .there .are .no
.peritoneal .signs. .His .stool .is .negative .for .blood .but .positive .for .white .blood
.cells. .Besides .exhibiting .severe .disease, .which .of .the .following .would .be .an
.indication .for .treatment? .- .CORRECT .ANSWER-Hemoglobinopathy
An .18-year-old .presents .with .nausea, .and .multiple .episodes .of .loose, .watery
.stools .that .began .yesterday, .one .day .after .she .entered .sub-Saharan .Africa .for
.a .camping .trip. .Vital .signs .are .temperature .102.2 .F .(39 .C), .heart .rate .98 .bpm,
.blood .pressure .100/80 .mm .Hg, .and .respiratory .rate .18 .breaths/min. .The
.physical .examination .is .normal. .Laboratory .tests .show .a .Hb .level .of .10.5 .g/dL,
.a .WBC .of .11000/mm3, .and .a .platelet .count .of .365,000/mm3. .Treatment .is
.initiated .for .traveler's .diarrhea. .Which .of .the .following .drugs .is .the .most
.suitable .for .her? .- .CORRECT .ANSWER-Loperamide, .with .a .single .oral .dose .of
.ciprofloxacin
