Posted: December 9th, 2022

Multiple Choice Items essay

Midterm Exam ANP 652
• 1
Patients with central nervous system injury may commonly have a specific type of gastric ulcer known as (select the best answer):

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Curling’s ulcer

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Duodenal ulcer

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H. pylori ulcer

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Barrett’s ulcer

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• Question Points: 1.0 / 1.0
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• 2
How do you differentiate a cholinergic crisis from a myasthenia crisis? Select the best answer.

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Perform a Tensilon (edrophonium) test.

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Order a stat plasmapheresis trial.

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Obtain a stat cortisol stimulation test.

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Administer rapid immunomodulating therapies (IVIG).

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• Question Points: 1.0 / 1.0
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• 3
Complications of giant cell arteritis include:

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Uveitis

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Arthritis

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Blindness

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Hemiparesis

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• Question Points: 1.0 / 1.0
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• 4
On the Folstein Mini-Mental State Exam, the maximum score is 30, but a score of 23 or less indicates _____.

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Cognitive impairment

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Mental retardation

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Alzheimer’s dementia

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Parkinson’s dementia

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• Question Points: 1.0 / 1.0
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• 5
Atypical antipsychotics like Seroquel, Zyprexa, and Risperdol are the preferred treatments for dementia-related aggression.

True False
• Question Points: 1.0 / 1.0
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• 6
A 67-year-old male with a past medical history significant for lung cancer is admitted with sepsis. On assessment, you notice petechiae and bruising. Which of the following statements about DIC is not true?

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Results from activation of the clotting cascade and results in clotting factor consumption.

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Diffuse clothing occurs simultaneously with bleeding.

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Heparin may improve lab parameters, but may aggravate bleeding.

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Lab results indicate increased platelet, increased fibrinogen, and prolonged PT/INR.

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• Question Points: 0.0 / 1.0
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• 7
Rickettsial infections include which of the following:

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Rocky Mountain spotted fever and Q fever

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Malaria and toxoplasmosis

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Histoplasmosis and cryptococcosis

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Epstein-Barr virus and cytomegalovirus

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• Question Points: 1.0 / 1.0
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• 8
A 20-year-old female has periodic episodes that begin with decreased vision that lasts for about 30 minutes and is followed by a throbbing occipital headache. Which of the following is the most likely diagnosis?

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Migraine

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Vertebral-basilar insufficiency

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Tension headache

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Panic attack

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• Question Points: 1.0 / 1.0
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• 9
Conductive hearing loss and sensorineural hearing loss are common in the elderly. What are three differential diagnoses for sensorineural hearing loss to include the most common pattern?

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Barotraumas, viral cochleitis, osteoma

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Acoustic neuroma, ototoxic drugs, presbycusis

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Exostosis, meningioma, vascular disease

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Presbycusis, trauma, Paget’s disease

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• Question Points: 1.0 / 1.0
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• 10
Fever of unknown origin, by definition, is a fever of 101 Fahrenheit or greater rectally persisting over at least how many weeks?

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2 weeks

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3 weeks

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1 week

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6 weeks

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• Question Points: 1.0 / 1.0
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• 11
Brain death criteria vary from state to state and involve the absence of breathing, absence of spontaneous movement, and several other neurological findings. Ancillary tests to prove brain death include all of the following except:

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Transcranial Doppler

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Electroencephalography

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Cerebral blood flow study

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Nerve conduction studies

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• Question Points: 1.0 / 1.0
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• 12
The classic triad of Parkinson’s includes all of the following except:

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Resting tremor

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Rigidity arms, legs, and neck stiffness

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Bradykinesia

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Severe cognitive deficits

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• Question Points: 1.0 / 1.0
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• 13
Focal seizures are often accompanied by automatisms, which are behaviors that include all of the following except:

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Lip smacking

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Picking at clothes

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Chewing

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Scratching

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• Question Points: 1.0 / 1.0
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• 14
Loss of central vision is a hallmark of:

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Macular degeneration

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Glaucoma

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Retinal detachment

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Cataracts

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• Question Points: 1.0 / 1.0
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• 15
Which of the following diseases cause degeneration or loss of nerve cells in the brain?

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Alzheimer’s, Parkinson’s, and Huntington’s

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Sepsis, chronic kidney disease, and scleroderma

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Rheumatoid Arthritis, Alzheimer’s, and Scleroderma

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Parkinson’s, B12 deficiency, and Myasthenia Gravis

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• Question Points: 1.0 / 1.0
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• 16
Immunologic mediators that play a role in the pathophysiology of fever include all of the following except:

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Interleukin 1 – primary

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Interleukin 2

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Interleukin 6

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Tumor necrosis factor

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• Question Points: 1.0 / 1.0
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• 17
The most common causes of fever in a geriatric patient include all of the following except:

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Malignancies

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Medication effect

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Connective tissue disorders (rheumatoid arthritis, sarcoidosis, temporal arteritis)

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Sexually transmitted infections (chlamydia, herpes)

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• Question Points: 1.0 / 1.0
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• 18
Anemia is the reduction of one or more of the following major red blood cell measurements:

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Hemoglobin, hematocrit, RBC count

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B12, folic acid, hemoglobin

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Hemoglobin, folic acid, fibrinogen

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Hemoglobin, RBC, and B12

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• Question Points: 1.0 / 1.0
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• 19
Areas of occult infection include:

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Sinuses, teeth, central nervous system

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Lung, ear, throat

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Skin, joints, lymph nodes

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Pelvis, abdomen, and chest

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• Question Points: 1.0 / 1.0
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• 20
A 62-year-old African American male with a past medical history significant for diabetes presents with sudden onset of headache on the right side and blurred vision in his right eye. Fundoscopic exam reveals a deeply cupped optic disc. Which of the following disorders is this patient likely experiencing?

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Acute angle-closure glaucoma

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Strabismus

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Bacterial conjunctivitis

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Cataracts

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• Question Points: 1.0 / 1.0
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• 21
Dementia is characterized by many things, except:

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General decrease in level of cognition

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Behavioral disturbance

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Interference with daily function and independence

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Focused attention to detail and obsession with dates and numbers

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• Question Points: 1.0 / 1.0
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• 22
Although the etiology of Guillain-Barre syndrome is largely unknown, which of the following possible triggers for this disease are most likely:

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Campylobacter jejuni enteritis, cytomegalovirus, Epstein-Barr, HIV, or mycoplasma infection

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Streptococcus pneumonia, Staph aureus, and E. coli

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Cytomegalovirus, Epstein Barr, strep throat, or thrush

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Any bacterial pneumonia or herpes zoster

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• Question Points: 1.0 / 1.0
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• 23
Parasitic infections include which of the following:

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Rocky Mountain spotted fever and Q fever

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Malaria and toxoplasmosis

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Histoplasmosis and cryptococcosis

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Epstein-Barr virus and cytomegalovirus

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• Question Points: 1.0 / 1.0
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• 24
A 65-year-old patient complains of recurrent temporal headaches, malaise, muscle aches, and low grade fever. The headache is described as superficial tenderness rather than deep pain. Temporal arteritis is suspected. Appropriate treatment is:

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Aspirin or acetaminophen every 4 hours as needed for pain and fever

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Refer for a temporal artery biopsy and initiation of oral prednisone

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CT scan of the head and lumbar puncture for CSF evaluation

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A daily three-blocker such as propranolol

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• Question Points: 1.0 / 1.0
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• 25
Which of the following lists of medications is generally contraindicated in geriatric patients?

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Beers list

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Anticholinergic list

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Universal list

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Alzheimer’s list

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• Question Points: 1.0 / 1.0
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• 26
Myasthenia gravis is a disorder of the neuromuscular junction, a pure motor syndrome, caused by an autoimmune attack on the acetylcholine receptor complex at the postsynaptic membrane of the neuromuscular junction. All of the following are true about this disease except (select the best answer):

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Ptosis occurs in up to 40% of these patients initially, and eventually in 80% of these patients with disease progression.

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Dysphagia

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Proximal limb weakness with upper limbs more noticeable than lower

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Loss of sensation with weakened or absent reflexes

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• Question Points: 1.0 / 1.0
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• 27
The most common causes of fever in a geriatric patient include all of the following except:

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Malignancies

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Medication effect

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Connective tissue disorders (rheumatoid arthritis , sarcoidosis, temporal arteritis)

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Sexually transmitted infections (chlamydia, herpes)

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• Question Points: 1.0 / 1.0
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• 28
Epidural hematomas are most often associated with the following findings (select the best answer):

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Seen in the frontal/temporal region, with an initial loss of consciousness followed by a brief lucid period.

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Seen mostly in occipital area, with complete loss of consciousness, and coma-like presentation.

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Seen mostly in frontal region with no loss of consciousness and subtle, stable neurologic deficits.

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None of the above

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• Question Points: 1.0 / 1.0
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• 29
Robert is a 72-year-old male with a past medical history significant for CHF, hypertension, and diabetes, who presents to the ER with a family member who states that Robert has been acting strange lately. Which of the following is an assessment tool most commonly used to screen for dementia?

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MMSE

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Tinetti

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Romberg

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GDS

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• Question Points: 1.0 / 1.0
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• 30
All of the following are correct except:

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It is acceptable to treat mild to moderate dementia with Aricept (donepezil) and Exelon (rivastigmine).

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It is acceptable to treat moderate to severe dementia with Namenda.

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It is acceptable to treat mild dementia with Razadyne (galantamine hydrobromide)

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It is acceptable to treat severe dementia with Exelon.

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• Question Points: 1.0 / 1.0
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• 31
A 27-year-old female presents with facial congestion, left-side facial pressure, and purulent nasal discharge for 11 days. Fever began 2 days ago. She has been trying OTC medications, but does not seem to be able to get any better. Which of the following is the best treatment option?

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Amoxicillin/Clavulanate

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Ciprofloxacin

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Erythromycin

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Doxycycline

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• Question Points: 1.0 / 1.0
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• 32
Viral infections include which of the following:

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Rocky Mountain spotted fever and Q fever

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Malaria and toxoplasmosis

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Histoplasmosis and cryptococcosis

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Epstein-Barr virus and cytomegalovirus

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• Question Points: 1.0 / 1.0
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• 33
A 32-year-old man presents with a 3-day history of fever, headache, and skin rash. Exam reveals positive Kernig and Brudzinski signs, as well as diffuse, erythematous, maculopapular rash. This presentation is most consistent with:

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Subarachnoid hemorrhage

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Viral encephalitis

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Epidural hematoma

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Bacterial meningitis

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• Question Points: 1.0 / 1.0
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• 34
A spinal injury involving C2-C3 usually results in the following (select the best answer):

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Respiratory paralysis and loss of sensation below the mandible

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Quadriplegia and priapism

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Paralysis from the nipple line down with sparing of ventilation and reflexes

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None of the above

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• Question Points: 1.0 / 1.0
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• 35
John is a 55-year-old male with a past medical history significant for IBS who presented to ER with knee pain after trauma. He is now POD #2 for knee replacement. His labs this morning indicated a platelet count of 15,000, but CMP and anticoagulation labs are within defined limits. What is the most likely diagnosis?

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DIC

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ITP

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TTP

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Cancer

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• Question Points: 1.0 / 1.0
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• 36
Tamara is a 68-year-old female with a past medical history significant for CHF and recently found to have DIC in the intensive care unit. Which one of the following is not a therapeutic option?

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Heparin

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Amicar or EACA

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Vitamin K

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Platelet transfusion

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• Question Points: 1.0 / 1.0
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• 37
Which of the following medications would be most appropriate for the patient who is suffering from neuropathic pain?

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NSAID

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Acetaminophen

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Gabapentin

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Morphine

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• Question Points: 1.0 / 1.0
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• 38
Patients with central nervous system injuries and paralysis suffer from venous pooling in the legs and orthostatic hypotension. Which of the following represent etiologies for this hypotension?

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Increased of skeletal muscle pump

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Impaired sympathetic nervous system

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Impaired parasympathetic nervous system

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Impaired absorption of antihypertensive medications

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• Question Points: 1.0 / 1.0
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• 39
Sarah is a 25-year-old female with no significant past medical history who presented to the ER with headache and loss of consciousness. Sarah was playing on a co-ed soccer team. She was doing a diving header to score a goal and accidentally hit her head on the goal post. What is the first diagnostic test to perform on the patient?

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Skull x-ray

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EEG

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CBC, PT/INR

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CT head

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• Question Points: 1.0 / 1.0
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• 40
A 22-year-old female presents with left ear pain that increases with external ear palpation. She also noticed discharge on her pillow this morning. On physical exam, patient is afebrile and mildly ill-appearing. Otoscopic examination reveals an erythematous and edematous left ear canal with purulent exudates. Which of the following is not the likely causative organism for the patient’s ear pain?

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Staphylococcus aureus

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H. influenzae

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Candida albicans

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Pseudomonas aeruginosa

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• Question Points: 1.0 / 1.0
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• 41
The diagnostic approach to fever of unknown origin includes a thorough history of all of the following except:

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Travel

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Diet

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Animal or insect bites

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Type of birth control, if any

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• Question Points: 1.0 / 1.0
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• 42
A differential diagnosis for a patient who presents with a severe headache of recent onset, neck stiffness, and fever is:

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Subdural hematoma

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Migraines

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Tension headaches

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Meningitis

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• Question Points: 1.0 / 1.0
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• 43
Which of the following ethnic groups is at particularly high risk for diabetes?

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Hispanic

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Caucasian

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African American

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Native American

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• Question Points: 1.0 / 1.0
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• 44
Which of the following has an association with AIDS dementia complex?

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“Wet, Wobbly, Whacky”

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CD4 count less than 200

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Exaggerated response to neuroleptics

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Multiple lacunar infarcts

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• Question Points: 1.0 / 1.0
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• 45
Chronic complications of diabetes include all of the following except:

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Neuropathy

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Retinopathy

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Gastroparesis

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Alopecia

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• Question Points: 1.0 / 1.0
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• 46
To assess the cerebellar functioning in the geriatric patient related to fall risk, the family nurse practitioner would evaluate:

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Close eyes and distinguish common odors

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Range of motion of all extremities

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Ability to recall name, year, and place

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Ability to balance on one foot, then the other

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• Question Points: 1.0 / 1.0
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• 47
A 60-year-old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. Which of the following is the most likely diagnosis?

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Bell’s palsy

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Parotiditis

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Trigeminal neuralgia

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Temporal arteritis

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• Question Points: 1.0 / 1.0
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• 48
A transient ischemic attack is:

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A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 24 hours.

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A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 48 hours.

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A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 72 hours.

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Any stroke-type symptoms that resolve within 1 hour.

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• Question Points: 1.0 / 1.0
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• 49
Jugular venous oxygen saturation is one way of monitoring brain oxygenation for traumatic brain injuries. The normal values for jugular venous saturation is (select the best answer):

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55-70%

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80-100%

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80-90%

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35-55%

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• Question Points: 1.0 / 1.0
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• 50
Bone resorption of postmenopausal women can be a key cause in a higher incidence of fractures. A primary cause could be due to:

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Prolactin deficiency

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Progesterone deficiency

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Estrogen deficiency

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Dental extractions

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• Question Points: 1.0 / 1.0

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