27 Dec a) Polypharmacy and nutritional
Week 4 Quiz
Question 1 (1 point)
An older male patient reports urinary frequency, back pain, and nocturia. A dipstick urinalysis reveals hematuria. What will the provider do next to evaluate this condition?
Question 1 options:
a) Order a PSA and perform a digital rectal exam
b) Refer for a biopsy
c) Refer the patient to a urologist
d) Schedule a transurethral ultrasound
Question 2 (1 point)
An older male patient has a screening PSA which is 12 ng/mL. What does this value indicate?
a) A normal result
b) Benign prostatic hypertrophy
c) Early prostate cancer
d) Prostate cancer
Question 3 (1 point)
A male patient reports nocturia and daytime urinary frequency and urgency without changes in the force of the urine stream. What is the likely cause of this?
a) Bladder outlet obstruction
b) Lower urinary tract symptoms
c) Prostate cancer
d) Urinary tract infection
Question 4 (1 point)
A 70-year-old male reports urinary hesitancy, post-void dribbling, and a diminished urine stream. A digital rectal exam reveals an enlarged prostate gland that feels rubbery and smooth. Which tests will the primary care provider order based on these findings?
a) Bladder scan for post-void residual
b) PSA and bladder imaging
c) Urinalysis and serum creatinine
d) Urine culture and CBC with differential
Question 5 (1 point)
The provider orders the oral phosphodiesterase type 5 inhibitor sildenafil to treat erectile dysfunction in a 65-year-old male patient. What will be included when teaching this patient about taking this medication?
a) The medication is best taken on an empty stomach.
b) The medication should be taken with a fatty food or meal.
c) The medication’s effects may last for 24 to 36 hours.
d) This medication has a rapid onset and short duration of action.
e) This medication may be taken once daily.
Question 6 (1 point)
Which is true about hypoactive sexual desire in older men?
Question 6 options:
a) Hypoactive sexual desire in older men is related to sexual aversion.
b) Hypoactive sexual desire is a conscious choice to avoid sexual relations.
c) Men with hypoactive sexual desire may have normal excitement and orgasm.
d) The most common type of sexual dysfunction is hypoactive sexual desire.
Question 7 (1 point)
A young adult male reports a dull pain in the right scrotum and the provider notes a bluish color showing through the skin on the affected side. Palpation reveals a “bag of worms” on the proximal spermatic cord. What is an important next step in managing this patient?
Question 7 options:
a) Anti-infective therapy with ceftriaxone or doxycycline
b) Consideration of underlying causes of this finding
c) Reassurance that this is benign and may resolve spontaneously
d) Referral to an emergency department for surgical consultation
Question 8 (1 point)
An adolescent male reports severe pain in one testicle. The examiner notes edema and erythema of the scrotum on that side with a swollen, tender spermatic cord and absence of the cremasteric reflex. What is the most important intervention?
Question 8 options:
a) Doppler ultrasound to assess testicular blood flow
b) Immediate referral to the emergency department
c) Prescribing anti-infective agents to treat the infection
d) Transillumination to assess for a “blue dot” sign
Question 9 (1 point)
A high school athlete is brought to the emergency department after collapsing during outdoor practice on a hot day. The patient is weak, irritable, and confused. Serum sodium is 152 mEq/L and has dry mucous membranes and tachycardia. What is the initial approach to rehydration in this patient?
Question 9 options:
a) Hypotonic intravenous fluid replacement
b) Intravenous fluid resuscitation with an isotonic solution
c) Loop diuretics and hypotonic intravenous fluids
d) Oral water replacement
Question 10 (1 point)
An elderly patient who is taking a thiazide diuretic has been ill with nausea and vomiting and is brought to the emergency department for evaluation. An assessment reveals oliguria, hypotension, and tachycardia and serum sodium is 118 mEq/L. What is the treatment?
Question 10 options:
a) A single infusion of hypertonic saline
b) Addition of spironolactone
c) Emergency volume repletion with 3% NaCl.
d) Fluid and dietary sodium restriction
Question 11 (1 point)
Which thyroid stimulating hormone (TSH) level indicates hyperthyroidism?
Question 11 options:
a) 0.2 uIU/L
b) 0.4 uIU/L
c) 2.4 uIU/L
d) 4.2 uIU/L
Question 12 (1 point)
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?
Question 12 options:
a) Radionucleotide imaging
b) Serum calcitonin
c) Serum TSH level
d) Thyroid ultrasound
Question 13 (1 point)
What are some common goals of neuropsychiatric evaluation?
Question 13 options:
a) To definitively diagnose neurobehavioral disorders
b) To determine the need for neurosurgical procedures
c) To evaluate cognition when neuro-diagnostic tests are normal
d) To help identify rehabilitation goals in brain-injured patients
e) To monitor changes in symptoms over time
Question 14 (1 point)
A patient exhibits visual field defect, ataxia, and dysarthria and complains of a mild headache. A family member reports that the symptoms began several hours prior. An examination reveals normal range of motion of the neck. What type of cerebrovascular event is most likely?
Question 14 options:
a) Hemorrhagic stroke
b) Hypertensive intracerebral hemorrhage
c) Ischemic stroke
d) Transient ischemic attack
Question 15 (1 point)
An elderly patient is brought to the emergency department after being found on the floor after a fall. The patient has unilateral sagging of the face, marked slurring of the speech, and paralysis on one side of the body. The patient’s blood pressure is 220/190 mm Hg. What is the likely treatment for this patient?
Question 15 options:
a) Carotid endarterectomy
b) Close observation until symptoms resolve
c) Neurosurgical consultation
d) Thrombolytic therapy
Question 16 (1 point)
What are initial approaches when managing delirium in a hospitalized patient who is agitated and confused?
Question 16 options:
a) Administer medications for sleep
b) Apply physical restraints
c) Attend to hydration and toileting needs
d) Decrease stimulation
e) Discontinue any non-essential medications
Question 17 (1 point)
A previously lucid patient with early-stage Alzheimer’s disease is hospitalized after a surgical procedure and exhibits distractibility and perceptual disturbances that occur only in the late afternoon. The patient has difficulty sleeping at night and instead sleeps much of the morning. What is the likely cause of these symptoms?
Question 17 options:
a) Hyperactive delirium
b) Hypoactive delirium
c) Sundowner syndrome
d) Worsening dementia
Question 18 (1 point)
An elderly patient has symptoms of depression and the patient’s daughter asks about possible Alzheimer’s disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient?
Question 18 options:
a) Order brain imaging studies such as CT or MRI
b) Perform genetic testing to identify true risk
c) Prescribe a trial of an antidepressant medication
d) Recommend a trial of a cholinesterase inhibitor drug
Question 19 (1 point)
A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient’s symptoms?
Question 19 options:
a) Alzheimer’s disease
b) Lewy body dementia
d) Vascular neurocognitive disorder
Question 20 (1 point)
Which medications may be useful in treating tension-type headache?
Question 20 options:
c) Muscle relaxants
Question 21 (1 point)
A patient has recurrent cluster headaches and asks about abortive therapy. Which therapy is effective for a majority of patients with cluster headaches?
Question 21 options:
Question 22 (1 point)
A patient with a seizure disorder has seizures which begin with eye twitching and occasionally visual hallucinations. Which site in the brain is the seizure focus?
Question 22 options:
Question 23 (1 point)
A patient who has a seizure disorder and who takes levetiracetam is brought to an emergency department with a seizure which has persisted for15 minutes and which immediately followed another 15 minute seizure. What is the priority action for this patient?
Question 23 options:
a) Administer a dose of levetiracetam now and repeat in 10 minutes
b) Administer lorazepam and monitor cardiorespiratory status
c) Administer phenytoin and phenobarbital along with oxygen
d) Admit the patient to the hospital for a diagnostic work up
Question 24 (1 point)
Which drug is used to treat patients with focal epilepsy and complex partial seizures?
Question 24 options:
Question 25 (1 point)
Benign prostatic hypertrophy is a common finding as men age. Classically, this condition has many symptoms. Please select all that apply:
Question 25 options:
a) Difficulty initiating urinary stream
b) Urinary hesitancy and urgency
c) Sensations of a full bladder and bladder spasms
d) Incontinence and post void dribbling
Question 26 (1 point)
A 63 year old client presents to you with hematuria, hesitancy and dribbling. Digital rectal examination (DRE) reveals a moderately enlarged prostate that is smooth. The client’s prostate specific antigen (PSA) is 1.2. What is the most appropriate management strategy for the provider to follow at this time?
Question 26 options:
a) Prescribe an alph adrenergic blocker
b) Recommend saw palmetto extract
c) Prescribe antibiotic
d) Refer the client to urology
Question 27 (1 point)
A 15 year old client comes in with acute abdominal pain. When taking his history the nurse practitioner (NP) finds that he fell off his bike this morning and has vomited. Upon closer examination the NP determines his pain is localized to the Left groin and testicle. He is afebrile and reports no dysuria. The most likely differential diagnosis is:
Question 27 options:
a) Testicular torsion
Question 28 (1 point)
A client is pregnant and has been taking the same levothyroxine medication for years. What might the provider expect to do with the levothyroxine medication?
Question 28 options:
a) Increase the dosage while pregnant
b) Maintain her established dose
c) Decrease her dosage during the pregnancy
d) Decrease her dosage during the pregnancy
Question 29 (1 point)
A TSH of 0.2 can lead to the following symptoms.
Question 29 options:
b) Weight loss
Question 30 (1 point)
Which of the following are causes of dementia in older adults that can be removed or reversed?
Question 30 options:
a) Polypharmacy and nutritional disorders
b) Alzheimer’s diease and vascular disorders
c) Metabolic disorders and space-occupying lesions
d) Infections affecting the brain and polypharmacy
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