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MN 568 Final Exam with Answers

1. After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?
2. Which of the following is diagnostic for diabetes mellitus?
3. Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
4. What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
5. The clinician finds numerous nodules on the thyroid of a 65-year-old woman. The clinician suspects thyroid cancer. Which of the following data would be most significant for this patient?
6. Which of the following medications can cause hyperglycemia?
7. You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient?
8. Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis?
9. How often should the clinician examine the feet of a person with diabetes?
10. Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
11. A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
12. A BMI of 29 kg/m2 is considered obesity.
13. Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions?
14. A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
15. Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis?
16. Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?
17. A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
18. Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?
19. You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
20. Which of the following is essential for diagnosing thyroid cancer?
21. The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which of the following data?
22. Urine-free cortisol is one of four diagnostic tests recommended for Cushing’s syndrome.
23. The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
24. Which of the following statements concerning the treatment of fibromyalgia syndrome is true?
25. A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
26. Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
27. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
28. Which of the following statements concerning the musculoskeletal examination is true?
29. Mr. W, 53 years old, is seen in the clinic with concerns about his left foot. He has a 40-year history of type 1 diabetes with “fairly good” control on twice-daily insulin. He denies injury but states that he tripped a few months ago and that his foot is sore when he walks. Physical examination reveals an edematous, erythremic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely diagnosis?
30. The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
31. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician?
32. Metformin is the first line of pharmacologic treatment for type 2 DM.
33. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?
34. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?
35. One of the most frequent presenting signs/symptoms of osteoporosis is:
36. Lifestyle modification is the treatment of choice for metabolic syndrome.
37. Mrs. Thomas was seen in the office 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 differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
38. The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective?
39. Osteoarthritis is primarily a noninflammatory condition.
40. A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods?
41. Which of the following tests should you order to confirm Mr. W’s diagnosis?
42. Which of the following are common signs of type 2 DM?
43. Which of the following statements is true concerning the management of the client with a herniated disc?
44. Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
45. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
46. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
47. The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
48. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
49. Which stage of Paget’s disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
50. A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?

MN 568 Final Exam Set 2

1. The clinician should question the patient with suspected gout about use of which of these medications?
2. A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
3. Which of the following statements concerning the musculoskeletal examination is true?
4. The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
5. Jennifer is an 18-year-old who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?
6. Which of the following is diagnostic for diabetes mellitus?
7. Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates?
8. A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?
9. A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which of the following should be included in the differential diagnosis?
10. You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is:
11. Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. ch of the following is a sign or symptom of cauda equina compression?
12. Mrs. Thomas was seen in the office 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 differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is:
13. The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
14. The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
15. Which of the following statements is true concerning the management of the client with a herniated disc?
16. Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
17. The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as:
18. Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?
19. Which stage of Paget’s disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
20. A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do?
21. Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
22. Urine-free cortisol is one of four diagnostic tests recommended for Cushing’s syndrome.
23. You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient?
24. After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?
25. Metformin is the first line of pharmacologic treatment for type 2 DM.
26. A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?
27. Which of the following are common signs of type 2 DM?
28. Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or “frozen shoulder.” Which clue in Mrs. Gray’s history supports this diagnosis?
29. The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective?
30. How often should the clinician examine the feet of a person with diabetes?
31. Osteoarthritis is primarily a noninflammatory condition.
32. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
33. Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways?
34. A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
35. Which of the following tests should you order to confirm Mr. W’s diagnosis?
36. One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure?
37. Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
38. A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
39. What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
40. Which of the following statements concerning the treatment of fibromyalgia syndrome is true?
41. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician?
42. Mr. W, 53 years old, is seen in the clinic with concerns about his left foot. He has a 40-year history of type 1 diabetes with “fairly good” control on twice-daily insulin. He denies injury but states that he tripped a few months ago and that his foot is sore when he walks. Physical examination reveals an edematous, erythremic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely diagnosis?
43. One of the most frequent presenting signs/symptoms of osteoporosis is:
44. Lifestyle modification is the treatment of choice for metabolic syndrome.
45. Which of the following is essential for diagnosing thyroid cancer?
46. Fruit juice with added sugar is the treatment of choice for anyone experiencing hypoglycemia.
47. Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions?
48. A BMI of 29 kg/m2 is considered obesity.
49. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome?
50. A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

MN 568 Chapter 16. Endocrine/Metabolic Problems

1. A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
2. The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
3. A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes?
4. A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
5. A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?
6. A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?
7. The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective?
8. A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?
9. After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?
10. Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions?
11. The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which of the following data?
12. A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?
13. After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat thyroid studies?
14. Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?
15. The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
16. A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
17. How often should the clinician examine the feet of a person with diabetes?
18. The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
19. Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
20. Mr. W, 53 years old, is seen in the clinic with concerns about his left foot. He has a 40-year history of type 1 diabetes with “fairly good” control on twice-daily insulin. He denies injury but states that he tripped a few months ago and that his foot is sore when he walks. Physical examination reveals an edematous, erythremic, and warm foot. There is a superficial ulcer on the plantar surface. Which of the following is the most likely diagnosis?
21. Which of the following tests should you order to confirm Mr. W’s diagnosis?
22. A vegetarian patient with gout asks the clinician about food he should avoid. The clinician should advise the patient to avoid which of the following foods?
23. The clinician should question the patient with suspected gout about use of which of these medications?
24. The clinician finds numerous nodules on the thyroid of a 65-year-old woman. The clinician suspects thyroid cancer. Which of the following data would be most significant for this patient?
25. Which of the following is essential for diagnosing thyroid cancer?
26. Which of the following are common signs of type 2 DM?
27. Which of the following medications can cause hyperglycemia?
28. Which of the following is diagnostic for diabetes mellitus?
29. Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?
30. A 35-year-old woman presents with symptoms of hypoglycemia. There is no history of diabetes mellitus. Which of the following should be included in the differential diagnosis?