Nokea
All of the statements about Medicare are true except:
- A. All of the funding for Medicare comes from federal taxes.
- B. Durable medical equipment has no out-of-pocket cost to the patient.
- C. Part B covers outpatient services and all physician professional fees whether inpatient or outpatient.
- D. Patients are generally responsible for 20% of Part B bills.
Correct Answer: B
Rationale: The correct answer is B because durable medical equipment under Medicare typically requires the patient to pay 20% of the Medicare-approved amount.
A is incorrect because Medicare funding also comes from payroll taxes and individual premiums.
C is incorrect as Part B covers outpatient services and physician fees only in outpatient settings.
D is incorrect as patients are generally responsible for 20% of Part B bills, not no out-of-pocket cost for durable medical equipment.
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Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman?
- A. Hirsutism
- B. Gynecomastia
- C. Oligomenorrhea
- D. Acne
Correct Answer: D
Rationale: Rationale for correct answer D: Acne is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman because hyperprolactinemia usually presents with symptoms related to hormonal imbalance, such as irregular menstrual cycles (oligomenorrhea), breast changes (gynecomastia), and excess body hair (hirsutism). Acne is not directly associated with elevated prolactin levels.
Summary of incorrect choices:
A: Hirsutism - Hirsutism is a common finding in hyperprolactinemia due to hormonal imbalances.
B: Gynecomastia - Gynecomastia can occur in hyperprolactinemia due to the suppression of testosterone.
C: Oligomenorrhea - Oligomenorrhea is a typical finding in hyperprolactinemia due to disruptions in the menstrual cycle.
A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is an aching located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or injury. He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs or incontinence. He was moving furniture for a friend over the weekend. On physical examination, you note muscle spasm, with normal deep tendon reflexes and muscle strength. What is the most likely cause of this patient's low back pain?
- A. Herniated disc
- B. Compression fracture
- C. Mechanical low back pain
- D. Ankylosing spondylitis
Correct Answer: C
Rationale: The correct answer is C: Mechanical low back pain. This is the most likely cause as the patient's pain is aching, located in the lumbosacral region, intermittent for years, with no radiation, numbness, tingling, or incontinence. The physical exam findings of muscle spasm, normal reflexes, and muscle strength support this diagnosis. Mechanical low back pain is common and often related to muscle strain or overuse, as seen in this construction worker who was moving furniture.
Choice A (Herniated disc) is incorrect as the patient does not have radiation of pain or neurological symptoms. Choice B (Compression fracture) is unlikely without a history of trauma or injury. Choice D (Ankylosing spondylitis) is less likely given the lack of inflammatory symptoms and typical age of onset.
A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings?
- A. Eczema
- B. Pityriasis rosea
- C. Psoriasis
- D. Tinea infection
Correct Answer: C
Rationale: The correct answer is C: Psoriasis. The key clinical features described, such as pruritic rash with scabbing, crusting, silvery scale, and nail pitting, are classic signs of psoriasis. The presence of small "pits" in the nails, known as nail pitting, is a common finding in psoriasis. The worsening of symptoms in winter and improvement with sun exposure is also typical of psoriasis. Eczema (choice A) typically presents with red, inflamed, and weeping skin lesions. Pityriasis rosea (choice B) presents with a herald patch followed by smaller similar lesions. Tinea infection (choice D) presents with scaling, redness, and itching but does not typically cause nail pitting. In this case, the combination of symptoms and nail pitting point to psoriasis as the most likely diagnosis.
Which of the following is the most common presenting sign of substance abuse in adolescents?
- A. Poor school performance
- B. Change in sleep habits
- C. Increased blood pressure
- D. Changes in behavior
Correct Answer: D
Rationale: The correct answer is D: Changes in behavior. This is the most common presenting sign of substance abuse in adolescents because substance use often leads to noticeable changes in behavior, such as irritability, mood swings, aggression, and withdrawal from family and friends. These behavioral changes are typically the first noticeable signs of substance abuse.
A: Poor school performance may be a consequence of substance abuse, but it is not necessarily the most common presenting sign.
B: Change in sleep habits can be a sign of substance abuse, but changes in behavior are more prominent and common.
C: Increased blood pressure is a physical symptom of substance abuse, but changes in behavior are usually more readily apparent and commonly observed in adolescents with substance abuse issues.
The medication that blocks the transportation of glucose across the intestines into the bloodstream to target prandial blood glucose is:
- A. Metformin (Glucophage XR)
- B. Acarbose (Precose)
- C. Rosiglitazone (Avandia)
- D. Glipizide (Glucotrol XL)
Correct Answer: B
Rationale: The correct answer is B: Acarbose (Precose). Acarbose is an alpha-glucosidase inhibitor that blocks the breakdown of carbohydrates into glucose in the intestines, reducing glucose absorption and lowering postprandial blood glucose levels. Metformin (A) works by decreasing glucose production in the liver. Rosiglitazone (C) is a thiazolidinedione that improves insulin sensitivity. Glipizide (D) is a sulfonylurea that stimulates insulin release from the pancreas. Acarbose specifically targets postprandial blood glucose by blocking glucose absorption in the intestines.