Nokea
The nurse practitioner palpates an enlarged right epitrochlear lymph node in a 30-year-old patient. The Nurse Practitioner should assess the patient's:
- A. Throat, face, and right ear
- B. Neck and supraclavicular region
- C. Right forearm and hand
- D. Right groin and abdomen
Correct Answer: C
Rationale: Enlarged epitrochlear nodes are associated with infections or conditions in the hand or forearm.
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Headache warning signs that need prompt investigation include all of the following except:
- A. New onset after 50
- B. Aggravated or relieved by change of position
- C. Precipitated by Valsalva maneuver
- D. Headaches relieved with mild recurrent use of analgesics
Correct Answer: D
Rationale: Headaches relieved with mild, infrequent analgesic use typically don’t require urgent investigation.
Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.
Which of the following is false about the Veterans Health Administration?
- A. It is an integrated network of service providers across the United States.
- B. It serves a population with an average age of nearly 65 years.
- C. It provides care management only for individuals with disabilities that are service-related.
- D. It can provide older adults home-based primary care, geriatric assessment, and long-term care.
Correct Answer: C
Rationale: The Veterans Health Administration provides care to all veterans, regardless of whether their disabilities are service-related.
On examination, a patient is noted to have a "mask-like" face with decreased blinking and a characteristic stare. These features may be characteristic of:
- A. Nephrotic syndrome
- B. Myxedema
- C. Cushing’s syndrome
- D. Parkinson disease
Correct Answer: D
Rationale: A "mask-like" face is a classic feature of Parkinson’s disease.
The National Institute of Neurologic Disorders and Stroke (NINDS) criteria for PD require a confirmatory autopsy but would rate as “probable” if three of the four primary clinical features were present. Which of the following lists three primary clinical features of PD?
- A. Fatigue, postural instability, gait dysfunction
- B. Rigidity, resting tremor, urinary urgency
- C. Rigidity, bradykinesia, resting tremor
- D. Freezing, sleep disturbance, arthralgias
Correct Answer: C
Rationale: The three primary features of PD are rigidity, bradykinesia, and resting tremor.