Test bank for primary care 6th edition by buttaro 2023-2024 Latest Update

1.      A patient who has a history of working around asbestos and silica fibers is concerned about developing lung disease. The primary care provider determines that the patient has a previous history of asthma as a child and currently has frequent episodes of bronchitis. A physical examination is normal and pulmonary function tests and radiographs are negative. What action is correct?

a.       Reassure the patient about the normal findings.

b.      Refer the patient to an occupational health specialist.

c.       Request a workplace environmental assessment.

d.      Suggest that the patient follow up with a pulmonologist.

ANS: B

Patients with environmental exposure may not have symptoms or positive findings. Because this patient reports frequent bronchitis, this should be followed up with an occupational health specialist who can evaluate the degree of exposure and perform further testing. Normal findings are not necessarily reassuring. The occupational specialist may request an environmental assessment. Pulmonologists are not trained in occupational health.

MULTIPLE RESPONSE

1.      During a preplacement screening for a person hired for a job requiring heavy lifting, a primary care provider notes that the newNUemRpSloIyNeGe ThaBs .enCvOirMonmental allergies, a history of

gastroesophageal reflux disease (GERD), recurrent eczema, a previous history of an ankle fracture, and normal lower back strength and flexibility. A urine drug screen is negative. What will be included in the report to the employer? (Select all that apply.)

a.       GERD history

b.      History of allergies and eczema

c.       History of ankle fracture

d.      Lower back screening results

e.       Urine drug screening results

ANS: D, E

Only findings related to the ability of the individual to perform position requirements for the job are included in the report. Other findings should not be included, even though they may need to be addressed.

MULTIPLE CHOICE

1.      A female college student seeks information about emergency contraception. What is the most important part of the assessment of this patient?

a.       Cultural considerations for use of contraception

b.      Feelings of guilt about a possible pregnancy

c.       Possible concerns about confidentiality

d.      The female’s sense of control in sexual situations

ANS: D

Because college women are at greater risk for sexual violence and assault, a request for emergency contraception must be followed by an evaluation of possible rape or assault. The other considerations may be part of the assessment but are not as important as determining whether a rape has occurred.

2.      A female freshman college student tells the primary care provider at the student health center that she has a history of anorexia nervosa that has been well-controlled for several years. What will the provider recommend for this student?

a.       Dietary counseling

b.      Participation in sports

c.       Regular weight assessments

d.      Stress management strategies

ANS: D                                   

Students with previous eating disorders may regress when stressed, so stress management is essential. Unless she begins to regress, dietary counseling is not indicated. Many who participate in sports will develop eating disorders to control weight. It is not necessary to evaluate weight regularly.

MULTIPLE CHOICE

1.      Which patient should have pulmonary function testing as part of the presurgical exam?

a.       A patient older than 60 years of age

b.      A patient undergoing major intrathoracic surgery

c.       A patient with a history of pneumonia in the last 2 years

d.      A patient with diabetes and morbid obesity

ANS: B

Any patient undergoing major thoracic surgery should have pulmonary function testing. Age over 60 years, a history of pneumonia, and diabetes and obesity do not require pulmonary function testing unless there is comorbid COPD.

MULTIPLE RESPONSE

1.      Which factors determine which diagnostic tests should be performed in a presurgical clearance evaluation? (Select all that apply.)

a.       Patient’s age

b.      Patient’s comorbidities

c.       Previous surgeries

d.      Surgeon’s preference

e.       Type of anesthetic agent planned

ANS: A, B, D, E

The patient’s age and comorbidities, surgeon preference, and the type of anesthetic planned all determine which presurgical diagnostic tests will be performed. The patient’s previous surgeries do not determine presurgical testing.

MULTIPLE CHOICE

1.      During a preparticipation sports physical, the examiner notes a difference in strength of the patient’s radial and femoral pulses with the femoral pulses being weaker. What will the provider do?

a.       Evaluate for orthostatic hypotension.

b.      Obtain Doppler studies of lower extremity circulation.

c.       Reassure the patient that this is a normal finding.

d.      Refer the patient for a cardiologic exam.

ANS: D

Differences in strength between radial and femoral pulses may indicate coarctation of the aorta and should be evaluated by a cardiologist. This finding does not indicate orthostatic hypotension. The likelihood of decreased circulation is low in a young athlete.

2.      A high-school adolescent is being screened for fitness before participating in sports. The adolescent has a normal examination and the examiner notes S1 and S2 heart sounds without murmur, normal blood pressure, and equal pulses. The parent reports that the adolescent’s father has a history or Wolff-Parkinson-White syndrome, which has been treated. What will the provider do?

a.       Clear the adolescent to play sports.

b.      Perform an electrocardiogram.

c.       Refer the adolescent to a ca

d.      Tell the adolescent that sports are not allowed.

ANS: C

A positive family history of Wolff-Parkinson-White syndrome requires physician consultation or referral before medical clearance can be given. The adolescent has a normal heart rate and physical exam, so the ECG may not yield significant or useful results. The examiner cannot clear the adolescent without consulting with a specialist. The adolescent may be cleared for sports by the specialist.

3.      An overweight adolescent who takes metformin has type 2 diabetes with a HgA1C of 8.5% and asks about sports participation. What will the provider recommend?

a.       Losing weight prior to initiating sports participation

b.      Participation in strenuous sports to help with weight loss

c.       Referral to the endocrinologist for sports clearance

d.      Switching to insulin therapy prior to participation

ANS: C

Patients with poorly controlled diabetes should be referred to a specialist prior to clearance for sports participation. This patient has an elevated HgA1C, indicating poor control. The endocrinologist may suggest the other options, but the primary care provider should not clear this patient for participation in sports.