NR511 Midterm Latest Version 2023 2024 Questions and Correct Answers Guaranteed Success A red tongue with enlarged papillae, sometimes seen with strep throat is called a _____ tongue
Raspberry Sandpaper Strawberry Blackberry - Correct Answer Strawberry
Age-related hearing loss (presbycusis) is classified as which type of hearing loss? - Correct Answer Sensorineural
Characteristics of AGE: - Correct Answer Nausea
Vomiting Diarrhea Fever Abd pain/cramping Fatigue Malaise Anorexia Tenesmus Rectal burning d/t frequent diarrhea Rectal abrasion Rectal bleeding Passing stool w/blood and mucus Severe dehydration Increased HR Dizziness
Clinical characteristics of GERD: - Correct Answer Heartburn
Regurgitation Water brash (reflex salivation) Dysphagia Sour taste in mouth in the morning Odynophagia (painful swallowing) Belching Coughing Hoarseness Wheezing usually at night Substernal or retrosternal chest pain Aggravating: reclining after eating, eating large meal, alcohol, chocolate, caffeine, fatty/spicy food, nicotine, constrictive clothes, heavy lifting, straining, bending over.
Alleviating: antacids, sitting upright after meal, eating small meals
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Compare and contrast otitis media and otitis externa. - Correct Answer Definition: OE: inflammation of membranous lining of auditory canal and/or contiguous structures of outer ear.
OM: Inflammation of structures within middle ear
Epidemiology/causes:
OE: 10-20x more likely to occur during warmer/summer months than in cooler seasons.Adults >50 = greatest risk. No ethnic or gender predispositions. Immunocompromised people at greater risk (esp of invasive disease). Excess moisture from any cause increases risk. Seborrheic dermatitis, hearing aids, ear plugs, cotton swabs all increase risk with extended use.
OM: Incidence increases in winter. Most common in very young or elderly. Native
American (esp Navajo) and Native AlaskCorrect Answer = higher prevalence. Men and women = risk. More rare in adults. Risk factors: allergies, sinusitis, rhinitis, pharyngitis, recent/recurrent URI, perforation of eardrum, active/passive smoking.
Pathogens:
OE: Pseudomonas aeruginosa (most common cause of diffuse infection). Staph aureus.Group A strep pyogenes. Bacteroids. Peptostreptococcus. Aspergillus niger.Pityrosporum. Candida albicans.
OM: Strep pneumoniae (most frequent cause in adults). H influenzae. Moraxella
catarrhalis. Strep aureus and strep pyogenes far less common causes.
Clinical presentation:
OE Subjective: acute, severe otalgia that may worsen at night. Worsens with pulling pinna or applying pressure to tragus. Chewing may exacerbate pain in severe cases.Initially ear may feel full/obstructed with temporary conductive hearing loss. May be pruritic. Systemic symptoms may be present with infectious etiology. Chronic illness may include dryness and pruritis of ear canal.OE Objective: tenderness on traction of pinna, pain w/pressure of tragus. Purulent drainage may be present w/bacterial infection. Canal may be reddened and edematous.Usually lacks cerumen. Auditory canal appears edematous/erythematous. Diffuse cases may have localized pustules or furuncles in canal or external processes. Green exudate w/Pseudomonas. Yellow crusting in midst of purulent drainage w/Staph. Fungal infections have fluffy white/black malodorus carpet of growth. Allergic reactions are scaly, cracked, and/or weepy tissue. Usually no lymphadenopathy. TMJ tenderness may be present in invasive disease.OME Subjective: Stuffiness, fullness, loss of acuity unilaterally. Pain is rare. Popping, crackling, gurgling. Rarely causes vertigo.AOM Subjective: Deep ear pain. Fever. unilateral hearing loss. Recent URI. Dizziness.Vertigo. Tinnitus. Chronic repeated bouts of AOM.OME Objective: external ear usually unremarkable. Mucus membranes may be infected or edematous. TM may be dull but not bulging.
AOM Objective: TM may be amber or yellow-orange. TM may be infected and pinkish
gray to fiery red. TM typically full and bulging w/absent or obscured bony landmarks and cone light reflex. Discharge present if TM perf'd. Otorrhea may be purulent or mucoid. 2 / 4
Chronic OM has perf'd, draining TM and possibly invasive granulation tissue.Lymphadenopathy or preauricular and post cervical nodes is common. If OM along with acute mastoiditis, tenderness over mastoid will be present.
Management:
OE: Localized application of heat or ice for pain. NonRx pain reliever for mild to mod pain. Tyl #3 for severe pain. Keep ear dry. Gentle cleaning of ear canal. Eval otic discharge and edema of auditory canal and TM. Select local med appropriate for etiology. May need I&D of pustules or furuncles. Diffuse infection may be treated
empirically. Topical otic preps. Abx: 1st gen cephs or pcns, 2nd gen cephs,
fluroquinolones, ceftazidime.
OM: Uncomplicated is often self-limiting. Treatment recommended for chronic or
recurrent OM. Supportive treatment indicated for acceptance of pt's auditory hearing loss r/t chronic dz. If symptoms persist >12wks, 10-day abx course is warranted. Abx: amox, augmentin, 2nd/3rd gen cephs. Steroids not recommended for kids.
Compare and contrast the two coding classification systems that are currently used in the US healthcare system. - Correct Answer ICD: International classification of disease codes are used to provide payer info on necessity of visit or procedure performed.Shorthand for pt's dx.
CPT: common procedural terminology codes offer the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and non-physician providers. Must have corresponding ICD.
Correctly ID a pt as a new or established given historical info. - Correct Answer Pt
status: whether or not pt is new or established.
New: has not received professional service from provider in same group within past 3 years.Established: has received professional service from provider in same group in last 3 years.
Correctly order the E&M office visit codes based on complexity from least to most
complex. - Correct Answer New pt:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204
5. Comprehensive: 99205
Established pt:
1. Minimal/RN visit: 99211
2. Problem focused: 99212
3. Expanded problem focused: 99213
4. Detailed: 99214
5. Comprehensive: 99215 3 / 4
Crohn's disease is the: - Correct Answer Inflammation of any or all of the bowel wall and any portion of the GI tract from the mouth to the anus. Can result in "skipped lesions."
Define and describe chronic cough. - Correct Answer Lasts 8wks or more in adults Lasts 4wks or more in kids Can be caused by various factors including, but not limited to, post-nasal drip, COPD, asthma, acute bronchitis.Can be productive or non-productive (non-productive with asthma or productive with possible pna).
Define diagnostic reasoning - Correct Answer Reflective thinking because the process involves questioning one's thinking to determine if all possible avenues have been explored and if the conclusions that are being drawn are based on evidence.
Seen as a kind of critical thinking.
Define the components of a SOAP note. - Correct Answer S: subjective (what the pt tells you) CC HPI PMH Fam Hx Social Hx ROS
O: objective (what you can see, hear, feel on exam)
Physical findings Vital signs General survey HEENT Etc...
A: assessment
Global assessment of pt including differentials in order from most to least likely Combination of subjective and objective info List of dx addressed and billed for at the visit
P: plan
What you will Rx When to come back Diagnostic tests Pt education
Describe classes of asthma. - Correct Answer Mild intermittent:
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