1. Which of the following statements best describes a differential diagnosis list?

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• Which of the following statements best describes a differential diagnosis list?
• It is a list of planned interventions for the problems assessed during the visit.

B.It is the list of concerns brought to the appointment by the patient.C.It is a list of different diagnoses experienced by the patient in the past.D.It is a list of potential/plausible diagnoses that may be causing the patient’s signs and symptoms.E.It is a list of diagnoses that have already been ruled out as causes for the chief complaint.Pg 83 It is also important to ask about the presence or absence of additional symptoms or other relevant information—such as risk factors for coronary artery disease in patients with chest pain, or current medications in patients with syncope—that may help you generate a list of possible causes (differential diagnosis) to explain the patient’s problem or condition. This list will include the most likely and, at times, the most serious causes, even if less likely. When clinicians obtain a history, they are continually generating possible explanations in their minds, allowing the patient’s answers to direct the logical use of additional probing questions. This process of probing with questions is similar to testing a hypothesis. With each question, the list of probable diagnoses (or hypotheses) is pared down until a few likely choices are left from a formerly longer list of diagnostic possibilities.

• A 66-year-old female presents to the primary care office with complaints of jaw pain, fatigue, and nausea for

the last 48 hours. What course of action is appropriate in the treatment of this patient?A.Refer the patient to an otolaryngologist to evaluate for jaw pain.B.Prescribe the medication for the jaw pain and nausea and reevaluate in 2-3 days.C.Order x-rays of the jaw and abdomen to further evaluate.D.Recognize these could be atypical symptoms of acute coronary syndrome and proceed accordingly.E.Order screening blood work to evaluate for thyroid disease.Pg 503 Upper back pain, neck or gaw pain, SOB; paroxysmal nocturnal dyspnea; N&V = careful history taking is especially important Atypical symptoms are particularly seen in woman esp if over the age of 65

• In an adult over the age of 40, an S3 assessment finding on cardiac auscultation may be indicative of what?

Select all that apply.A.anemia B.myocardial infarction C.heart failurepg 551 D.normal for athletes -pg 522 E.ventricular volume overload from aortic or mitral regurgitation- pg 551 Pg 551 Pathologic S3 or ventricular gallop sounds like a physiological S3 - in adult over 40 is usually pathologic, arising from high left ventricular filling pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase of diastole. Causes include decreased myocardial contractility, heart failure, and ventricular volume overload from aortic or mitral regurgitation and left to right shunts Pg 548 MI can cause soft S1; pg 495 MI causes pathological ventricular stiffness which marks an S4 heart sound right before the S1 (also heard in HTN) Pg 1049 Chronic Anemia and following exercise can cause pulmonary flow murmurs - in the presence of volume overload

• A 72-year-old male is admitted to intensive care from the Emergency Room for the initial complaint of chest

pain. After the history and physical examination, the NP documents the following cardiovascular findings: JVP is 5 cm above the sternal angle with the head of the bed elevated to 50°. Carotid upstrokes are brisk; a bruit is heard over the left carotid artery. The PMI is diffuse, 3 cm in diameter, palpated at the anterior axillary line in the fifth and sixth intercostal spaces. S1 and S2 are soft. S3 is present at the apex. High-pitched harsh 2/6 holosystolic murmur best heard at the apex, radiating to the axilla.Which of the following possible diagnoses is based on the accurate interpretation of the assessment findings?A.These findings suggest heart failure.B.These findings suggest previous myocardial infarction.C.These findings suggest right carotid occlusion.D.These findings suggest mitral stenosis.E.These findings suggest aortic aneurysm.This scenario is word for word on pg 530 answer in red =these findings suggest heart failure with volumeoverload with possible left carotid occlusion and mitral regurgitation

• A 76-year-old male presents to the office for a routine physical examination. The NP documents the

following skin findings:

Decreased elasticity with multiple lentiginous macules on habitually sun-exposed skin. Multiple, discrete, brown, stuck-on, non-indurated, verrucous plaques on the back and abdomen varying from 1-2 centimeters.Which of the following is the most accurate interpretation of these findings?A.These findings suggest seborrheic keratoses.B.These findings suggest actinic keratoses.C.These findings suggest malignant melanoma.D.These findings suggest lichen planus.E.These findings suggest psoriasis.This exact scenario is described on pg 286 = seborrheic keratosis Description elements = number, color, shape, texture, primary lesion, location and configuration Seborrheic keratosesPg 286 5 mm - 2 cm tan to brown, oval, stuck on, flat topped verrucous (cauliflower like) plaques on the back and abd, following skin tension lines Actinic keratosesPg 313 Superficial keratotic papules come and go on sun-damaged skin - keratotic scales can evolve and SCC (squamous cell carcinoma) is formed by keratin and can result in cutaneous horn - (scalp, lip, ears) Malignant melanomaPg 286 Melanoma with all the classic features from the ABCD method: Asymmetry, Border irregularity, Color variation, and Diameter >6mm.When screening moles for melanomas, ABCD-EFG method. Asymmetry, boarder irregularity - ragged, notched, or blurred; color variation (more than 2 colors, esp blu-black, white or red); diameter >6 mm; evolving or changing rapidly in size, symptoms or morphology; elevation; firmness to palpation and proggressive Growing over several weeks….Lichen planus290 freq on wrist, forearms, genitals and lower legs.Psoriasis Pg 290 freq affects the scalp, extensor surfaces of the elbows and knees, umbilicus and the gluteal cleft.- 288 psoriasis commonly form plaques

• A 14-year-old male presents to the clinic with his grandmother for a complaint of a sore throat. The patient

is afebrile and denies cough. After completing the history and physical examination, the NP documented the

following partial assessment findings:

Throat—Oral mucosa pink, dental caries in lower molars, tongue midline, uvula, and pharynx erythematous, bilateral tonsils enlarged, no exudates.Neck—Trachea midline. Neck supple; thyroid isthmus midline, lobes palpable but not enlarged.Lymph Nodes—Submandibular and anterior cervical lymph nodes tender, 1 cm × 1 cm, rubbery and mobile; no posterior cervical, epitrochlear, axillary, or inguinal lymphadenopathy.Which of the following is the most accurate interpretation of the findings?A.These findings suggest pharyngitis.B.These findings suggest tonsillar abscess.C.These findings suggest lymphoma.D.These findings suggest mononucleosis.E.These findings suggest upper respiratory illness.Pg 427 this scenario is detailed with -these findingssuggest pharyngitis or mild tonsillitis Pg 1018 Tonsillar abscess -a peritonsillar abscessis suggested by erythema and asymmetric protrusion of one tonsil, pain, difficulty opening mouth (trismus), and lateral displacement of the uvula.Pg 427Asymmetry tonsils particularly when associatedwith other symptoms, may signify and underlying pathology such as lymphoma Pg 432 - infectious mononucleosis - enlarged posterior cervical lymph nodes (orgeneral lymphadenopathypg 345); fatiguepg 212; pg 1047an adolescent with persistentfever, sore throat, swollen tonsils and cervical lympadenopathy may have streptococcal pharyngitis or infectious mononucleosis Pg 402 - Upper respiratory infection - Is nasal or sinus congestion preceded by a viral upper respiratory tract infection? Is there purulent nasal discharge, loss of smell, tooth pain, facial pain made worse by bending forward, ear pressure, cough or fever? -Acute bacterial sinusitis(rhinosinusitis) is unlikely until viral URI symptoms persist more than 7 days; both purulent drainage and facial pain should be present for diagnosis (sensitivity and specificity are above 50%)if nasal congestion only on one side- consider nasal septum, nasal polyp, foreign body, granulomatous disease or CA

• The NP is assuming care for a 56-year-old female resident of a long-term assisted living facility. The woman

is seated in a wheelchair next to a window in her private room. After completing the history and physical

examination, the NP documented the following mental status findings:

The patient appears sad and fatigued; clothes are wrinkled. Speech is slow and words are mumbled.Thought processes are coherent, but insight into current life reverses is limited. The patient is oriented to person, place, and time. Digit span, serial 7s, and calculations accurate, but responses delayed.Clock drawing is good.Which of the following is the most accurate interpretationof the findings?A.These findings suggest depression.B.These findings suggest anxiety.C.These findings suggest mood disorder.D.These findings suggest a neurocognitive disorder.E.These findings suggest intellectual disability.This scenario is detailed on page 262- these findingssuggest depression Pg 245 - Anxiety -common risk factors in patientwith anxiety and related disorders include family history of anxiety

personal history of anxiety or mood disorder, childhood stressful life events or trauma, being female, chronic medical illness and behavioral inhibition.Pg 247Anxiety is often comorbid with substance useand mood disorders Pg 250Sudden-onset memory problems are concerningfor major vascular neurocognitive disorders, wherein vascular occlusion damages structures important for memory. Rapid-onset memory problems after a head injury should raise suspicion for a major neurocognitive disorder due to TBI.delirium and dementia fall under neurocognitive disorders pg 249; mini mental is best known screening for dementia pg 264 Intellectual disability - poor scoring in constructional ability (daw these simple shapes) pg 261; poor abstract thinking

• ask what a proverb means (don’t count your chickens before they hatch) pg 261; impaired recent memory pg 260;

poor performance in serial 7s pg 259; digit span - poor performance at - repeat # back pg 259; poor judgment pg 258;

• The NP conducted a physical assessment on a 74-year-old male with a complaint of shortness of breath.

His history is significant for a 20 pack-year history of smoking. He uses 2 inhalers daily (medication unknown) but did not bring them with him to his appointment. The documentation for the respiratory findings is as

follows:

Which of the following is the most accurate interpretation of the findings?A.These findings suggest COPD.- total guess (2 inhalers- smoker? - makes me think emphysema not list) B.These findings suggest pneumonia.C.These findings suggest asthma.D.These findings suggest chronic bronchitis.E.These findings suggest left-sided heart failure.COPD - unable to speak more than two or three words at a time due to shortness of breath. He has intercostal muscle retraction when breathing and sits upright in bed. He is thin, with diffuse muscle wasting. Height is 6 ft 2 in; weight, 175 lb; BP, 160/95, right arm; HR, 108 and irregular; RR, 32 and labored; temperature, 101.2°F.” Pneumonia - pg 87 fever and cough - hx of smoking - rhinorrhea, asymmetric chest wall excursion and dullness to chest w/ percussion p 145; exudates seen on c ray; pleuritic pain with deep inspiration pg 448; sputum often green with bacterial pneumonia pg 450 Asthma - pg 483 WH pg 455 retraction occurs in severe asthma Chronic bronchitis - pg 477 - chronic cough; sputum mucoid to purulent, may be blood-streaked or even bloody - often recurrent WH and dyspnea and prolonged hx of tobacco Left-side HF - rales or crackles ( pg 462); orthopnea and PND pg 504; increase JVP (508)

• A 28-year-old female presents to the office for an annual physical examination. The NP is evaluating the

cranial nerves (CNs) while assessing the eyes. The findings are represented in this image. Damage or inflammation of which of the following cranial nerve(s) is demonstrated in this image?

ADA Description: Eyes looking right and looking left.

A.CN II

B.CN IIIsomewhat of a guess

C.CN IV

D.CN V

E.CN VI