CK- UWSA 3- Block 3

Time limit: 0

Quiz Summary

0 of 40 Questions completed

Questions:

Information

You have already completed the quiz before. Hence you can not start it again.

Quiz is loading…

You must sign in or sign up to start the quiz.

You must first complete the following:

Results

Quiz complete. Results are being recorded.

Results

0 of 40 Questions answered correctly

Your time:

Time has elapsed

You have reached 0 of 0 point(s), (0)

Earned Point(s): 0 of 0, (0)
0 Essay(s) Pending (Possible Point(s): 0)

A 3-month-old girl is brought to the office due to a worsening rash. The mother first noted a few red spots on the child’s feet 2 weeks ago, but the rash has since spread diffusely. The patient has been more irritable than normal, particularly overnight. There has been no fever, vomiting, diarrhea, or cough. The mother recently developed a few erythematous papules along the wrists and elbows for which she has applied an over-the-counter topical lotion. The 5-year-old brother and the father are asymptomatic. Both the patient and the brother are unvaccinated. Examination shows a fussy but consolable infant. There are diffuse, 3- to 4-mm, erythematous papules, pustules, and vesicles on the trunk, extremities, fingers, soles, face, and scalp. The rest of the examination is unremarkable. The rash on the feet is shown below.

The treatment plan for this patient’s diagnosis is discussed. Medical intervention should be provided to which of the following people?

Option	Patient	Sibling	Mother	Father
A	—	X	—	X
B	—	X	X	—
C	X	—	—	—
D	X	—	X	—
E	X	X	—	—
F	X	X	X	X

Correct

Incorrect

Question 14 of 40

14. Question
A 52-year-old man is brought to the emergency department due to right-sided weakness and slurred speech. His wife states that the patient was sitting in his recliner 30 minutes ago when he suddenly grasped his chest and “blacked out.” The patient spontaneously regained consciousness within a minute, but when he began to speak his speech was garbled. He was also unable to stand or walk due to right-sided weakness. Medical history is significant for hypertension and medication nonadherence. Blood pressure is 180/105 mm Hg in the right arm and pulse is 110/min. On examination, the patient is awake, alert, and anxious appearing with expressive aphasia. There is weakness of the right upper and lower extremities. A left-sided carotid bruit is present. The left radial pulse is decreased. Noncontrast CT scan of the head reveals no hemorrhage. Which of the following is the most appropriate next step in evaluation of this patient?
- A. Cardiac rhythm monitoring
- B. CT aortography
- C. CT pulmonary angiography
- D. Echocardiographic bubble study
- E. MR venography of the brain
Correct

Incorrect

Question 15 of 40

15. Question

A 70-year-old woman comes to the emergency department due to an 8-hour history of right groin pain, nausea, and vomiting. Medical history is significant for end-stage renal disease for which the patient undergoes hemodialysis 3 times a week. The last hemodialysis session was 24 hours ago. The patient lives alone and manages her activities of daily living. Temperature is 39 C (102.2 F), blood pressure is 92/58 mm Hg, and pulse is 114/min. Physical examination shows a 6-cm, firm, tender, right inguinal mass. Lungs are clear to auscultation. Trace lower extremity edema is present bilaterally. Laboratory results are as follows:

Complete blood count
Hemoglobin	10 g/dL
Platelets	240,000/mm³
Leukocytes	17,000/mm³
Neutrophils	80%

Serum chemistry
Sodium	136 mEq/L
Potassium	5.8 mEq/L
Chloride	104 mEq/L
Bicarbonate	22 mEq/L
Blood urea nitrogen	36 mg/dL
Creatinine	3.6 mg/dL

ECG shows no abnormalities. Intravenous fluids and empiric intravenous antibiotics are initiated. Which of the following is the most appropriate next step in management of this patient?

A. Administer an erythropoiesis-stimulating agent then proceed with surgery
B. Complete an extended hemodialysis session then proceed with surgery
C. Delay surgery until normalization of serum potassium with medical management
D. Proceed with surgery immediately with intraoperative monitoring of potassium
E. Recommend hospice care

Correct

Incorrect

Question 16 of 40

16. Question
A 63-year-old man comes to the emergency department due to loss of vision in his left eye. He says that he was playing catch with his grandchildren 2 hours ago when the vision in his left eye “just went away.” He did not experience any noticeable trauma and has had no pain. The right eye is unaffected. Medical history includes hypertension and type 2 diabetes mellitus, both of which have been reasonably well controlled with medication. On examination, extraocular movements are intact, and there is no conjunctival erythema or edema. There is an afferent pupillary defect of the left eye. He has light perception in both eyes, but he cannot distinguish fingers with the left eye. Right eye visual acuity is intact. Which of the following is the most appropriate next step in diagnosis?
- A. Dilated fundus examination
- B. Fluorescein angiography
- C. Ocular tonometry
- D. MRI of the brain
- E. Visual field testing
Correct

Incorrect

Question 17 of 40

17. Question

A 62-year-old hospitalized man is evaluated for worsening renal dysfunction. The patient has a history of cirrhosis due to nonalcoholic fatty liver disease. He was admitted 4 days ago with coffee-ground emesis and melena. Esophagogastroduodenoscopy revealed bleeding gastric antral vascular ectasia that was treated endoscopically. The patient has had no further bleeding, and hemoglobin has remained stable. However, serum creatinine has increased to 2.6 mg/dL from 1.3 mg/dL. The patient’s home furosemide and spironolactone were stopped at admission, and his current medications are pantoprazole, lactulose, and prophylactic ceftriaxone. Urine output over the last 24 hours has been 800 mL. Temperature is 36.9 C (98.4 F), blood pressure is 90/62 mm Hg, and pulse is 78/min. Physical examination shows clear lungs, normal heart sounds, and normal jugular venous pressure. Abdominal examination shows moderate ascites without tenderness. There are scattered spider angiomas but no other rashes. The remainder of the physical examination is unremarkable. The most recent laboratory studies are as follows:

Complete blood count
Hemoglobin	9.8 g/dL
Platelets	120,000/mm³
Leukocytes	4,200/mm³

Serum chemistry
Sodium	132 mEq/L
Potassium	4.8 mEq/L
Chloride	103 mEq/L
Blood urea nitrogen	64 mg/dL
Creatinine	2.6 mg/dL

Urinalysis	No protein, cells, or casts

Urine sodium is 5 mEq/L. Renal ultrasonography reveals no abnormalities. Treatment for this patient’s kidney dysfunction is aimed primarily at which of the following parameters?

A. Increasing hemoglobin level
B. Increasing mean arterial pressure
C. Reducing cardiac contractility
D. Reducing portal venous pressure
E. Reducing renal interstitial inflammation

Correct

Incorrect

Question 18 of 40

18. Question
A 47-year-old, previously healthy man comes to the office due to substernal burning and regurgitation of sour fluids intermittently for the past year. The patient’s symptoms are partially relieved by over-the-counter famotidine. Review of systems is also notable for occasional hoarseness and intermittent cough. The patient takes no other medications. He does not use tobacco, alcohol, or recreational drugs. Family history is unremarkable. Vital signs are normal. Physical examination is normal. Laboratory results are as follows:

Complete blood count

Hemoglobin

11 g/dL

Mean corpuscular volume

75 µm³

Platelets

380,000/mm³

Leukocytes

5,900/mm³

Fecal occult blood testing is negative. Screening colonoscopy 2 years ago was normal. Which of the following is the most appropriate next step in management of this patient?
- A. CT scan of the chest and abdomen
- B. Esophageal pH monitoring
- C. Gastrointestinal endoscopy
- D. Helicobacter pylori stool antigen test
- E. High-dose lansoprazole for 2 months
Correct

Incorrect
Question 19 of 40

19. Question
A 19-year-old woman comes in for a routine examination. The patient feels well and has no symptoms. She has been sexually active for 2 years. The patient has no chronic medical conditions, and her only medication is oral contraceptive pills. Vital signs are normal. The physical examination, including pelvic examination, is normal. Urine pregnancy testing is negative. Nucleic acid amplification testing (NAAT) is positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. Which of the following is the most appropriate next step in management of this patient?
- A. Obtain cervical cultures and prescribe antibiotics if positive
- B. Prescribe antibiotics to be taken only if symptoms develop
- C. Prescribe antibiotics to be taken now
- D. Repeat the NAAT testing and prescribe antibiotics if positive
- E. Schedule a follow-up visit in a week for a repeat pelvic examination
Correct

Incorrect
Question 20 of 40

20. Question
A 3-year-old boy is brought to the office by his parents due to worsening cough and fever for 5 days. He has had 2 episodes of right lower lobe pneumonia in the past 4 months. The patient had fever with each episode that resolved with antibiotics; however, his cough has persisted for the past 4 months. The cough is worse with activity. He lives at home with his mother and father and does not attend day care. Immunizations are up to date. Height and weight are tracking at the 70th percentile. Temperature is 38.3 C (100.9 F), blood pressure is 90/50 mm Hg, pulse is 140/min, and respirations are 38/min. Examination shows crackles and expiratory wheezes over the right lower lobe. Heart sounds are normal, and the abdomen is soft and nontender. Chest radiograph reveals a right lower lobe infiltrate. Which of the following underlying conditions is most likely responsible for this patient’s findings?
- A. Cystic fibrosis
- B. Gastroesophageal reflux disease
- C. Moderate persistent asthma
- D. Paradoxical vocal cord motion
- E. Retained foreign body
Correct

Incorrect
Question 21 of 40

21. Question
A 45-year-old woman comes to the emergency department due to 3 weeks of recurrent fever, malaise, dry cough, and myalgias. The patient’s medical history is significant for mitral valve prolapse. She has not taken antibiotics in the last 5 years and does not use tobacco, alcohol, or recreational drugs. The patient works at a dairy farm. Temperature is 38.4 C (101.1 F), blood pressure is 122/78 mm Hg, pulse is 86/min, and respirations are 16/min. Cardiac auscultation reveals a 3/6 holosystolic murmur at the cardiac apex. The spleen is palpable. Multiple sets of blood cultures are negative. Echocardiography reveals small vegetations over the mitral valve leaflets. Erythrocyte sedimentation rate is markedly elevated. Which of the following organisms is most likely responsible for this patient’s current symptoms?
- A. Coagulase-negative Staphylococcus
- B. Coxiella burnetii
- C. Enterococcus
- D. Staphylococcus aureus
- E. Streptococcus viridans
Correct

Incorrect
Question 22 of 40

22. Question
A 50-year-old man comes to the office due to a 3-day history of worsening redness and swelling of his left foot. The patient reports only minimal pain and has had no fever, chills, or malaise. One day prior to the onset of these symptoms, the patient slightly twisted his foot while getting out of the bathtub, but he recalls no major injury. Medical history is significant for type 1 diabetes mellitus, hypertension, and hypercholesterolemia. Temperature is 36.7 C (98.1 F), blood pressure is 124/80 mm Hg, and pulse is 78/min. On examination, the entire left foot is edematous, erythematous, and warm compared to the right foot, with moderately restricted range of motion. Monofilament testing reveals significant impairment of sensation of both feet. No skin ulcers or gross bony abnormalities are noted. Dorsalis pedis pulses are 2+ and symmetric. Laboratory results are as follows:

Hemoglobin

12 g/dL

Leukocytes

9,800/mm³

Platelets

240,000/mm³

Erythrocyte sedimentation rate

15 mm/hr

Creatinine

1.1 mg/dL

X-rays of the left foot show mild soft tissue edema but no fracture or dislocation. Which of the following is the most appropriate next step in management of this patient?
- A. Antibiotic therapy covering gram-positive and gram-negative organisms
- B. Avoidance of weight bearing with the use of a cast
- C. Measurement of serum uric acid level
- D. Surgical incision and drainage
Correct

Incorrect
Question 23 of 40

23. Question
A 46-year-old man comes to the emergency department for evaluation of left ankle pain. The patient was walking down a flight of stairs when he missed a step and landed on the lateral aspect of his foot. He immediately experienced pain in the ankle that has progressively worsened over the past 4 hours despite ibuprofen and application of ice. The patient’s medical conditions include chronic hypertension and hyperlipidemia. Temperature is 36.7 C (98.1 F), blood pressure is 130/80 mm Hg, and pulse is 76/min. BMI is 29 kg/m². Examination of the left ankle shows significant bruising over the lateral aspect. Range of motion is limited on external rotation of the foot due to pain. There is no tenderness to palpation over bony prominences of the ankle, and sensation is normal. The patient can take 5-6 steps before stopping due to pain. Which of the following is the best next step in management of this patient?
- A. Ankle brace
- B. Immediate surgical fixation
- C. Intraarticular corticosteroid injection
- D. MRI of the ankle
- E. X-ray of the ankle
Correct

Incorrect
Question 24 of 40

24. Question
A 21-year-old man comes to the office due to a persistent “dragging” sensation in his left lower abdomen for the past 4 weeks. He does not recall any trauma to that area. He has had no fever, nausea, vomiting, weight loss, or urinary or bowel symptoms. The patient has no chronic medical conditions and takes no medication. He has had 4 sexual partners over his life and uses condoms “most of the time.” Vital signs are normal. The abdomen is soft and nontender with no palpable masses. There is no inguinal lymphadenopathy. The left testis is noticeably larger than the right testis. No tenderness or nodules are noted on palpation of the left testis, and transillumination is negative. When the patient is placed in the recumbent position, the testes do not change size. No ulcerations or skin discoloration is present. Which of the following is the most appropriate next step in evaluation of this patient’s current condition?
- A. Chlamydia and gonorrhea testing
- B. CT scan of the abdomen
- C. Reassurance only
- D. Scrotal ultrasonography
- E. Semen analysis
Correct

Incorrect
Question 25 of 40

25. Question
A clinic administration committee is analyzing results of patient surveys and finds a recent trend of low satisfaction scores associated with extended wait times. A clinic-wide brainstorming meeting is held to elicit staff feedback about reasons for the high wait times. Reasons are grouped into specific categories, including “staffing,” “organization,” “patients,” and “scheduling.” During the discussion, a medical assistant expresses his observation that although patients may arrive on time, multiple patients are often booked for the same time slot and examination rooms may be fully occupied with other patients when they arrive. The medical assistant’s observations are most appropriately placed in which position on the fishbone diagram shown below?
- A
- B
- C
- D
- E
Correct

Incorrect
Question 26 of 40

26. Question
During planned maintenance of the electronic medical record system in a tertiary care hospital, computerized provider order entry is temporarily unavailable. A prescriber handwrites an order for “insulin glargine 10 U SC every 24 hours” for an adult patient in the intensive care unit and faxes it to the pharmacy. Which modification will most improve the safety of the order?
- A. Add a decimal point and 0 after 10
- B. Add a weight-based dose in addition to the number of units
- C. Change “U” to “units” and “SC” to “subcutaneously”
- D. Specify the time of administration in addition to “every 24 hours”
- E. Write out the brand name of insulin instead of “glargine”
Correct

Incorrect
Question 27 of 40

27. Question
A 36-year-old man is brought to the emergency department after sustaining multiple facial and scalp lacerations in an altercation. He has chronic HIV infection that has been treated with antiretroviral medications, but he has been off therapy for the past 6 months. The physician irrigates the patient’s lacerations in preparation for repair; she is wearing protective equipment for the face and eyes but accidentally splashes the patient’s blood and contaminated irrigation solution on her exposed neck and upper arm. The exposed skin is intact, and all visible blood is cleaned with soap and water. Which of the following is the most appropriate management of this physician’s occupational exposure?
- A. No additional testing or postexposure prophylaxis is needed
- B. Order a CD4 count on the patient to determine the next step
- C. Order an HIV viral load assay on the patient to determine the next step
- D. Order serologic HIV testing on the physician and start postexposure prophylaxis if positive
- E. Order serologic HIV testing on the physician and start postexposure prophylaxis now
Correct

Incorrect
Question 28 of 40

28. Question
A 72-year-old man is evaluated in the emergency department for sudden-onset severe abdominal pain and vomiting. Medical conditions include hypertension, dyslipidemia, and coronary artery disease. His coronary artery disease is being medically managed. The most recent echocardiogram showed an ejection fraction of 40%. Review of symptoms is notable for substernal chest pain upon walking 2-3 blocks that resolves with rest, but the patient has no active chest pain. Temperature is 38.3 C (100.9 F), blood pressure is 96/64 mm Hg, pulse is 108/min, and respirations are 24/min. Cardiopulmonary examination is unremarkable. The abdomen is mildly distended and diffusely tender to palpation with rebound and guarding. ECG shows sinus tachycardia with nonspecific ST-T wave abnormalities. Upright x-ray of the chest shows free air under the diaphragm. After an intravenous fluid bolus, the patient’s blood pressure is 112/72 mm Hg and pulse is 96/min. Antibiotics are administered. Which of the following is the next best step in management of this patient?
- A. Obtain serial cardiac troponin I and brain natriuretic peptide levels
- B. Order coronary CT angiography
- C. Order pharmacologic cardiac stress testing
- D. Proceed to surgery without further testing
- E. Proceed with coronary angiography
Correct

Incorrect
Question 29 of 40

29. Question
A 36-year-old, previously healthy woman comes to the office due to worsening right hand numbness. The patient first noticed intermittent numbness of the right fifth digit 8 months ago with activities such as combing her hair. Since then, the symptoms have progressed to involve more of the right hand and forearm. She has had difficulty performing her job in which she has to stack boxes on high shelves. The symptoms resolve with rest. Physical examination shows normal strength, reflexes, and sensation in the right upper extremity. Distal pulses are normal and capillary refill is not delayed. There is no neck deformity or tenderness. The symptoms are reproduced when the patient is instructed to raise her right arm over her head. Compression of the neural structures at which of the following locations is the most likely cause of this patient’s current symptoms?
- A. C5 and C6 nerve roots at the spinal canal
- B. C8 and T1 nerve roots at the thoracic outlet
- C. Median nerve at the proximal forearm
- D. Radial nerve at the midhumerus
- E. Ulnar nerve at the wrist
Correct

Incorrect
Question 30 of 40

30. Question
A 31-year-old woman comes to the office for inability to conceive. The patient has been having unprotected intercourse 2 or 3 times weekly with her male partner for the past 12 months. Her menstrual cycles occur every 26 days, with moderate cramping on the first 2 days, and 5-7 days of moderate bleeding. The patient has celiac disease managed with a gluten-free diet; her only medication is a daily prenatal vitamin. She has had no surgeries. The patient does not use tobacco, alcohol, or recreational drugs. BMI is 24 kg/m². Vital signs are normal. Physical examination is unremarkable. Her partner’s semen analysis is normal. Which of the following is the best next step in management of this patient?
- A. Antimüllerian hormone level
- B. Antiphospholipid antibody testing
- C. Diagnostic laparoscopy
- D. Karyotype analysis
- E. Observation and reassurance only
Correct

Incorrect

Question 31 of 40

31. Question

The following vignette applies to the next 2 items. The items in the set must be answered in sequential order. Once you click Proceed to Next Item, you will not be able to add or change an answer.

A group of psychiatry residents developed a short test for depression in adolescents. To evaluate the performance of the test, the residents selected 100 adolescents seeking outpatient psychiatric care. All 100 adolescents underwent evaluation using the gold standard test for depression in this population and the short test. Of 50 adolescents found to have depression according to the gold standard test, 35 were found to have depression according to the short test. Of 50 adolescents found to not have depression according to the gold standard test, 10 were found to have depression according to the short test.

Item 1 of 2

Which of the following is correct about the short test for depression in adolescents developed by the group of residents?

A. The accuracy of the short test is 45%
B. The prevalence of depression is 70%
C. The rate of false positives is 20%
D. The sensitivity of the short test is ~78%
E. The specificity of the short test is ~73%

Correct

Incorrect

Question 32 of 40

32. Question
Item 2 of 2

A primary care physician estimates that the prevalence of depression among her adolescent patients is 20%. The physician decides to implement the short test for depression in adolescents as a screening tool in her practice. Which of the following measures is expected to be equal in value whether the short test is used on primary care patients or outpatient psychiatric care patients?
- A. Negative predictive value
- B. Positive likelihood ratio
- C. Pretest probability of depression
- D. Prevalence of depression
Correct

Incorrect
Question 33 of 40

33. Question
A 26-year-old woman comes to the office for a health maintenance examination. The patient is asymptomatic. She has a history of asthma and takes an inhaled glucocorticoid and a long-acting beta agonist daily. The patient states that she last used her rescue inhaler (inhaled albuterol) 2 months ago. She has never been hospitalized for acute asthma exacerbation. The patient has no other medical conditions. She is planning to become pregnant and recently began taking an over-the-counter prenatal vitamin. Blood pressure is 128/72 mm Hg and pulse is 68/min. BMI is 32 kg/m². The lungs are clear on auscultation. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate recommendation at this visit to improve this patient’s pregnancy outcome?
- A. Additional folate supplementation
- B. Beta-agonist discontinuation
- C. Glucocorticoid discontinuation
- D. Prepregnancy weight loss
- E. Tetanus–reduced diphtheria–acellular pertussis vaccination
Correct

Incorrect
Question 34 of 40

34. Question
A 4-year-old boy is brought to the emergency department by his aunt with right arm pain and swelling. The aunt says that the patient fell off the monkey bars at the park and landed on his right hand. There was no head injury or vomiting. On physical examination, the patient cries in pain and feels tingling in his right fifth digit. The right elbow is swollen and deformed. The right radial pulse is diminished but sensation is intact. X-ray of the right elbow is shown in the exhibit. The patient is currently staying with his aunt while his parents are out of town. The aunt mentions that he was brought to this hospital by his mother 3 months ago and treated for an ankle fracture. Which of the following is the most appropriate next step in management?
- A. Delay further treatment until consent is obtained from the patient’s parents
- B. Obtain consent from the aunt to treat the patient
- C. Provide treatment for the patient’s injury without obtaining consent
- D. Treat the patient due to concern for child abuse
- E. Treat the patient since his mother recently provided consent for treatment of a similar injury
Correct

Incorrect
Question 35 of 40

35. Question
A 75-year-old woman comes to the emergency department due to severe back pain for 2 days that started suddenly while she was vacuuming her house. She also reports sharp pain in the right flank. Medical history includes hypertension and stage 1 chronic kidney disease. Temperature is 37 C (98.6 F), blood pressure is 142/94 mm Hg, and pulse is 88/min. Physical examination shows spinal tenderness at T10. There is no costovertebral angle tenderness. The abdomen is soft and nontender with no palpable masses. In addition to appropriate pain control, what is the most appropriate next step in management?
- A. Abdominal ultrasound
- B. CT scan with contrast of the abdomen
- C. No additional testing needed
- D. Plain x-ray of the spine
- E. Technetium 99m scan
Correct

Incorrect
Question 36 of 40

36. Question
A 42-year-old man comes to the office for postprandial bloating, inability to belch, and epigastric discomfort. Sodas and other carbonated beverages have become especially troublesome for him. The patient has no difficulty swallowing, early satiety, vomiting, constipation, diarrhea, or unintentional weight loss. Two months ago, he underwent an uncomplicated fundoplication for gastroesophageal reflux disease; he has not since experienced heartburn or regurgitation. Vital signs are within normal limits. The abdomen is nontender and nondistended. In addition to avoidance of carbonated beverages, which of the following would be the best next step in management?
- A. Barium esophagography
- B. Surgical revision
- C. Treatment with rifaximin
- D. Treatment with simethicone
- E. Upper endoscopy with esophageal dilation
Correct

Incorrect
Question 37 of 40

37. Question
A 11-year-old girl is brought to the office due to fatigue and excessive hair loss for the past 4 weeks. She was diagnosed with type 1 diabetes mellitus 5 years ago and uses insulin glargine plus premeal lispro insulin. The patient has no changes in appetite. Vital signs show a temperature of 36.9 C (98.4 F), blood pressure of 104/70 mm Hg, pulse of 64/min, and respirations of 16/min. Her height has dropped from the 40th percentile to the 15th percentile over the past year. Examination shows dry, thinning hair but is otherwise unremarkable. Hemoglobin A1c level is 6.6%. What is the most appropriate next step in management?
- A. Increase insulin glargine dose
- B. Obtain ACTH stimulation test
- C. Obtain serum antinuclear antibody assay
- D. Obtain serum TSH level
- E. Perform microscopic examination of shed hair
Correct

Incorrect
Question 38 of 40

38. Question
A 22-year-old woman is admitted to the hospital for influenza pneumonia. Due to increased requirement for oxygen and respiratory distress, the attending physician believes that intubation is imminent. Medical history includes severe intellectual and developmental disability with minimal verbal communication. The patient requires assistance with eating, dressing, and bathing and has urinary and bowel incontinence. After discussion with her mother regarding the patient’s declining respiratory status, which of the following is the most appropriate statement to be made by the physician?
- A. “Because of your daughter’s underlying medical conditions, I recommend comfort measures only and a referral to hospice.”
- B. “In light of your daughter’s chronic illnesses, the benefits of intubation likely do not outweigh the risks and discomfort. What are your thoughts?”
- C. “Pneumonia is often an acute infection from which young patients can recover. My recommendation would be to pursue intubation and carefully monitor her progress.”
- D. “We can try intubation first, but if your daughter continues to worsen, we may not want to proceed with further resuscitative measures.”
Correct

Incorrect
Question 39 of 40

39. Question
A 69-year-old woman comes to the office due to concerns about lack of sleep that has been ongoing for the past 2 years. The patient goes to bed around 10:00 PM and is able to fall asleep quickly but wakes up at 4:30 AM every day. She is unable to fall back asleep; she reads a book in bed and rises at 7:00 AM. The patient feels sleepy after lunch and sometimes takes a nap for 20 minutes around 2:00 PM, after which she feels energetic. She does brisk walking for exercise 5 days a week around 4:30 PM. The patient lives with her husband and is retired; she participates regularly in volunteering activities with friends and enjoys playing with her 2 grandchildren several days a week. Medical history includes well-controlled hypertension, for which she takes lisinopril. She drinks 1 or 2 glasses of wine on weekends with dinner and does not smoke cigarettes. Vital signs are within normal limits. BMI is 21 kg/m². Physical examination, including tests of recall and attention, are within normal limits. The patient is anxious that her health could be affected if she does not get more sleep. Which of the following is the best next step in management?
- A. Advise complete alcohol cessation
- B. Advise exercise closer to bedtime to promote restorative sleep
- C. Prescribe melatonin therapy at bedtime
- D. Provide reassurance
- E. Recommend a sleep diary
- F. Recommend sleep actigraphy
Correct

Incorrect
Question 40 of 40

40. Question
A 65-year-old woman is brought to the office by her husband due to several behavioral changes for the past year. The patient has had difficulty remembering how to perform routine household chores, such as operating the washing machine, and has been neglecting bills, which the husband attributed to old age. She also recently started smoking and has tried to kiss and hug strangers on multiple occasions and has offered to have sex with younger men whom she does not know well; she appears unconcerned when her husband describes these behaviors. She spends most of the day watching either religious television shows and cooking shows even though she previously did not enjoy cooking and was not particularly religious. Which of the following is the most likely diagnosis?
- A. Alzheimer dementia
- B. Frontotemporal dementia
- C. Late-onset schizophrenia
- D. Meningosyphilis
- E. Vascular dementia
Correct

Incorrect

CK- UWSA 3- Block 3

CK- UWSA 3- Block 3

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

Patient Information

Age: 38 years

Gender: F, self-identified

Race/Ethnicity: unspecified

Site of Care: office

History

Reason for Visit/Chief Concern: “My face and legs are swollen.”

History of Present Illness:

• 6 weeks of facial edema, lower extremity edema, and weight gain of 7 kg (15 lb)

• frothy urine; no dysuria or hematuria

Past Medical History:

• none

Medications:

• none

Allergies:

• no known drug allergies

Family History:

• noncontributory

Psychosocial History:

• restaurant manager

• 1-2 alcoholic drinks/day

• does not use tobacco or recreational drugs

Physical Examination

Temp

Pulse

Resp

BP

O2 Sat

Ht

Wt

BMI

37.1 C

(98.8 F)

70/min

16/min

132/82

mm Hg

96%

on RA

168 cm

(5 ft 6 in)

71 kg

(156 lb)

25.1 kg/m2

• Appearance: alert; oriented

• Pulmonary: diffuse crackles; diminished breath sounds at bilateral bases

• Cardiac: regular rhythm; S1 and S2

• Abdominal: soft, nontender

• Musculoskeletal: bilateral pitting edema

Diagnostic Studies

• Creatinine: 1.1 mg/dL

• Urinalysis: 4+ protein

• Kidney biopsy: diffuse thickening of the glomerular basement membrane without an increase in cellularity or evidence of active inflammation; immune staining: diffuse granular deposits of IgG and C3 along the basement membrane; electron microscopy: numerous subepithelial electron-dense deposits

Question: In addition to ACE inhibitor and diuretic therapy, which of the following interventions is needed?

11. Question

12. Question

13. Question

The treatment plan for this patient’s diagnosis is discussed. Medical intervention should be provided to which of the following people?

Option

Patient

Sibling

Mother

Father

O₂ Sat

25.1 kg/m²

• Cardiac: regular rhythm; S₁ and S₂

240,000/mm³

17,000/mm³