APEA 3P EXAM PREP6 –GL WITH VERIFIED QUESTIONS AND ANSWERS WTH RATIONALE
Mrs. Lovely, an 84-year-old, complains of fecal incontinence. A likely cause
... [Show More] is: inactivity.
constipation.
poor fluidconsumption.
medication-related.
B.
Underlying constipation is a common cause of fecal incontinence in older adults. However,
typically it is multifactorial. Risk factors include: age > 80 years, impaired mobility, and
neurologic disorders including dementia. Inactivity and poor fluid consumption may contribute
to constipation but are not causes of fecal incontinence.
A 79-year-old withappendicitisisunlikely to exhibit:
generalized abdominal pain. initial
WBC elevation.
UTI symptoms.
low-gradefever.
B.
Very young children and elderly adults are not likely to have initial WBC elevations.
Consequently, appendicitis can be easily missed in these populations. Generalized abdominal
pain is typical initially. UTI symptoms in older adults can manifest as lower abdominal pain and
are a common presentation in this age group. Low-grade fever is common too.
The relationship between colon polyps and colon cancer is those polyps: eventually, all
become malignant.
have a slow progression to colon cancer. have a
rapid progression to colon cancer. have no
relationship to colon cancer.
B.
Colon polyps are usually slow-growing and take a long time to progress to cancer. This is the
reason that a colonoscopy does not need to be repeated annually. While not all polyps grow
slowly, this is the usual progression.
A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are no other
members of the household. How should his mother be managed?
Reassure the mother that if she develops symptoms, she will need to be treated. Visually
assess the mother’s rectum for redness or presence of worms.
Have the mother collect a stool specimen and send it to the laboratory. Perform the
“scotch tape” test and look at the collection under the microscope. D.
The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on a tongue
depressor. It is touched against the patient’s rectum. The greatest yield of eggs will occur
during the nighttime or early AM. Eggs will be found here if they are present. Worms and eggs
are rarely found in stool specimens, so this is not a good plan. When the scotch tape is
examined under a low power microscope, the eggs will be easily visualized since they are
large and bean shaped. The finding of an adult worm would confirm the diagnosis. These are
large enough to be seen with the naked eye. If the mother is symptomatic, she should be
treated with or without a rectal exam. It is very likely she is infected.
A patienthasbeendiagnosed withhepatitis B.The mostcommonlyreportedrisk factor is:
drinkingcontaminated water. eating
contaminated food. exposure to
blood.
sexual exposure. D.
Hepatitis B is transmitted by blood and body fluids. While exposure to infected blood or blood
products would significantly increase the risk of infection in unvaccinated people, this is
much less likely than becoming infected via sexual exposure or IV drug use. Hepatitis A is
transmitted via fecal-oral routes. Drinking contaminated water and eating contaminated food
implicate hepatitis A as the etiologic agent.
The three most common causes of bacterial diarrhea in the US are Salmonella,
Campylobacter, and:
E. coli.
Enterovirus.
Yersinia.
Shigella. D.
Shigella will be shed continuously in the stool and should be easily identified on stool culture.
When bacterial gastroenteritis is suspected, a stool specimen could be ordered for
confirmation. Generally, these three pathogens are easily identified if they are present.
Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called
bubonic plague. E. coli is a typical colonic pathogen.
An 83-year-old patient is diagnosed with diverticulitis. The most common complaint is:
rectal bleeding. bloating
and cramping.
left lower quadrant pain. frequent
belchingandflatulence.
C.
Diverticular disease is more common in older adults. About 70% of patients diagnosed with
diverticulitis have left lower quadrant pain. Rectal bleeding may have varied etiologies, such as
rectal carcinoma or hemorrhoids. Bloating and cramping are often found in patients with
diverticular disease (diverticulosis) but not specifically diverticulitis. Belching and flatulence
are not specifically associated with diverticulosis.
What is true regarding older adults who are overweight?
This is clearly associated with increased mortality in older adults. Mortality in older
adults related to overweight states declines over time. BMI is a good way to assess
nutritional status in older adults.
There arenopotential metabolic or functional benefits to weight loss in older adults. B.
Overweight and obese states are not as important in predicting mortality in older adults as
they are in their younger counterparts. After age 65 years (some studies demonstrate after
age 70), weight is less significant in decreasing risk for mortality than in younger adults. There
are some benefits to weight loss in the obese older adults. One of them is better balance and
decreased risk for falls. Others include less sleep apnea, decreased risk of diabetes, and
decreased rates of shortness of breath with respiratory and cardiac diseases.
What medication used to treat patients who have GERD provides the fastest relief of heartburn
symptoms?
Calcium carbonate
Ranitidine Amantadine
Pantoprazole
A.
Calcium carbonate is an antacid. It provides rapid changes in gastric pH. This provides relief
that can be noticed immediately. The increase in pH lasts for about 30 minutes and
corresponds with resolution of symptoms. However, as pH decreases within 30 minutes,
symptoms may return. Ranitidine is an H2 blocker. It provides relief in 1-2 hours. This usually
lasts for about 6-12 hours. Amantadine is an antiviral not used to treat GERD. Pantoprazole is
a proton pump inhibitor. This provides relief after several hours or days of daily consumption.
An 84-year-old presents with a stated involuntary weight loss. He states that he’s lost about 6
pounds in the last 6 or 8 weeks. What statement below is NOT part of the assessment?
The weight loss should be measured today and again in the next few weeks. A
laboratory evaluation should be performed.
Evaluate his dietary intake.
Evaluate his upper and lower extremity muscle mass. D.
Involuntary weight loss in older adults is often due to malignancy or disease. The initial
assessment of an older adult who reports involuntary weight loss is to document the weight
loss. If prior measurements are part of the patient’s chart, this would be helpful. Laboratory
assessment should also be performed. Consideration should be given to performing a CBC, TSH,
and metabolic panel. Also consider chest and abdominal X-rays. If all are normal, he should be
monitored and reweighed on the same scale for comparison. A dietary consult should be
ordered. However, even with negative initial findings, a significant number of patients are later
found to have disease or malignancy
A patient has a positive hepatitis B surface antibody. This means he: has acute
hepatitis B.
has chronic hepatitis B. is
immune to hepatitis B.
needs immunization to hepatitis B. C.
The hepatitis B surface antibody indicates immunity to hepatitis B virus. Specifically, if this
patient comes in contact with hepatitis B virus, he will not become infected with hepatitis B. The
presence of hepatitis B surface antibody indicates immunity from immunization or actual
infection. It also indicates recovery if the patient was infected.
A patient with a suspected inguinal hernia should be examined: in the
prone position.
standing.
side-lying.
with patient squatting. B.
The patient should be examined while he is standing. He should be asked to bear down, cough,
or strain during the exam. Though hernias are far more common in males, they can be found in
females too. In males, the patient should be asked to stand. The examiner should put his 2nd or
3rd finger through the scrotum and into the external ring. When the patient is asked to cough,
a “silky” feel will butt up against the examiner’s finger, and the hernia can be easily felt.
A 15-year-old is about 10% below her ideal body weight. Laboratory studies were performed.
Which complaint might be common in this patient (Labs in image)?
Headaches
Dizziness withstanding Muscle
cramps [Show Less]