Exam (elaborations) NSG6420 Gero Midterm South University GRADED A+
South University
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Gerontology Class….
Week 1:
1. Question :
The
... [Show More] major impact of the physiological changes that occur with aging is:
Reduced physiological reserve
Reduced homeostatic mechanisms
Impaired immunological response
CORRECT All of the above
Instructor Explanation: The major impact of all of these physiological changes can be
highlighted with three primary points. First, there is a reduced physiological reserve of most body
systems, particularly cardiac, respiratory, and renal. Second, there are reduced homeostatic mechanisms
that fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance.
Third, there is impaired immunological function: infection risk is greater, and autoimmune diseases are
more prevalent. (Kennedy-Malone 3)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 2. Question :
Men have faster and more efficient biotransformation of drugs and this is thought to be due to:
Less obesity rates than women
Prostate enlargement
CORRECT Less estrogen than women
Instructor Explanation: Men have faster and more efficient biotransformation, presumably
because of serum testosterone. Conditions of increased or decreased liver perfusion alter the overall
level of the drug that is absorbed and how it is metabolized. (Kennedy-Malone 5)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 3. Question :
The cytochrome p system involves enzymes that are generally:
Inhibited by drugs
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Induced by drugs
CORRECT Inhibited or induced by drugs
Associated with decreased liver perfusion
Instructor Explanation: Biotransformation occurs in all body tissues but primarily in the liver,
where enzymatic activity (cytochrome P [CYP] system) alters and detoxifies the drug and prepares it for
excretion. (Kennedy-Malone 5)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 4. Question :
Functional abilities are best assessed by:
Self-report of function
CORRECT Observed assessment of function
A comprehensive head-to-toe examination
Family report of function
Instructor Explanation: Two well-established tools used to evaluate function in older adults are
the Katz Activities of Daily Living Scale (Katz et al., 1963) and the Lawton and Brody scale for
Instrumental Activities of Daily Living (Lawton & Brody, 1969). It is important to be cautious about selfreport
of function (rather than direct observation of function) and to ask, “Do you …?” instead of “Can
you …?” in order to determine if patients actually perform the activity. (Kennedy-Malone 40)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 5. Question :
Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers
to which of the following laboratory data?
Hemoglobin and Hematocrit
CORRECT Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
Serum ferritin and serum iron
Total iron binding capacity and transferrin saturation
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Instructor Explanation: RBC indices reveal an MCV (mean corpuscular volume/RBC size) that will
be decreased to <80 fL in adults; MCH (mean corpuscular hemoglobin/RBC color) will show hypochromia
or pale cells; RBC distribution width (RDW)/volume variation will be increased.
(Kennedy-Malone page 519)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 6. Question :
When interpreting laboratory data, you would expect to see the following in a patient with Anemia of
Chronic Disease (ACD):
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
CORRECT Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased
Instructor Explanation: Hemoglobin (Hgb): <12 g/dL (120 g/L) women <13 g/dL (130 g/L) men
Rarely <10 g/dL (100 g/L) Mean corpuscular volume: 80–96 mcm3 (normocytic) Mean corpuscular
hemoglobin Normochromic (normal color) RBC distribution width: normal (Kennedy-Malone page 517)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 7. Question :
The pathophysiological hallmark of ACD is:
Depleted iron stores
CORRECT Impaired ability to use iron stores
Chronic uncorrectable bleeding
Reduced intestinal absorption of iron
Instructor Explanation: The pathophysiological hallmark of ACD is a disregulation of iron
homeostasis, characterized by an increased uptake and retention of iron within the cells of the
reticuloendothelial system (liver/spleen), resulting in decreased RBC production. Essentially, iron is
present but inaccessible for use in the production of Hgb with the erythrocytes (Bross et al., 2010). A
shortened RBC survival is also a contributing factor to ACD. (Kennedy-Malone page 516-517)
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Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 8. Question :
The main focus of treatment of patients with ACD is:
Replenishing iron stores
Providing for adequate nutrition high in iron
CORRECT Management of the underlying disorder
Administration of monthly vitamin B12 injections
Instructor Explanation: Treatment: Treatment of ACD focuses on management of the underlying
disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic
trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and
IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004).
(Kennedy-Malone page 518)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 9. Question :
In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is
considered to be most useful in diagnosing ACD and IDA?
Student Answer: Serum iron
Total iron binding capacity
Transferrin saturation
CORRECT Serum ferritin
Instructor Explanation: Treatment: Treatment of ACD focuses on management of the underlying
disorder. Iron supplementation is of no benefit in ACD, except in cases of coexisting IDA. A therapeutic
trial of iron supplementation of no longer than 1 month may be useful in delineating between ACD and
IDA. In ACD, there would be no hematological response to iron therapy (Chen & Gandhi, 2004).
(Kennedy-Malone page 518)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file
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Question 10. Question :
Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except:
Sore throat
Fever
CORRECT Weight loss
Headache
Instructor Explanation: Signal symptoms: The initial HIV infection is characterized by
mononucleosis-like illness with fever, sore throat, lymphadenopathy, headache, and fatigue. A roseolalike
rash may also develop. These initial symptoms are followed by an asymptomatic phase, which may
last 10 years or more. Later, if untreated, lymphadenopathy, weight loss, myalgias, and diarrhea may
develop (Cohen, Kuritzkes, & Sax, 2011). In advanced disease, malignancies and opportunistic infections
occur. Co-infection with hepatitis B or C is common (25% to 30%) in IV drug users, so hepatitis symptoms
may also appear (Centers for Disease Control and Prevention [CDC], 2010a).
(Kennedy-Malone page 521)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank. Advanced Practice Nursing in the Care of
Older Adults. F.A. Davis Company, 2014-01-14. VitalBook file.
Question 11. Question :
Essential parts of a health history include all of the following except:
Chief complaint
History of the present illness
CORRECT Current vital signs
All of the above are essential history components
Instructor Explanation: Vital signs are part of the physical examination portion of patient
assessment, not part of the health history.
Question 12. Question :
Which of the following clinical reasoning tools is defined as evidence-based resource based on
mathematical modeling to express the likelihood of a condition in select situations, settings, and/or
patients?
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Clinical practice guideline
CORRECT Clinical decision rule
Clinical algorithm
Clinical recommendation
Instructor Explanation: Clinical decision (or prediction) rules provide another support for clinical
reasoning. Clinical decision rules are evidence-based resources that provide probabilistic statements
regarding the likelihood that a condition exists if certain variables are met with regard to the prognosis of
patients with specific findings. Decision rules use mathematical models and are specific to certain
situations, settings, and/or patient characteristics. Goolsby page 7
Question 13. Question :
The first step in the genomic assessment of a patient is obtaining information regarding:
CORRECT Family history
Environmental exposures
Lifestyle and behaviors
Current medications
Instructor Explanation: A critical first step in genomic assessment, including assessment of risk,
is the use of family history. Family history is considered the first genetic screen (Berry & Shooner 2004)
and is a critical component of care because it reflects shared genetic susceptibilities, shared
environment, and common behaviors (Yoon, Scheuner, & Khoury 2003). Goolsby page 18
Question 14. Question :
In autosomal recessive (AR) disorders, individuals need:
Only one mutated gene on the sex chromosomes to acquire the disease
Only one mutated gene to acquire the disease
CORRECT Two mutated genes to acquire the disease
Two mutated genes to become carriers
Instructor Explanation: In autosomal recessive (AR) disorders, the offspring inherits the
condition by receiving one copy of the gene mutation from each of the parents. Autosomal recessive
disorders must be inherited through both parents (Nussbaum et al. 2007). Individuals who have an AR
disorder have two mutated genes, one on each locus of the chromosome. Parents of an affected person
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are called carriers because each carries one copy of the mutation on one chromosome and a normal
gene on the other chromosome. Carriers typically are not affected by the disease. Goolsby page 28
Question 15. Question :
In AR disorders, carriers have:
Two mutated genes; two from one parent that cause disease
A mutation on a sex chromosome that causes a disease
A single gene mutation that causes the disease
CORRECT One copy of a gene mutation but not the disease
Instructor Explanation: Individuals who have an AR disorder have two mutated genes, one on
each allele of the chromosome. Parents of an affected person are called carriers because each parent
carries one copy of the mutation on one chromosome and a normal gene on the other chromosome.
Carriers typically are not affected by the disease. In pedigrees with an AR inheritance patterns, males
and females will be equally affected because the gene mutation is on an autosome. Goolsby page 28
Question 16. Question :
A woman with an X-linked dominant disorder will:
Not be affected by the disorder herself
CORRECT Transmit the disorder to 50% of her offspring (male or female)
Not transmit the disorder to her daughters
Transmit the disorder to only her daughters
Instructor Explanation: Everyone born with an X-linked dominant disorder will be affected with
the disease. Transmission of the disorder to the next generation varies by gender, however. A woman will
transmit the mutation to 50% of all her offspring (male or female). Goolsby page 29
Question 17. Question :
According to the Genetic Information Nondiscrimination Act (GINA):
Nurse Practitioners (NPs) should keep all genetic information of patients confidential
NPs must obtain informed consent prior to genetic testing of all patients
Employers cannot inquire about an employee’s genetic information
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CORRECT All of the above
Instructor Explanation: On May 21, 2008, President George W. Bush signed the Genetic
Information Nondiscrimination Act (GINA) to protect Americans against discrimination based upon their
genetic information when it comes to health insurance and employment, paving the way for patient
personalized genetic medicine without fear of discrimination (National Human Genome Research
Institute 2012). Goolsby page 43
Question 18. Question :
Which of the following would be considered a “red flag” that requires more investigation in a patient
assessment?
Colon cancer in family member at age 70
Breast cancer in family member at age 75
CORRECT Myocardial infarction in family member at age 35
All of the above
Instructor Explanation: Early onset cancer syndromes, heart disease, or dementia are red flags
that warrant further investigation regarding hereditary disorders. Goolsby page 36
Question 19. Question :
Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures,
single transverse palmar crease, and a low nasal bridge. These are referred to as:
Variable expressivity related to inherited disease
CORRECT Dysmorphic features related to genetic disease
De novo mutations of genetic disease
Different penetrant signs of genetic disease
Instructor Explanation: Assessing for dysmorphic features may enable identification of certain
syndromes or genetic or chromosomal disorders (Jorde, Carey, & Bamshad 2010; Prichard & Korf 2008).
Dysmorphology is defined as “the study of abnormal physical development” (Jorde, Carey, & Bamshad
2010, 302). Goolsby page 37
Question 20. Question :
In order to provide a comprehensive genetic history of a patient, the NP should:
Ask patients to complete a family history worksheet
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Seek out pathology reports related to the patient’s disorder
Interview family members regarding genetic disorders
CORRECT All of the above
Instructor Explanation: Asking the patient to complete a family history worksheet prior to the
appointment saves time in the visit while offering the patient an opportunity to contribute to the
collection of an accurate family history. Reviewing the family information can also help establish family
rapport while verifying medical conditions in individual family members. If a hereditary condition is
being considered but family medical information is unclear or unknown, requesting medical records and
pathology or autopsy reports may be warranted.
Week 2:
1. Question :
An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition
to possible hearing aid malfunction, this condition is often due to:
Acoustic neuroma
CORRECT Cerumen impaction
Otitis media
Ménière’s disease
Instructor Explanation: Elderly clients frequently present with complaints of hardened cerumen
and decreased hearing resulting from cerumen impaction aggravated by hearing aid wear.
(Goolsby 137-138)
Conductive hearing loss is caused by a lesion involving the outer and middle ear to the level of the oval
window. Various structural abnormalities, cerumen impaction, perforation of the tympanic membrane,
middle ear fluid, damage to the ossicles from trauma or infection, otosclerosis, tympanosclerosis,
cholesteatoma, middle ear tumors, temporal bone fractures, injuries related to trauma, and congenital
problems are some of the causes.
(Kennedy-Malone 170-171)
Question 2. Question :
In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous
discharge. This is most likely indicative of:
Bacterial sinusitis
CORRECT Allergic rhinitis
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Drug abuse
Skull fracture
Instructor Explanation: When examining the nose, assess the mucosa for integrity, color,
moistness, and edema/lesions and the nasal septum for patency. The turbinates should be assessed for
color and size. Pale, boggy turbinates suggest allergies; erythematous, swollen turbinates are often seen
with infection. Any discharge should be noted. Clear, profuse discharge is often associated with allergies.
(Goolsby 128-129)
Patients with seasonal allergic rhinitis report rhinorrhea, sneezing, obstructed nasal passages, and
pruritic eyes, nose, and oropharynx during the spring and fall. Patients with perennial allergic rhinitis
have similar symptoms associated with exposure to environmental allergens typically in their homes.
Physical examination may reveal a pale, boggy nasal mucosa, injected conjunctiva, enlarged turbinates,
dark discoloration or bags under the eyes, and mouth breathing; absence of pale, boggy nasal mucosa
does not rule out allergic rhinitis.
(Kennedy-Malone 182-183)
Question 3. Question :
A 45 year old patient presents with ‘sore throat’ and fever for one week. After a quick strep screen you
determine the patient has Strep throat. You know that streptococcal pharyngitis should be treated with
antibiotics to prevent complications and to shorten the course of disease. Which of the following
antibiotics should be considered when a patient is allergic to Penicillin?
Amoxicillin
CORRECT EES (erythromycin)
Bicillin L-A
Dicloxacillin
Instructor Explanation: MedU Card #1
Question 4. Question :
Presbycusis is the hearing impairment that is associated with:
CORRECT Physiologic aging
Ménière’s disease
Cerumen impaction
Herpes zoster
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Instructor Explanation: Presbycusis is an age-related cause of gradual sensorineural hearing loss
and involves diminished hairy cell function within the cochlea as well as decreased elasticity of the TM.
Although the changes associated with presbycusis often start in early adulthood, the decreased hearing
acuity is usually not noticed until the individual is older than 65. (Goolsby 138)
Because presbycusis is gradual and insidious, hearing loss may go unnoticed until it has progressed
significantly.
(Kennedy-Malone 170)
Question 5. Question :
Epistaxis can be a symptom of:
Over-anticoagulation
Hematologic malignancy
Cocaine abuse
CORRECT All of the above
Instructor Explanation: Cocaine abuse, which is more common than might be expected,
frequently causes epistaxis. Hematologic disorders likely to cause bleeding include thrombocytopenia,
leukemia, aplastic anemia, and hereditary coagulopathies. High doses of anticoagulants can cause
epistaxis and bleeding from the gums. (Goolsby 142)
Epistaxis results from a spontaneous rupture of a blood vessel in the nose, usually in the anterior septum
in Kiesselbach's plexus (Nguyen, 2012). The bleeding may be secondary to local infections, systemic
infections, drying of the nasal mucous membrane, trauma, arteriosclerosis, hypertension, or bleeding
disorders. Trauma is usually the primary mechanism of disruption of the nasal mucosa. Posterior
epistaxis can result in nausea and respiratory compromise. In older adults, nasal and paranasal tumors
may be involved (Mäkitie, 2010). (Kennedy-Malone 168-169)
Question 6. Question :
Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white
ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize
that very often this is:
Malignant melanoma
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CORRECT Squamous cell carcinoma
Aphthous ulceration
Behcet’s syndrome
Instructor Explanation: Most oral malignancies are painless until quite advanced, so patients are
often unaware of the lesion unless the lip or anterior portion of the tongue is involved. The patient may
become aware of the lesion if it bleeds. Squamous cell cancer lesions vary in appearance, from the
reddened patches of erythroplakia to areas of induration/thickening, ulceration, or necrotic lesions.
Lesions of malignant melanoma have varied pigmentation, including brown, blue, and black. Even lesions
that appear flat and smooth may be nodular, indurated, or fixed to adjacent tissue on palpation. Even
though patients with squamous cell malignancies often have a history of heavy alcohol and/or tobacco
use or poor dentition, these are not risk factors for malignant melanoma. In Behcet’s syndrome, the
patient complains of recurrent episodes of oral lesions that are consistent with aphthous ulcers. The
number of lesions ranges from one to several; the size of the ulcers varies from less than to greater than
1 cm. Like aphthous ulcers, the lesions are well defined, with a pale yellow or gray base surrounded by
erythema. The majority of patients also develop lesions on the genitals and eyes. (Goolsby 153)
Tobacco use and heavy alcohol consumption, alone or synergistically, are strongly related to the
development of oral cancer. Pipe smoking and sun exposure have been implicated in lip cancer.
Leukoplakia and erythroplasia are often precursors to oral cancer. Relationships between oral cancer and
Epstein-Barr virus, HPV, herpes simplex virus, and immunodeficiency states also have been found
(Stenson, 2011). (Kennedy-Malone 177).
Question 7. Question :
A 26 year old patient presents with cough and general malaise for 3 days. They note that their eyes have
been watering clear fluid and a ‘runny nose’ since yesterday. They note they ‘feel miserable’ and demand
something to make them feel better. What would be the best first plan of treatment?
CORRECT Saline nasal spray for congestion and acetaminophen as needed for pain.
Z-pack (azithromycin) for infection and Cromolyn nasal for congestion
Hydrococone/acetaminophen as needed for pain and Guaifensin for congestion
Cephalexin for infection and Cromolyn ophthalmic for congestion
Instructor Explanation: MedU Card #4
Question 8. Question :
Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?
History of bright flash of light followed by significantly blurred vision
CORRECT History of transient and painless monocular loss of vision
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History of monocular severe eye pain, blurred vision, and ciliary flush
All of the above
Instructor Explanation: Amaurosis fugax is a monocular, transient loss of vision. It stems from
transient ischemia of the retina and presents an important warning sign for impending stroke.
Depending on the circumstances reported, the patient should be immediately referred to either a
cardiovascular or neurological specialist. (Goolsby 108)
Question 9. Question :
Dizziness that is described as "lightheaded" or, "like I'm going to faint," is usually caused by inadequate
cerebral perfusion and is classified as?
CORRECT Presyncope
Disequilibrium
Vertigo
Syncope
Instructor Explanation: MedU Card #5
Question 10. Question :
It is important to not dilate the eye if ____ is suspected.
Cataract
Macular degeneration
CORRECT Acute closed-angle glaucoma
Chronic open-angle glaucoma
Instructor Explanation: If the patient has experienced sudden onset of eye pain, it is important
not to dilate the eyes before determining whether acute closed-angle glaucoma is present because
dilating the eye may increase the intraocular pressure.
(Goolsby 108)
Acute glaucoma, also known as angle-closure or narrow-angle glaucoma, is an obstruction to the outflow
of aqueous humor from the posterior to the anterior chamber through the trabecular meshwork, canal
of Schlemm, and associated structures. It results in an elevation of intraocular pressure, damaging the
optic nerve and causing loss of peripheral vision, eye pain, and redness. This type of glaucoma is
uncommon but may occur as a primary disease or secondary to other conditions and constitutes an
ophthalmic emergency
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(Kennedy-Malone 161)
Question 11. Question :
Mr. GC presents to the clinic with nausea and vomiting for 2 days, prior to that time he reports
occasional ‘dizziness’ that got better with change in position. He denies a recent history of URI or any
history of headaches or migraines. What would the most likely diagnosis be?
Vestibular neruitis
CORRECT Benign paroxysmal positional vertigo
Vestibular migraine
Benign hypertensive central vertigo
Instructor Explanation: MedU Card #9
Question 12. Question :
Which of the following patients with vertigo would require neurologic imaging?
CORRECT A 68-year-old woman with a history of hypertension and sudden acute
onset constant vertigo. She has right nystagmus that changes direction with gaze and that does not
disappear when she focuses.
A 45-year-old man with recurrent episodes of brief intense vertigo every time
he turns his head rapidly. He has no other neurologic signs or symptoms. He has a positive Dix-Hallpike
maneuver.
A 66-year-old man with recurrent episodes of vertigo associated with tinnitus
and hearing loss. His head thrust test is positive.
A 28-year-old otherwise well woman with new onset constant vertigo with no
other neurologic symptoms. On physical exam, she has unidirectional nystagmus that disappears when
her gaze is fixed.
Instructor Explanation: MedU Card #11. There are multiple reasons to be concerned about a
central lesion and possible infarct in this patient. Her age puts her at risk as does her hypertension. Her
physical exam shows nystagmus that changes direction and that does not inhibit with focus. Both of
these findings are consistent with a central lesion. She needs an urgent MRI.
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Question 13. Question :
A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals
the palpable preauricular nodes, which are most likely with:
Bacterial conjunctivitis
Allergic conjunctivitis
Chemical conjunctivitis
CORRECT Viral conjunctivitis
Instructor Explanation: Preauricular nodes are nonpalpable and nontender in allergic
conjunctivitis, usually nonpalpable in bacterial conjunctivitis, and palpable in viral conjunctivitis.
(Goolsby 112)
Question 14. Question :
In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye
redness?
History of prior red-eye episodes
CORRECT Grossly visible corneal defect
Exophthalmos
Photophobia
Instructor Explanation: Red flag warnings for eye redness include pain (not discomfort or
irritation), decreased vision, profuse discharge, and corneal defect grossly visible. (Goolsby 112)
Question 15. Question :
A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The
symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which
of the following is most likely because of the inflammation?
Bacterium
CORRECT Allergen
Virus
Fungi
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Instructor Explanation: Patients with seasonal allergic rhinitis report rhinorrhea, sneezing,
obstructed nasal passages, and pruritic eyes, nose, and oropharynx during the spring and fall. Patients
with perennial allergic rhinitis have similar symptoms associated with exposure to environmental
allergens typically in their homes. Physical examination may reveal a pale, boggy nasal mucosa, injected
conjunctiva, enlarged turbinates, dark discoloration or bags under the eyes, and mouth breathing;
absence of pale, boggy nasal mucosa does not rule out allergic rhinitis.
(Kennedy-Malone 182-183)
Question 16. Question :
Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have
histamine stimulated as an immediate phase response. This release of histamine results in which of the
following?
Sinus pain, increased vascular permeability, and bronchodilation
CORRECT Bronchospasm, vascular permeability, and vasodilatation
Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction
Vasodilatation, bronchodilation, and increased vascular permeability
Instructor Explanation: Rhinitis may be either allergic or nonallergic. Allergic rhinitis results as a
response of the nasal mucosa to airborne allergens in atopic genetically prone individuals. This response
is mediated by the production of immunoglobulin E (IgE). IgE antibodies produced in response to the
initial and subsequent exposure to allergens bind to the nasal mucosa. With repeated exposure,
immediate type 1 hypersensitivity reactions may occur (Simoens & Laekeman, 2009). Antigen-specific T
cells are activated through the lymphatic system in response to the antigen. The activated antigenspecific
T cells activate B cells, and IgE is created in lymphoid tissue and at local tissue sites (Adelman,
Casale, & Corren, 2002; Novak, 2009). The newly created antigen-specific IgE is released by plasma cells
and binds to high-affinity IgE receptors located on the basophils and mast cells. This leads to the
sensitization of the cells in the tissues of the nose, lung, or skin (Adelman et al., 2002; Cirillo, Pistorio,
Tosca, & Ciprandi, 2009). IgE also binds with the antigen protein, beginning degranulation of the mast
cells and basophils. These actions start the allergic cascade. Mediators are released as a result of the
degranulation and include histamine, proteoglycans, enzymes, leukotrienes, cytokines, and many others. [Show Less]