Quiz Hpe Procedures

History & Physical Exam – Procedures

18May2009

HPE – Sensitive Patient Examination Commitment (SPEC) 1) How much more at risk is a patient to developing breast cancer if her sister developed bilateral breast cancer after menopause? a) Two times b) Three times c) Four times d) Nine times 2) What is the most frequent location of breast cancer? a) Upper medial quadrant b) Upper lateral quadrant c) Lower medial quadrant d) Lower lateral quadrant e) Nipple/areolar area 3) The breast bud stage in males corresponds to what Tanner stage of development? a) Tanner I b) Tanner II c) Tanner III d) Tanner IV e) Tanner V 4) Hair on the inner thighs in males and females corresponds to what Tanner stage of development? a) Tanner I b) Tanner II c) Tanner III d) Tanner IV e) Tanner V 5) When are the female nipples less tender and less nodular and thus the best time for breast selfexamination (BSE)? a) Two weeks prior to menstruation b) One week prior to menstruation c) During menstruation d) One week after menstruation e) Two weeks after menstruation 6) A female patient presents with complaints of a clear yellow discharge that sometimes looks bloody. Examination revels several non-painful, non-moveable firm lumps about 2cm in diameter. When you ask the patient to raise their arms, you see distinct dimpling in the areas where lumps were palpated (peau d'orange). Which of the following is most likely? a) Paget disease (of the breast) b) Normal during menstruation c) Benign or malignant disease d) Galactorrhea due to hypertension e) Intraductal papilloma with fat necrosis 7) Which of the following directions describes a lesion that is directly medial to the left breast? a) 3 o’clock b) 6 o’clock c) 9 o’clock

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History & Physical Exam – Procedures

18May2009

d) 12 o’clock 8) Which breast palpation method is recommended as it has the least chance of missing a palpable lesion, while spending approximately three minutes on each breast? a) Spokes of a wheel b) Slices of a pie c) Concentric circles d) Horizontal strip method (lawnmower) e) Vertical strip method (lawnmower) 9) Which of the following is NOT associated with gynecomastia? a) Calcium channel blockers and digitalis glycosides b) Tamoxifen, clomiphene, and letrozole c) Cancer chemotherapies d) Spironolactone and ketoconazole e) Histamine-2 receptor blockers f) Marijuana 10) Approximately what percentage of breast cancer cases occur in men, which are diagnosed at 59-years-old on average? a) 0.1% b) 0.9% c) 2.4% d) 3.7% e) 5.8% 11) Which of the following is important to screen for and diagnose in male patients between the ages of 15 and 35? a) Prostate cancer b) Testicular torsion c) Testicular cancer d) Varicocele e) Breast cancer 12) Which of the following is located only on the dorsal surface of the penis? a) Frenulum b) Epispadias c) Hypospadias d) Penile root e) Penile shaft 13) The ____ testicle usually hangs lower and the ____ pampiniform plexus arises from the renal vein (not the inferior vena cava) and thus is more likely to be involved in a varicocele. a) Left; Left b) Left; Right c) Right; Right d) Right; Left 14) A male patient presents with complaints of hematuria at the beginning of his flow. Which of the following is the most likely location of the blood source? a) Massive hemorrhage b) Prostate gland c) Above the prostate

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History & Physical Exam – Procedures

18May2009

d) Bladder e) Urethra 15) An 18-year-old male patient presents in January with complaints of soreness is his scrotum on the left side. Raising the left testicle is painful for the patient (Pren sign). History reveals the pain started immediately after sexual activity with his partner. Which of the following is most likely? a) Prostate cancer b) Testicular torsion c) Testicular cancer d) Varicocele e) Ureter dilation 16) A patient presents with pain in the right testicle. If ureter dilation were suspected, which of the following would be the most likely location? a) Upper ureter on the left b) Upper ureter on the right c) Lower ureter on the left d) Lower ureter on the right 17) Which of the following is true regarding hernias? a) Males have more femoral hernias than females, females have more inguinal hernias than males, and females have more femoral than inguinal hernias b) Males have more femoral hernias than females, females have more inguinal hernias than males, and females have more inguinal than femoral hernias c) Females have more femoral hernias than males, males have more inguinal hernias than females, and males have more femoral than inguinal hernias d) Females have more femoral hernias than males, males have more inguinal hernias than females, and males have more inguinal than femoral hernias 18) What type of hernia could enter the scrotum of a male patient? a) Direct hernia b) Indirect hernia c) Femoral hernia 19) After a rectal exam, when should a test be done for occult blood? a) If stool is present b) If bleeding is suspected c) After every rectal exam d) If the patient complains of blood e) If a glove was worn 20) Which technique could help decrease pain during the initial part of a rectal exam? a) Using warm water instead of lubricant b) Putting the pad of the finger on the anus then inserting quickly c) Asking the patient to bear down before insertion of the finger d) Sweeping the finger slowly 90-degrees during entrance e) Using a two-finger approach 21) If a female patient is injured during a pelvic exam, which of the following is most likely? a) The patient will not return and may not ever get another pelvic exam b) The patient will sue the clinician and the healthcare facility for malpractice c) The patient will ignore the event and come back to see you again

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History & Physical Exam – Procedures

18May2009

d) The patient will sue the clinician for sexual harassment 22) Which of the following describes the location of the Bartholin glands with respect to the vaginal introitus? a) 12 o’clock and 6 o’clock b) 2 o’clock and 10 o’clock c) 4 o’clock and 8 o’clock d) At the posterior commissure (fourchette) e) Location differs widely between patients 23) Which of the following arteries does NOT supply blood to the vagina? a) Inferior gluteal b) Uterine c) Internal iliac d) Middle hemorrhoidal 24) The lower one-third of vaginal lymph drains to which of the following nodes? a) Inguinal b) Hypogastric c) Pre-Sacral d) Obturator e) Aortic 25) Which of the following hormones is a reliable sign of ovulation based on basal body temperature increasing? a) Estrogen b) Progesterone c) Follicle stimulating hormone (FSH) d) Luteinizing hormone (LH) e) Antidiuretic hormone (ADH) 26) In a patient with no family history of breast cancer, what is the appropriate age for beginning bilateral mammogram screening? a) 30-years-old b) 35-years-old c) 40-years-old d) 45-years-old e) 50-years-old 27) Which of the following patients would NOT be at risk for secondary amenorrhea? a) Anorexic patient b) Bulimic patient c) Long-distance runner d) Pituitary tumor e) Obese patient 28) How many couples have some degree of infertility? a) 1 in 10 b) 1 in 8 c) 1 in 6 d) 1 in 4 e) 1 in 2

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History & Physical Exam – Procedures

18May2009

29) Which of the following is the proper method for charting catemenia in a patient who began menstruation at age 12, has 3-5 days of bleeding, and menstruates every 28 days? a) CAT 12 x 3-5 x 28 b) CAT 3-5 x 12 x 28 c) CAT 28 x 3-5 x 12 d) CAT 12 x 28 x 3-5 e) CAT 28 x 12 x 3-5 30) A woman has had 6 pregnancies, 3 were full-term, 2 were pre-mature, 1 was miscarried, and she has 6 living children (with an adoption). Which of the following describes the proper method for charting this patient’s gravidity and parity? a) Grav 6 Para 3-2-1-6 b) Grav 6 Para 3-1-2-6 c) Grav 6 Para 2-3-1-6 d) Grav 6 Para 3-2-6-1 e) Grav 6 Para 6-1-2-3 31) A female patient presents with an itching sensation on her vagina. A KOH test is positive with a distinct fishy odor, vaginal pH is elevated, and Clue cells are found on pathological evaluation. Which of the following is most likely? a) Candida vulvitis b) Lichen sclerosus c) Bacterial vaginosis d) Gonorrhea e) Syphilis 32) Using the Bethesda System (TBS) for Pap (Papanicolaou) smear result interpretation, which result requires colposcopic and surgical evaluation? a) Within normal limits (WNL) b) Atypical squamous cells of undetermined significance (ASCUS) c) Low-grade squamous intraepithelial lesions (LSIL) d) High-grade squamous intraepithelial lesions (HSIL) e) Atypical glandular cells of undetermined significance (AGUS) f) Squamous cell carcinoma 33) When beginning a pelvic exam on a female patient, which of the following phrases is the most appropriate (language awareness)? a) I’m going to feel your leg now b) I’m going to touch you now c) My hand might touch you soon d) Relax and don’t make any sudden movements e) You’re going to feel my hand against your leg 34) Which of the following describes the gloving and hand use during a Pap smear at the beginning of a pelvic exam? a) Both hands are sterile patient hands b) One sterile patient hand and one room hand c) One clean patient hand and one room hand d) Both hands are clean patient hands e) Both hands are room hands 35) Which of the following is true when using a speculum for the Pap smear?

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History & Physical Exam – Procedures

18May2009

a) It should be covered with generous lubricant b) It should be coated thinly with lubricant c) It should be in warm water for lubrication d) It should be in cold water for lubrication e) It should be inserted dry to prevent contamination 36) Which of the following anatomical landmarks is used during the ovary palpation portion of the bimanual exam? a) Umbilicus b) Anterior superior iliac spine (ASIS) c) Anterior inferior iliac spine (AIIS) d) Mons pubis e) Inguinal ligament 37) If a male patient is uncircumcised, which of the following should NOT be done at the end of a genital exam? a) Move the foreskin back over the glans penis b) Ask the patient to move the foreskin back over the glans penis c) Leave the foreskin pulled back behind the glans penis 38) Which of the following images represents the bimanual pelvic exam?

HPE – Ophthalmology Practical Techniques Commitment (OPTC) 1) When looking through an ophthalmoscope at a patient’s eyes from at about a foot away, what structure is responsible for the red reflex?

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History & Physical Exam – Procedures

18May2009

a) Vitreous cavity b) Cornea c) Lens d) Sclera e) Retina 2) What cranial nerve innervates the orbicularis muscle and thus is responsible for closing the eyelids? a) CN II b) CN III c) CN IV d) CN VI e) CN VII 3) An elderly patient presents with a progressive decrease in the ability to read the newspaper. Examination including a Rosenbaum pocket vision screener reveals a decreased ability to focus on near objects. This is known as: a) Amblyopia/Strabismus b) Hyperopia/Hypermetropia c) Presbyopia d) Myopia e) Astigmatism f) Anisocoria 4) Which of the following acronyms stands for the right eye? a) OS – oculus sinister b) OD – oculus dexter c) OU – oculus uterque 5) A patient is able to read Snellen letters at 20 feet away that a normal person could read at 25 feet away. When viewing through a pinhole, they can now read letters at 20 feet away that a normal person could read at 20 feet away. The patient is not using corrective lenses. Which of the following describes this patient? a) CC OU 25/20 (PH 20/20) b) SC OU 25/20 (PH 20/20) c) CC OU 20/25 (PH 20/20) d) SC OU 20/25 (PH 20/20) 6) What percentage of Snellen letters must a patient get correct for a row to be counted toward visual acuity? a) 33% b) 50% c) 66% d) 75% e) 100% 7) Which of the following would NOT be used to assess presence of vision in a patient who is uncooperative, malingering, or hysterically blind (exception in cortical blindness)? a) Optokinetic nystagmus b) Pupillary response c) Fundoscopic exam d) Light localization

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History & Physical Exam – Procedures

18May2009

8) The swinging flashlight test is used to document Marcus-Gunn pupil seen in optic nerve disease. What type of defect is this? a) Afferent pupillary defect b) Efferent pupillary defect c) Visual cortex defect d) Anisocoria e) Ophthalmoplegia 9) Which of the following is associated with neurosyphilis? a) Adie syndrome b) Parinaud syndrome c) Argyle-Robertson pupil d) Cavernous sinus syndrome e) Crocodile tears f) Duane syndrome g) Foster-Kennedy syndrome h) Gradengo syndrome i) Mobius syndrome j) Oculogyric crisis 10) Which of the following describes unequal pupils? a) Amblyopia b) Hyperopia/Hypermetropia c) Presbyopia d) Myopia e) Astigmatism f) Anisocoria 11) The cover test examines for which of the following? a) Amblyopia/Strabismus b) Hyperopia/Hypermetropia c) Presbyopia d) Myopia e) Astigmatism f) Anisocoria 12) Using the visual field image, damage to which area would lead to this vision-loss pattern?

a) Area 1 (Optic Nerve) b) Area 2 (Optic Chiasm) c) Area 3 (Optic Tract) d) Area 4 (Meyer Loop) e) Areas 5 & 6 (Optic Radiation) f) None of the above 13) When testing the confrontational visual field of a patient, what finger signals should the examiner use? a) 1 or 2 fingers

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History & Physical Exam – Procedures

18May2009

b) 1, 3, or 5 fingers c) 1, 2, or 5 fingers d) 1, 2, or 4 fingers e) 1, 2, 3, 4, or 5 fingers 14) Tonometry (e.g. Schiotz) should be performed on a patient when which of the following is suspected? a) Retinal detachment b) Cataracts c) Blepharitis d) Strabismus e) Glaucoma 15) When examining an eye for corneal abrasions that has been fluorescein-stained, what ophthalmoscope aperture should be used? a) Spot (small, medium, large) b) Slit c) Red-free (green) d) Cobalt blue e) Fixation (bull’s-eye) 16) Anterior chamber depth assessment via perpendicular light should be used to test for which of the following (a contradiction to chemical pupillary dilation)? a) Primary open angle glaucoma b) Angle closure glaucoma c) Retinal detachment d) Severe glaucoma e) Diabetic retinopathy f) Hypertensive retinopathy 17) Which of the following provides short acting mydriasis and cycloplegia? a) Tropicamide b) Pilocarpine c) Haloperidol d) Tetracaine e) Morphine 18) Which of the following ophthalmoscope apertures would be used to detect and quantify papilledema? a) Spot (small, medium, large) b) Slit c) Red-free (green) d) Cobalt blue e) Fixation (bull’s-eye) 19) Which of the following ophthalmoscope apertures would be used for easier identification of veins, arteries, and nerves as well as distinguish retinal hemorrhage? a) Spot (small, medium, large) b) Slit c) Red-free (green) d) Cobalt blue e) Fixation (bull’s-eye)

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History & Physical Exam – Procedures

18May2009

20) Which of the following ophthalmoscope apertures is of historical significance as it is rarely used today? a) Spot (small, medium, large) b) Slit c) Red-free (green) d) Cobalt blue e) Fixation (bull’s-eye) 21) A patient presents with a large cup-to-disc ratio (greater than 0.2-0.3). Which of the following is most likely? a) Retinal detachment b) Afferent pupillary defect c) Diabetic retinopathy d) Cataracts e) Glaucoma 22) When comparing the retinal vessels, what is the expected arteriole to venule ratio? a) 1 to 1 b) 1 to 2 c) 2 to 1 d) 2 to 3 e) 3 to 2 23) When examining a patient’s pupillary reflex, you notice a spasmodic, rhythmic but irregular dilating and contraction of pupillary movements (hippus, athetosis). Which of the following is most likely? a) Hypertensive retinopathy b) Afferent pupillary defect c) Diabetic retinopathy d) Glaucoma e) Physiologic 24) During a fundoscopic exam, you notice the venules seem to bulge on either side as they are crossed by arterioles (AV nicking). Which of the following is most likely? a) Hypertensive retinopathy b) Afferent pupillary defect c) Diabetic retinopathy d) Glaucoma e) Physiologic 25) A man presents with vision changes. Upon examination, his visual acuity after correction is 20/20 in both eyes, with intact color perception. A Goldman visual field test is shown. A fundoscopic exam is normal, but with a mild degree of optic disk swelling. Which of the following may also be seen in this patient? a) Breast discharge b) Facial droop c) Palpitations d) Polyuria e) Strabismus f) Binasal hemianopsia

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History & Physical Exam – Procedures

18May2009

HPE – Tobacco & Smoking Cessation 1) When performing a physical exam on a patient who has smoked for several years, which of the following would provide the LEAST useful information? a) Blood pressure, pulse rate and quality, respiratory rate b) Inspection of mouth, lips, tongue, palpation of mouth c) Abdominal auscultation, liver span, abdominal aortic width d) Lung auscultation, heart auscultation, lymphatic palpation e) Distal pulses, extremity inspection, extremity reflexes, finger sensation 2) Which of the following is a benefit of smoking cessation? a) Heart rates drops to normal 20-minutes after quitting b) Carbon monoxide levels drop to normal 12-hours after quitting c) Lung function improves 2-weeks to 3-months after quitting, lower MI risk d) Decreased coughing, fatigue, shortness of breath 1- to 9-months after quitting e) All of the above 3) Which of the following improvements occurs within one year of quitting smoking? a) Risk of stroke same as that of non-smoker b) Risk of coronary heart disease same as that of non-smoker c) Risk of coronary heart disease reduced in half d) Risk of dying from lung cancer reduced in half e) Risk of mouth, through, and esophagus cancer reduced in half 4) How many additional years will someone live if they quite at the age of 40? a) 9 additional years b) 6 additional years c) 3 additional years d) 2 additional years e) 1 additional year 5) Which of the following does NOT exclude self-treatment for smoking cessation? a) Serious heart disease or uncontrolled blood pressure b) Pregnant or breast feeding c) Prescription drugs for depression or asthma d) Older than 18-years e) Active PUD or uncontrolled diabetes 6) Telephone quit lines have been shown to be effective with increased cessation in patients with more than 4 sessions lasting more than 10 minutes. a) True b) False 7) Which of the following is NOT true of nicotine gum? a) Is chewed like bubble gum during the day as needed b) Patient should not eat or drink 15 minutes before or during use c) Should not be swallowed and caution should be taken with dentures d) Is chewed until a peppery taste then parked, every 2-4 hours while awake e) May cause mouth soreness or stomach ache 8) A patient states that they eat several small meals during the day and drink a great deal of water. They do not with to deter from this schedule. History reveals the patient has asthma. Which of the following nicotine replacement options would be best? a) Nicotine inhaler

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History & Physical Exam – Procedures

18May2009

b) Nicotine patch c) Nicotine gum d) Nicotine lozenge e) Nicotine nasal spray 9) A patient states that they have a strong habit for putting a cigarette to their mouth. They even buy fake candy cigarettes because the motion helps with their urges. Which of the following nicotine replacement options would help maintain this psychological connection? a) Nicotine inhaler b) Nicotine patch c) Nicotine gum d) Nicotine lozenge e) Nicotine nasal spray 10) A 23-year-old African American woman presents who would like to quit smoking, but is not confident about her ability to do so because of 6 prior failed attempts. She has smoked 2.5 packs of cigarettes a day since the age of 13. In prior quit attempts, she used both the nicotine patch and nicotine gum individually, but not together. In each case, weight gain contributed significantly to her resumption of smoking. She has had no difficulty with withdrawal symptoms. Other than smoking cigarettes, her relevant past medical, surgical, social, and family histories and review of symptoms are notable for a 5-year history of depression. She is presently on no medications. She is recently divorced and lives with her mother who also smokes cigarettes. Her physical examination is unremarkable. Which is the most appropriate for this patient? a) Nicotine gum b) Bupropion SR (Zyban) c) Nortriptyline (Pamelor) d) Nicotine patch e) Clonidine (Catapres) f) Varenicline (Chantix) 11) In patients unwilling to quit smoking, which of the 5 R’s involves asking a patient how it is effecting their health and their family’s health? a) Relevance b) Risks c) Rewards d) Roadblocks e) Repetition 12) All patients making quit attempts are encouraged to use both counseling and medication, such as a nicotine patch, as this combination is more effected than either counseling or medication alone. a) True b) False 13) Prior to starting a patient on a smoking cessation medication, which of the following questions should you ask? a) Do you have esophagitis or pelvic inflammatory disease? b) Are you pregnant or breast-feeding? c) Do you have any serious heart conditions? d) Do you have any tooth, mouth, or jaw problems? e) All of the above

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History & Physical Exam – Procedures

18May2009

14) Which of the following is NOT true when selecting nicotine products? a) A noncompliant patient or one who smokes continuously throughout the day should begin with a nicotine patch b) Patients with esophagitis should not use nicotine gum or lozenge c) Patients who smoke intermittently throughout the day or smoke intensely for short periods followed by no smoking periods should being with nicotine gum or lozenge d) Patients with braces, dentures, or TMJ disease should begin with nicotine gum e) Patients allergic to adhesive tape or with skin problems should avoid nicotine patches 15) A patient presents with a history of several failed quit attempts. You decide to initiate pharmacotherapy. Which of the following has been shown to have the largest effect on abstinence rates? a) Nicotine patch + bupropion SR b) Nicotine patch + nicotine inhaler c) Long-term nicotine patch + ad libitum nicotine gum d) Nicotine patch + nortriptyline e) Nicotine patch + paroxetine 16) A patient presents who would like to quit smoking but has had six prior failed attempts and lacks self-confidence. All of the following interventions would address her concern about relapse EXCEPT: a) Counsel the patient about how to cope with her urges to smoke b) Schedule a follow-up appointment to prevent relapse c) Encourage adherence to prescribed tobacco cessation plan d) Set a quit date e) Hypnosis HPE – Surgery: Suturing & Gowning Match the wound type with the recommended suturing pattern: 1) Low-tension, cosmetically important wound a) Horizontal mattress 2) Wound edges tend to evert (e.g posterior neck) b) Vertical mattress 3) High-tension wounds or fragile skin wounds c) Half-buried mattress 4) Triangular wounds with limited blood supply d) Subcuticular running, continuous 5) Most common technique, for simple laceration e) Simple interrupted 6) Which of the following is the recommended wound irrigation agent prior to laceration repair? a) Povidone-iodine alone b) Povidone-iodine in saline c) Hydrogen peroxide d) Detergents or soaps e) Warm tap water or normal saline 7) Which of the following is NOT appropriate attire for the operating room? a) Brand-name protective eyewear for athletes b) Lint-free caps or hoods that cover sideburns and neck hairline c) Open back nursing clogs, nail polish, or artificial nails d) A mask that covers the nose and mouth completely e) Snapped warm-up jacket for non-scrubbed personnel 8) A student is retracting during a surgical procedure in the operating room. If they get the urge to sneeze, they should:

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History & Physical Exam – Procedures

18May2009

a) Turn away from the head surgeon and sneeze b) Turn toward the head surgeon and sneeze c) Look directly upward and sneeze d) Grab their nose to prevent sneezing e) Look directly at the surgical incision site and sneeze 9) When performing a surgical scrub, which of the following is NOT appropriate? a) Brush all four planes of extremity surface, 10 strokes per plane b) Brush starting at finger tips, including all fingers, down to elbow c) Discard all trash in a receptacle bin, not in the scrub sink d) Rinse arms under running water from elbow downward to fingertips e) Hold wet arms up when entering the OR, with elbows lower than hands 10) A surgical wound is considered contaminated after: a) 1-hour b) 3-hours c) 6-hours d) 12-hours e) 24-hours 11) Lidocaine can be used as a local anesthetic everywhere EXCEPT: a) Fingers and toes b) Penis and nose c) Earlobes d) All of the above 12) Bupivacaine can last up to 20-hours as a local anesthetic, compared to the 2- to 6-hours of lidocaine. The maximum dose for lidocaine is 4.5mg/kg and 3mg/kg for bupivacaine. What are the maximum doses, respectively, for lidocaine and bupivacaine in an average 70kg patient? a) 30cc and 50cc b) 50cc and 30cc c) 50cc and 80cc d) 80cc and 50cc e) 30cc and 80cc 13) Which of the following should NOT be done when injecting local anesthetic? a) Use the smallest gauge needle available (7g is huge, 33g is tiny) b) Warm anesthetic by rolling syringe in hands c) Use sodium bicarbonate if available d) Topical anesthetic creams may help via placebo effect e) Inject 1/3 of dose into 3 triangular spots near area to be anesthetized 14) Which of the following should be performed when cleaning a wound? a) Use betadine or soap in the wound b) Shave hair or eyebrows before cleaning c) Prep the skin around the wound with Betadine or equivalent d) Examine wound carefully for foreign bodies e) Use wide, liberal debridement in key structural areas (e.g. face) Match the scenario with the common scalpel blade: 15) Creating a puncture wound for a central line a) #10 blade 16) Held like a pencil for fine cuts, plastic surgery b) #11 blade 17) A long abdominal cut at the beginning of surgery c) #15 blade

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History & Physical Exam – Procedures

18May2009

18) Which of the following “0” suture sizes would be used for ophthalmologic surgery? a) 10-0 b) 5-0 c) 4-0 d) 2-0 e) 1-0 19) Which of the following “#” suture sizes is the smallest, but would be large enough to tie off a middle colic artery? a) #7 b) #6 c) #5 d) #3 e) #0 20) Which of the following is recommended for wound closure? a) Use 4-0 nylon for general wound closure b) Use 5-0 nylon for face of small child c) Use absorbable material for buried sutures d) Use silk for hemostasis e) All of the above 21) Generally, needle entry angle should be 90-degrees and wound edges should be approximated with square knots, not strangulated. Which of the following is also recommended, as described by the idiom “build pyramids, not ditches?” a) Invert wound edges b) Evert wound edges c) Add gauze at wound edge d) Add absorbable gauze deep in wound e) Close vermillion lip border or philtrum with larger sutures 22) Which of the following is a sign of wound infection? a) Rubor (redness) b) Calor (heat) c) Dolor (pain) d) Tumor (swelling) e) Odor (purulent) f) All of the above HPE – Venipuncture (Phlebotomy), Injections, & Arterial Blood Gases (ABG) 1) Which of the following is NOT true of assessing a patient’s veins? a) Veins in the hand are a good first choice, especially for long-term therapy b) Veins are collapsible and feel spongy, resilient, and tube-like c) If a tourniquet is dropped, dull, or soiled, it should be thrown away d) Veins of the inner aspect of the arm or wrist are good first options e) Larger veins of the antecubital fossa (AC) are more resistant to phlebitis f) If a vein becomes “blown,” unilateral proximal veins may be used 2) What cannula size is recommended for surgical patients and for blood transfusion? a) 16-gauge b) 18-gauge

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History & Physical Exam – Procedures

18May2009

c) 20-gauge d) 22-gauge e) 24-gauge 3) What cannula size is recommended for infants, children, and very small veins? a) 16-gauge b) 18-gauge c) 20-gauge d) 22-gauge e) 24-gauge 4) Which IV cannula advancement method is good for inexperienced providers as it reduces the likelihood of puncturing the vein’s opposite wall and causing infiltration? a) Floating the cannula into the vein b) One-step technique c) Two-handed technique d) One-handed cannula push technique 5) A nurse gives a tetanus shot (Td) into the upper lateral aspect of a patient’s arm. The nurse enters at a 90-degree angle, pulls the plunger back to ensure she has not entered a vessel, then gives the injection using an air-lock technique. What type of injection is this? a) Intradermal b) Intravenous c) Intramuscular d) Subcutaneous e) Interosseous 6) A clinician places a tuberculin PPD (Mantoux) injection, creating a small intradermal wheal on the patient’s arm. What entry angle, with needle bevel up, is recommended? a) 15-degrees b) 30-degrees c) 45-degrees d) 75-degrees e) 90-degrees 7) Which intramuscular injection site has the highest risk of striking a nerve? a) Vastus lateralis b) Ventrogluteal c) Deltoid d) Dorsogluteal 8) The Z-track method of injection is preferable for irritating injections, such as prochlorperazine (Compazine) and which of the following? a) SubQ heparin b) IM iron c) IV saline d) IM tetanus vaccine e) IO fluid bolus 9) At what point should a tourniquet be removed when performing phlebotomy? a) After the vein is found, before the needle enters the skin b) After the needle has entered the vein c) After the first tube of blood has been drawn

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History & Physical Exam – Procedures

18May2009

d) After blood is drawn, before removing the needle from the skin e) After the blood is drawn and after the needle is removed 10) A nurse prepares to administer a medication to a patient by IV. She checks the patient’s name and birth date then sets up her equipment, taking care to loosen the IV catheter from the needle stylet. Shortly after the IV drug injection, a patient begins developing signs of a serious allergic reaction. What is the drug of choice to prevent anaphylaxis? a) Methylprednisolone (Solu-Medrol) b) Epinephrine (1:1000 IM) c) Prochlorperazine (Compazine) d) Morphine (MS) e) Penicillin (PCN) 11) A positive tuberculin PPD skin test is over 10mm in diameter or 5mm in at-risk individuals. The results should be read within what time frame? a) Within 6 hours b) 6- to 12-hours c) 12- to 24-hours d) 24- to 48-hours e) 48- to 72-hours 12) Which of the following is NOT true when taking an arterial blood gas (ABG)? a) An Allen test must be performed before the procedure b) A blood gas syringe should be pre-heparinized c) Blood gas samples should be transported to the lab on ice d) The patient’s coagulation status should be determined first e) Three minutes of pressure at the sample site is sufficient to stop bleeding 13) What is the most common cause of low signal strength of inaccurate pulse oximetry (oxygen saturation) readings? a) Hypotension b) Nail polish c) Motion artifact d) Bright room lights e) Carboxyhemoglobin James Lamberg

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History & Physical Exam – Procedures AnswerKey SPEC 1) C 2) B 3) A 4) E 5) D 6) C 7) C 8) E 9) B 10) B 11) C 12) B 13) A 14) E 15) B 16) B 17) D 18) B 19) C 20) C 21) A 22) C 23) A 24) A 25) B 26) C 27) E 28) C 29) D 30) A 31) C 32) F 33) E 34) C 35) C 36) B 37) C 38) D

OPTC 1) E 2) E 3) C 4) B 5) D 6) B 7) A 8) A 9) C 10) F 11) A 12) D 13) C 14) E 15) D 16) B 17) A 18) B 19) C 20) E 21) E 22) D 23) E 24) A 25) A

DO NOT DISTRIBUTE

18May2009 Tobacco 1) C 2) E 3) C 4) A 5) D 6) A 7) A 8) B 9) A 10) B 11) A 12) A 13) A 14) D 15) C 16) E

Suturing 1) D 2) B 3) A 4) C 5) E 6) E 7) C 8) E 9) D 10) D 11) D 12) A 13) E 14) C 15) B 16) C 17) A 18) A 19) E 20) E 21) B 22) F

Vein/ABG 1) D 2) B 3) E 4) A 5) C 6) A 7) D 8) B 9) D 10) B 11) E 12) E 13) C

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