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A patient reports to urgent care for colicky pain in the upper right quadrant that they rate as a seven out of ten. The night before they ate a fatty meal with two glasses of wine. Which of the following tests would help you asses for cholecystitis?
Murphy's sign
Mc Burney's point
Psoas sign
Rovsing's sign
Explanation
A positive Murphy's sign is an indication of cholecystitis, or gallbladder inflammation. Testing for Murphy's sign is performed during an abdominal exam by asking the patient to breathe out slowly while the fingers of the examiner are slid under the right costal margin and held in place with firm pressure. The patient is then asked to inhale, which forces the abdominal contents upward. Murphy's sign is considered positive if the patient winces or flinches when breathing in, due to pain when the inflamed gallbladder comes in contact with the examiner's fingertips.
Rovsing's sign, psoas sign, and McBurney's point are all tests for appendicitis.
Alice is a 25-year-old female who is visiting her primary care physician for a routine physical. Which of the following may be conducted at the appointment?
A papanicolaou test
A rapid antigen detection test
A urine analysis
A cervical cerclage
A vaginal ultrasound
Explanation
A papanicolaou test (pap smear) may be preformed routinely on adult women as a screening for cervical cancer. A rapid antigen detection test (rapid strep test), urine analysis, cervical cerclage, or vaginal ultrasound would not be part of routine screening.
A three year old patient presents for a seizure that occurred at home. To her father's knowledge, she has never had a seizure in the past. She was not ill at the time of the seizure, and she is not on any type of medication. There was no head trauma before the incident. Her father states that her older brother was diagnosed with epilepsy at age seven, and that his grandmother was also epileptic. Is it safe to assume that this child is also epileptic?
No, a diagnosis of epilepsy requires two or more seizures without a clear provocation.
Yes, she has a positive family history for epilepsy, and has had a seizure with no clear provocation.
No, epilepsy is not hereditary, and must present with a history of at least two seizure episodes before diagnosis.
Yes, epilepsy is defined as seizures in the absence of fever, head trauma, or medication.
Explanation
While epilepsy may certainly be hereditary, the diagnosis of epilepsy requires the occurrence of at least two seizures during two separate incidents, regardless of positive family history. These must occur in the absence of provocative factors such as fever, head trauma, or medication.
The nurse completes a cervical exam on her laboring patient. She determines that her patient's cervix is 1cm in length. How would the nurse describe this length?
Explanation
The normal cervical canal is 2cm in length. Effacement is the thinning of the cervix as the body prepares for delivery. Thus, a 2cm cervix is 0% effaced and a 0cm cervix is 100% effaced.
Where does lipid digestion begin?
The duodenum
The ileum
The stomach
The jejunum
Explanation
While a small amount of fat digestion may occur in the mouth via the action of lingual lipase, the majority of lipid digestions begins in the duodenum. The presence of fat in the small intestine triggers release of pancreatic lipase, which enters the duodenum via the pancreatic duct. Fat digestion does not occur in the stomach.
What enzyme, present in saliva, initiates the digestion of carbohydrates?
Amylase
Lipase
Pepsin
Protease
Explanation
The digestion of dietary carbohydrates is initiated by amylase, an enzyme present in saliva. This enzyme breaks down long carbohydrate molecules into shorter units such as disaccharides. Lipase breaks down fats and is not present in the saliva, rather it is secreted by the pancreas into the duodenum. Pepsin is a protease - an enzyme that breaks down proteins. This enzyme is secreted by the chief cells of the stomach in its zymogen form (pepsinogen). It is activated by the product of the parietal cells (hydrochloric acid). Note that amylase is also secreted by the pancreas to complete the chemical digestion of carbohydrates into monosaccharides so that they can be absorbed by the brush border of the small intestine.
A client calls the clinic and tells the nurse that her daughter has just been stung by a bee on the arm. She is worried that her daughter will have a severe reaction. What should the nurse do?
Tell the client to call back if the condition worsens
Ask the client if her daughter has ever been stung by a bee in the past
Instruct the client to keep the arm elevated until swelling goes away
Advise the client to bring her daughter to the emergency room
Explanation
The nurse does not have reason to suspect that the child will have an allergic reaction before symptoms are present. Thus, the patient should call back or come to the emergency room if symptoms present.
Which agar would be the best choice option to identify_Escherichia coli_?
EMB (eosin methylene blue), because it is selective and differential
Nutrient agar
Selenium enriched media
Phenethyl alcohol
Explanation
The question requires the knowledge that Escherichia coli is a facultative, Gram negative, lactose fermenting bacteria. EMB (eosin methylene blue), or Mac (MacConkey) media is superior for isolating Escherichia coli because it is both selective and differential. Nutrient agar is neither selective nor differential. Selenium enriched media would not help identify this bacteria because Escherichia coli does not require this supplemented media to grow. Phenethyl alcohol can be used to select for anaerobic bacteria, which is of no utility in this situation.
Alice is a 25-year-old female who is visiting her primary care physician for a routine physical. Which of the following may be conducted at the appointment?
A papanicolaou test
A rapid antigen detection test
A urine analysis
A cervical cerclage
A vaginal ultrasound
Explanation
A papanicolaou test (pap smear) may be preformed routinely on adult women as a screening for cervical cancer. A rapid antigen detection test (rapid strep test), urine analysis, cervical cerclage, or vaginal ultrasound would not be part of routine screening.
What enzyme, present in saliva, initiates the digestion of carbohydrates?
Amylase
Lipase
Pepsin
Protease
Explanation
The digestion of dietary carbohydrates is initiated by amylase, an enzyme present in saliva. This enzyme breaks down long carbohydrate molecules into shorter units such as disaccharides. Lipase breaks down fats and is not present in the saliva, rather it is secreted by the pancreas into the duodenum. Pepsin is a protease - an enzyme that breaks down proteins. This enzyme is secreted by the chief cells of the stomach in its zymogen form (pepsinogen). It is activated by the product of the parietal cells (hydrochloric acid). Note that amylase is also secreted by the pancreas to complete the chemical digestion of carbohydrates into monosaccharides so that they can be absorbed by the brush border of the small intestine.