Description

Answer: vesicular The three normal breath sounds are vesicular, bronchovesicular, and bronchial. Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung fields. Bronchial breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx. Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase. They are normally heard over the hilar region. Crackles are adventitious sounds heard in the lungs and may be due to abnormalities in the lungs. 121. Which risk factor has the greatest impact on HIV transmission? A. Viral load b. Type of sexual activity c. Presence of other STDs d. Patient gender Answer: viral load Viral load at the time of infection is the greatest risk factor in contracting HIV. It also is the greatest predictor of prognosis. High levels of viremia correspond to higher rates of infection. There are equal rates of transmission in sexual intercourse between same and opposite sex couples. the presence of STDs at the time of infection does increase risk of transmission, but not to as great an extent as viral load. 122. Which choice below characterizes a patient who has aortic regurgitation? A. Long asymptomatic period followed by exercise intolerance, then dyspnea at rest b. An acute onset of shortness of breath in the fifth or sixth decade c. Dyspnea on exertion for a long period of time before sudden cardiac death d. A long asymptomatic period with sudden death usually during exercise Answer: long asymptomatic period followed by exercise intolerance, then dyspnea at rest the natural course of aortic regurgitation (AR) is that the patient has a long asymptomatic period with slowing of activities but remains essentially asymptomatic. Shortness of breath develops with activity and finally, shortness of breath at rest. the left ventricle eventually fails unless the aortic valve is replaced. 123. Which recommendation below reflects CDC’s recommendation for administration of the recombinant zoster vaccine? A. It should be given to immunocompetent adults age 50 and older b. It should be given to immunocompetent adults age 65 and older c. It can be given regardless of immune status at age 50 d. It can be given regardless of immune status at age 60 Answer: it should be given to immunocompetent adults age 50 and older CDC’s recommendation for the recombinant zoster vaccine (Shingrix) is for administration in immunocompetent adults aged 50 years and older. Shingrex is an inactivated (not live) vaccine and while not contraindicated in patients who are immunocompromised, it is not currently recommended by the Advisory Council on Immunization Practices (ACIP). It should not be administered during an acute outbreak ofshingles, but can be administered as soon as the acute phase has resolved. Shingrix is given in a two−dose series, with the second dose administered in 2−6 months. It if has been longer than 6 monthsfrom the first dose, just give the second dose, there is no need to restart the series. There is no need to screen the patient for a prior history of varicella nor to obtain serologic testing for antibodies. 124. The major advantage of the CAGE questionniare is: a. Brevity of questions b. Its sensitivity and specificity c. Identifies at risk drinkers d. Ease of interpretation Answer: brevity of questions The CAGE questionnaire is a screen for alcohol abuse. It consists of 4 questions that can be quickly and easily incorporated when eliciting a patient’s history. the “C” is to remind the questioner to ask the patient whether he’s ever felt the need to “c”ut down on drinking; “A”nnoyed by criticism about his drinking; “G”uilty about his drinking; in need of an “E”ye opener. These 4 questions are very easy to ask and can be answered with a simple yes/no response. The majority of patients with alcohol problems respond yes to at least 2 of these questions. Patients without alcohol problems virtually never respond “yes” to 2 or more. the questionnair is known to have high sensitivity and specificity, but other screens for alcohol abuse do too. 125. Depression is diagnosed on clinical presentation. What time frame is important for distinguishing between depressed mood and clinical depression? A. 1 week b. 2 weeks c. 3 weeks d. 4 weeks Answer: 2 weeks Screening tests for depression include questions about depressed mood or other symptoms that have lasted at least 2 weeks. this is an important time frame. Typicalscreening questions ask: “in the past 2 weeks, have you felt little interest or pleasure in doing things” or “in the past 2 weeks, have you felt down, depressed, or hopeless”? 126. Routine screening for gestational diabetes: a. Takes place only if the mother is asymptomatic b. Takes place at about 16−20 weeks c. Takes place at about 24−48 weeks d. Takes place routinely in each trimester