Premier. Clinical Knowledge Assessment 1.0

not-available-via-ai

The correct answer is "All of the above". This means that if you see a child at Premier with concerning injuries that may indicate abuse, you should fill out a CY47 form, call the clinical line, call the Child Line, and if you are not completely certain that the child will be safe, you should send them to the ER via EMS. All of these actions are necessary to ensure the well-being and safety of the child.

The patient in this scenario is experiencing pain over her lateral malleolus after tripping. RICE (Rest/Ice/Compression/Elevation) is the appropriate recommendation for this patient. Resting the affected area will allow for healing and prevent further injury. Applying ice will help reduce swelling and alleviate pain. Compression with a bandage or brace can provide support and reduce swelling. Elevation of the leg will also help reduce swelling by allowing fluid to drain away from the injured area. This combination of interventions is commonly recommended for acute injuries and can help promote healing and relieve symptoms.

The correct answer is B and C are true. This means that only patients with mucopurulent discharge should be treated with antibiotic ointment, specifically erythromycin QID x 3-5 days. Additionally, in contact lens wearers, Pseudomonas infections are more common, so a quinolone antibiotic ointment, such as Ciloxan BID x 5-7 days, is the preferred treatment. It is important to stress the necessity of good hygiene since this condition is highly contagious.

not-available-via-ai

The child's persistent wrist pain and the fact that they fell 3 days ago suggest that there may be a fracture. The x-ray confirms this by showing a fracture. Since it is a fracture, it requires proper splinting and orthopedic care for appropriate treatment. Referral to an orthopedic specialist is necessary to ensure proper management of the fracture.

The patient's symptoms of a cough with clear or white sputum, absence of distress, normal examination findings, and absence of any significant medical history or smoking history suggest that he likely has a viral infection. Antibiotics are not effective against viral infections, so treating him with antibiotics would be unnecessary and potentially harmful. Symptomatic therapy, such as over-the-counter cough suppressants or throat lozenges, would be appropriate to provide relief from his symptoms.

The correct answer suggests that the patient likely has parotitis, which is inflammation of the parotid gland. The recommended treatment is antibiotics, specifically Augmentin 875mg bid (twice a day) for 7 days, along with lemon drops. This treatment is appropriate because parotitis is commonly caused by bacterial infection, and Augmentin is an antibiotic effective against the most common bacteria that cause parotitis. Lemon drops can help stimulate saliva production and relieve symptoms.

The patient fell onto his outstretched hand, which is a common mechanism of injury for a Colles fracture. A Colles fracture is a fracture of the distal radius with dorsal displacement of the distal fragment. It is typically treated with a sugar-tong, reverse sugar-tong, or double sugar-tong splint. These splints provide stability to the fracture site and allow for proper alignment and healing. A circumferential cast may not provide enough support and immobilization for this type of fracture. The presence of a puncture wound at the site of the fracture would not change the management, as the primary concern is addressing the fracture itself.

The patient's symptoms of a nonproductive cough at night while supine and waking up with a sore throat suggest that they may have gastroesophageal reflux disease (GERD). GERD occurs when stomach acid flows back into the esophagus, causing irritation and symptoms such as coughing and sore throat. Treatment with a proton pump inhibitor (PPI) can help reduce the production of stomach acid and alleviate the symptoms of GERD. Therefore, this patient should be treated with a PPI.

The correct answer is "All of the above." The presence of diarrhea and conjunctivitis makes Group A Streptococcus (GAS) less likely because these symptoms are not typically associated with GAS pharyngitis. On the other hand, the presence of tender lymphadenopathy and a tonsillar exudate makes GAS more likely as these are common findings in GAS pharyngitis. It is important to differentiate between Group A and Group B streptococci as Group A strep causes pharyngitis, while Group B strep is normal GI flora that can cause serious illness in neonates.

The correct answer is "There is a fracture that should be buddy taped to a healthy toe." This is because the patient stubbed her toe and it is black and blue, indicating bruising and possible trauma. The x-ray reveals a fracture, which should be treated by buddy taping the fractured toe to a healthy toe for support and stabilization.

not-available-via-ai

The patient's symptoms of RUQ pain, exacerbated by greasy food, raise suspicion for gall bladder disease. The normal abdominal exam except for RUQ pain with deep palpation further supports this possibility. Ordering routine chemistries, a lipase, and an ultrasound would help evaluate the patient for gall bladder disease and pancreatitis, which can present with similar symptoms. Referring the patient to a surgeon for an outpatient evaluation ensures appropriate follow-up and management. Sending the patient to the ER is not necessary unless there are signs of acute complications.

not-available-via-ai

The patient is tender over the snuff box, which is a common sign of scaphoid fracture. However, the x-ray does not show a fracture. Despite this, the patient should still be placed in a thumb spica splint as a precautionary measure and referred to orthopedics as an outpatient for further evaluation. This is because scaphoid fractures are often missed on initial x-rays and can develop later. The thumb spica splint helps immobilize the wrist and provides support while waiting for further evaluation.

Based on the symptoms described (RLQ pain, nausea, low grade fever, anorexia) and the fact that the patient is currently experiencing mild pain, it is important to send the patient to the emergency department (ED). These symptoms could be indicative of appendicitis, which is a medical emergency that requires immediate evaluation and potentially surgery. Therefore, sending the patient to the ED is the most appropriate course of action to ensure timely and appropriate care.

Amylase is not more sensitive than Lipase in the diagnosis of acute pancreatitis. Lipase is actually considered to be more specific and more sensitive than amylase in diagnosing acute pancreatitis. Lipase levels remain elevated for a longer duration compared to amylase, making it a more reliable marker for the diagnosis of acute pancreatitis.

The patient's symptoms of low grade fever, LLQ abdominal pain, and tenderness to deep palpation over the left lower quadrant with voluntary guarding are consistent with diverticulitis. The fact that he has had similar symptoms twice in the past further supports this diagnosis. A CT scan is necessary to evaluate the cause of his abdominal pain and confirm the diagnosis of diverticulitis. Antibiotic treatment with Levaquin and Flagyl is also appropriate for presumptive diverticulitis. Therefore, options A and C are both correct.

The correct answer states that the abscess needs to be drained in addition to antibiotics and referral to a dentist. This is because the patient presents with dentalgia (tooth pain) and has a fluctuant area above their right 1st incisor, indicating the presence of an abscess. Abscesses are usually caused by a bacterial infection and can lead to severe pain and swelling. Antibiotics alone may not be sufficient to treat the abscess, as the pus-filled pocket needs to be drained to effectively remove the infection. Referral to a dentist is necessary for proper evaluation and treatment of the underlying dental issue causing the abscess.

The given answer is FALSE because bronchitis is typically a viral infection and does not require treatment with antibiotics. Antibiotics are only indicated if there is a bacterial infection or if the patient has risk factors for a bacterial infection. The patient's symptoms, such as productive cough with green sputum and crackles on lung exam, are more consistent with pneumonia rather than bronchitis. Therefore, the patient may be treated with PO antibiotics, such as ZPak or Levaquin, for pneumonia.

The patient's presentation of acute onset severe left flank pain radiating to his testicle, along with vomiting and diaphoresis, is consistent with renal colic. Renal colic is caused by the passage of a kidney stone, which can cause severe pain. The suggested treatment of IV fluids, Toradol 30mg IV, and a KUB (kidney-ureter-bladder X-ray) is appropriate for managing renal colic. If the pain can be controlled, the patient can be safely discharged for follow-up with urology.

The statement "This patient needs a STAT CT" is false because the patient's neuro exam is normal and there are no indications of a more serious underlying condition such as a stroke or tumor. A CT scan is not necessary in this case.

The correct answer states that reduction may be considered if the injury occurred within 6 hours, but it is not necessary. If the injury is beyond 6 hours, the fracture does not require immediate treatment. Instead, treatment may be needed at a later date if there are any complications such as cosmetic issues or difficulty breathing through the nose. This suggests that the patient does not need to see a plastic surgeon immediately, but should monitor for any potential complications in the future.

In this scenario, the patient is experiencing symptoms of a stroke (weakness in right arm and difficulty speaking) which began 45 minutes ago. Time is crucial in stroke management, as immediate medical attention can help minimize damage and improve outcomes. Therefore, the correct course of action is to call 911, as emergency medical services can provide timely transportation to the hospital where the patient can receive appropriate care.

All of the given options - Hypertension, Cholesterol, Family History, Smoking, and Diabetes - are major risk factors for CAD (Coronary Artery Disease). CAD is a condition where the arteries that supply blood to the heart become narrowed or blocked due to the buildup of plaque. Hypertension (high blood pressure), high cholesterol levels, a family history of CAD, smoking, and diabetes are all well-established risk factors that can contribute to the development of CAD. Therefore, none of the options listed are not major risk factors for CAD.

As people age, their risk of complications from head injuries increases. Therefore, when evaluating a minor head injury in a patient over 65 years old, it is important to include a head CT scan. This imaging test can help identify any potential brain injuries or bleeding that may not be immediately apparent. By conducting a head CT, healthcare professionals can ensure that any necessary treatment or intervention is provided promptly, reducing the risk of further complications or long-term damage.

not-available-via-ai

An appropriate order for IV fluid replacement in this case would be NS 400 cc bolus. This is because the child has been experiencing diarrhea for 3 days, which can lead to dehydration. The heart rate of 110 bpm indicates that the child may be tachycardic, which can be a sign of dehydration. The weight of 44 lbs suggests that the child is of average weight for a 4-year-old. The dry mucous membranes also indicate dehydration. Therefore, a bolus of normal saline (NS) is appropriate to rapidly restore fluid volume and correct dehydration.

not-available-via-ai

A 3 week old infant with a fever of 100.9 rectally is a concerning sign, especially in such a young age. The fact that the fontanelles are flat, neck is supple, lungs are clear, and there is no rash does not rule out the possibility of a serious infection. In infants, a fever can be a sign of a potentially life-threatening condition such as sepsis. Therefore, it is important to send the patient to the emergency room for a septic work-up to determine the cause of the fever and provide appropriate treatment.

Atrial Fibrillation is a cardiac arrhythmia characterized by irregular and rapid heart rate. It is typically seen as chaotic, disorganized electrical activity in the atria on an EKG. This can be identified by the absence of distinct P waves and the presence of irregularly spaced QRS complexes.

The patient should be sent to the ER for evaluation because painless, gross hematuria could be a sign of a serious condition such as bladder or kidney cancer. It is important to rule out any life-threatening conditions and provide appropriate and timely medical care.

The patient's symptoms of chest tightness, mild nausea, and diaphoresis, along with a history of similar discomfort while climbing stairs, are concerning for unstable angina. Unstable angina is a serious condition that requires immediate evaluation and treatment. Giving the patient aspirin while at Premier can help to reduce the risk of further cardiac events. Referring the patient to the emergency room by EMS is necessary for further evaluation and management of his condition.

Based on the information provided, the patient experienced knee pain after a fall. The correct answer states that there is a fracture that needs a knee immobilizer at full extension and referral to ortho within 48 hours. This implies that the x-ray revealed a fracture in the knee, which requires immobilization and a referral to an orthopedic specialist within a specific time frame. This course of action is appropriate for managing a fracture in the knee.

not-available-via-ai

The correct answer is "This patient should be treat with Benadryl 25 mg q 6 prn, This patient should receive prednisone 40mg, tapered over 5-7 days, This patient may be treated with Pepcid 20mg bid." This is because the patient is presenting with diffuse hives and itching, which are symptoms of an allergic reaction. Benadryl is an antihistamine that can help relieve these symptoms. Prednisone is a corticosteroid that can help reduce inflammation and allergic reactions. Pepcid is an H2 blocker that can help reduce stomach acid production, which may be beneficial in some cases of allergic reactions.

Based on the patient's symptoms of increasing shortness of breath, one pillow orthopnea, mild cough, rales at both bases, and 2+ pitting edema in both legs, along with an SaO2 of 92% on room air, it suggests that the patient is experiencing acute decompensated heart failure (ADHF). Giving the patient a dose of IV Lasix, 40mg, and reassessing in 2 hours is the appropriate course of action in this situation. IV Lasix is a loop diuretic that helps to relieve fluid overload and reduce symptoms of heart failure. Reassessing the patient's symptoms after administration of Lasix will help determine if further intervention or hospitalization is necessary.

The patient fell onto his elbow and is experiencing persistent pain. The x-ray shows a soft tissue sign that suggests a fracture of the radial head. This type of fracture can be treated with a sling, indicating that immobilization is necessary but not for a prolonged period of time.

The correct answer is B and C. The woman's symptoms of urinary frequency and dysuria, along with the presence of TNTC WBC's and moderate RBC's in her urinalysis, suggest a urinary tract infection (UTI). The mild, right-sided CVAT indicates possible kidney involvement. Levaquin and Bactrim DS are both antibiotics commonly used to treat UTIs. Pyridium is a medication that can provide relief for discomfort associated with UTIs. Therefore, starting the woman on Levaquin or Bactrim DS and treating her discomfort with Pyridium would be appropriate in this case.

The patient's symptoms, such as fever and decreased appetite, are not indicative of a specific infection. The physical examination findings, including a supple neck, normal ENT exam, clear lungs, and soft abdomen, do not suggest any specific underlying condition. Therefore, there is no immediate need for further evaluation or treatment with antibiotics. Discharging the patient with symptomatic relief medication and instructing the father to return if the child develops any specific site of infection is appropriate in this case.

Both A and B are reasonable approaches because the given scenario describes a 4-year-old child with severe ear pain for the past 24 hours, a temperature of 100.8, and no signs of toxicity. These symptoms are consistent with acute otitis media (OM), which can be caused by both viral and bacterial infections. Viral OM is more common and typically resolves on its own with supportive care, such as NSAIDs for pain relief. However, bacterial OM may require antibiotic treatment with Amoxicillin. Therefore, both approaches of reassurance with NSAIDs (for viral OM) and treatment with Amoxicillin (for bacterial OM) are reasonable in this case.

The correct answer suggests that there is a fracture present in the foot that requires a cast-shoe. However, the patient can bear weight on the foot as tolerated, indicating that the fracture is not severe enough to require complete non-weight bearing. This suggests that the fracture is stable and can be managed with the use of a cast-shoe for support while allowing the patient to bear some weight on the foot.

The patient has reported pain in her right hip when she walks, and the x-ray shows a fracture. However, there is no indication of any other serious symptoms or complications that would require immediate surgery or a visit to the emergency room. Therefore, the patient can be sent home with pain medication to manage the discomfort caused by the fracture.

The correct answer is A. The bleeding site is likely on the nasal septum. Once identified, it should be cauterized with silver nitrate and then packed. This is the most appropriate course of action for a patient presenting with recurrent epistaxis. The use of silver nitrate cauterization helps to stop the bleeding by sealing off the blood vessels in the nasal septum. Packing the nose afterwards helps to maintain pressure on the site and prevent further bleeding. The other options mentioned in the explanation, such as CBC and PT/PTT tests, are not directly related to the treatment of acute epistaxis.

not-available-via-ai

not-available-via-ai

The correct answer is to transport the patient to the ED. The patient's symptoms of increasing shortness of breath, dark yellow sputum, confusion, and abnormal vital signs indicate a worsening of her condition and potential respiratory distress. Given her history of COPD and the findings on lung exam, it is important to provide immediate medical attention in a higher level of care setting, such as the emergency department, where she can receive further evaluation, monitoring, and appropriate treatment.

This patient is presenting with an acute exacerbation of asthma triggered by exposure to a cat. The absence of fever and cough, as well as the patient's normal exam findings and oxygen saturation, suggest that the exacerbation is mild to moderate. The appropriate management for this patient would include bronchodilators such as albuterol via handheld nebulizer (HCN) and ipratropium bromide (Atrovent) via handheld nebulizer (HFN) every 20-30 minutes to relieve wheezing. Peak flow measurements should be taken before and after treatment to assess response. Systemic corticosteroids such as prednisone or solumedrol should be given to reduce airway inflammation. Counseling on trigger avoidance should also be provided.

The appropriate management for this patient includes administering Albuterol via HCN and Atrovent via HFN every 20-30 minutes to relieve the wheezing and improve respiratory distress. Prednisone 40 mg PO and Solumedrol 125 mg IV should be given to reduce inflammation and further improve symptoms. Counseling on trigger avoidance is important to prevent future exacerbations. Finally, EMS transport to the ED is necessary due to the patient's moderate distress and the need for immediate medical attention.