Gohealth Providers Escalation Guidelines Review
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- 1.
In dealing with a potentially violent patient, it is recommended that you:
- A.
Approach the patient within arms length to make them feel cared for and respected.
- B.
Explain to them calmly but forcefully why they are incorrect in their worries or concerns.
- C.
Use "reflective listening" techniques that allow you to echo the patient's feelings back to them, making them feel understood, and without imposing judgement.
- D.
Ignore any hostile or aggressive behavior or posturing, which will cause them to deescalate spontaneously.
Correct Answer
C. Use "reflective listening" techniques that allow you to echo the patient's feelings back to them, making them feel understood, and without imposing judgement.Explanation
In dealing with a potentially violent patient, it is recommended to use "reflective listening" techniques that allow you to echo the patient's feelings back to them, making them feel understood, and without imposing judgment. This approach helps to establish rapport and trust with the patient, showing them that you are actively listening and empathizing with their concerns. It can also help to de-escalate the situation by diffusing their anger or aggression. By using reflective listening, you are creating a safe and non-confrontational environment, which can ultimately lead to a more positive outcome in managing the patient's behavior.Rate this question:
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- 2.
Diabetic patients who present with new onset of shortness of breath
- A.
Will rarely have heart disease because they get lung problems long before they become ischemic.
- B.
Must be evaluated for CAD because of the entity of "silent ischemia".
- C.
Are almost always in DKA, since SOB is the most common symptom of DKA.
- D.
Can safely be treated with a test dose of Lasix for presumed CHF to see if their symptoms resolve.
Correct Answer
B. Must be evaluated for CAD because of the entity of "silent ischemia". -
- 3.
A known insulin dependent diabetic presents to a GoHealth clinic accompanied by his family. They say he is "talking out of his head" and they think he has had another stroke like he did last year. The patient has obvious AMS with occasional periods of semi-arousability. You must immediately:
- A.
Call EMS and arrange for emergent transport for head CT and possible interventional CVA management.
- B.
Start an IV, administer 5 units of IV insulin, 1000 cc of NS wide open, and call EMS for transport.
- C.
Administer an oral glucose solution.
- D.
Do a fingerstick accucheck while starting an IV.
Correct Answer
D. Do a fingerstick accucheck while starting an IV.Explanation
The correct answer is to do a fingerstick accucheck while starting an IV. This is the most appropriate action to take in this scenario because the patient is an insulin-dependent diabetic and is displaying symptoms of altered mental status (AMS). The fingerstick accucheck will help determine the patient's blood glucose level, which is crucial in managing a diabetic patient with AMS. Starting an IV is also important for providing immediate access for further interventions if necessary. Calling EMS for transport may be required depending on the results of the fingerstick accucheck.Rate this question:
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- 4.
Drooling and spitting saliva into a pan or washcloth in a patient who arrives at GoHealth:
- A.
Is not concerning if it is only saliva.
- B.
Is always associated with a more serious condition like retropharyngeal abscess or epiglottitis requiring hospitalization, usually in an ICU.
- C.
Will always have an associated tachycardia due to the severe dehydration associated with this symptom.
- D.
Should prompt an assessment for systemic signs of dehydration as well as evidence of impending airway compromise.
- E.
(B) and (C).
Correct Answer
D. Should prompt an assessment for systemic signs of dehydration as well as evidence of impending airway compromise. -
- 5.
Dizziness provoked by rapid head movement
- A.
May cause nausea or vomiting based on the vestibular/ocular disconnect.
- B.
Is usually vestibular in nature.
- C.
Is consistent with someone who also has tinnitus and/or hearing loss.
- D.
Would NOT be expected to have associated focal neurological findings.
- E.
All of the above.
Correct Answer
E. All of the above.Explanation
The correct answer is "All of the above." This is because dizziness provoked by rapid head movement can indeed cause nausea or vomiting due to the vestibular/ocular disconnect. It is usually vestibular in nature, which means it is related to the inner ear and balance system. This type of dizziness may also be associated with tinnitus and/or hearing loss. However, it would not be expected to have associated focal neurological findings, such as weakness or numbness in specific body parts. Hence, all the statements mentioned in the options are true for dizziness provoked by rapid head movement.Rate this question:
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- 6.
Unexplained jaw pain may be due to:
- A.
Angina
- B.
Bruxism
- C.
Sinusitis
- D.
Metastatic disease
- E.
(A) and (C)
- F.
All of the above
Correct Answer
F. All of the aboveExplanation
Unexplained jaw pain can be caused by several conditions, including angina, bruxism, sinusitis, and metastatic disease. Angina refers to chest pain caused by reduced blood flow to the heart, which can radiate to the jaw. Bruxism is the habit of grinding or clenching the teeth, leading to jaw pain. Sinusitis is inflammation of the sinuses, which can cause pain in the jaw area. Metastatic disease refers to the spread of cancer from one part of the body to another, and jaw pain can be a symptom of this. Therefore, all of the above conditions can contribute to unexplained jaw pain.Rate this question:
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- 7.
Historical data which may indicate that a behavioral problem following recent death of a loved one is likely to be self limited is:
- A.
A serious suicide attempt that is stopped by being discovered.
- B.
Trouble sleeping for 2 weeks.
- C.
New onset of hallucinations in an 18 year old.
- D.
Persistent thoughts about mortality and uncertainty about the future.
- E.
(B) and (D) above.
Correct Answer
E. (B) and (D) above.Explanation
The correct answer is (B) and (D) above. Trouble sleeping for 2 weeks and persistent thoughts about mortality and uncertainty about the future are both potential indicators of a self-limited behavioral problem following the recent death of a loved one. Difficulty sleeping is a common symptom of grief and can improve over time. Persistent thoughts about mortality and uncertainty about the future are also common during the grieving process but tend to diminish as the individual adjusts to the loss. The other options, a serious suicide attempt and new onset of hallucinations, suggest more severe and potentially ongoing mental health issues that may require intervention.Rate this question:
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- 8.
The most worrisome condition(s) out of the following is:
- A.
An 88 year old female who has not recognized her daughter for the last 6 weeks.
- B.
A 15 year old who feels "underwater" and "foggy" after a head injury on the football field where he did not pass out or vomit.
- C.
A 28 year old with track marks and a headache with low-grade fever and a heart murmur.
- D.
A known hypertensive with the worst headache of his life and a BP of 190/140.
- E.
(B) and (C) above.
- F.
(C) and (D) above.
Correct Answer
F. (C) and (D) above.Explanation
The most worrisome condition(s) out of the options given is the combination of (C) and (D) above. This is because the 28-year-old with track marks, headache, low-grade fever, and a heart murmur may be showing signs of infective endocarditis, which is a serious infection of the heart valves. Additionally, the known hypertensive individual with the worst headache of his life and a high blood pressure reading of 190/140 may be experiencing a hypertensive emergency, which can lead to complications such as stroke or organ damage. Both of these conditions require immediate medical attention and are potentially life-threatening.Rate this question:
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- 9.
With respect to URIs:
- A.
Green nasal discharge mandates an immediate search for a bacterial source.
- B.
COPD patients require antibiotics for all exacerbations with fever.
- C.
Patients who have severe facial pain, and fever over 39.0C for 3-4 days at the start of an upper respiratory illness may benefit from antibiotic treatment for presumed bacterial sinusitis.
- D.
True sinusitis can be viral in origin about as often as it is bacterial in origin.
- E.
(C) and (D) above.
Correct Answer
E. (C) and (D) above.Explanation
The given answer, (C) and (D) above, is correct because it states that patients who have severe facial pain and fever over 39.0C for 3-4 days at the start of an upper respiratory illness may benefit from antibiotic treatment for presumed bacterial sinusitis, and it also mentions that true sinusitis can be viral in origin about as often as it is bacterial in origin. This means that both statements are true and provide accurate information about the use of antibiotics for sinusitis.Rate this question:
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- 10.
Hypoxia in children that is not due to a monitoring error:
- A.
Is common and should not be a source of concern in the absence of other serious signs.
- B.
Occurs later in the course of an illness than in adults due to their large cardiovascular reserves.
- C.
Is rarely from primary pulmonary causes.
- D.
Can occur as an isolated finding, in a patient without signs of recruitment of compensatory mechanisms such as tachycardia, tachypnea or accessory muscle use.
Correct Answer
B. Occurs later in the course of an illness than in adults due to their large cardiovascular reserves.Explanation
The correct answer is that hypoxia in children occurs later in the course of an illness than in adults due to their large cardiovascular reserves. This means that children have a greater ability to compensate for low oxygen levels compared to adults. Therefore, hypoxia may not be a significant concern in children unless there are other serious signs present. It is also mentioned that hypoxia in children is rarely caused by primary pulmonary issues and can occur as an isolated finding without signs of compensatory mechanisms like increased heart rate or breathing rate.Rate this question:
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- 11.
With respect to UTIs:
- A.
Women must have at least a urinalysis to confirm the diagnosis.
- B.
Treatment of a first UTI in adult women without sending a urine culture is malpractice.
- C.
Adult male dysuria always has an anatomic (structural) cause.
- D.
Pregnant patients are at higher risk of UTIs due to hormonal effects on smooth muscle.
Correct Answer
D. Pregnant patients are at higher risk of UTIs due to hormonal effects on smooth muscle.Explanation
Pregnant patients are at higher risk of UTIs due to hormonal effects on smooth muscle. During pregnancy, hormonal changes can cause relaxation of the smooth muscles in the urinary tract, leading to decreased bladder tone and reduced ability to effectively empty the bladder. This can create an environment that is more conducive to bacterial growth and increase the risk of developing a urinary tract infection. It is important to monitor and address UTIs in pregnant patients to prevent complications for both the mother and the baby.Rate this question:
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- 12.
You saw a female patient with dysuria and frequency last week. Her UCG was negative and you started her on Microbic. She now has a fever, shaking chills, back pain and vomiting, including her Microbic. Reasonable next steps might be:
- A.
Repeat her UCG
- B.
Change her antibiotics, send her home, and call her tomorrow.
- C.
Send her to the ED for lab testing including blood cultures, IV antibiotics, and admission.
- D.
Try some IV Zofran and give her a dose of IV Cetriaxone and send her home on Keflex if she keeps down fluids.
- E.
(A) and (C) above.
Correct Answer
E. (A) and (C) above.Explanation
The patient's symptoms of fever, shaking chills, back pain, and vomiting, along with the fact that she is unable to tolerate her current antibiotic (Microbic), suggest that she may have a urinary tract infection (UTI) that has progressed to a kidney infection (pyelonephritis). It is reasonable to repeat her UCG to rule out pregnancy as a cause of her symptoms and to send her to the emergency department (ED) for further evaluation. This would include lab testing, blood cultures, IV antibiotics, and admission if necessary. Therefore, options (A) and (C) are both reasonable next steps to manage the patient's condition.Rate this question:
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- 13.
A 14 year old patient presents to GoHealth after a contact sports injury at school 1 hour ago. (Remember, Massapequa GoHealth is across the street from a high school!) He hit his head and left clavicle. Witnesses say he had no LOC, he was mildly confused but this is resolving, and he has had no vomiting. He is mainly complaining of left clavicular pain. The single most important thing for you to do now is:
- A.
Get a head CT to rule out ICH or other traumatic brain injury.
- B.
Put him in a sling to prevent subclavian arterial injury.
- C.
Take steps to insure he does not have a cervical spine injury.
- D.
(A) and (C) above.
Correct Answer
C. Take steps to insure he does not have a cervical spine injury.Explanation
The most important thing to do in this situation is to take steps to ensure that the patient does not have a cervical spine injury. This is because the patient experienced a contact sports injury and hit his head and left clavicle. While he did not lose consciousness and is showing signs of improvement, it is still crucial to rule out any potential cervical spine injury, as this can be a serious and potentially life-threatening condition. Getting a head CT to rule out traumatic brain injury is not the most important step at this time, as the patient's main complaint is left clavicular pain. Putting him in a sling to prevent subclavian arterial injury is not the most important step either, as there is no indication of arterial injury at this point.Rate this question:
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- 14.
The "discriminatory zone" for serum HCG is
- A.
1500-2000 IU/L
- B.
Not useful when over 1500 IU/L and a negative TVUS is obtained.
- C.
Only valuable in patients known to have an IUP.
- D.
Not useful in second and subsequent pregnancies.
Correct Answer
A. 1500-2000 IU/LExplanation
The discriminatory zone for serum HCG is 1500-2000 IU/L. This means that if a woman's HCG levels are below 1500 IU/L, a negative transvaginal ultrasound (TVUS) result is not useful in ruling out an intrauterine pregnancy (IUP). However, if the HCG levels are above 1500 IU/L, a negative TVUS result can be considered reliable in excluding an IUP. The discriminatory zone is only valuable in patients who are already known to have an IUP and is not useful in second and subsequent pregnancies.Rate this question:
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- 15.
Weakness as a presenting complaint in children is usually a conversion reaction and should be treated expectantly with psychiatric referral, or referral back to their pediatrician for management.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because weakness as a presenting complaint in children is not always a conversion reaction. It can be caused by various medical conditions such as muscle weakness, neurological disorders, or even nutritional deficiencies. Therefore, it is important to thoroughly evaluate the child's symptoms and medical history before making any assumptions. Referral to a pediatrician or appropriate specialist for further investigation and management is necessary in such cases.Rate this question:
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- 16.
Which of the following factors is NOT an assessment of a laceration and how to repair it?
- A.
Nature of causative agent or object.
- B.
Host factors re: healing, infection.
- C.
Duration since injury.
- D.
Magnitude of force involved.
- E.
History of keloid formation.
Correct Answer
E. History of keloid formation.Explanation
The history of keloid formation is not an assessment of a laceration and how to repair it because keloid formation is a response of the body to injury, not a factor that directly affects the assessment or repair of the laceration. The other factors listed, such as the nature of the causative agent, host factors related to healing and infection, duration since injury, and magnitude of force involved, are all relevant factors that can impact the assessment and repair of a laceration.Rate this question:
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- 17.
Inner lip lacerations
- A.
Are a large source of serious facial infections.
- B.
Can trap food particles if gaping.
- C.
Always require repair.
- D.
Often injure deeper important structures.
Correct Answer
B. Can trap food particles if gaping.Explanation
Inner lip lacerations can trap food particles if gaping. When the inner lip is lacerated, it can create a gap or opening in the tissue. If this gap is not properly closed or repaired, it can allow food particles to become trapped inside. This can lead to an increased risk of infection as bacteria can thrive in this environment. Therefore, it is important to repair inner lip lacerations to prevent the trapping of food particles and minimize the risk of serious facial infections.Rate this question:
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- 18.
Which of the following is true?
- A.
Herpetic Whitlows will not heal unless drained.
- B.
I&D of a kerion is standard of care, without which no healing will occur.
- C.
Cat Scratch disease has suppurative proximal nodes that will heal better after drainage.
- D.
Abscesses under 5 cm which are culture negative for MRSA do not need antibiotic treatment.
Correct Answer
D. Abscesses under 5 cm which are culture negative for MRSA do not need antibiotic treatment. -
- 19.
Vaginal bleeding in patients who are not pregnant may be due to:
- A.
Undiagnosed VonWillebrands disease
- B.
Anticoagulant use
- C.
DUB
- D.
Malignancy
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
The correct answer is "All of the above." Vaginal bleeding in patients who are not pregnant can be caused by various factors. Undiagnosed VonWillebrands disease is a hereditary bleeding disorder that affects the blood's ability to clot properly. Anticoagulant use, such as taking medications like aspirin or warfarin, can also lead to vaginal bleeding. DUB (dysfunctional uterine bleeding) refers to abnormal bleeding from the uterus that is not caused by any identifiable structural or hormonal abnormalities. Lastly, malignancy, such as cervical or endometrial cancer, can also cause vaginal bleeding. Therefore, all of these factors can contribute to vaginal bleeding in non-pregnant patients.Rate this question:
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- 20.
Which is NOT true of Intussusception?
- A.
Usually presents as continuous severe pain in children.
- B.
Caused significant third spacing due to mesenteric ischemia.
- C.
Can look like sepsis or meningitis.
- D.
Bowel necrosis causes the "current jelly stool".
Correct Answer
A. Usually presents as continuous severe pain in children.Explanation
Intussusception is a condition where a part of the intestine slides into an adjacent part, causing an obstruction. It commonly affects infants and young children. The given answer states that intussusception usually presents as continuous severe pain in children, which is not true. Intussusception typically presents with intermittent severe abdominal pain, often accompanied by drawing up the legs and crying. The pain may come and go in waves and is usually associated with episodes of vomiting. Therefore, the correct answer is that intussusception does not usually present as continuous severe pain in children.Rate this question:
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- 21.
Acute visual loss
- A.
Is almost always an emergency.
- B.
Can be caused by retinal detachment.
- C.
Can be caused by central retinal artery occlusion (CRAO).
- D.
All of the above.
Correct Answer
D. All of the above.Explanation
The correct answer is "All of the above" because acute visual loss can indeed be an emergency, as it may indicate a serious underlying condition that requires immediate medical attention. Additionally, it can be caused by retinal detachment, which occurs when the retina separates from the back of the eye, and central retinal artery occlusion (CRAO), which is a blockage of the main artery supplying blood to the retina. Therefore, all three options are valid explanations for acute visual loss.Rate this question:
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- 22.
Acute torticollis not associated with trauma
- A.
Always requires emergent imaging.
- B.
Can have the neurological exam deferred due to the pain the patient is in.
- C.
Is often a local muscular issue rather than a bony problem.
- D.
Should never be treated without a neurosurgical consult.
Correct Answer
C. Is often a local muscular issue rather than a bony problem.Explanation
Acute torticollis refers to a sudden onset of neck pain and stiffness, causing the head to tilt to one side. It is commonly caused by muscle spasms or strains rather than any underlying bone problem. This is why it is often considered a local muscular issue. The statement suggests that acute torticollis is not typically associated with trauma or any serious neurological condition. While emergent imaging may not always be necessary, it is important to evaluate the patient's neurological status. However, the pain experienced by the patient may make it difficult to perform a thorough neurological exam, so it can be deferred. Neurosurgical consultation is not always required for the treatment of acute torticollis.Rate this question:
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- 23.
Which is NOT true about acute traumatic neck pain?
- A.
May not be detected in a patient with other painful "distracting" injuries.
- B.
Must have a careful motor and sensory examination to rule out nerve root or spinal cord injury.
- C.
May require advanced imaging.
- D.
Should in general have a soft collar applied once an acute fracture is ruled out.
Correct Answer
D. Should in general have a soft collar applied once an acute fracture is ruled out.Explanation
The statement "Should in general have a soft collar applied once an acute fracture is ruled out" is not true about acute traumatic neck pain. Soft collar application is no longer recommended as a routine treatment for acute neck pain, as it may limit mobility and delay recovery. Instead, active movement and exercise are encouraged to promote healing and prevent further complications.Rate this question:
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- 24.
The following is NOT a life threatening infection requiring immediate surgical consultation and probable surgical intervention:
- A.
Necrotizing fasciitis
- B.
Cavernous sinus thrombosis
- C.
Compartment syndrome
- D.
Excessive Domino's pizza consumption by GoHeath staff
Correct Answer
D. Excessive Domino's pizza consumption by GoHeath staffExplanation
Excessive Domino's pizza consumption by GoHeath staff is not a life-threatening infection requiring immediate surgical consultation and probable surgical intervention. The other options, necrotizing fasciitis, cavernous sinus thrombosis, and compartment syndrome, are all serious medical conditions that can be life-threatening and require urgent medical attention. However, excessive pizza consumption does not fall into the category of a life-threatening infection or condition.Rate this question:
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- 25.
For the following five questions, choose the answer choice that best matches the term stated. Do not select the same answer choice twice.Question 1 of 5:Nursemaid's elbow
- A.
Vertebral fracture
- B.
$2M malpractice judgement against you
- C.
Axial traction
- D.
Avascular necrosis
- E.
Compartment syndrome
Correct Answer
C. Axial tractionExplanation
Axial traction is the best match for the term "Nursemaid's elbow" because it refers to a technique used to reduce the dislocation of the radial head in children. Nursemaid's elbow is a common injury in young children where the radial head becomes partially dislocated from the elbow joint. Axial traction involves applying gentle traction along the axis of the forearm to realign the radial head back into its proper position. This technique is often successful in reducing the dislocation and relieving the associated pain.Rate this question:
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- 26.
Question 2 of 5:Calcaneus fracture
- A.
Vertebral fracture
- B.
$2M malpractice judgement against you
- C.
Axial traction
- D.
Avascular necrosis
- E.
Compartment syndrome
Correct Answer
A. Vertebral fractureExplanation
The given answer, vertebral fracture, is the most likely explanation because it is listed among other medical terms related to fractures and injuries. The other options, such as calcaneus fracture, axial traction, avascular necrosis, and compartment syndrome, do not seem to fit the context of the question as they are not directly related to the topic of fractures. Therefore, vertebral fracture is the most appropriate answer based on the given information.Rate this question:
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- 27.
Question 3 of 5:"Neuro exam normal"
- A.
Vertebral fracture
- B.
$2M malpractice judgement against you
- C.
Axial traction
- D.
Avascular necrosis
- E.
Compartment syndrome
Correct Answer
B. $2M malpractice judgement against youExplanation
The given correct answer, "$2M malpractice judgement against you," suggests that the reason for a normal neuro exam could be a legal consequence rather than a medical condition. This implies that the individual might have been accused of malpractice, resulting in a large monetary judgement against them. The normal neuro exam could indicate that the individual's medical practice was not responsible for any harm or negligence in this particular case.Rate this question:
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- 28.
Question 4 of 5:Horrific pain
- A.
Vertebral fracture
- B.
$2M malpractice judgement against you
- C.
Axial traction
- D.
Avascular necrosis
- E.
Compartment syndrome
Correct Answer
E. Compartment syndromeExplanation
Compartment syndrome is a condition in which increased pressure within a muscle compartment impairs blood flow and causes severe pain. It can be caused by various factors, such as trauma or excessive exercise. The other terms mentioned in the question, such as vertebral fracture, malpractice judgement, axial traction, and avascular necrosis, do not directly relate to compartment syndrome. Therefore, compartment syndrome is the most appropriate answer in this context.Rate this question:
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- 29.
Question 5 of 5:Navicular fracture
- A.
Vertebral fracture
- B.
$2M malpractice judgement against you
- C.
Axial traction
- D.
Avascular necrosis
- E.
Compartment syndrome
Correct Answer
D. Avascular necrosisExplanation
Avascular necrosis is the death of bone tissue due to a lack of blood supply. This condition can occur in any bone, including the navicular bone in the foot. It is often caused by trauma or injury, such as a fracture or dislocation. Without proper blood flow, the bone tissue begins to deteriorate, leading to pain, stiffness, and potentially the collapse of the bone. Avascular necrosis can be a serious and debilitating condition that may require surgical intervention to alleviate symptoms and restore blood flow to the affected bone.Rate this question:
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