Gohealth Providers Escalation Guidelines Review

29 Questions | Total Attempts: 66

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Gohealth Providers Escalation Guidelines Review

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Questions and Answers
  • 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.

  • 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.

  • 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.

  • 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).

  • 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.

  • 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

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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

  • 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.

  • 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.

  • 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.

  • 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

  • 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".

  • 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.

  • 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.

  • 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.

  • 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

  • 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

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