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Quiz Session - Attempts With Random Questions

BCEN CEN Exam Questions

Page 4 of 50

61.

A 42-year-old male patient arrives at the emergency department with burns to his entire trunk and left arm. Using the Rule of Nines, what is the extent of his burns?

  • 45%

  • 27%

  • 18%

  • 40%

Correct answer: 45%

The Rule of Nines is a method used to estimate the Total Body Surface Area (TBSA) affected by burns. For adults, the trunk is considered 36% (18% for the anterior trunk and 18% for the posterior trunk) and each arm is 9% (4.5% for the anterior arm and 4.5% for the posterior arm). 

Therefore, an adult male patient with burns to his entire trunk (36%) and left arm (9%) has a total burn injury extent of 45% of his TBSA.

62.

In regard to osteoporosis, which of the following statements is FALSE?

  • It is more common in males than in females

  • It is more common in individuals with small and thin frames

  • It is more common in individuals who have a family history of osteoporosis

  • It is more common in individuals who have low calcium and vitamin D intake

Correct answer: It is more common in males than in females

Osteoporosis, characterized by significant bone loss that raises the likelihood of fractures, is a major contributor to morbidity and mortality in postmenopausal women and older men alike. The two primary risk factors for fractures in both genders are advanced age and reduced bone mineral density. However, this condition is more commonly observed in women than in men. Alendronate and risedronate are typically the first-choice treatments for individuals diagnosed with osteoporosis.

63.

A 50-year-old male patient arrives at the emergency department with chest pain, and an Electrocardiogram (ECG) shows inverted T waves in leads II, III, and aVF. What should be the NEXT step in his management?

  • Obtain cardiac biomarkers

  • Administer magnesium sulfate

  • Initiate fluid resuscitation

  • Perform a pericardiocentesis

Correct answer: Obtain cardiac biomarkers

Inverted T waves in the inferior leads (II, III, and aVF) can indicate myocardial ischemia or infarction. You should obtain cardiac biomarkers (like troponin) to confirm the diagnosis of myocardial infarction and assess the extent of cardiac injury. Cardiac biomarkers are essential in diagnosing Acute Coronary Syndromes (ACS), including unstable angina and myocardial infarction, as they provide information about cardiac muscle damage.

Magnesium sulfate is used primarily for treating torsades de pointes and not for initial management of suspected myocardial infarction. Fluid resuscitation is generally reserved for patients in shock or those with significant volume loss, which is not indicated by inverted T waves alone. A pericardiocentesis is indicated in cases of cardiac tamponade, which would present with different clinical signs, such as muffled heart sounds, hypotension, and jugular venous distension.

64.

A 17-year-old male presents to the emergency department with severe, sudden onset of right testicular pain that started two hours ago. He also reports nausea and denies any recent trauma to the groin. Which of the following findings on physical examination is MOST suggestive of testicular torsion in this patient? 

  • High-riding testicle with an abnormal longitudinal lie

  • Positive Prehn's sign

  • Tenderness localized to the superior aspect of the testicle

  • Increased pain with elevation of the scrotum

Correct answer: High-riding testicle with an abnormal longitudinal lie

Testicular torsion is an urgent medical emergency in urology characterized by the rotation of a testicle, leading to the twisting of the spermatic cord which supplies blood to the scrotum. This restriction of blood flow results in abrupt and frequently intense pain and swelling. While it predominantly affects adolescents, testicular torsion can happen at any life stage, including prenatally.

A high-riding or horizontal testicle is characteristic of testicular torsion, as the spermatic cord twist can lead to elevation of the testicle and an abnormal position. Prehn's sign, where pain decreases with elevation of the scrotum, is more commonly associated with epididymitis, not torsion. Tenderness localized to the superior aspect of the testicle can be seen in various conditions, including epididymitis, and is not as specific for torsion. Increased pain with elevation of the scrotum is actually a misunderstanding of Prehn's sign, which is supposed to indicate relief of pain with elevation, not an increase. Moreover, Prehn's sign is associated with epididymitis rather than torsion.

Treatment requires emergency surgery to untwist the spermatic cord and restore blood flow to the testicle. If performed within a few hours of symptom onset, the testicle can usually be saved, but the chances of success decrease significantly as time passes. If the testicle is necrotic (dead due to lack of blood flow), it might need to be removed.

65.

What class of hemorrhagic shock does a patient with slight anxiety, normal blood pressure, and cool, pink skin have?

  • Class I

  • Class II

  • Class III

  • Class IV

Correct answer: Class I

A patient with class I hemorrhagic shock has cool pink skin, feels slightly anxious, and has normal blood pressure. Patients with class II hemorrhagic shock have cool pale skin, feel mildly anxious, and have normal blood pressure. Patients with class III hemorrhagic shock have skin that is cold, moist and pale. They are anxious or confused and have decreased blood pressure. Patients with class IV hemorrhagic shock have cold, clammy, and cyanotic skin. They are confused and lethargic and have decreased blood pressure.

66.

A 40-year-old male presents to the emergency department with anterior epistaxis. Which of the following is the FIRST step in managing this patient's condition?

  • Application of topical oxymetazoline

  • Place a balloon catheter 

  • Chemical cautery with silver nitrate sticks 

  • Anterior nasal packing with antibiotics

Correct answer: Application of topical oxymetazoline

The first step in managing anterior epistaxis, or nasal hemorrhage, is the application of a topical vasoconstrictor (i.e., oxymetazoline) to reduce blood flow to the area and facilitate clotting. Nasal packing and cauterization are subsequent steps if initial measures like compression and vasoconstrictors fail. Antibiotics are not typically used in initial management unless there's a specific indication, such as a sinus infection contributing to epistaxis or, in the case of prolonged packing, to prevent infection. An epistaxis balloon catheter is an appropriate intervention for a posterior nosebleed, not an anterior one. 

67.

A three-year-old male patient with a Ventriculoperitoneal (VP) shunt presents to the emergency department with increasing lethargy, vomiting, and a decreased appetite. Which of the following findings is MOST consistent with VP shunt malfunction?

  • Irritability

  • Hypothermia 

  • Hypotension

  • Bradycardia 

Correct answer: Irritability 

Irritability is most consistent with a VP shunt malfunction, often indicating increased Intracranial Pressure (ICP). It commonly accompanies symptoms like lethargy and vomiting in such cases.

Hypothermia is not related to VP shunt malfunction and usually indicates other systemic or environmental issues. Hypotension is not a direct symptom of shunt malfunction. It could be seen in shock or severe dehydration, but it is not a typical presentation of increased ICP. Bradycardia is not typically associated with shunt malfunction; instead, it might be seen in late stages of increased ICP as a part of Cushing's triad.

68.

Which of the following conditions is MOST likely to cause acute azotemia?

  • Acute kidney injury

  • Liver failure

  • Diabetic ketoacidosis

  • Chronic renal failure

Correct answer: Acute kidney injury

Azotemia is the buildup of nitrogenous products in the blood, typically due to poor or absent kidney function. Acute kidney injury can result in azotemia. 

Chronic renal failure is unlikely to cause acute azotemia except in noncompliance with treatments. Liver failure and Diabetic Ketoacidosis (DKA) are not likely to cause azotemia.

69.

Which of the following values represents normal intraocular pressure?

  • 16 mmHg

  • 8 mmHg

  • 24 mmHg

  • 32 mmHg

Correct answer: 16 mmHg

Normal Intraocular Pressure (IOP) typically ranges from 10 to 21 mmHg. Values outside this range may indicate various ocular conditions:

  • Elevated IOP may suggest glaucoma, a condition in which increased pressure can damage the optic nerve.
  • Low IOP could be associated with conditions like globe rupture or ocular hypotony, which can occur after eye surgery or injury.

Regular eye exams are crucial for monitoring IOP and ensuring ocular health.

70.

Which of the following BEST describes the obligation that healthcare professionals have regarding diversity?

  • Respecting and addressing issues of diversity

  • Accepting all kinds of diversity, even if it creates potential safety issues during care

  • Avoiding drawing attention to areas of diversity

  • Asking questions that challenge views conflicting with mainstream healthcare

Correct answer: Respecting and addressing issues of diversity

Healthcare professionals have the obligation to respect diversity and address any issues that arise from it. Accepting all kinds of diversity, even if it creates potential safety issues during care, is not an obligation healthcare professionals face. Diversity that leads to potential safety issues should be respected to the greatest extent possible, but in a way that ensures safety is maintained. Avoiding drawing attention to areas of diversity is not an appropriate response. Healthcare professionals should explore views conflicting with mainstream healthcare but should not challenge diverse views unless they present a safety issue.

71.

A 68-year-old male with a history of Ventricular Tachycardia (VT) and Implanted Cardioverter Defibrillator (ICD) placement presents to the emergency department with complaints of his ICD firing three times in the last 24 hours. 

Which of the following initial interventions would be MOST appropriate?

  • Tape a magnet over the ICD to prevent firing and monitor with external defibrillation pads in place

  • Instruct the patient to call the device representative

  • Recommend the patient be transcutaneously paced

  • Place external defibrillation pads a minimum of 5 cm from the ICD

Correct answer: Tape a magnet over the ICD to prevent firing and monitor with external defibrillation pads in place

ICDs are the standard of care for many cardiovascular conditions, including Long QT Syndrome (LQTS), ventricular dysrhythmias, and advanced heart failure or cardiomyopathy, for which it is needed for ventricular resynchronization.

One of the most common reasons patients visit an emergency department for their ICD is firing of the device. It is important to determine whether firing was appropriate to terminate a dysrhythmia or it was inappropriate because it was caused by a malfunction or low battery.

The most appropriate initial interventions include taping a magnet over the ICD to prevent firing and monitoring with external defibrillation pads in place. The pads should be placed about 10 cm from the ICD to reduce the risk of damaging the device. You should also obtain the patient's ICD information card and then contact the device representative to request an interrogation of the ICD and obtain rhythm/shock history. If the patient was symptomatic upon arrival, it would be appropriate to manage chest pain as you would in any other patient with ischemic chest pain.

Transcutaneous pacing is not the most appropriate initial intervention unless further identification of a rhythm warrants it.

72.

What is the MOST important initial step in management when an inhalation injury is identified in a patient exposed to smoke from a fire?

  • Initiate high-flow oxygen therapy

  • Administer intravenous antibiotics

  • Perform immediate tracheostomy

  • Administer systemic corticosteroids

Correct answer: Initiate high-flow oxygen therapy

The primary concern with inhalation injuries is ensuring adequate oxygenation, as these injuries can compromise breathing. High-flow oxygen therapy helps support oxygen levels while further assessment and treatment are conducted. 

While antibiotics might be necessary later to prevent or treat infections secondary to the injury, they are not the first step in managing an acute inhalation injury. A tracheostomy might be necessary in severe cases when airway swelling obstructs breathing, but it is not the initial step before assessing the need for such an invasive procedure. Systemic corticosteroids are used in some cases to reduce inflammation, but their use is controversial and is not considered the first step in treatment.

73.

Which of the following conditions is LEAST likely to cause noncardiogenic pulmonary edema?

  • Acute decompensated heart failure

  • Submersion injury

  • Heroin overdose

  • Kidney failure

Correct answer: Acute decompensated heart failure

Noncardiogenic pulmonary edema is defined as the buildup of fluid in the extravascular spaces of the lungs. The classification of pulmonary edema as cardiogenic or noncardiogenic depends on its underlying cause.

Acute decompensated heart failure is the most frequent cause of cardiogenic pulmonary edema. On the other hand, noncardiogenic pulmonary edema can result from various conditions such as Acute Respiratory Distress Syndrome (ARDS), kidney failure, submersion injury, head trauma or seizures, rapidly re-expanding lung, high-altitude pulmonary edema, and toxic gas inhalation as well as overdoses of heroin, cocaine, or methadone.

74.

Which of the following statements made by a patient would NOT support a diagnosis of major depression?

  • "I have been eating less recently, but my weight has stayed the same."

  • "I feel exhausted all the time."

  • "I have been sleeping a lot less than normal."

  • "I have been sleeping a lot more than normal."

Correct answer: "I have been eating less recently, but my weight has stayed the same."

Major depression is diagnosed when at least five of the following are present for at least two weeks:

  • Loss of interest in usual activities
  • Depressed mood
  • Appetite changes with weight change
  • Insomnia or hypersomnia
  • Fatigue
  • Psychomotor agitation or retardation
  • Decreased ability to think
  • Recurrent thoughts of death
  • Feelings of worthlessness

Both insomnia and hypersomnia are potential symptoms of major depression, as is fatigue. Appetite changes must affect weight to be used to diagnose major depression.

75.

If a patient getting a blood transfusion immediately exhibits an anaphylactic reaction, what should you do?

  • Stop the transfusion, keep the vein open using saline, and notify the physician and the blood bank

  • Closely monitor urine output and hemoglobin

  • Stop the transfusion and administer oxygen

  • Stop the transfusion and obtain cultures of the patient's blood to send to the blood bank, along with the remaining transfusion blood

Correct answer: Stop the transfusion, keep the vein open using saline, and notify the physician and the blood bank

An anaphylactic transfusion reaction is a severe, potentially life-threatening allergic reaction that occurs during or shortly after a blood transfusion. It is one of the most serious types of transfusion reactions and requires immediate medical intervention. If this occurs, discontinue the transfusion immediately and keep the IV line open with normal saline to maintain venous access. Notify the physician and the blood bank. Ensure the patient has a clear airway and administer supplemental oxygen as necessary. Intramuscular (IM) injection of epinephrine is the first-line treatment. 

For a sepsis transfusion reaction, stop the transfusion and obtain cultures of the patient's blood, then send it to the blood bank, along with the remaining transfusion blood. For symptoms of a noncardiac pulmonary edema transfusion reaction, stop the transfusion and administer oxygen. For a delayed hemolytic transfusion reaction, monitor urine output and hemoglobin.

76.

Which of the following statements about rabies is TRUE?

 

  • Most human incidents of rabies are the result of exposure to wildlife

  • Postexposure vaccination is ineffective

  • Rabies is rarely fatal in humans

  • Rabies is transmitted through the infected blood of a mammal

Correct answer: Most human incidents of rabies are the result of exposure to wildlife

Currently, rabies among dogs has been eliminated in the United States. Most human incidents are the result of exposure to wildlife, including bats, raccoons, skunks, and foxes. Rabies is transmitted through the saliva of an infected mammal.  Once rabies has infected a human, it is almost always fatal. Additionally, postexposure prophylaxis is critical. The rabies vaccine provides rapid, passive immunity and has been shown to produce antibodies within seven to ten days.

77.

In regard to suicide, which of the following statements is FALSE?

  • Suicidal thoughts are always conscious thoughts

  • Individuals who die by suicide may have a family history of suicide

  • Substance abuse is sometimes a factor of suicide

  • Suicide can be either premeditated or impulsive

Correct answer: Suicidal thoughts are always conscious thoughts

Suicide occurs when an individual willingly takes their own life. Suicidal thoughts are not always conscious; they can also be unconscious. It is true that suicide can be either premeditated or impulsive. Substance abuse is sometimes a factor of suicide, and individuals who die by suicide may have a family history of suicide.

78.

What percussion tone would you MOST likely hear in normal lungs?

  • Resonant

  • Flat

  • Dull

  • Hyperresonant

Correct answer: Resonant

The percussion tone you would most likely hear in normal lung tissue is resonant. A resonant percussion tone has a medium intensity, low pitch, long duration, and hollow quality.

Hyperresonant is the percussion tone that is generally heard in hyperinflated lungs. The dull percussion tone is generally heard in the liver, spleen, or heart. The flat percussion tone is generally heard in muscle or bone.

79.

Which of the following BEST describes the function of cryoprecipitate (a blood product)? 

  • It replaces clotting factors

  • It expands blood volume

  • It restores oxygen-carrying capacity

  • It corrects low platelet levels

Correct answer: It replaces clotting factors

Cryoprecipitate is the blood product that replaces clotting factors. It is the most common replacement for fibrinogen and is indicated in patients who are acutely bleeding or at high risk for bleeding. It may also be used to treat factor deficiencies when factor concentrates are not readily available. 

Platelets are the blood products used to correct low platelet levels. Packed red blood cells and whole blood are the blood products that restore oxygen-carrying capacity. Fresh frozen plasma, albumin, and plasma protein fraction are the blood products that expand blood volume.

80.

A patient presents complaining of hearing difficulties. You explain the anatomy of the ear to the patient, detailing how sound waves travel through different parts of the ear.

Which structure does NOT transmit sound waves from the middle ear to the inner ear?

  • Pinna

  • Malleus

  • Incus

  • Stapes

Correct answer: Pinna

The pinna, or auricle, is a component of the outer ear and is not involved in the transmission of sound waves from the middle ear to the inner ear. Its primary role is to capture sound waves and direct them into the ear canal toward the eardrum.

On the other hand, the malleus, incus, and stapes, which are small bones in the middle ear collectively referred to as the ossicles, play a vital role in transmitting sound vibrations from the eardrum to the inner ear.

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