08-13-2010, 06:55 AM
32. One week after cholecystectomy for acute cholecystitis, a 57-year-old woman comes to the physician because of a 1-day history of abdominal cramps and watery, green, foul-smelling diarrhea. She finished a 7-day course of cefoxitin 3 days ago. She appears dehydrated. Her temperature is 39.8°C (103.6°F), pulse is 115/min, and blood pressure is 105/70 mm Hg. Abdominal examination shows moderate distention and diffuse tenderness, there is no guarding. Test of the stool for occult blood is positive, the stool contains leukocytes. Her hemoglobin level is 10.8 g/dL, and leukocyte count is 39,000/mm3. The patient is admitted to the hospital, and administration of intravenous fluids is begun. Which of the following is the most appropriate next step in pharmacotherapy?
O A) Intravenous amphotericin
O B) Intravenous ampicillin, clindamycin, and gentamicin
O C) Intravenous corticosteroids
O D) Oral diphenoxylate and atropine
0 E) Oral metronidazole
37. A 2-year-old girl is found floating facedown in a swimming pool. On rescue, she immediately coughs and breathes spontaneously. She is conscious and oriented. Without treatment, which of the following is the most likely outcome for this child?
A) Complete recovery
B) Development of acute respiratory distress syndrome
C) Hemolysis
D) Pulmonary hypertension
E) Severe neurologic deficit
42. Twelve days after sustaining a cerebral infarction, a 72-year-old man has fever and cough. Initial symptoms included inability to move his right arm and leg, swallow, speak, or respond to questions. He has been receiving a diet of pureed foods since he recovered his ability to swallow 3 days ago. He is wearing false teeth. His temperature now is 38.8°C (101.8°F), blood pressure is 135/85 mm Hg, pulse is 94/min, and respirations are 28/min. Examination shows moderate weakness of the facial muscles and right extremities. Gag reflex is absent. Breath sounds are decreased, and there is dullness to percussion over the right lung base posteriorly. An x-ray film of the chest shows an infiltrate in the posterior basal segment of the right lung. Which of the following is most likely to prevent recurrence of this patient's lung condition?
O A) Removal of false teeth
O B) Suppression of gastric acid production
O C) Chronic antibiotic prophylaxis
O D) Administration of metoclopramide to increase gastrointestinal motility
O E) Insertion of a feeding jejunostomy tube
36. A 42-year-old man with hypertension is brought to the emergency department 1 hour after the onset of chest discomfort, severe headache, irritability, and confusion. His blood pressure is 2201148 mm Hg. Examination shows papilledema. Urinalysis shows blood. An ECG shows ischemic changes with left ventricular hypertrophy. A CT scan of the head shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?
O A) Atenolol
O B) Captopril
O C) Diltiazem
O D) Furosemide
O E) Guanethidine
O F) Hydralazine
O G) Losartan
O H) Methyldopa
O I) Nitroprusside
O J) Prazosin
0 K) Thiazide diuretic
O A) Intravenous amphotericin
O B) Intravenous ampicillin, clindamycin, and gentamicin
O C) Intravenous corticosteroids
O D) Oral diphenoxylate and atropine
0 E) Oral metronidazole
37. A 2-year-old girl is found floating facedown in a swimming pool. On rescue, she immediately coughs and breathes spontaneously. She is conscious and oriented. Without treatment, which of the following is the most likely outcome for this child?
A) Complete recovery
B) Development of acute respiratory distress syndrome
C) Hemolysis
D) Pulmonary hypertension
E) Severe neurologic deficit
42. Twelve days after sustaining a cerebral infarction, a 72-year-old man has fever and cough. Initial symptoms included inability to move his right arm and leg, swallow, speak, or respond to questions. He has been receiving a diet of pureed foods since he recovered his ability to swallow 3 days ago. He is wearing false teeth. His temperature now is 38.8°C (101.8°F), blood pressure is 135/85 mm Hg, pulse is 94/min, and respirations are 28/min. Examination shows moderate weakness of the facial muscles and right extremities. Gag reflex is absent. Breath sounds are decreased, and there is dullness to percussion over the right lung base posteriorly. An x-ray film of the chest shows an infiltrate in the posterior basal segment of the right lung. Which of the following is most likely to prevent recurrence of this patient's lung condition?
O A) Removal of false teeth
O B) Suppression of gastric acid production
O C) Chronic antibiotic prophylaxis
O D) Administration of metoclopramide to increase gastrointestinal motility
O E) Insertion of a feeding jejunostomy tube
36. A 42-year-old man with hypertension is brought to the emergency department 1 hour after the onset of chest discomfort, severe headache, irritability, and confusion. His blood pressure is 2201148 mm Hg. Examination shows papilledema. Urinalysis shows blood. An ECG shows ischemic changes with left ventricular hypertrophy. A CT scan of the head shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?
O A) Atenolol
O B) Captopril
O C) Diltiazem
O D) Furosemide
O E) Guanethidine
O F) Hydralazine
O G) Losartan
O H) Methyldopa
O I) Nitroprusside
O J) Prazosin
0 K) Thiazide diuretic