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+--- Thread: mcq thread of today - stefan78 (/showthread.php?tid=357556)
mcq thread of today - stefan78 - ArchivalUser - 11-06-2008
A 67-year-old man presents to your office complaining of severe shortness of breath and a cough. The
man is a long-time patient who you have been treating for chronic obstructive pulmonary disease
(COPD). He has a 120 pack-year smoking history. He was recently hospitalized for a flare of his COPD
and he has been intubated in the past for respiratory distress. His other medical history is notable for
diabetes mellitus and hypercholesterolemia. He reports to you that for the past 3 days he has
increasing dyspnea and a fever. He has gradually developed a cough. On examination, he is
moderately dyspneic at rest and has marked dyspnea on exertion. His blood pressure is 130/80 mm
Hg, heart rate is 78 /min, and respirations are 20 /min. The patient does not appear cyanotic. His lung
exam demonstrates a markedly prolonged expiratory time and diffusely diminished breath sounds. The
most appropriate intervention at this time is to
A. admit the patient to the hospital
B. obtain a chest radiograph and prescribe antibiotics if an infiltrate is present
C. prescribe oral cefuroxime and oral steroids
D. prescribe oral cefuroxime and see the patient in seven days
E. refer the patient to the local emergency department
0 - ArchivalUser - 11-06-2008
e...........................................
0 - ArchivalUser - 11-06-2008
ans is aaaaaaaaaaaaaaaaaaaaaaaaa
0 - ArchivalUser - 11-06-2008
A 87-year-old man with a long-standing history of smoking, chronic obstructive lung disease, peripheral vascular disease, and multiinfarct dementia is admitted to the hospital under your care for gangrenous involvement of the second and fourth toe of his right foot. An arteriogram shows that revascularization is not feasible. After extensive evaluation the surgeon recommends amputation below the knee. The patient is alert and oriented to person, place, and situation. He has some in short-term memory deficits and higher cognitive functions seem intact. You and the surgeon explain the situation to the patient, and despite his dementia, you both believe that he adequately understands the risks and benefits of the surgery. Another physician and nurse also witness the consent procedure and believe that the patient has full comprehension of the risks and benefits of the surgical procedure. However, the patient's son, who is the designated proxy in the patient's power of attorney health care documents, adamantly opposes any surgical intervention. He points out that the patient has indicated in the document that he would not like any aggressive measures to save his life. Despite detailed discussions and several family meetings, the son remains adamant about refraining from any surgical intervention. The most appropriate action is to
A. arrange for a psychiatry referral to assess patient's competency
B. ask the son to find other physicians to care for his father
C. consult your hospital attorney
D. discharge the patient form hospital
E. proceed with a below-the-knee amputation
0 - ArchivalUser - 11-06-2008
E...
0 - ArchivalUser - 11-06-2008
A 51-year old woman with systemic lupus erythematosus comes to the clinic with right hip pain for the past 3 days. She has no history of trauma. The patient has been postmenopausal for the past 3 years. She takes naproxen, ibuprofen, and prednisone 100 mg a day. She has been taking these medications for the past 10 years. She tells you that she stopped taking estrogen secondary to occasional nausea. Her temperature is 37.4 C (99.4 F). Physical examination reveals a butterfly facial rash, multiple swollen joints of the hands and feet, and a systolic flow murmur. A plain radiograph of the hip is normal. A bone scan reveals decreased 99Tc MDP tracer uptake in the right femoral head. The patient should be advised to
A. avoid weightbearing and immediately stop prednisone
B. avoid weightbearing and taper off prednisone
C. begin an exercise program and calcium supplementation
D. begin an exercise program and taper off prednisone
E. begin an exercise program, calcium supplementation, and estrogen replacement therapy
0 - ArchivalUser - 11-06-2008
bbb
0 - ArchivalUser - 11-06-2008
B...
0 - ArchivalUser - 11-06-2008
yes pindi u r right
0 - ArchivalUser - 11-06-2008
B. avoid weightbearing and taper off prednisone