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+--- Thread: swaspraswaas - ingoditrust (/showthread.php?tid=538805)
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swaspraswaas - ingoditrust - ArchivalUser - 10-06-2010
A 13-year-old boy is brought to the emergency department because of shortness of breath. He has a medical history significant for asthma and he has been admitted to the hospital several times in the past, most recently 3 months ago when he needed to be intubated for extreme respiratory distress. He lives at home with his mother and 2 cats. His medications include albuterol, ipatroprium, and steroid inhalers. As you approach him you notice that he is using all accessory muscles of respiration and you hear audible wheezing. His temperature is 37.0 C (98.6 F), blood pressure is 122/68 mmHg, pulse is 102/min, and his respiratory rate is 34/min. His oxygen saturation on room air is 94%. Physical examination is significant for diffuse expiratory wheezes. The factor in this patient's history that constitutes a predictor of poor outcome with respect to his risk for morbidity from his asthma is
A. age
B. history of having a pet
C. history of living in a single parent household
D. history of previous intubation
E. sex
0 - ArchivalUser - 10-06-2010
An 80-year-old male is admitted to your inpatient medical service with a presumed aspiration pneumonia. He has a medical history significant for chronic renal failure, hypertension, aspiration pneumonias, and Alzheimer's disease. His medications include furosemide, thiamine, and folate. He has a history of alcohol abuse in the past and currently is a nursing home resident. He is a cachectic old man who is confused, which you are told is his baseline mental status. He has a nasogastric tube in place, which has been used for tube feeds. His temperature is 37.8 C (100 F), blood pressure is 122/67 mm Hg, heart rate is 98/min, respiratory rate is 23/min, and his room air oxygen saturation is 97%. He has decreased breath sounds in his right lower lung field and his cardiac examination is unremarkable. A chest radiograph shows a right lower lobe consolidation, consistent with pneumonia. While reviewing his medical records, you notice that this patient has been admitted for aspiration 4 times over the past 12 months. The intervention that could be instituted to reduce his risk of aspiration pneumonia in the future is to
A. change his nasogastric tube to a feeding tube placed via a nasogastric route
B. change his nasogastric tube to a percutaneous gastrostomy tube
C. change his nasogastric tube to a percutaneous jejunostomy tube
D. change his nasogastric tube to an open (surgically placed) gastrostomy tube
E. elevate the head of his bed
0 - ArchivalUser - 10-06-2010
A 72-year-old woman with a 6-month history of non-small cell lung cancer comes to the office because of neck and facial swelling. She denies any shortness of breath or hemoptysis. Physical examination shows dilated neck veins and edema of the face and right arm. A CT scan of the chest shows a right paratracheal mass with diminished opacification of the central venous structures. The most appropriate next step in the management of this patient is to
A. administer dexamethasone every 6 hours
B. begin chemotherapy
C. biopsy the mass
D. give her intravenous morphine
E. recommend radiation therapy
( Hint: A similar question posted a few days back had answers as FNA of the node...)
0 - ArchivalUser - 10-06-2010
A 34-year-old airline pilot is admitted to the hospital with a first episode of a spontaneous pneumothorax. The pneumothorax resolved after 2 days of pleural decompression by a chest tube. A chest x-ray shows complete resolution of the pneumothorax, and a CT scan of the chest shows an apical bulla in the right lung. While discussing further management of his condition, it is appropriate to advise the patient to
A. avoid flying until after bullectomy
B. carry oxygen with him during the flight
C. change his career
D. quit smoking
E. resume his duties after 1 week of rest
0 - ArchivalUser - 10-06-2010
D,C,E,A
0 - ArchivalUser - 10-06-2010
An 83-year-old female nursing home patient is brought to the emergency department after she is found down on her bedroom floor next to her walker. The nursing home staff reports that she appeared confused and disoriented. The patient suffered an embolic stroke 2 years ago, leaving her with residual dysarthria. The patient appears mildly dyspneic and cannot appropriately follow commands. Her temperature is 39.8 C (103.6 F), blood pressure is 110/70 mm Hg, and pulse is 70/min. Laboratory studies show a leukocyte count of 17,000/mm3. A chest x-ray shows a right lower lobe infiltrate. Gram stain of a sputum sample shows many neutrophils and Gram-negative rods. The most appropriate pharmacotherapy is
A. cefuroxime
B. clindamycin
C. erythromycin
D. levofloxacin
E. penicillin G
0 - ArchivalUser - 10-06-2010
Ans: D, D, A, A, B
0 - ArchivalUser - 10-06-2010
ANS: B, IN An 83-year-old female
0 - ArchivalUser - 10-06-2010
D C C A B
0 - ArchivalUser - 10-06-2010
1-D
2-E
3-E
4-A
5-D