11-06-2009, 10:12 PM
30. A 20-year-old woman returns to the office for the results of her prenatal laboratory studies. By date of her last menstrual period she is 14 weeks pregnant with her second child. Her first pregnancy, which you followed, resulted in an uncomplicated vaginal delivery approximately 11 months ago. Her prenatal serology screening for syphilis is positive with a titer of 1:126, and a fluorescent treponemal antibody absorption (FTA-ABS) test is positive. The patient denies having lesions consistent with syphilis, and her current physical examination shows no lesions. Serology during her first pregnancy was negative. At this time, which of the following is the most appropriate management?
A) Do an amniocentesis to obtain fluid for darkfield evaluation
[B) Follow the treatment regimen recommended for primary or secondary syphilis]
C) Postpone treatment until the patient is at least 20 weeks pregnant
D) Schedule a lumbar puncture before instituting treatment
E) Withhold treatment until further studies rule out a biologic false-positive
32. A 25-year-old Latino man comes to the health center for a periodic health evaluation. He tells you that he has attended a day-treatment program for his schizophrenia, paranoid type, since his discharge from the hospital 1 year ago. The patient's most recent psychiatrist is moving away and he now wants you to refill his medications. He takes haloperidol, benztropine and valproic acid. He says, "The voices aren't telling me to harm myself anymore. And I know now that my food is not poisoned." The patient is 183 cm (6 ft) tall and weighs 86 kg (190 lb). Vital signs are: temperature 37.0°C (98.6°F), pulse 72/min, respirations 14/min and blood pressure 130/86 mm Hg. Physical examination is significant for darting and protruding movements of the tongue and some facial grimacing. Which of the following is the most appropriate change in pharmacotherapy?
A) Prescribe vitamin A
B) Increase the dose of benztropine
C) Increase the dose of haloperidol
[D) Replace haloperidol with risperidone]
E) Replace valproic acid with lithium
A) Do an amniocentesis to obtain fluid for darkfield evaluation
[B) Follow the treatment regimen recommended for primary or secondary syphilis]
C) Postpone treatment until the patient is at least 20 weeks pregnant
D) Schedule a lumbar puncture before instituting treatment
E) Withhold treatment until further studies rule out a biologic false-positive
32. A 25-year-old Latino man comes to the health center for a periodic health evaluation. He tells you that he has attended a day-treatment program for his schizophrenia, paranoid type, since his discharge from the hospital 1 year ago. The patient's most recent psychiatrist is moving away and he now wants you to refill his medications. He takes haloperidol, benztropine and valproic acid. He says, "The voices aren't telling me to harm myself anymore. And I know now that my food is not poisoned." The patient is 183 cm (6 ft) tall and weighs 86 kg (190 lb). Vital signs are: temperature 37.0°C (98.6°F), pulse 72/min, respirations 14/min and blood pressure 130/86 mm Hg. Physical examination is significant for darting and protruding movements of the tongue and some facial grimacing. Which of the following is the most appropriate change in pharmacotherapy?
A) Prescribe vitamin A
B) Increase the dose of benztropine
C) Increase the dose of haloperidol
[D) Replace haloperidol with risperidone]
E) Replace valproic acid with lithium