08-12-2014, 05:59 PM
1. An 82-year-old man is brought by his wife to the office for an urgent appointment. He has chronic obstructive pulmonary disease, prostatic hyperplasia, and arthritis. The wife tells you that this morning she found him slumped over the breakfast table. He was minimally responsive for several seconds and then fell to the floor, after which he immedicately regained full consciousness. This type of episode has never happened before. The patient now feels well. Vital signs are pulse 80/min and blood pressure 130/80 mm Hg. Physical examination is normal. ECG shows evidence of trifascicular heart block (first-degree AV block,left anterior hemiblock and right bundle-branch block). You arrange for the patient to be admitted to the telemetry unit of the hospital. Which of the following is the most accurate statement concerning this patient?
A) He has had a mild stroke; the ECG abnormatlities are normal for his age
B) he will be evaluated for open heart surgery
C) He will require a pace maker
D) If he has no periods of irregular beats he can be discharged in 24 hours
E) Medications are available to correct the ECG changes
2. A 16-year-old African American boy who has been your patient since birth comes to the office because of back pain. He has sickle cell disease, and he has a history of multiple hospital admissions for vaso-occlusive crises, fever and suspected sepsis. Current medications include daily penicillin and folic acid. Today he states that he is seldom free of discomfort, that the pain is worse in the morning, and that it is exacerbated by long periods of inactivity. He rates his pain as a 3/10. He says the pain does not limit his daily activities but it is almost always present and is causing him to be short-tempered with family and peers. Vital signs are T 37.0 C, pulse 70/min, respirations 14/min, and blood pressure 118/74 mm Hg. PE is remarkable for tenderness over the back at approximately the level of T8 and there is some limitationof flexion. Which of the following is the most appropriate pharmacotherapy at this time?
A) Amitriptyline
B) Carbamazepine
C) Codeine
D) Ibuprofen
E) Meperidine
Thanks
A) He has had a mild stroke; the ECG abnormatlities are normal for his age
B) he will be evaluated for open heart surgery
C) He will require a pace maker
D) If he has no periods of irregular beats he can be discharged in 24 hours
E) Medications are available to correct the ECG changes
2. A 16-year-old African American boy who has been your patient since birth comes to the office because of back pain. He has sickle cell disease, and he has a history of multiple hospital admissions for vaso-occlusive crises, fever and suspected sepsis. Current medications include daily penicillin and folic acid. Today he states that he is seldom free of discomfort, that the pain is worse in the morning, and that it is exacerbated by long periods of inactivity. He rates his pain as a 3/10. He says the pain does not limit his daily activities but it is almost always present and is causing him to be short-tempered with family and peers. Vital signs are T 37.0 C, pulse 70/min, respirations 14/min, and blood pressure 118/74 mm Hg. PE is remarkable for tenderness over the back at approximately the level of T8 and there is some limitationof flexion. Which of the following is the most appropriate pharmacotherapy at this time?
A) Amitriptyline
B) Carbamazepine
C) Codeine
D) Ibuprofen
E) Meperidine
Thanks