06-01-2009, 07:34 AM
20. Six hours after undergoing surgical excision of the distal colon for cancer, a 77-year-old man has decreased urine output. His urine output has been 10 mUh during the past 3 hours. During the 4-hour operation, he lost 500 mL of blood and underwent transfusion of 1 unit of packed red blood cells. His initial postoperative course was uncomplicated. Two years ago. he had a myocardial infarction and underwent coronary artery bypass grafting. He has a 10-year history of hypertension well controlled with atenolol. Current medications include morphine and labetalol. He currently appears pale and diaphoretic. His temperature is 37°C (98.6°F). pulse is85/min, respirations are 14/min, and blood pressure is 90/60 mm Hg. Pulse oximetry on 2 L/min of oxygen via nasal cannula shows an oxygen saturation of 89%. Cardiopulmonary examination shows no abnormalities. The abdomen is nondistended with mild tenderness overthe incision. His hematocrit is 24%. serum sodium concentration is 140 mEq/l_. and serum creatinine concentration is 2.1 mg/dL. The patient is switched to administration of 100% oxygen by a nonrebreathing face mask The most appropriate next step in management is administration of which of the following?
O A) Bumetanide
o B) 5% Dextrose in water
O C) Fresh frozen plasma
O D) Furosemide
O E) Packed red blood cells
O F) 0.45% Saline
>>I guess he is only dehydrated with oligouria? Then how come the choice do not provide 0.9% NS??
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23. A 25-year-old woman comes to the physician because of a 1-month history of severe headaches. During this period, she has missed several days of work because ofthe pain. She has a 10-year history of intermittent headaches that are responsive to treatment with naproxen. She has major depressive disorder treated with fluoxetine. She
appears uncomfortable. She is 160 cm (5 ft 3 in) tall and weighs 50 kg (110 lb); BMI is 20 kg/m Funduscopic examination shows bilateral papilledema. The pupils are 5 mm and reactive to light. The remainder ofthe neurologic examination shows no abnormalities. An MRIofthe brain is shown. Which of the following is the most likely cause of these findings?
O A) Idiopathic intracranial hypertension
o B) Impaired resorption of cerebrospinal fluid (CSF)
O C) Infection ofthe CSF
O D) Obstruction ofthe ventricular system
O E) Overproduction of CSF
>> I was wondering if this is ependymoma and thus I chose E..... but the answer key is D...
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30. A 17-year-old boy is brought to the emergency department by his parents because they were informed by his school counselor that he wants to commit suicide. Last week he broke up with his girlfriend of 2 years, and today he learned that he did not get accepted to his university of choice. On questioning, he says that he is sad and admits that he had spoken ofsuicidetoafriend but states that he does not want to hurt himself because of religious beliefs. "My family would be hurt, too," he states. He has no history of medical or psychiatric illness and takes no medications. He does not smoke cigarettes or drink alcohol. Physical examination shows no abnormalities. On mental status examination, he is cooperative and makes good eye contact. In addition to recommending outpatient therapy, which of the following is the most appropriate physician recommendation to this patient's parents?
O A) "Dont make him go to school until he feels better. He can't concentrate in his present state of mind."
O B) "Let him rest and spend time alone. He needs space to think."
O C) "Make sure he does not have access to guns."
o D) "Perhaps you should invite his ex-girlfriend overto cheer him up."
O E) "Pray with him daily. Religion is an important protective factor."
Why is it E but not C?
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38. An 87-year-old woman who is a resident of a skilled nursing care facility is brought to the physician by staff because offeverfoM day. A urinary catheter was placed 2 weeks ago because of urinary incontinence. She has dementia. Alzheimertype. and is unable to communicate verbally. Her temperature is 37.8°C (100°F), pulse is 86/min, respirations are 14/min, and blood pressure is 12D/74 mm Hg. Mucous membranes are moist and pinK. Urinalysis shows:
Color cloudy brown
PH 8.8
Blood 2+
Glucose negative
Protein 2+
RBC too numerous to count
WBC 20-25/hpf
Nitrites 3+
Leukocyte esterase 3+
Bacteria many
A Gram stain of urine shows gram-negative bacilli. Which of the following measures is most likely to have prevented this patient's current condition?
O A) Use of incontinence briefs instead of the catheter
O B) Changing the catheter daily
O C) Cleaning the urethral orifice with povidone-iodine daily
O D) Flushing the catheter with an antibiotic solution daily
O E) Oral antibiotic prophylaxis
O F) Oral oxybutynin therapy
This may be an easy question for other board members, but I just have no clue.... When do we use oral antibiotic prophylaxis in UTI?? I picked incontinence briefs, but I am not sure what an incontinence brief is...
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43. A 16-year-old girl comes to the physician because of painful genital lesions for 2 days. Over the past 6 months, she has been sexually active with five male partners; she last had sexual intercourse 2 weeks ago. As far as she knows, her sexual partners have not had similar symptoms. Examination shows two 3 x3-mm ulcerated lesions on the anteri or vagi nal vault. She currently has a new boyfri end with whom she has not had sexual i ntercourse and would li ke to know the best way to prevent transmi ssi on of her infection. Which of the following is the most appropriate strategyto prevent transmission?
o A) Use of condoms when lesions are present
O B) Consistent condom use
O C) Acyclovir therapy for the patient far 7 days
O D) Penicillin therapy for the patient for 3 weeks
O E) Prophylactic acyclovir t
I am not certain about this diagnosis either. Can someone kindly help with this one? If this is Herpes, can consistent condom use help prevent transmission????
Many questions and many thanks............
A clueless man.
O A) Bumetanide
o B) 5% Dextrose in water
O C) Fresh frozen plasma
O D) Furosemide
O E) Packed red blood cells
O F) 0.45% Saline
>>I guess he is only dehydrated with oligouria? Then how come the choice do not provide 0.9% NS??
===============================
23. A 25-year-old woman comes to the physician because of a 1-month history of severe headaches. During this period, she has missed several days of work because ofthe pain. She has a 10-year history of intermittent headaches that are responsive to treatment with naproxen. She has major depressive disorder treated with fluoxetine. She
appears uncomfortable. She is 160 cm (5 ft 3 in) tall and weighs 50 kg (110 lb); BMI is 20 kg/m Funduscopic examination shows bilateral papilledema. The pupils are 5 mm and reactive to light. The remainder ofthe neurologic examination shows no abnormalities. An MRIofthe brain is shown. Which of the following is the most likely cause of these findings?
O A) Idiopathic intracranial hypertension
o B) Impaired resorption of cerebrospinal fluid (CSF)
O C) Infection ofthe CSF
O D) Obstruction ofthe ventricular system
O E) Overproduction of CSF
>> I was wondering if this is ependymoma and thus I chose E..... but the answer key is D...
===============================
30. A 17-year-old boy is brought to the emergency department by his parents because they were informed by his school counselor that he wants to commit suicide. Last week he broke up with his girlfriend of 2 years, and today he learned that he did not get accepted to his university of choice. On questioning, he says that he is sad and admits that he had spoken ofsuicidetoafriend but states that he does not want to hurt himself because of religious beliefs. "My family would be hurt, too," he states. He has no history of medical or psychiatric illness and takes no medications. He does not smoke cigarettes or drink alcohol. Physical examination shows no abnormalities. On mental status examination, he is cooperative and makes good eye contact. In addition to recommending outpatient therapy, which of the following is the most appropriate physician recommendation to this patient's parents?
O A) "Dont make him go to school until he feels better. He can't concentrate in his present state of mind."
O B) "Let him rest and spend time alone. He needs space to think."
O C) "Make sure he does not have access to guns."
o D) "Perhaps you should invite his ex-girlfriend overto cheer him up."
O E) "Pray with him daily. Religion is an important protective factor."
Why is it E but not C?
===============================
38. An 87-year-old woman who is a resident of a skilled nursing care facility is brought to the physician by staff because offeverfoM day. A urinary catheter was placed 2 weeks ago because of urinary incontinence. She has dementia. Alzheimertype. and is unable to communicate verbally. Her temperature is 37.8°C (100°F), pulse is 86/min, respirations are 14/min, and blood pressure is 12D/74 mm Hg. Mucous membranes are moist and pinK. Urinalysis shows:
Color cloudy brown
PH 8.8
Blood 2+
Glucose negative
Protein 2+
RBC too numerous to count
WBC 20-25/hpf
Nitrites 3+
Leukocyte esterase 3+
Bacteria many
A Gram stain of urine shows gram-negative bacilli. Which of the following measures is most likely to have prevented this patient's current condition?
O A) Use of incontinence briefs instead of the catheter
O B) Changing the catheter daily
O C) Cleaning the urethral orifice with povidone-iodine daily
O D) Flushing the catheter with an antibiotic solution daily
O E) Oral antibiotic prophylaxis
O F) Oral oxybutynin therapy
This may be an easy question for other board members, but I just have no clue.... When do we use oral antibiotic prophylaxis in UTI?? I picked incontinence briefs, but I am not sure what an incontinence brief is...
===============================
43. A 16-year-old girl comes to the physician because of painful genital lesions for 2 days. Over the past 6 months, she has been sexually active with five male partners; she last had sexual intercourse 2 weeks ago. As far as she knows, her sexual partners have not had similar symptoms. Examination shows two 3 x3-mm ulcerated lesions on the anteri or vagi nal vault. She currently has a new boyfri end with whom she has not had sexual i ntercourse and would li ke to know the best way to prevent transmi ssi on of her infection. Which of the following is the most appropriate strategyto prevent transmission?
o A) Use of condoms when lesions are present
O B) Consistent condom use
O C) Acyclovir therapy for the patient far 7 days
O D) Penicillin therapy for the patient for 3 weeks
O E) Prophylactic acyclovir t
I am not certain about this diagnosis either. Can someone kindly help with this one? If this is Herpes, can consistent condom use help prevent transmission????
Many questions and many thanks............
A clueless man.