Questions Flashcards
Vignette: You are the physician assistant on duty in the medical-surgical unit. A 65-year-old male patient with a history of hypertension and diabetes mellitus was admitted with chest pain. He underwent a coronary angiogram, which revealed a significant blockage in the left anterior descending artery, for which he underwent percutaneous coronary intervention (PCI) with stent placement. He is currently on dual antiplatelet therapy (aspirin and clopidogrel) and is being monitored closely. Today, the patient complains of black, tarry stools. What is your immediate action?
A. Administer a proton pump inhibitor (PPI).
B. Order a stool guaiac test.
C. Discontinue clopidogrel.
D. Initiate heparin therapy.
Why?
Order a stool guaiac test
The patient’s complaint of black, tarry stools (melena) is concerning for gastrointestinal bleeding, which could be a side effect of antiplatelet therapy (clopidogrel). Need to determine source of bleeding.
You are the PA on the cardiology team. A 70-year-old male patient was admitted for heart failure exacerbation. He has been receiving intravenous diuretics and his fluid balance has improved. However, today, he complains of severe muscle cramps and paresthesias in his extremities. His laboratory results show a potassium level of 2.8 mEq/L. What is your next step?
A. Increase the diuretic dose.
B. Administer oral potassium supplements.
C. Administer intravenous potassium replacement.
D. Discontinue diuretics.
Administer intravenous potassium replacement
You are working in the surgical intensive care unit (ICU). A 55-year-old female patient underwent abdominal surgery for bowel obstruction. She is now post-operative day 4 and has been intubated and ventilated. Today, her white blood cell count is elevated, and she has a fever of 101.5°F (38.6°C). Her chest X-ray shows infiltrates in both lung bases. What is the most likely diagnosis, and what is the initial management?
A. Hospital-acquired pneumonia; initiate broad-spectrum antibiotics.
B. Aspiration pneumonitis; perform bronchoscopy.
C. Acute respiratory distress syndrome (ARDS); initiate high-frequency ventilation.
D. Pulmonary embolism; start anticoagulation therapy.
What if the fever presented within 24 hours of surgery?
Hospital-acquired pneumonia; initiate broad-spectrum antibiotics
Atelectasis would be the primary cause (WIND)
