Quiz 16 Flashcards
When you examine her you find no exophthalmos or lid lag and no pretibial edema, but her skin
is warm, smooth, and moist. You also find a smooth, non-nodular, nontender, enlarged thyroid
gland, clear lungs, a resting tremor, and hyperactive reflexes.
Laboratory testing reveals a low TSH level, elevated free T3 and free T4, and high uptake on a
radioactive iodine uptake scan.
This patient has symptoms consistent with hyperthyroidism, which could be caused by any of the options
listed. TSH is suppressed and free T4 and free T3 are elevated in all of these conditions. Only Graves
disease, however, will cause high radioactive iodine uptake on a thyroid scan. Uptake will be low in the
other conditions.
confusion
fever and cough
temperature of 39.0°C (102.2°F), a heart rate of 125
beats/min, a respiratory rate of 25/min, a blood pressure of 85/46 mm Hg, and an O2 saturation
of 88%. Laboratory findings include a WBC count of 15,500/mm3 (N 4300–10,800), a
glomerular filtration rate of 45%, and a hemoglobin level of 9.1 g/dL (N 13.0–18.0). A chest
radiograph reveals a large left lower lobe infiltrate.
severe inflammatory response syndrome (SIRS) (fever >38.5°C, heart
rate >90 beats/min, respiratory rate >20/min, WBC count >12,000/mm3).
severe sepsis, with a positive chest radiograph and evidence of organ hypoperfusion (mental status
changes),
septic shock (mean arterial pressure <60 mm Hg)
The most appropriate initial
treatment for patients with hypotension in septic shock is fluid resuscitation (SOR A). While vasopressor
therapy is certainly appropriate in septic shock, it should be initiated only after fluid resuscitation fails to
restore mean arterial pressure (>65 mm Hg) or when there is evidence of continued organ hypoperfusion.
hit on the lower leg by an opposing
player’s helmet
significant swelling and bruising of the lower leg.
no weakness of the extremity and sensation is intact. You examine the leg and can palpate
pulses. Plain radiographs do not show a fracture.
What should you order
Tissue pressure studies
This patient has symptoms and findings consistent with acute compartment syndrome, which is an
emergency. The diagnostic test is tissue pressure studies. This condition can occur after a severe injury
to the extremity, although it can also develop after a relatively minor injury. Associated problems include
fractures, a badly bruised muscle, crush injuries, constricting bandages, and bites with swelling.
23-year-old healthy male is sexually active with other men and does not use condoms.He is
interested in reducing his risk of contracting HIV by using a daily oral antiretroviral medication.
Which one of the following laboratory tests should be done no more than 7 days before initially
prescribing pre-exposure prophylaxis with emtricitabine/tenofovir disoproxil (Truvada)?
It is of critical importance that patients have a documented negative HIV antibody test (from serum or
point-of-care fingerstick) prior to starting pre-exposure prophylaxis (PrEP) to avoid inadvertent treatment
of HIV infection with emtricitabine/tenofovir. This is the only medication currently approved in the United
States for PrEP, but it is inadequate for HIV treatment.
Other recommended testing prior to PrEP use includes creatinine clearance calculation, hepatitis B antibody
testing, screening for sexually transmitted diseases, and pregnancy testing in females capable of pregnancy.
A patient is admitted to the hospital for acute deep vein thrombosis of the lower extremity and
started on anticoagulation therapy. The nursing staff asks for an activity order.
Which one of the following should be ordered?
early ambulation over initial bed rest in patients with acute DVT of the leg (SOR C).
there is
no statistically significant difference between ambulation and bed rest for development of a pulmonary
embolus, a new thrombus, or progression of a thrombus. Therefore, based on the evidence and the
well-recognized benefits of mobility, the current recommendation is to consider early ambulation as soon
as effective anticoagulation has been achieved.
Which one of the following potential bioterrorism agents requires treatment with 60 days of continuous antibiotics? (check one) A. Anthrax B. Botulism C. Pneumonic plague D. Smallpox E. Tularemia
anthrax requires 60 days of antibiotic treatment
Anthrax
anthrax spores would be released into the air to be inhaled by the target population.
The full incubation period of the bacterium is 60 days and treatment should cover the entire period.
Appropriate antibiotics include oral fluoroquinolones and doxycycline.
Smallpox
variola virus. Potential treatments include postexposure treatment
with the smallpox vaccine and two compounds currently in development
Pneumonic plague,
Yersinia pestis, can be provoked by inhalation of the released bacterium or by contact with an infected
individual. Treatment consists of a 10-day course of an aminoglycoside or doxycycline.
Inhalational botulism
an antitoxin (equine-derived heptavalent antitoxin)
Tularemia
bacterium Francisella tularensis, which would cause a
pneumonia. Treatment is a 10-day course of an aminoglycoside, ciprofloxacin, or doxycycline.
Which one of the following is recommended in all patients with croup, including those with mild
disease?
A single dose of dexamethasone (0.15–0.60 mg/kg, usually given orally) is recommended in all patients
with croup
Nebulized epinephrine is an accepted treatment in patients with moderate to severe croup.
A 17-year-old male presents to the urgent care clinic 15 minutes after being stung by a wasp.
He feels weak, his voice is hoarse, and he is beginning to have trouble breathing.
Which one of the following should be administered first?
the first treatment should be immediate administration of intramuscular epinephrine.
A pet reptile is most likely to transmit which one of the following to human contacts?
Salmonella
Pasteurella
multocida
dog or cat bites
