Quiz 17 Flashcards
A mother brings in her 2-month-old infant for a routine checkup. The baby is exclusively
breastfed, and the mother has no concerns or questions.
In addition to continued breastfeeding, which one of the following would you recommend
continuing or adding at this time?
Although breast milk is the ideal source of nutrition for healthy term infants, supplementation with 400
IU/day of vitamin D is recommended beginning in the first few days of life and continuing until the child
is consuming at least 500 mL/day of formula or milk containing vitamin D (SOR B). The purpose of
supplementation is to prevent rickets
For exclusively breastfed infants, iron supplementation should begin
at 4 months of age
The introduction of cereal is
recommended at 6 months of age.
A 78-year-old white male
peripheral neuropathy and mild Alzheimer’s dementia.
daughter
asks whether he should continue to drive his car.
What do you do?
A thorough history focused on the patient’s driving, from both him and his daughter
Many older drivers have physiologic or cognitive impairment that may affect mobility and driving safety,
and older drivers have an increased crash rate per mile driven. However, older individuals who stop
driving are at higher risk for isolation and depression and there is also an increased cost to the family and
society in general for transportation assistance.
In this patient a medication review would also be appropriate. His tricyclic antidepressant, benzodiazepine,
and insulin could all contribute to unsafe driving. Medical illnesses should also be considered in this
history. Dementia, peripheral neuropathy, and retinopathy can all increase the risk for unsafe driving.
Further testing such as a Snellen eye test, audiometry, timed gait, range of motion, muscle strength, clock
drawing, and a Mini-Mental State Examination may also be indicated, but a thorough driving history
should be obtained first. If a concern arises about unsafe driving, referral to a rehabilitative driving center
or the appropriate government agency for further written/road testing may be warranted.
Which one of the following should be monitored during testosterone replacement therapy?
Hematocrit
Testosterone replacement therapy can cause erythrocytosis, so monitoring hematocrit at regular intervals
is recommended
Which one of the following is most likely to be associated with resistant hypertension in adults? (check one) A. Obstructive sleep apnea B. Primary aldosteronism C. Renal artery stenosis D. Renal parenchymal disease E. Thyroid disease
Obstructive sleep apnea is found in 30%–40% of hypertensive patients and 60%–70% of patients with
resistant hypertension, whereas primary aldosteronism is present in only 7%–20% of patients with resistant
hypertension. Renal artery stenosis is seen in 2%–24% of cases of resistant hypertension in various studies,
renal parenchymal disease in 2%–4%, and thyroid disease in less than 1%.
A 78-year-old female presents with a red eye. She reports drainage and pain in her left eye since
she woke up today, but no photophobia. Examination of the eye shows conjunctival erythema
and a mucopurulent discharge. The pupil is normal in size and reactive to light.
Which one of the following should prompt immediate referral to an ophthalmologist?
Reduced visual acuity may be a symptom of acute angle-closure glaucoma and requires immediate referral
to an ophthalmologist. Copious mucopurulent drainage from the eye is a sign of infectious conjunctivitis,
most likely bacterial, and bilateral eye redness is typically seen with allergic conjunctivitis. Allergic or
infectious conjunctivitis and small corneal abrasions can be managed by the family physician. Bright red
blood under the conjunctiva is consistent with a subconjunctival hemorrhage that will typically resolve
without intervention.
A. Determine the patient’s competence
B. Assess the patient’s decision-making capacity
C. Confirm the code status with the patient’s wife
D. Write a Do Not Resuscitate (DNR) order
E. Order comfort measures only
Assess the patient’s decision-making capacity
There is a relationship between capacity and cognition but a patient with dementia can still have
decision-making capacity. With Mini-Mental State Examination scores <20 (maximum score = 30) there
is an increased likelihood of incapacity, but this varies from case to case and is situation dependent.
Competence is a legal term and is a judicial decision made by a court. Any licensed physician can make
a determination of capacity, and a psychiatrist is not required.
The sensitivity of a test is defined as
percentage of patients with a disease who have a positive test result.
Specificity
percentage of patients without the disease who have a negative test result
Pretest probability
probability of disease before a test is performed
Posttest probability
probability of disease after a test is performed.
Positive predictive value
percentage of patients with a positive test result who are confirmed to have the disease.
The physical examination suggests
rotator cuff tendinitis.
You discuss treatment options and the patient decides to proceed with a corticosteroid injection.
Which one of the following is the appropriate anatomic location for the injection?
Injection of glucocorticoids (usually mixed with a local anesthetic) into the subacromial space may be
considered in patients with rotator cuff tendinitis if the pain is significant enough to interfere with sleep
and/or function despite adequate analgesia.
An intra-articular injection is appropriate for a patient with severe shoulder osteoarthritis. A corticosteroid
injection into the biceps or deltoid insertions is not appropriate. An acromioclavicular injection is
appropriate for acromioclavicular arthritis but not for rotator cuff tendinitis.
According to the U.S. Preventive Services Task Force, which one of the following is the most
appropriate initial recommendation for weight-loss management in this patient?
The U.S. Preventive Services Task Force found that the most effective behavioral counseling interventions
for obesity management were comprehensive and of high intensity (12–26 sessions in a year), and involved
multiple behavioral management activities, such as group and individual sessions, setting weight-loss goals,
addressing barriers to change, and active use of self-monitoring. Low-carbohydrate diets are minimally
effective over the long term without behavioral interventions.
