Quiz 2 questions Flashcards
1
Q
1) What is the correct treatment for a male patient with acute urinary retention with who has experienced trauma to their urethra?
a. Urethral Catheterization.
b. Nothing, treat the trauma and worry about the urinary retention later.
c. Supra Pubic Catheterization.
d. Condom-catheter.
e. I&O Catheter.
A
c. Supra Pubic Catheterization.
2
Q
2) A 62-year-old female presents to the ED with a chief complaint of worsening dyspnea for about a month. She has had an associated cough and hoarseness as well. She has no significant PMH. Her vitals are as follows: BP 121/67, RR 20, HR 88 and regular, Temperature 98.2 degrees Fahrenheit. On physical exam, diffuse edema is present in her neck as well as her left upper extremity. All of the following are appropriate steps to take EXCEPT:
a) CXR
b) Place a central IV catheter
c) CT with contrast
d) IV Dexamethasone
e) IV Furosemide
A
b) Place a central IV catheter
3
Q
3) An 18 year old female comes in complaining that since being on the pill she has been getting a lot of acne. She was hoping to be able to switch to a different birth control pill. Which progestin option would help decrease her symptoms? A. Norgestrel B. Levonorgestrel C. Drosperinone D. Norethindrone E. Norethindrone acetate
A
C. Drosperinone
4
Q
4) A 63-year-old Female presents with a history of Breast cancer. She says she feels general malaise and has been experiencing constipation and nausea the last couple of days with intermittent back pain. An EKG was order which revealed an elongated PR interval with low voltage. All of the following could be potential treatment options for this patient EXCEPT? A. IV Hydration B. IV Pamindronate C. Sub Q Calcitonin D. IM Calcitonin E. Oral Phosphates
A
E. Oral Phosphates
5
Q
5) All of the following are non-contraceptive benefits of hormonal contraception except:
A. Treatment of menorrhagia
B. Improved bone mineral density
C. Treatment of pelvic pain due to endometriosis
D. Decrease in risk of breast cancer
E. Prevention of menstrual migraines
A
D. Decrease in risk of breast cancer
6
Q
6) A 69-year-old financial manager had what his co-workers think was a stroke while he was at his desk. They called EMS and he presents to your Emergency Department. Upon checking his past medical history, you see this patient came in 2 years ago and was diagnosed with Atrial Fibrillation and CKD with a CrCl of 20 ml/min. What would be is the most appropriate prophylactic treatment for this patient to avoid future strokes?
CT SCAN: Large middle cerebral artery infarct, with no acute hemorrhage
A. Administer Aspirin 325 mg
B. Administer Ticagrelor 90 mg BID
C. ASA + Dypyridamole 200mg BID
D. Rivaroxaban 20mg QD
E. Warfarin
A
E. Warfarin
7
Q
7) A 16-year-old female presents to the ER via EMS with her brother who claims she couldn’t stop vomiting when he found her in the bathroom half an hour ago with an empty Tylenol bottle next to her. She’s pale, diaphoretic, and nauseous upon arrival. Upon questioning, she didn’t count how many pills she took, just “the rest of it” about an hour ago. All of the following options are appropriate for the management of this patient at this time EXCEPT: Ipecac Activated charcoal NAC Gastric lavage
A
NAC
8
Q
8) Ms. B is a 67 year old female with past medical history of HTN, DM, chronic kidney disease (CrCl = 40), and newly diagnosed atrial fibrillation who we would like to initiate on antithrombotic therapy for prevention of ischemic CVA. Calculate Ms. B’s CHA2DS2-VASc score, and select the corresponding appropriate best therapy option for her at this time.
CHA2DS2-VASc score of 3, ASA 81 mg QD
CHA2DS2-VASc score of 3, Clopidogrel 75 mg QD
CHA2DS2-VASc score of 4, Warfarin - dose to INR of 2-3
CHA2DS2-VASc score of 4, Rivaroxaban 20 mg QD
Ms. B is not a candidate for antithrombotic therapy at this time
A
CHA2DS2-VASc score of 4, Warfarin - dose to INR of 2-3
9
Q
9) A 27 year-old female started combo OCPs 3 months ago. She has been having breakthrough bleeding (BTB) on days 1-9 of her cycle. What hormonal effect is causing the BTB on these days? Increased estrogen Decreased estrogen Increased progestin Decreased progestin
A
Decreased estrogen
10
Q
10) A 28-year-old woman presents with her husband to discuss methods of temporary contraception. They plan to have children in the future but would like to wait a few years. They are both healthy. The patient’s routine pelvic and physical examinations show a healthy young woman; her past medical history is unremarkable. She is a non-smoker and there is no family history of breast, ovarian, or uterine cancer.
What would be the most effective means of temporary contraception for this couple?
A. Levonorgestrel (Plan B)
B. Oral contraceptives
C. Intrauterine device
D. Condoms
E. Cervical cap
A
Answer: C. IUD efficacy is similar to sterilization, and is reversible
11
Q
11.) Which of the following is false when managing a stable patient being treated for an upper GI bleed?
A. Deliver high dose Omeprazole IV
B. Encourage patient to drink clear liquids only, as tolerated, for fluid resuscitation
C. Begin monitoring urine output and watching for signs of fluid overload
D. Contact GI for early endoscopy
A
B. Encourage patient to drink clear liquids only, as tolerated, for fluid resuscitation
12
Q
12) A 55 y/o male is brought into the ED by his wife who reports that he experienced a brief 3-minute episode of slurred speech, right-sided facial drooping, and inability to lift his right arm. The patient’s symptoms began about 15 minutes ago and he has since returned to baseline. The patient has a history of HTN and HLD. He currently is taking ASA 325 mg PO once daily, lisinopril 40 mg once daily, and atorvastatin 40 mg once daily. Based on the patient’s symptoms and medical history, what treatment do you recommend at this time?
A) do nothing- the patient’s symptoms were transient and returned to baseline so no further intervention needed
B) increase ASA dose to 650 mg PO once daily
C) d/c ASA, start Aggrenox (ASA 25 mg + dipyridamole 200 mg) PO BID
D) d/c ASA, start Aggrenox (ASA 25 mg + dipyridamole 200 mg) PO BID, and increase atorvastatin dose to 80 mg PO once daily
E) d/c ASA, begin rivaroxaban 20 mg PO once daily
A
D) d/c ASA, start Aggrenox (ASA 25 mg + dipyridamole 200 mg) PO BID, and increase atorvastatin dose to 80 mg PO once daily
13
Q
13) A 55-year old male presents to the ED with 2-days of colicky abdominal pain that radiates to the groin and testes. He also complains of increased urinary frequency. You suspect a kidney stone. Where is the stone most likely located?
a. ureteropelvic junction
b. ureterovesicular junction
c. mid-ureter
d. urethra
e. bladder
A
b. ureterovesicular junction
14
Q
14) All of the following diagnostic studies are recommended by AHA/ASA in the evaluation of a patient with a suspected stroke. All of the below diagnostics are recommended, but should NOT delay IV rtPA. Which one MUST precede the initiation of rtPA? Baseline EKG Baseline troponin assessment Blood glucose level CXR Noninvasive intracranial vascular study
A
Blood glucose level
15
Q
15) A 26-year-old female presents to the clinic complaining of fatigue and weight gain ever since she started her birth control 3 months ago. She is currently on a combined OCP. How can you as a provider manage the unwanted side effects?
Fatigue and weight gain are probably not due to the medication. Counsel her on a healthy diet and exercise plan.
Fatigue and weight gain are caused by an estrogen excess. Switch her to a progestin only pill.
Fatigue and weight gain are caused by a progesterone excess. Switch her to a combined OCP that contains less progesterone.
Fatigue and weight gain are caused by an estrogen deficiency. Switch her to a combined OCP that contains more estrogen.
Fatigue and weight gain are caused by a progesterone deficiency. Switch her to a combined OCP that contains more progesterone.
A
Fatigue and weight gain are caused by a progesterone excess. Switch her to a combined OCP that contains less progesterone.
16
Q
16) Which one of the following statements regarding contraception is true?
A. Monophasic OCPs are more effective than 4-phasic
B. Norgestrel has low androgenic potential
C. First day start is the preferred method for starting a patient on OCPs
D. The paraguard is the most effective form of emergency contraception
E. Progestin only pills are very effective at suppressing follicular cysts
A
D. The paraguard is the most effective form of emergency contraception
17
Q
17.) A 16-year-old female with a BMI of 32 presents to your office because she is interested in starting birth control and wants to know more about the Orthoevra patch. Which of the following points is important to counsel your patient on?
A.) Smoking prevention or cessation B.) Return of fertility is delayed C.) It may be less effective in obese patients D.) All of the above E.) A & C
A
E.) A & C
18
Q
18.) A 17 year old female comes into your office with the request to start birth control, as she is newly sexually active with her boyfriend. After hearing horror stories about weight gain from her friend who just started birth control, she demands an option with low risk. The patient smokes socially on occasion and states that she has a hard time remembering to take her multivitamin each morning. The patient has a history of irregular and heavy menses and would like this to be a target for treatment. What is the best treatment option for this patient?
a. OCP (Not preferred due to noncompliance with daily multivitamin)
b. Nexplanon implant (Not preferred due to irregular bleeding patterns)
C. Skylena IUD (TREATMENT CHOICE = lighter, and shorter menses, no daily dosing)
d. Depo-provera (Not preferred due to risk of weight gain)
e. Orthoevra (Not preferred due to BBW for smokers due to increased clot risk)
A
C. Skylena IUD (TREATMENT CHOICE = lighter, and shorter menses, no daily dosing)
19
Q
19.) Which of the following is not a related life-threatening concern that must be corrected with Acute Tumor Lysis Syndrome? A. Hyperkalemia B. Hyperuricemia C. Hyperphosphatemia D. Hypocalcemia E. Hypernatremia
A
E. Hypernatremia
20
Q
20.) A 60-year-old male presents to the ED because about 1 hour ago he experienced weakness in his right arm and dizziness, which resolved in the car ride here. The patient has a past medical history of hypertension, CKD, and atrial fibrillation. His current medications include Lisinopril 40mg PO once daily and Metoprolol 100mg PO BID. What is the best next step in this patient’s management? Initiate Aspirin 81mg PO once daily Initiate Clopidogrel 75mg once daily Initiate Warfarin PO dosed to INR 2-3 Initiate Apixiban 5mg PO BID Initiate rt-PA 0.9mg/kg IV
A
Initiate Warfarin PO dosed to INR 2-3
21
Q
21.) A 27 year old woman presents to your office complaining that since she has stopped her OCPs last month her menstrual cycle has not come back. She is concerned since this is the first time she’s ever been off birth control. What is the best way to counsel this patient?
A. Inform her that this is an unnatural occurrence and refer her to the OBGYN office.
B. Inform the patient that it will take 3 months for her cycle to normalize after stopping OCPs.
C. Encourage the patient to go on a different form of OCPs to get back her regular menstrual cycle.
D. Perform an immediate pregnancy test because the patient is pregnant.
E. Reassure the patient that it can take about 90 days for her menses to return after stopping OCPs.
A
E. Reassure the patient that it can take about 90 days for her menses to return after stopping OCPs.
22
Q
22.) A 54-year-old male presents with abdominal pain and mentions that he has gained considerable weight over the past 2 months. The patient also explains that he has been consuming alcohol heavily for the past 25 years. On physical exam, you note scleral icterus, bilateral lower extremity edema, and a markedly distended abdomen with a transmitted thrill. How will this patient most likely be managed? A. Salt restriction B. Diuretic therapy C. Large volume paracentesis D. A&B E. A, B, and C
A
E. A, B, and C
23
Q
23) Your patient is a 62 year old male who presents to the ED via EMS with a 2 hour long history of confusion and hemiparesis on the left side. The patient’s wife says he was doing yard work and when she went to bring him some lemonade she found him laying on the grass confused and mumbling. His wife is concerned as he had a concussion one week ago caused by a high speed baseball strike to the head which resulted in syncope and concussion. She wants to know if his current state is a relapse of his concussion. His BP is 170/100, 20RR, pulse of 80, and pulse ox of 98%. A brain CT shows no hemorrhage and an infarct of the middle cerebral artery (MCA). What is the most appropriate treatment?
A. Labetalol 10–20 mg IV over 1–2 min to reduce blood pressure then administer rt-PA.
B. Aspirin 325mg PO
C. No treatment as his condition is only due to his concussion and will get better on his own
D. Immediately administer rt-PA.
A
B. Aspirin 325mg PO (head injury=CI to rt-PA!)
24
Q
24.) Which of the following drugs are more effective than warfarin in patients with TIA/Stroke A.) dabigatran B.) Clopidigrel C.) apixaban d.) both A & C E.) all of the above
A
d.) both A & C
25
25.) Mr. Johnson, a 65-year-old male, presents to urgent care with urinary urgency and dribbling that started two days ago after getting over a bad cold. He currently takes Atorvastatin, Metformin, Liraglutide, and Viagra to manage his hyperlipidemia, Type II Diabetes, and erectile dysfunction. After you complete his bedside ultrasound of the bladder, you find that he has 600cc urine in his bladder. You decide to place a Foley catheter and initiate further treatment. Which of the following is the BEST medication to use in this patient?
```
A) Terazosin (Hytrin)
B) Doxazosin (Cardura)
C) Alfuzosin (Uroxatral)
D) Finesteride (Proscar)
E) Dutasteride (Avodart)
```
C) Alfuzosin (Uroxatral)
26
26.) A 76yo male presents to the ED stating "he cannot pee enough and his belly is getting larger". You gather a history and discover he is relatively healthy. He admits to taking Benadryl for the last 7 nights to help him sleep through his allergy symptoms. On physical exam, you note a mildly uncomfortable man with a distended abdomen that is nontender to palpation. His medications include Benadryl PRN for allergies and Albuterol PRN for asthma. His vitals are: BP 156/76, HR 108 regular, T 98.9 F oral, RR 20, SpO2 99% RA, Pain 0/10. You decide to bladder scan his abdomen and note 800cc of urine. What is the next best immediate step?
A. Obtain CT abdomen/pelvis to rule out obstruction
B. Straight cath to empty the bladder
C. Advise patient he will be fine and to just wait it out. Eventually, his body will release all the urine in his bladder.
D. Begin Finasteride 5mg PO daily and Lasix 20mg IV immediately
E. Start Tamsulosin 1mg PO daily as long as he has not taken any PDE-5 inhibitors in the last 24 hours
B. Straight cath to empty the bladder
27
27) A 31 year old female, 1 month postpartum comes into the office today to re-evaluate use of contraception. She tells you she wants something that won’t make her gain any more weight and that she also plans to be pregnant again within the next year. Which of the following would be an appropriate option for contraception?
A. Ask her if she is exclusively breastfeeding, as she may meet criteria for lactational amenorrhea method of contraception.
B. Prescribe her Cryselle, a combination oral contraceptive and if breastfeeding, continue with caution.
C. Prescribe progestin only oral contraception, counsel her to take them at the same time every day.
D. Prescribe and inject Depo-Provera, as it is highly effective and progesterone only.
E. A and C are both possible contraception options.
E. A and C are both possible contraception options.
28
28) A 31 y/o woman was diagnosed with lung cancer 1 year ago and has been undergoing chemotherapy treatment. She presents to her oncology PA today feeling more fatigued than usual and complains of pain while urinating. Her vitals are: T = 101.4 degree F, HR 102, RR 18, BP 120/80, O2 sat 97%. You run a CBC and a urine culture. The CBC reveals an ANC of 800
and the urine culture reveals no bacteria in the urine. What is NOT recommended for her treatment?
a) Admit and administer Vancomycin and Cefepime
b) Admit and perform vaginal exam and then administer Vancomycin and Cefepime
c) Admit and administer Vancomycin and Cefepime as well as G-CSF
d) Admit and administer Vancomycin and Cefepime and do blood culture
b) Admit and perform vaginal exam and then administer Vancomycin and Cefepime
29
```
29) A 24 year of female with at BMI of 27 comes to see you in clinic today. She tells you she is going away for a “girls trip” in 2 weeks. She plans on using condoms but also wants an additional back up method. While taking her history she tells you, she smokes around a pack of cigarettes a week and she has previously used an IUD, which was taken out a year ago and refuses to use it again because of the heavy bleeding she experienced. She also wants something she doesn’t have to deal with changing or taking a pill. Patient says she should be getting her period in 7 days. What form of birth control would you recommend for this patient?
A. Depo-provera
B. Ortho-Evra
C. Nuva-ring
D. Nexplanon
E. Skyla
```
D. Nexplanon
30
30) A 74 year old man with a history of HTN and Parkinson’s disease presents from his nursing home due to staff concern that he has not urinated in the past 24 hours. They said he is usually incontinent. His current medications include HCTZ, aspirin, Sinamet and oxybutynin. You get a bladder ultrasound and find there is 1400cc of urine in his bladder. What is the best next step?
A. Place a suprapubic catheter
B. Discontinue oxybutynin
C. Check serum Cr to rule out serious obstructive pathologies
D. Place a foley catheter
E. Start treatment with tamsulosin
D. Place a foley catheter
31
31) Your patient is a 72 year old male who suffered acute urinary retention due to BPH 2 months ago. He was started on Tamsulosin .4mg daily. He returns today and you want to start him on Finasteride, to help to further shrink his prostate. Which of the following statements are important to remember when starting a patient on an alpha- reductase inhibitor?
A. Alpha reductase inhibitors work very quickly so you should warn your patients about polyuria
B. Patients on Finasteride experience irreversible erectile dysfunction and depression
C. You must consider the effect that finasteride has on PSA levels when screening for prostate cancer
D. The patient should have been started on this medication immediately in the setting of Acute Urinary retention 2 months ago
E. Alpha reductase inhibitors assert their actions by Relaxing the muscle of the prostate and bladder neck
C. You must consider the effect that finasteride has on PSA levels when screening for prostate cancer
32
32. Mrs. S is a 38 year old female patient started on sertraline (Zoloft) by her primary care provider 10 days ago. She is presenting today with concerns about some mild diarrhea, nausea, headache, and weight gain. You should:
A. Switch her to escitalopram (Lexapro).
B. Switch her to vilazodone (Viibrid).
C. Reduce her dose of sertraline (Zoloft).
D. Make no changes to her regimen at this time, provide reassurance, and continue to monitor side effects.
Correct answer: D
Mild diarrhea, nausea, headache, and weight gain are normal initial responses to SSRIs and should subside after being on these medications for 4-6 weeks.
Incorrect answers:
A - no indication to change her medication regimen at this time, although this would be the second best choice because escitalopram has lower rates of diarrhea, nausea, headache, and weight gain than sertraline.
B - vilazodone is no more efficacious than sertraline and has higher rates of side effects.
C - no indication to change her medication regimen at this time. Mild diarrhea, nausea, headache, and weight gain are normal initial responses to SSRIs and should subside after being on this medication for 4-6 weeks.
33
33) A 46 yo Female with a history of breast cancer presents to the clinic complaining of progressive dyspnea. On exam, she has muffled heart sounds and jugular venous distention. Low voltage was also noted on the ECG. The patient states she just finished a chemo regimen last week . What diagnostic tool would be the BEST first option?
```
A) CT angiogram
B) Chest CT w/ contrast
C) Chest CT w/o contrast
D) Echocardiogram
E) Bronchoscopy
```
D) Echocardiogram
34
34. A 20-year-old female seeks your medical advice for contraception. She is not on any medications, past medical history and family history is healthy. She has a regular and normal menstrual cycle (23 days between each menses, menses lasting 5 days, light/ average menstrual flow). You can discuss and recommend:
```
A.) Combined oral contraceptive pills
B.) Nuvaring vaginal insert
C.) Depo- provera injection
D.) IUD
E.) All of the above
```
E.) All of the above
35
35. A 50 year old male patient with a history of diabetes presents to your ER with suspicion of Fournier's Gangrene. You confirm the diagnosis and are looking to treat him ASAP. What would NOT be an acceptable option to be part of treatment regiment for a patient with Fournier's Gangrene?
A. Debridement
B. Triple therapy- Zosyn/Vanco/Clindamycin
C. Clindamycin ONLY because it targets strep and staph, which are the only bacteria that cause FG
D. IVF
E. none of the above
C. Clindamycin ONLY because it targets strep and staph, which are the only bacteria that cause FG
36
36. Patient with PMH significant for Non-Hodgkin’s Lymphoma currently undergoing R-CHOP chemo regimen presents to the clinic with acute onset of vague malaise, nausea and oliguria. The patient’s last chemo treatment was 2 days ago. She is afebrile, BP 110/65, HR 100, RR 16, T 99.2. Labs revealed WBC 8.0, BUN 40/Cr 3.8, K+ 5.5, Ca2+ 6.8, phosphate 5.6, uric acid 16. Which of the following is the best treatment option for this patient?
A. Telemetry monitoring + IVF NS + Rasburicase
B. Stop chemotherapy + telemetry monitoring + IVF NS + Calcitonin IM
C. IVF NS + Rasburicase + Cefepime IV + Vancomycin IV
D. Stop chemotherapy + IVF NS + zolendronic acid
E. Stop chemotherapy + telemetry monitoring + IVF NS + Rasburicase + kayexalate
E. Stop chemotherapy + telemetry monitoring + IVF NS + Rasburicase + kayexalate
37
```
37. Which of the following is a contraindication of implanting an IUD?
A. History of smoking
B. Hypertension
C. Didelphys
D. Migraine with aura
```
C. Didelphys
38
38. Which of the following is true in terms of fentanyl?
a. slow onset
b. detected by opiate screening immunoassays
c. used transdermal for chronic pain
d. DEA schedule III
e. semi-synthetic opioid
c. used transdermal for chronic pain
39
```
39. A 17-year-old male attempts suicide by swallowing several tablets of acetaminophen. Which of the following is considered the most effective antidote to administer to this patient?
A) Diazepam
B) Hemodialysis
C) Sodium Bicarbonate
D) Sodium nitroprusside
E) N-acetylcysteine
```
E) N-acetylcysteine
40
40. A 22 year old female presenting to her primary care physician complaining of acne and BTB on day 3 of her menstrual cycle. She states she has been on a combined oral contraceptive pill for 4 months which is intermediate in both estrogen and progestin. Which of the following options is the best management decision for this patient?
a) Switch her to a low progestin and low estrogen pill
b) Switch her to a low progestin but keep her estrogen intermediate
c) Switch her to Skyla since it is progestin only.
d) Discontinue all forms of contraception in order to fix her acne and regulate her cycle.
e) Reevaluate her in 2 months because the pill can take up to 6 months to regulate
b) Switch her to a low progestin but keep her estrogen intermediate
41
```
41. You work in a primary care office and are seeing an 80-year old with a history of GERD, HTN, Hyperlipidemia and 2 CVA’s (2004, 2008) for a well visit. Below is her med list and vitals:
Omeprazole 20mg PO, once daily
Lisinopril 40mg PO, once daily
Atrovastatin 80mg PO, once daily
Endoxaban 60mg, PO, once daily
```
T 99.0/P78/R16/BP118/78/H62/W140
Which of the following should be your next course of action?
a. The Endoxaban dose should be lowered to 30mg PO, once daily due to the patients age.
b. The patient should be switched from Endoxaban 60mg to Dabigatran 75mg, BID to increase efficacy
c. This patient does not have to be on a direct oral anticoagulant because it has been over 10 years since her last CVA.
e. The Endoxaban 60mg should be switched to Aspirin 325mg due to her CHAD score.
d. No adjustments should be made at this time.
d. No adjustments should be made at this time.
42
42. Which treatment option is correct in hypercalcemia of malignancy:
A. IV fluids, once patient is euvolemic give hydrochlorothiazide
B. IV loop diuretics should be avoided
C. Discontinue Tums and Ibuprofen
D. Hypercalcemia can be successfully treated with one dose of IM Calcitonin
E. Administer Vitamin D 800 IU to help absorb the calcium quicker
C. Discontinue Tums and Ibuprofen
43
43. Mr. R is a 69 year old male with non-hodgkins lymphoma who began chemotherapy treatment two days ago and presents today with weakness, cramps and altered mental status. In the ED he was started on IV fluids and labs were abnormal with a potassium of 6.8. What is the most appropriate treatment at this time?
A. Aggressive IV hydration NS/diuresis
B. Allopurinol and hold chemotherapy
C. Kayexalate and restart chemotherapy 24 hrs after initial dose
D. Emergency hemodialysis
D. Emergency hemodialysis
44
44. A 60 year old male with a past medical history of prostate cancer presents to the ED for a second time complaining of low back pain that began last week when he was planting in his garden. He states the pain has gotten progressively worse and now is experiencing lower extremity weakness as well as an episode of urinary incontinence. Which of the following is the next BEST step for this patient?
A. Place a Foley Catheter
B. Order a non-contrast head CT
C. Order an MRI as soon as possible and consult Neurosurgery
D. Order a Spine CT with contrast
C. Order an MRI as soon as possible and consult Neurosurgery
45
```
45. A 27-year-old female presents to the clinic to request contraception. She is 2 weeks postpartum and is breastfeeding her newborn. Which of the following contraceptives would you NOT recommend to her?
A. Norethindrone
B. Nuvaring
C. Depo-provera
D. Nexplanon
E. Mirena IUD
```
B. Nuvaring
46
46. A 65 year old morbidly obese man with history of HTN and T2DM presents to your ED today complaining of scrotal pain. He reports that he hasn’t been able to get a good look at the scrotum because of his severe obesity but he reports it is very painful and feels “on fire” for the past 2 days. You immediately suspect Fournier’s gangrene and want to start him on antibiotic therapy right away. What is the first line of antibiotic therapy?
a) Zosyn + vanco +clindamycin
b) Cipro+ doxycycline
c) Flagyl
d) Vanco + cephalexin + neomycin
a) Zosyn + vanco +clindamycin
47
47. A 24 year old female with a BMI of 45 is coming into your office seeking a form of birth control that doesn’t require a daily commitment. She has a PMH of DM type 2 and yeast infections. She is also looking to begin a family within 5 years. Which of the following forms of birth control would be most appropriate for this patient?
```
A. Orthoevra
B. Nuvaring
C. Norethidrone
D. Depo-provera
E. Nexplanon
```
E. Nexplanon
48
48. BR presents to your primary care clinic complaining that her depression has not improved after you started her on Paroxetine (Paxil) 2 weeks prior. BR reports daily compliance taking her pill, yet she reports she still can’t get out of bed some days because she is so tired. She is upset that since starting the drug she has been frequenting the gym less due to fatigue, and has subsequently gained weight. What is the best next step in managing BR’s depression?
A. Discontinue Paroxetine (Paxil) and start BR on Fluoxetine (Prozac) to decrease weight gain.
B. Counsel BR that it may take 4-8 weeks to see a full response to the medication. If she still complains of symptoms at her next visit in 2 weeks, consider adding a SNRI to her regimen.
C. Screen now for suicidal thoughts or actions. Counsel BR that it may take 4-8 weeks to see a full response to the medication. If symptoms persist at her next visit in 2 weeks, consider adding Mirtazapine.
D. Screen now for suicidal thoughts or actions. Counsel BR that it may take 4-8 weeks to see a full response to the medication. If symptoms persist at her next visit in 2 weeks, consider adding Bupropion.
E. Screen now for suicidal thoughts or actions. Counsel BR that it may take 4-8 weeks to see a full response to the medication. If there is less than a 25% reduction in her symptoms at her next visit in 2 weeks, consider increasing the dose of Paroxetine (Paxil).
D. Screen now for suicidal thoughts or actions. Counsel BR that it may take 4-8 weeks to see a full response to the medication. If symptoms persist at her next visit in 2 weeks, consider adding Bupropion.
49
49. 25 year old female presents with left-sided flank pain radiating to ipsilateral labia. The female notes history of 5 UTI's in the past 6 months, treated with Cipro each time.
VS: H R 108, Temp: 101.2
UA: 4RBC/HF, WBC 18k, pH 3.5
NCCT noted 1 cm calculi at the UPJ with unilateral hydronephrosis and perinephric stranding.
What is the next best step for this patient?
A. IVF, Tamsulosin, Cipro, discharge
B. Admission, stent placement and percutaneous nephrostomy
C. Uteroscopy and laser lithotripsy
D. ESWL
E. PNL with ESWL
B. Admission, stent placement and percutaneous nephrostomy
50
50. A 34yo patient presents to your clinic complaining of blood in their stool. A stool sample is obtained showing hematochezia. The patient has a noted history of diverticulosis. Their vital signs show HR 120 and BP 95/60. What is the best approach to this patient?
1) Colonoscopy after resolution
2) Tagged RBC scan
3) CT angiogram
4) Catheter Angiography
5) EGD
4) Catheter Angiography
51
```
51. A 25 year old obese female presents to the office desiring contraception. She recently started dating and is sexual active, however she does not want to become pregnant. Her past medical history includes type 2 diabetes and she has a 10 year pack history of smoking. She is not compliant with her diabetes medication, as she feels taking pills doesn’t work for her. Due to her noncompliance you decide to prescribe her an alternative to oral contraception. Which of the following is the LEAST appropriate choice?
A. Nuvaring
B. Nexplanon
C. Transdermal patch (Orthoevra)
D. Depo provera
E. None of the above
```
Answer: C- Transdermal patch has BBW for smokers because the high levels of estrogen increase the risk for a clot
52
52. A 60-year-old lymphoma patient presents to you, his PCP, complaining of cough, shortness of breath, and nasal stuffiness. He has an indwelling PICC line, and when you are checking that, you notice a purplish, splotchy discoloration across his chest. You now have a diagnosis you suspect - what other physical exam or laboratory findings would best support that diagnosis?
a) 101.4F temp orally, ANC of 750, and cervical lymphadenopathy
b) anuria, hyperphosphatemia, and CVAT
c) narrow pulse pressure, pulsus paradoxus, and JVD
d) JVD, facial edema, and Horner Syndrome
e) BP 86/58, 102F temp orally, and +2 positive blood cultures
D, this is SVCS.
53
53. A 30 year old obese patient comes in for a visit and states that she is having severe menstrual bleeding and would like to be put on a birth control that is very low maintenance as she is done having children for the next couple of years. She states that she doesn’t like needles and tends to be very forgetful. What is the best form of contraceptive that you can offer her?
a. Depo Provera
b. Mirena IUD
c. Norethindrone Pill
d. Ortho Tri-Cyclin Lo Pill
e. Nexplanon
Answer is B Mirena IUD
54
54. A 52 YO male with a PMH of type 1 diabetes comes into the ER complaining of flu-like symptoms and body aches for 2 days. On exam, patient is diaphoretic, tachycardic and in distress. GU exam reveals an erythematous tender scrotum with crepitus and necrosis. What is the best treatment for this patient?
```
A.) IV Fluids
B.) Clindamycin, Zosyn, and Vanco
C.) Clindamycin and Zosyn
D.) Surgical debridement only
E.) Surgical debridement, Clindamycin, Zosyn, and Vanco
```
E.) Surgical debridement, Clindamycin, Zosyn, and Vanco
55
55. TK is a 79-year- old male recently diagnosed with major depressive disorder. His past medical history is significant for seizure disorder and poorly controlled hypertension. He tells you he would like to avoid being “super sleepy”. Which of the following medications is most appropriate for TK?
```
A. Bupropion
B. Sertraline
C. Duloxetine
D. Imipramine
E. Mirtazepine
```
B. Sertraline
56
```
56. 38yo F presents 2y s/p left masectomy with LN ressection complaining of facial swelling, head aches, fatigue and dyspnea. Which of the following diagnostic procedures would be most appropriate in confirming your suspicion?
A. AP and lateral cervical films
B. Chest CT with contrast
C. Chest Xray
D. Contrast venography head/neck/chest
E. MRI
```
B. Chest CT with contrast
57
57. A 67-year-old male patient presents to his primary care provider. He reports that for the past 6 weeks, he has had difficulty sleeping, decreased ability to concentrate, fatigue, weight gain, and depressed mood. These symptoms have persisted despite recently starting cognitive behavioral therapy. He is open to starting medication to treat his depression, but is concerned that antidepressants will negatively impact his romantic relationship. Which of the following medications would be best to treat his depression, in addition to the CBT?
```
A. Paroxetine (Paxil)
B. Lorazepam (Ativan)
C. Escitalopram (Lexapro)
D. Vilazodone (Viibryd)
E. Aripiprazole (Abilify)
```
C. Escitalopram (Lexapro)
58
58. Your patient is a 19-year-old female who is currently on a combined OCP. While on the OCP, she complains of painful and heavy menses. What is the best approach for this patient?
A. Prescribe a new OCP with lower androgen activity
B. Prescribe a new OCP with lower estrogen activity
C. Prescribe a new OCP with lower progestin activity
D. Wait a couple of cycles to see if the painful and heavy menses will resolve on its own
E. Have her continue her current OCP; painful and heavy menses is expected while on OCP
B. Prescribe a new OCP with lower estrogen activity
59
59. Mr. T is a 65-year-old diabetic, overweight male with the inability to fulling extent his ring finger. He first noticed it a month ago when he was having progressive difficulty shaking hands during meetings at work.
PMH: DM, HTN, CAD
Social history: heavy alcohol used for 32 years, 15 pack year tobacco smoker, denies IV/IM drug use
Family history: Father died at 45 from MI. Mother died at 85 with Alzheimer’s.
PE: Distended abdomen with shifting dullness. No palpable masses
VS: afebrile, HR 75, BP 138/90, RR 19, O2 sat 98% RA
Concerning for Grade II ascites, you start Mr. T with spironolactone 100mg/day. How do you titrate the medication and when you consider adding on Furosemide to the treatment plan?
a. Increase by 50mg/day – add Furosemide if there is weight loss < 2 kg/week
b. Increase by 50 mg/day – add Furosemide if the patient is hyperkalemic
c. Increase by 100mg/day – add Furosemide if the patient is hypokalemic
d. Increase by 100mg/day – add Furosemide if there is weight loss < 2 kg/week
e. Spironolactone is not titrated – add Furosemide if the patient is hyperkalemic
d. Increase by 100mg/day – add Furosemide if there is weight loss < 2 kg/week
60
60. A 68 year old male presents to the Emergency Department with his son with new onset of confusion and shortness of breath. It is concluded that the patient is hypoxic and has pneumonia. Patient was treated with antibiotics, yet the confusion persisted. His past social history includes smoking cigarettes 1 pack per day for 44 years and consumes at least a 6-pack of beer per day which he has not restricted since his diagnosis with cirrhosis a couple months prior. Patient also complains of having no more than 3 bowel movements a week for the last few weeks. Upon admission, what is the first diagnostic test you should order?
A. CXR
B. HEAD CT
C. EKG
D. Paracentesis
E. No diagnostic test needed, start broad spectrum antibiotics
B. HEAD CT
61
61. ) Mr. K is a 47 y/o Caucasian male with a history alcohol abuse presenting to your urgent care with a complaint of abdominal discomfort. Mr. K is still an active drinker (six 12 oz. beers/day). Mr. K endorses recent weight gain stating that he has had to increase his pant size over the past month. Upon examination of Mr. K’s abdomen, you note a symmetrically protuberant abdomen and shifting dullness without a transmitted thrill. Mr. K’s labs are notable for a sodium 122 [normal range: 135-145 mEq] and potassium of 3.2 [normal range: 3.5-5.0]. Which of the following treatment plans is the most appropriate for Mr. K?
a. ) Furosemide 40 mg PO QD with strict monitoring of patient’s sodium concentration.
b. ) Spironolactone 100 mg PO QD with strict monitoring of patient’s sodium concentration as well as “ins and outs”.
c. ) Spironolactone 100 mg PO QD and NS 100 ml/hr IV.
d. ) Drainage of 5 L of ascites fluid via Large volume paracentesis with 30-40 g of albumin IV.
e. ) Encourage patient to exercise regularly to for weight loss, discuss cessation of alcohol, and encourage patient to attend alcoholics anonymous meetings
Answer B: Spironolactone is a diuretic which can be used to treat grade 2 ascites and will not exacerbate the patient’s hypokalemia (Furosemide will cause further hypokalemia). The patient’s sodium is also low (<125) which is an indication for fluid restriction (giving IVF will cause dilutional hyponatremia). LVP is indicated for grade 3 ascites.
62
62.75 year old male presents with syncope X 2, coffee ground emesis and large tarry BM. VS are BP: 89/55 HR: 130 T:98.9 O2:98% RA RR:20. He is pale, and diaphoretic. Abdomen tender, Normal bowel sounds in all 4 quadrants.
Which of the following is NOT incorporated in his initial treatment?
A. Fluid Resuscitation
B. Blood replacement/ transfusion
C. Contact GI for urgent Endoscopy
D. Wait 48 hours and then start on high dose IV PPI
D. Wait 48 hours and then start on high dose IV PPI
63
63. ) A 65 yo female arrives at the ED with a history of facial drooping that began an hours ago but has now resolved. She has a PMH of hypertension, hyperlipidemia, type 2 diabetes and a 30 pack/year history of smoking. Her medications include Lisinopril 40mg QD, Aspirin 81mg QD, Glucophage 1000mg BID, and atorvastatin 40 mg QD. Non-contrast head CT shows no signs of intracranial bleeding. Which of the following interventions would NOT be recommended for prophylaxis of future cerebrovascular events?
a. Increase dose of atorvastatin to 80mg
b. Aggrenox 25/200mg BID
c. Apixaban 5 mg BID
d. Clopidogrel 75mg QD
e. Quitting smoking
c. Apixaban 5 mg BID
64
64. A 56 year old patient with HTN, currently controlled with chlorthalidone and lisinopril, presents after passing a calcium oxalate renal stone. In hopes of preventing further renal stones, all of the following are appropriate interventions EXCEPT:
a. Increase dietary citrate
b. Increase fluid intake
c. Restrict sodium intake
d. Discontinue Thiazide diuretic, consider switching to loop diuretic
e. Restrict calcium intake
d. Discontinue Thiazide diuretic, consider switching to loop diuretic
65
65. A 16-year-old female has recently been diagnosed with depression. At the time of diagnosis she did not meet the criteria for diagnosis of anxiety, but displayed several features of anxiety. Please match the BEST pharmacotherapy option for this patient with the BEST dosing strategy:
Agent → Dosing strategy
A: Paroxetine → Titrate up from low dose
B: Escitalopram → Start at full MDD dose
C: Fluoxetine → Start at full MDD dose
D: Sertraline → Titrate up from low dose
E: Escitalopram → Titrate up from low dose
E: Escitalopram → Titrate up from low dose
Explanation: Escitalopram has the strongest evidence for efficacy in age group 12-17 YO. Anyone with features of anxiety or comorbid anxiety and depression should be started at a LOW dose and titrated up. This is to prevent the increase in 5-HT from causing a spike in anxiety upon initiation of the SSRI.
66
66.A 17 year old female is seeing you in your primary care office complaining that she has been experiencing breast tenderness since being started on a ethinyl estradiol/norgestrel OCP. She is stating that it is becoming really bothersome to her daily life. Her urine HCG is negative and she is on no other medications. Physical exam, including breast exam is normal. What would be your next step in managing this patients complaint?
A. There is nothing that you can do, tell her this may go away.
B. Decrease the estrogen dose of her OCP
C. Increase the estrogen dose of her OCP
D. Decrease the progestin dose of her OCP
E. Increase both the estrogen and progestin dose of her OCP
B. Decrease the estrogen dose of her OCP
67
26-year-old overweight female with T2DM expresses interest in starting a new birth control method. Because of her constant monitoring of her blood glucose, she wants a birth control that she "doesn't have to worry about" and preferably long-term. What is the BEST contraceptive option for this patient?
a) Aviane
b) Norethindrone 0.35mg
c) NuvaRing
d) Kyleena
e) Nexplanon
d) Kyleena
68
67. You have just diagnosed a patient with Grade III Ascites. All of the following are necessary initial treatment strategies EXCEPT:
A). LVP with albumin infusion
B). Prevention of Hepatorenal Syndrome
C). STAT surgical consult for TIPS procedure
D). Salt restriction and Spironolactone
E). All are indicated/necessary
C). STAT surgical consult for TIPS procedure
69
68) A 64 year old male presents to the urgent care clinic with a chief complaint of shortness of breath. He has a 30 pack year history of smoking and was diagnosed with small cell carcinoma in bilateral lungs about 6 months ago. He states that the shortness of breath came on suddenly a few hours ago and also complains of a cough. On physical exam you observe swelling in the face and neck and distention in the veins on his right arm. Based on clinical suspicion, which of the following is the best immediate treatment for this patient?
a. IV unfractionated heparin
b. IV steroids and emergent mediastinal radiation
c. Oxygen, Aspirin, and Nitroglycerin
d. Hydrochlorothiazide and lisinopril
e. Mucinex and furosemide
b. IV steroids and emergent mediastinal radiation
70
69) Lee is a 80 year old male with the complaint of being unable to void urine for the past 36 hours. After a thorough history taking, you discover he is on narcotics for treatment of chronic pain. The bladder US reveals 900 cc of urine. What is the first step in treating him?
a) catheterization
b) diuretic
c) tamulosin
d) finasteride
e) urology consult
a) catheterization
71
70) A 54 y/o female has been having feelings of depression since her husband left her almost three years ago. The patient states she also has a hard time concentrating at work and goes to bed right after she eats dinner every evening because she is so tired throughout the day. Select the patient’s diagnosis and appropriate treatment.
A. Major Depressive Disorder- Duloxetine
B. Persistent Depressive Disorder- Escitalopram
C. Adjustment Disorder- Cognitive Behavioral Therapy
D. Minor Depressive Disorder- Paroxetine
E. Bipolar Disorder- Vortioxetine
B. Persistent Depressive Disorder- Escitalopram
72
71) A 68-year-old male presents to the ED at around 10:00 pm complaining of a painful erection that “won’t go away.” When taking a history, he informs you that he had just got back from a fancy dinner with his wife for their anniversary. The patient denies that this has ever happened to him before, and confirms that he occasionally uses erectile dysfunction medications. The patient states that he has never experienced penile trauma of any kind. You determine that the patient is currently suffering from priapism: what type (most likely) and what is the appropriate course of action for treatment of this patient?
A. Ischemic; Call urology as the patient will need corporal aspiration followed by irrigation with epinephrine.
B. Non-Ischemic; Call urology as the patient will need corporal aspiration followed by irrigation with phenylephrine.
C. Ischemic; Call urology as the patient will need corporal aspiration followed by irrigation with phenylephrine.
D. Non-Ischemic; Console the patient as this condition will improve with time.
C. Ischemic; Call urology as the patient will need corporal aspiration followed by irrigation with phenylephrine.
73
72) 26-year-old overweight female with T2DM expresses interest in starting a new birth control method. Because of her constant monitoring of her blood glucose, she wants a birth control that she "doesn't have to worry about" and preferably long-term. What is the BEST contraceptive option for this patient?
a) Aviane
b) Norethindrone 0.35mg
c) NuvaRing
d) Kyleena
e) Nexplanon
d) Kyleena
74
73.) AD is a 16 year old female presenting to her PCP for a birth control prescription. She is a cigarette smoker and says that she would rather not take a pill every day because she’s afraid that she’ll miss multiple doses. Which contraceptive option is the BEST option for her at this time?
a. ) Vaginal ring (ethinylestradiol/etonogestrel)
b. ) Norethindrone 0.35 mg
c. ) Implanted device (Nexplanon)
d. ) Loestrin Fe 1.5/30
c.) Implanted device (Nexplanon)
75
74. A patient presents to the Emergency Room after ingesting ½ of a bottle of Tylenol. She states she took the pills about 3 hours ago. Her acetaminophen plasma concentration is found to be 150mg/dL. What is the best next step?
A. Wait 1 hour and check levels again
B. Give patient Ipecac
C. Start patient on hemodialysis
D. Give patient N-acetylcysteine (NAC)
E. Start IV Fluids and keep patient in ER for a few hours for observation
D. Give patient N-acetylcysteine (NAC)
76
75. All of the following are acceptable treatment options for acute tumor lysis syndrome EXCEPT?
```
A. Emergent hemodialysis
B. Immediate cessation of chemotherapy
C. Aggressive IV hydration
D. Bisphosphonates
E. Rasburicase
```
D. Bisphosphonates
77
76. Your patient is a 70 year old male with small cell lung cancer. He presents to you today with new onset dyspnea, hoarseness, and cough. Upon examination, you find he has neck vein distention and orbital swelling. All of the following are appropriate aspects of the treatment plan except:
```
A. Keep patient in head up position
B. IV Beta blocker
C. IV Steroids
D. IV Diuretics
E. Emergent mediastinal radiation treatment
```
B. IV Beta blocker
78
77. A 44-year-old, febrile male with a history of Alcohol Use Disorder and a recent vasectomy presents with a chief complaint of scrotal pain. On exam, the patient’s scrotum is odorous, erythematous, tender, and has crepitus. What should be done to treat the patient at this time?
A) Obtain a bacterial culture and wait for the results to treat based on sensitivity
B) Advise patient to place a warm, moist compress over affected area twice daily until symptoms resolve
C) Provide triple antibiotic therapy with Zosyn, Vancomycin, and Clindamycin
D) Send patient home with Tylenol for pain and fever
E) Provide triple antibiotic therapy (Zosyn, Vancomycin, and Clindamycin) and stat surgical consult
E) Provide triple antibiotic therapy (Zosyn, Vancomycin, and Clindamycin) and stat surgical consult
79
78. A 54-year-old male patient with a history of GERD presents to the ED complaining of abdominal pain. He presents with hemoptysis and syncope x 2. He is pale and diaphoretic with a BP of 90/65. What would you like to do next?
a. Do nothing
b. Stabilize the patient and start 2 Large bore IVs
c. Determine his Rockall score
d. Give high dose IV PPI
b. Stabilize the patient and start 2 Large bore IVs
80
79)When would you NOT CONSIDER using G-CSF in a febrile neutropenic patient?
A. Profound neutropenia
B. Shock or comorbid conditions
C. Worsening clinical course and expected prolonged neutropenia
D. The patient has previously received G-CSF
E. The patient is not responding to antibiotics despite documented infection
D. The patient has previously received G-CSF
81
80. Which of the following patients does NOT have a contraindication to combined oral contraceptives?
A. A 35 year old female with a history of DVT during pregnancy.
B. A 45 year old female with a suspicious mass in her left breast.
C. A 40 year old female who has smoked a pack a day for 20 years.
D. A 30 year old female who suffers from migraine with aura.
E. A 47 year old female with a BP of 148/94
Answer: E (OCPs are contraindicated in patients with BP >160/100)
E. A 47 year old female with a BP of 148/94
Answer: E (OCPs are contraindicated in patients with BP >160/100)
82
```
81. A 52 year old male presents to the ER with acute onset of severe left flank pain, nausea and vomiting. On exam, he is afebrile, BP 145/78, HR 108, RR 24, 98% RA. He appears uncomfortable and has marked CVA tenderness. CT scan of abdomen and pelvis without IV contrast reveals a 3mm mid ureteral calculi. Which of the following is NOT an appropriate initial treatment?
A. Alpha blocker
B. Analgesics
C. 2 Liters a day of water
D. Potassium Citrate
E. Strain urine
```
Potassium Citrate
83
82. A 64y/o male presents to your primary care office with a complaint of abdominal discomfort. After a thorough history is taken, you discover he has been a heavy drinker for the past 35 years. He has no other co-morbid medical conditions. Despite saying this discomfort has been gradual in onset, he denies anything like this happening before. On physical exam of his abdomen, you note shifting dullness. No abdominal tenderness or pulsations are noted, but the patient appears moderately distended. When labs and Ultrasound come back, you diagnose this patient with Ascites, secondary to Cirrhosis. Assuming electrolytes are normal, what is the appropriate treatment regimen for this patient, and can they be treated on an outpatient basis?
A) Large Volume Paracentesis and Spironolactone 100mg/day; patient cannot be treated outpatient.
B) Salt restriction and Spironolactone 100mg/day; patient can be treated outpatient.
C)Salt restriction and Spironolactone 100mg/day; patient cannot be treated outpatient.
D) Salt restriction; patient can be treated outpatient.
E) Spironolactone 100mg/day; patient can be treated outpatient.
B) Salt restriction and Spironolactone 100mg/day; patient can be treated outpatient.
84
83. A 45 yo female patient undergoing treatment for Non-Hodgkin's lymphoma presents to the ED with weakness, polydipsia, confusion and vomiting. Her CMP reveals a corrected Ca2+ of 14.2 and low serum Cl-. EKG reveals short QT intervals. Which of the following is NOT an appropriate treatment to give this patient?
A. IV Normal Saline hydration to euvolemia
B. Pamindronate 60-90mg IV over 60 minutes
C. Denosumab 120 mg sc
D. Potassium Phosphate 250 mg PO
E. Salmon calcitonin sc
D. Potassium Phosphate 250 mg PO
85
```
84: Ms. B is a 28-year-old pregnant female who presents to the ED with right sided flank pain that radiates to the groin, along with increased frequency and urgency of urination. On exam, she is afebrile, HR 102, RR 20. Her abdominal exam is unremarkable, but she does present with unilateral right sided CVA tenderness. Which of the following is the most appropriate choice for initial management in this patient with suspected nephrolithiasis?
A. Abdominal NCCT
B. NSAIDs
C. Tamsulosin
D. Ultrasound
```
D. Ultrasound
86
85.
A 72 year old male with known ascites presents with abdominal pain and tenderness of the abdomen. A paracentesis is performed along with a fluid analysis. Ascitic fluid culture came back negative, but fluid analysis of the ascitic fluid has a neutrophil count of 300 cells/mm3. What is the next step?
a. redo paracentesis and fluid culture until culture comes back positive
b. IV Cefriaxone
c. Lactulose to decrease neutrophil count
d. oral vancomycin
b. IV Cefriaxone
87
86. A 41-year-old woman presents to your Urgent Care with complaints of low back pain. Upon watching her ambulate, you observe a slight gait disturbance. On physical exam you note localized tenderness to her lower back upon palpation. Her past surgical history is positive for a double mastectomy with reconstruction in 2012. What is the appropriate next step in treating this woman’s pain?
a. Advise the patient that NSAIDs should help and tell her to return if it gets worse
b. Schedule the patient for an X-Ray and get a consult
c. Send the patient to the ED for an emergent Non-contrast CT and get a consult
d. Send the patient to the ED for an emergent MRI and get a consult
d. Send the patient to the ED for an emergent MRI and get a consult
88
87. A 72-year-old male presents to the Emergency Department with severe pain in the lower abdomen. He has been treated with oxybutynin for overactive bladder and says since starting the medication, he has noticed when he uses the bathroom, he has a decreased stream and often a “dribble.”
Physical Exam
VS: afebrile BP: 130/80 HR: 90 RR: 22 O2 Sat: 98 on RA
Distended bladder approximately half way to the umbilicus
Bladder US is done at bedside revealing >500 cc
What is the BEST treatment for this patient?
A. Place Foley catheter to drain urine and check Serum Cr to rule out obstructive uropathy. Start Tamsulosin and refer to a urologist for a voiding trial in 3-7 days. Discontinue oxybutynin.
B. Keep inpatient and monitor for urine output and monitor serum and urine electrolytes. Discontinue oxybutynin.
C. Start Finasteride and refer to a urologist for a voiding trial in 3-7 days. Discontinue oxybutynin.
D. Give IVF at 75% of the cc/hr rate of diuresis. Discontinue oxybutynin.
A. Place Foley catheter to drain urine and check Serum Cr to rule out obstructive uropathy. Start Tamsulosin and refer to a urologist for a voiding trial in 3-7 days. Discontinue oxybutynin.
