Quiz 28 Flashcards
Immunosuppression is defined as:
Zoster vaccine, a live attenuated virus vaccine, is contraindicated in this patient due to her
immunocompromised state.
Immunosuppression is defined as:
• Treatment with glucocorticoids (treatment with the equivalent of 20 mg/day of prednisone for 2
weeks or more, and discontinuation within the previous 3 months)
• Ongoing treatment with effective doses of 6-MP/azathioprine or discontinuation within the
previous 3 months
• Treatment with methotrexate or discontinuation within the previous 3 months
• Treatment with infliximab or discontinuation within the previous 3 months
Pcos infertility
Metformin
When treating acute adult asthma in the emergency department, using a metered-dose inhaler (MDI) with a spacer has been shown to result in which one of the following, compared to use of a nebulizer?
Compared to nebulizers, MDIs with spacers have been shown to lower pulse rates, provide greater improvement in peak-flow rates, lead to greater improvement in arterial blood gases, and decrease required albuterol doses. They have also been shown to lower costs, shorten emergency department stays, and significantly lower relapse rates at 2 and 3 weeks compared to nebulizers. There is no difference in hospital admission rates
A 24-year-old female with a 2-year history of dyspnea on exertion has been diagnosed with exercise-induced asthma by another physician. Which one of the following findings on pulmonary function testing would raise concerns that she actually has vocal cord dysfunction? (check one)
A. A good response to an inhaled β-agonist
B. Flattening of the inspiratory portion of the flow-volume loop, but a normal expiratory phase
C. Flattening of the expiratory portion of the flow-volume loop, but a normal inspiratory phase
D. Flattening of both the inspiratory and expiratory portion of the flow-volume loop
E. A decreased FEV1and a normal FVC
Flattening of the inspiratory portion of the flow-volume loop, but a normal expiratory phase
The diagnosis of vocal cord dysfunction should be considered in patients diagnosed with exercise-induced asthma who do not have a good response to β-agonists before exercise. Pulmonary function testing with a flow-volume loop typically shows a normal expiratory portion but a flattened inspiratory phase (SOR C). A decreased FEV1and normal FVC would be consistent with asthma.
A 45-year-old female presents to your office with a 1-month history of pain and swelling posterior to the medial malleolus. She does not recall any injury, but reports that the pain is worse with weight bearing and with inversion of the foot. Plantar flexion against resistance elicits pain, and the patient is unable to perform a single-leg heel raise.
The diagnosis of tendinopathy of the posterior tibial tendon is important, in that the tendon’s function is to perform plantar flexion of the foot, invert the foot, and stabilize the medial longitudinal arch. An injury can, over time, elongate the midfoot and hindfoot ligaments, causing a painful flatfoot deformity.
Without proper treatment, progressive degeneration of the tendon can occur, ultimately leading to tendon rupture.
Pain and swelling of the tendon is often noted, and is misdiagnosed as a medial ankle sprain. With the patient standing on tiptoe, the heel should deviate in a varus alignment, but this does not occur on the involved side. A single-leg toe raise should reproduce the pain, and if the process has progressed, this maneuver indicates progression of the problem.
While treatment with acetaminophen or NSAIDs provides short-term pain relief, neither affects long-term outcome. Corticosteroid injection into the synovial sheath of the posterior tibial tendon is associated with a high rate of tendon rupture and is not recommended. The best initial treatment is immobilization in a cast boot or short leg cast for 2–3 weeks.
Which one of the following is true concerning Norwalk virus?
Viral shedding continues long after the acute illness
Outbreaks of Norwalk gastroenteritis occur in a wide variety of settings, involve all ages, and are more likely to involve high-risk groups such as immunocompromised patients or the elderly. Not only does viral shedding of the Norwalk virus often precede the onset of illness, but it can continue long after the illness has clinically ended. The virus persists on environmental surfaces and can tolerate a broad range of temperatures. There are multiple strains of the virus, so a single infection does not confer immunity, and repeated infections occur throughout life. It is the most common cause of diarrhea in adults.
Which one of the following Mantoux tuberculin skin test results should be read as NEGATIVE for latent tuberculosis infection?
Three different cutoff levels
For those who are at highest risk and/or immunocompromised, including HIV-positive patients, transplant patients, and household contacts of a tuberculosis patient, an induration ≥5 mm is considered positive. For those at low risk of exposure, a screening test is not recommended, but if one is performed, induration ≥15 mm is considered positive.
For those who have an increased probability of exposure or risk, an induration ≥10 mm should be read as positive. This group includes children; employees or residents of nursing homes, correctional facilities, or homeless shelters; recent immigrants; intravenous drug users; hospital workers; and those with chronic illnesses. For individuals who are subject to repeated testing, such as health-care workers, an increase in induration of 10 mm or more within a 2-year period would be considered positive and an indication of a recent infection withMycobacterium tuberculosis.
Vancomycin labs
The best predictor of vancomycin efficacy is the trough serum concentration, which should be over 10 mg/L to prevent development of bacterial resistance.
A patient who takes fluoxetine (Prozac), 40 mg twice daily, develops shivering, tremors, and diarrhea after taking an over-the-counter cough and cold medication. On examination he has dilated pupils and a heart rate of 110 beats/min. His temperature is normal.
Which one of the following medications in combination with fluoxetine could contribute to this patient’s symptoms? (check one)
A. Dextromethorphan B. Pseudoephedrine C. Phenylephrine D. Guaifenesin E. Diphenhydramine (Benadryl)
Correct.
Dextromethorphan is commonly found in cough and cold remedies, and is associated with serotonin syndrome. SSRIs such as fluoxetine are also associated with serotonin syndrome, and there are many other medications that increase the risk for serotonin syndrome when combined with SSRIs. The other medications listed here are not associated with serotonin syndrome, however.
Ref: Ables AZ, Nagubilli R: Prevention, recognition, and management of serotonin syndrome.Am Fam Physician2010;81(9):1139-1142.
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Your score:100%| 1 of 10
Passing score: 80%
