Quiz 35 Flashcards
A 14-year-old female with a history of asthma is having daytime symptoms about once a week and symptoms that awaken her at night about once a month. Her asthma does not interfere with normal activity, and her FEV1 is >80% of predicted.
Which one of the following is the most appropriate treatment plan for this patient?
(check one)
A. A short-acting inhaled β-agonist as needed
Based on this patient’s reported frequency of asthma symptoms, she should be classified as having intermittent asthma. The preferred first step in managing intermittent asthma is an inhaled short-acting β-agonist as needed. Daily medication is reserved for patients with persistent asthma (symptoms >2 days per week for mild, daily for moderate, and throughout the day for severe) and is initiated in a stepwise approach, starting with a daily low-dose inhaled corticosteroid or leukotriene receptor antagonist and then progressing to a medium-dose inhaled corticosteroid or low-dose inhaled corticosteroid plus a long-acting inhaled β-agonist.
On examination she has a systolic crescendo-decrescendo murmur heard loudest at the right
upper sternal border. An EKG in the office is within normal limits. Echocardiography shows
mild aortic stenosis based on peak aortic jet velocity, aortic valve area, and mean pressure
gradient. Her ejection fraction is 55%. At a follow-up visit she states that she continues to be
symptom free.
Which one of the following should be the next step in the evaluation and management of her
aortic stenosis?
Repeat echocardiography in 3 years
Although aortic stenosis can result in adverse
cardiac events, most of these events occur in patients who are symptomatic. Thus, the American Heart
Association and the American College of Cardiology recommend that asymptomatic patients with mild
aortic stenosis undergo repeat echocardiography every 3–5 years.
Exercise treadmill testing may be indicated
in patients with severe AS based on echocardiography even if they are asymptomatic.
An ACE inhibitor would be indicated in patients who have a
reduced ejection fraction.
A 54-year-old female presents with a 2-month history of intense vulvar itching that has not improved with topical antifungal treatment. On examination you note areas of white, thickened, excoriated skin. Concerned about malignancy you perform punch biopsies, which reveal lichen sclerosus.
The treatment of choice for this condition is topical application of:
Lichen sclerosus is a chronic, progressive, inflammatory skin condition found in the anogenital region. It is characterized by intense vulvar itching. The treatment of choice is high-potency topical corticosteroids.
Which one of the following is the most accurate imaging study for assessing early osteomyelitis? (check one) A. Plain radiography B. Ultrasonography C. CT D. MRI E. A bone scan
Osteomyelitis is a serious complication of diabetic foot infections and is present in up to 20% of mild to
moderate infections and in 50%–60% of severe infections. While a bone biopsy and/or bone cultures are
definitive for making the diagnosis, radiologic studies can also be helpful.
The 90% sensitivity and 80% specificity of MRI is superior to all
other imaging modalities.
A pregnant 32-year-old gravida 2 para 1 develops an acute deep-vein thrombosis in the left lower extremity during the third trimester. The patient had a cesarean delivery with her first pregnancy and wants to breastfeed.
Which one of the following is the treatment of choice?
(check one)
The preferred anticoagulant for venous thrombosis during pregnancy is low molecular weight heparin. Unfractionated heparin requires more monitoring and may increase the risk of heparin-induced thrombocytopenia.
Fibromyalgia mgt
amitriptyline and duloxetine treatment of pain and sleep disturbance
heated pool treatment with or without exercise, tramadol for the management of pain
In the secondary prevention of ischemic cardiac events, which one of the following is most likely to be beneficial in a 68-year-old female with known coronary artery disease and preserved left ventricular function? (check one)
A. ACE inhibitors
B. Hormone therapy
C. Calcium channel blockers
D. Vitamin E
E. Oral glycoprotein IIb/IIIa receptor inhibitors
Secondary prevention of cardiac events consists of long-term treatment to prevent recurrent cardiac morbidity and mortality in patients who have either already had an acute myocardial infarction or are at high risk because of severe coronary artery stenosis, angina, or prior coronary surgical procedures.
Effective treatments include aspirin, β-blockers after myocardial infarction, ACE inhibitors in patients at high risk after myocardial infarction, angiotensin II receptor blockers in those with coronary artery disease, and amiodarone in patients who have had a myocardial infarction and have a high risk of death from cardiac arrhythmias.
A chest radiograph of the driver of an automobile involved in a head-on collision shows a widened mediastinum. This suggests: (check one)
A. myocardial contusion
B. spontaneous rupture of the esophagus
C. rupture of a bronchus
D. partial rupture of the thoracic aorta
E. acute heart failure
Deceleration-type blows to the chest can produce partial or complete transection of the aorta. A chest radiograph shows an acutely widened mediastinum and/or a pleural effusion when the condition is severe. The other conditions listed would produce mediastinal emphysema (esophageal or bronchial rupture), a widened heart, or pulmonary edema (acute heart failure, myocardial contusion).
The most common initial symptom of Hodgkin lymphoma is
painless lymphadenopathy
The most common presenting symptom of Hodgkin lymphoma is painless lymphadenopathy. Approximately one-third of patients with Hodgkin lymphoma present with unexplained fever, night sweats, and recent weight loss, collectively known as “B symptoms.” Other common symptoms include cough, chest pain, dyspnea, and superior vena cava obstruction caused by adenopathy in the chest and mediastinum.
