Quiz 36 Flashcards
A 91-year-old white male presents with a 6-month history of a painless ulcer on the dorsum of the proximal interphalangeal joint of the second toe. Examination reveals a hallux valgus and a rigid hammer toe of the second digit. His foot has mild to moderate atrophic skin changes, and the dorsal and posterior tibial pulses are absent.
Appropriate treatment includes which one of the following? (check one)
A. Surgical correction of the hammer toe
B. Custom-made shoes to protect the hammer toe
C. Bunionectomy
D. A metatarsal pad
. Custom-made shoes to protect the hammer toe
Conservative, supportive, and palliative therapy replace definitive reconstructive surgical therapy. Surgical correction of a hammer toe and bunionectomy could be disastrous in an elderly patient with a small ulcer and peripheral vascular disease. The best approach with this patient is to prescribe custom-made shoes and a protective shield with a central aperture of foam rubber placed over the hammer toe.
Hantavirus
Hantavirus pulmonary syndrome results from exposure to rodent droppings, mainly the deer mouse in the southwestern U.S
Mice
A 28-year-old white female consults you with a complaint of irregular heavy menstrual periods. A general physical examination, pelvic examination, and Papanicolaou test are normal and a pregnancy test is negative. A CBC and chemistry profile are also normal.
The next step in her workup should be: (check one)
A. endometrial aspiration
B. dilatation and curettage
C. LH and FSH assays
D. administration of estrogen
E. cyclic administration of progesterone for 3 months
cyclic administration of progesterone for 3 months
Abnormal uterine bleeding is a relatively common disorder that may be due to functional disorders of the hypothalamus, pituitary, or ovary, as well as uterine lesions. However, the patient who is younger than 30 years of age will rarely be found to have a structural uterine defect. Once pregnancy, hematologic disease, and renal impairment are excluded, administration of intramuscular or oral progesterone will usually produce definitive flow and control the bleeding. No further evaluation should be necessary unless the bleeding recurs.
A 45-year-old male with chronic nonmalignant back pain is on a chronic narcotic regimen. Which one of the following behaviors is LEAST likely to be associated with pseudoaddiction, as opposed to true addiction? (check one)
A. Requesting a specific drug
B. Aggressive complaining about needing more medication
C. Hoarding drugs during periods of reduced symptoms
D. Requesting medication exactly at prescribed times when hospitalized
E. Concurrent abuse of alcohol or illicit drugs
Concurrent abuse of alcohol or illicit drugs
The use of narcotics for chronic nonmalignant pain is becoming more commonplace. Guidelines have been developed to help direct the use of these medications when clinically appropriate. However, even when given appropriately, the use of opioid medications for pain relief can cause both the physician and the patient to be concerned about the possibility of addiction.
Addiction is a neurobiologic, multifactorial disease characterized by impaired control, compulsive drug use, and continued use despite harm. Pseudoaddiction is a term used to describe patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining specific medications, seem to watch the clock, or engage in other behaviors that appear to be due to inappropriate drug seeking. Pseudoaddiction can be distinguished from true addiction because the behaviors will resolve when the pain is effectively treated.
The concurrent use of alcohol and/or illicit drugs complicates the management of chronic pain in patients. If these are known problems, patients should be referred for psychiatric or pain specialty evaluation before the decision is made to use opioids. Agreements for use of chronic opioids should include the expectation that alcohol and illicit drugs will not be used concurrently, and doing so suggests addiction rather than pseudoaddiction.
Which one of the following is true regarding death certificates? (check one)
A. The immediate cause of death is the final or terminal cause of death, such as cardiac arrest
B. A physician can certify a death from a natural cause but a coroner or medical examiner must certify a death due to any other cause
C. In a case of unknown or probable cause of death, the manner of death is designated as “uncertain”
D. Death certificates are part of the patient’s medical record and, as such, are confidential and regulated by HIPAA laws
E. In a case of death due to an accidental fall, the immediate attending physician must complete the death certificate
Only coroners and medical examiners can complete a death certificate when the manner of death is not natural. The immediate cause of death is a specific etiology, not a general concept. “Uncertain” is not a manner of death, but “undetermined” may be used by coroners and medical examiners. The death certificate is a public document when filed
Which one of the following is true concerning Paget’s disease of bone? (check one)
A. It is a precursor of multiple myeloma
B. Both bone formation and bone resorption are increased
C. The treatment of choice for symptomatic disease is a calcium channel blocker
D. Pagetic bone pain is difficult to relieve and resistant to medical treatment
E. Extracellular calcium homeostasis is typically abnormal
Both bone formation and bone resorption are increased
Paget’s disease of bone is a focal disorder of skeletal metabolism in which all elements of skeletal remodeling (resorption, formation, and mineralization) are increased.
The preferred treatment for nearly all patients with symptomatic disease is one of the newer bisphosphonates. Treatment of bone pain resulting from Paget’s disease is generally very satisfactory, and in fact, relief may continue for many months or years after treatment is stopped, lending support for intermittent symptomatic therapy. Finally, despite the massive bone turnover, extracellular calcium homeostasis is almost invariably normal.
The FDA recommends that over-the-counter cough and cold products not be used in children below the age of
2 yo
In a patient with hyperuricemia who has experienced an attack of gout, which one of the following is LEAST likely to precipitate another gout attack? (check one) A. Red meat B. Milk C. Seafood D. Nuts E. Beans
Reducing consumption of red meat, seafood, and alcohol may help reduce the risk of a gout attack. Dairy products, in contrast to other foods high in protein, decrease the risk of another attack. Nuts and beans are high in purines and will worsen gout.
Which one of the pharmacologic effects of transdermal medications changes the LEAST with aging?
Transdermal absorption of medications CHANGES VERY LITTLE with age.
Due to an increase in the ratio of fat to lean body weight, the volume of distribution changes with aging, especially for fat-soluble drugs. Both liver metabolism and renal excretion of drugs decrease with aging, increasing serum concentrations.
