Quiz 45 Flashcards
A 26-month-old child presents with a 2-day history of 6–8 loose stools per day and a low-grade fever. When evaluating the child to determine whether he is dehydrated, which one of the following would NOT be useful? (check one) A. Skin turgor B. Capillary refill time C. Respiratory rate and pattern D. The BUN/creatinine ratio E. The serum bicarbonate level
The most useful findings for identifying dehydration are prolonged capillary refill time, abnormal skin turgor, and abnormal respiratory pattern (SOR C). Capillary refill time is not affected by fever and should be less than 2 seconds. Skin recoil is normally instantaneous, but recoil time increases linearly with the degree of dehydration. The respiratory pattern should be compared with age-specific normal values, but will be increased and sometimes labored, depending on the degree of dehydration.
Unlike in adults, calculation of the BUN/creatinine ratio is not useful in children. Although the normal BUN level is the same for children and adults, the normal serum creatinine level changes with age in children. In combination with other clinical indicators, a low serum bicarbonate level (<17 mmol/L) is helpful in identifying children who are dehydrated, and a level <13 mmol/L is associated with an increased risk of failure of outpatient rehydration efforts.
A 70-year-old Asian male presents with hematochezia. He has stable vital signs. Lower endoscopy is performed, but is unsuccessful due to active bleeding.
Which one of the following would be most appropriate at this point?
A technetium-99m blood pool scan
In most patients with heavy gastrointestinal bleeding, localizing the bleeding site, rather than diagnosing the cause of the bleeding, is the most important task.
In most patients with heavy gastrointestinal bleeding, localizing the bleeding site, rather than diagnosing the cause of the bleeding, is the most important task.
Exploratory laparotomy may be indicated if a blood pool scan or an arteriogram is nondiagnostic and the patient continues to bleed heavily.
A patient presenting with severe carbon monoxide poisoning should be treated with:
Patients with carbon monoxide poisoning should be treated immediately with normobaric oxygen, which speeds up the excretion of carbon monoxide
Based on U.S. Preventive Services Task Force guidelines, screening for lung cancer with
low-dose CT of the chest is indicated for which one of the following patients with a 30-pack-year
smoking history?
(check one)
A. 50-year-old current smoker
B. n 85-year-old current smoker
C. A 60-year-old who quit smoking 10 years ago
D. A 75-year-old who quit smoking 20 years ago
A 60-year-old who quit smoking 10 years ago
adults 55–80 years of age who have a 30-pack-year smoking history and
currently smoke or have quit within the past 15 years.
A 40-year-old nurse presents with a 1-year history of rhinitis, and a more recent onset of episodic wheezing and dyspnea. Her symptoms seem to improve when she is on vacation. She does not smoke, although she says that her husband does. Her FEV1 improves 20% with inhaled β-agonists.
Which one of the following is the most likely diagnosis?
Occupational asthma
A previously healthy 60-year-old male is diagnosed with multiple myeloma after a workup for an incidental finding on routine laboratory work. He has no identified organ or tissue damage and is asymptomatic.
Which one of the following would be appropriate treatment of this patient’s condition?
This patient has smoldering (asymptomatic) multiple myeloma. He does not have any organ or tissue damage related to this disease and has no symptoms. Early treatment of these patients does not improve mortality (SOR A) and may increase the likelihood of developing acute leukemia. The standard treatment for symptomatic patients under age 65 is autologous stem cell transplantation. Patients over 65 who are healthy enough to undergo transplantation would also be appropriate candidates. Patients who are not candidates for autologous stem cell transplantation generally receive melphalan and prednisolone with or without thalidomide. Radiotherapy can be used to relieve metastatic bone pain or spinal cord compression.
Nonspecific Back Pain
In addition to analgesics (e.g., acetaminophen or NSAIDs) (SOR A) and spinal manipulation (SOR B), a multidisciplinary rehabilitation program is the best choice for management (SOR A).
Which one of the following patients is unlikely to benefit from vaccination against hepatitis A? (check one)
A. A missionary traveling to Mexico
B. A man who has sex with men
C. A methamphetamine addict
D. A patient with chronic hepatitis
E. A 40-year old recent immigrant from India
A 40-year old recent immigrant from India
Each of the individuals listed is at increased risk for hepatitis A infection or its complications, except for the Indian immigrant. Hepatitis A is so prevalent in developing countries such as India that virtually everyone is infected by the end of childhood, and therefore immune. Infection with hepatitis A confers lifelong immunity, so an adult from a highly endemic area such as India has little to gain from vaccination.
