Quiz 49 Flashcards
Which one of the following drugs inhibits platelet function for the life of the platelet?
A number of drugs inhibit platelet function, but aspirin is the only effective drug that interferes with platelet aggregation for the life of the platelet. It does this by permanently acetylating the platelet enzyme cyclooxygenase, thus inhibiting prostaglandin synthesis. This phenomenon is clinically helpful when an antithrombotic effect is desired, but it may require that necessary surgical procedures be delayed. The effect of a single aspirin on bleeding times can persist for up to 5 days. Other NSAIDs (i.e., indomethacin, sulfinpyrazone) also inhibit platelet activity, but their effect on prostaglandin synthesis is reversible. The anti-platelet effect of dipyridamole is less well understood. Warfarin is a biochemical antagonist of prothrombin and vitamin K-dependent coagulation factors, and therefore has no significant effect on platelet activity.
An otherwise healthy 10-year-old female presents with a papulovesicular eruption on one leg.It extends from the lateral buttock, down the posterolateral thigh, to the lateral calf. It is mildly painful. The patient’s immunizations are up to date, including varicella and MMR. Her family has a pet cat at home, and another child at her school was sent home with a rash earlier in the week.
Herpes zoster can occur from either a wild strain or a vaccine strain of varicella-zoster virus in vaccinated children, but the incidence is low. All cases are mild and uncomplicated.
A 7-year-old male with recurrent sinusitis has difficulty breathing through his nose. He has had chronic diarrhea and his weight is at the 5th percentile. Nasal polyps are noted on examination, in the form of grayish pale masses in both nares. No nasal purulence or odor is present. Which one of the following tests should you order? (check one)
A. A serum angiotensin-converting enzyme level
B. A serum alpha1-antitrypsin level
C. A serum ceruloplasmin level
D. An erythrocyte sedimentation rate
E. A sweat chloride test
E. A sweat chloride test
This child has chronic diarrhea, recurrent sinusitis, and nasal polyps, and is underweight. Nasal polyps tend to occur more often in adult males, with the prevalence increasing in both sexes after age 50. Any child 12 years or younger who presents with nasal polyps should be suspected of having cystic fibrosis until proven otherwise. A sweat chloride test, along with a history and clinical examination, is necessary to evaluate this possibility.
A 30-year-old female with abnormal uterine bleeding asks about treatment options. An examination is normal and blood testing is negative. She is unmarried and is undecided about having children.
Which one of the following would be the most appropriate treatment for this patient?
Few treatments for abnormal uterine bleeding have been studied. NSAIDs, oral contraceptive pills, and danazol have not been shown to have sufficient evidence of effect. Progestin is effective when used on a 21-day cycle, but not if used only during the luteal phase. Hysterectomy and ablation are very effective, but both destroy fertility.
In a young woman unsure about having children, the levonorgestrel releasing IUD is most effective and preserves fertility.
You are treating an 18-year-old white male college freshman for allergic rhinitis. It is September, and he tells you that he has severe symptoms every autumn that impair his academic performance. He has a strongly positive family history of atopic dermatitis.
Which one of the following medications is considered optimal treatment for this condition?
Topical intranasal glucocorticoids are currently believed to be the most efficacious medications for the treatment of allergic rhinitis.
Cromolyn sodium is also an effective topical agent for allergic rhinitis; however, it is more effective if started prior to the season of peak symptoms. Because of the high risk of rhinitis medicamentosa with chronic use of topical decongestants, these agents have limited usefulness in the treatment of allergic rhinitis.
Antihistamines have side effects and are not as effective as corticosteroids
You are treating a 53-year-old female for a deep-vein thrombosis in her left leg. The use of compression stockings for this problem has been shown to: (
decrease the risk of post-thrombotic syndrome
Post-thrombotic syndrome (PTS) is a complication of acute deep-vein thrombosis (DVT), and is characterized by chronic pain, swelling, and skin changes in the affected limb.
Cochrane review documented no increased incidence of pulmonary embolism, and a reduction in pain and swelling in the treatment group. Compression stockings should be applied when anticoagulation therapy is started,
Which one of the following is true concerning the use of dexamethasone to treat acute laryngotracheitis (croup)?
Treatment with corticosteroids is now routinely recommended for acute laryngotracheitis (croup). A single dose of dexamethasone, either orally or intramuscularly, is appropriate. Prolonged courses of corticosteroids provide no additional benefit and may lead to secondary bacterial or fungal infections. Secondary infections rarely occur with single-dose treatment. Corticosteroid therapy shortens emergency department stays and decreases the need for return visits and hospitalizations. It is indicated for patients with croup of any severity.
A 55-year-old male who had a recent episode of atrial fibrillation that converted in the emergency department is asymptomatic and currently in sinus rhythm. He is in good health otherwise and has no history of hypertension, diabetes mellitus, heart failure, transient ischemic attack, or stroke.
Which one of the following would be best for preventing a stroke in this patient?
The absolute rate of stroke depends on age and comorbid conditions. The stroke risk index CHADS , used to quantify risk of stroke for patients who have atrial fibrillation and to aid in the selection of antithrombotic therapy, is a mnemonic for individual stroke risk factors: C (congestive heart failure), H (hypertension), A (age 75), D (diabetes mellitus), and S (secondary prevention for prior ischemic stroke or transient attack—most experts include patients with a systemic embolic event). Each of these clinical parameters is assigned one point, except for secondary prevention, which is assigned 2 points. Patients are considered to be at low risk with a score of 0, at intermediate risk with a score of 1 or 2, and at high risk with a score 3. Experts typically prefer treatment with aspirin rather than warfarin when the risk 2 of stroke is low. The patient in this question has a CHADS score of 0, which is low risk. Treatment with aspirin is therefore appropriate.
Which one of the following serum proteins is typically DECREASED in a hospitalized patient with sepsis?
The acute phase response refers to the multiple physiologic changes that occur with tissue injury. The synthesis of acute-phase proteins by hepatocytes is altered, leading to decreased serum levels of several of these proteins, including albumin and transferrin. Serum levels rise for other proteins, such as ceruloplasmin, complement proteins, haptoglobin, fibrinogen, and C-reactive protein. Serum levels of ferritin may be extremely high in certain conditions, but are also influenced by total-body iron stores.
