quiz 51 Flashcards
Which one of the following is most associated with falls in older adults? (check one) A. Diphenhydramine (Benadryl) B. Atorvastatin (Lipitor) C. Metformin (Glucophage) D. Memantine (Namenda) E. Theophylline (Theo-24)
Certain classes of medications are frequently associated with falls in older adults. These classes include benzodiazepines, antidepressants, antipsychotics, antiepileptics, anticholinergics, sedative hypnotics, muscle relaxants, and cardiovascular medications. Diphenhydramine is one of the anticholinergic medications associated with falls in older adults. The other drugs listed are not in the higher-risk groups of medications.
A 78-year-old white male is scheduled to undergo CT with contrast. His current diagnoses include type 2 diabetes mellitus, heart failure, anemia of chronic disease, and renal insufficiency. Evidence supports the use of which one of the following to reduce the risk of contrast-induced nephropathy in this patient? (check one) A. Intravenous furosemide B. Ascorbic acid C. Calcium antagonists D. Isotonic bicarbonate infusion E. High osmolar contrast media
. Isotonic bicarbonate infusion
Prospective randomized trials examining the risk for contrast-induced nephropathy have identified significant differences between contrast agents due to their physiochemical properties. Low-osmolar or iso-osmolar contrast media should be used to prevent contrast-induced nephropathy in at-risk patients. The volume of contrast medium should be as low as possible. Evidence also supports hydration before the 8 procedure, preferably with isotonic saline or isotonic sodium bicarbonate solution. There is limited evidence that any pharmacologic intervention will prevent contrast-induced nephropathy.
A 70-year-old white female complains of two episodes of urinary incontinence. On both occasions she was unable to reach a bathroom in time to prevent loss of urine. The first episode occurred when she was in her car and the second while she was in a shopping mall. She is reluctant to go out because of this problem.
The most likely cause of her problem is: (check one)
A. overflow incontinence
B. stress incontinence
C. urge incontinence
D. functional incontinence
urge incontinence
At least 10 million Americans suffer from urinary incontinence. In the neurologically intact individual the most common subtypes are stress incontinence, which occurs with coughing or lifting; urge incontinence, which occurs when patients sense the urge to void but are unable to inhibit leakage long enough to reach the toilet; and overflow incontinence, which occurs when the bladder cannot empty normally and becomes overdistended. The term functional incontinence is applied to those cases where lower urinary tract function is intact but other factors such as immobility and severe cognitive impairment lead to incontinence.
This patient has mild urge incontinence. The first approach to this problem should be behavioral. In a mild case such as this, a cure can be expected, with success rates of 30%–90% in published studies. For more severe cases, various pharmacologic agents, including anticholinergics, are useful. Failure of these modalities should lead to urodynamic testing and consideration of surgery.
A 17-year-old soccer player presents for a preparticipation examination. His family history is significant for the sudden death of his 12-year-old sister while playing basketball, and for his mother and maternal grandmother having recurrent syncopal episodes.
His medical history and examination are completely normal. Prior to approving his participation in sports, which one of the following is recommended? (check one)
A. A resting EKG
B. A stress EKG
C. An echocardiogram
D. Pulmonary function testing
E. No further evaluation
A resting EKG
A family history of sudden death and recurrent syncope is highly suspicious for genetic long-QT syndrome. It is best diagnosed with a resting EKG that shows a QTc >460 msec in females and >440 msec in males. This syndrome especially places young people at risk for sudden death. Management may include β-blockers, an implantable cardioverter-defibrillator, and no participation in competitive sports.
Which one of the following dietary supplements has the best evidence of efficacy in the treatment of osteoarthritis of the knee?
Glucosamine sulfate
Glucosamine sulfate may be used to reduce symptoms and possibly slow disease progression in patients with osteoarthritis of the knee
A 24-year-old female has a history of mood swings over the past several months, which have created marital and financial problems, in addition to jeopardizing her career as a television news reporter. You have made a diagnosis of bipolar disorder, and she has finally accepted the need for treatment. However, she insists that you choose a drug that “won’t make me fat.”
Which one of the following would be best for addressing her concerns? (check one) A. Aripiprazole (Abilify) B. Olanzapine (Zyprexa) C. Quetiapine (Seroquel) D. Risperidone (Risperdal)
All of the atypical antipsychotics are associated with some degree of weight gain. Of the choices listed, aripiprazole is associated with the least amount of weight gain, generally less than 1 kilogram. The other agents listed are likely to cause considerably more weight gain.
A 75-year-old white female presents with back pain of several months’ duration, which is worsened by movement. A physical examination is unremarkable except for mild pallor. She takes furosemide (Lasix) for hypertension.
Laboratory Findings
Hemoglobin.. . . . . . . . . . . . . . . . . . . . . 10.0 g/dL (N 12.0–16.0)
Serum creatinine.. . . . . . . . . . . . . . . . . . 2.0 mg/dL (N 0.6–1.5)
BUN. . . . . . . . . . . . . . . . . . . . . . . . . . 40 mg/dL (N 8–25)
Serum uric acid. . . . . . . . . . . . . . . . . . . 8.0 mg/dL (N 3.0–7.0)
Serum calcium. . . . . . . . . . . . . . . . . . . . 12.0 mg/dL (N 8.5–10.5)
Total serum protein. . . . . . . . . . . . . . . . . 9.8 g/dL (N 6.0–8.4)
Globulin. . . . . . . . . . . . . . . . . . . . . . . . 6.1 g/dL (N 2.3–3.5)
Albumin. . . . . . . . . . . . . . . . . . . . . . . . 3.7 g/dL (N 3.5–5.0)
Serum IgG.. . . . . . . . . . . . . . . . . . . . . . 3700 mg/dL (N 639–1349)
Urine. . . . . . . . . . . . . . . . . . . . . . . . . . positive for Bence-Jones protein
Which one of the following would be most appropriate at this point?
This patient has typical symptoms and laboratory findings of multiple myeloma, which accounts for 1% of all malignant diseases and has a mean age at diagnosis of 61 years. The diagnosis is confirmed by a bone marrow examination showing >10% plasma cells in the marrow. The serum level of monoclonal immunoglobulin is typically >3 g/dL. A bone scan is inferior to conventional radiography and should not be used. Tamoxifen is indicated for the treatment of breast cancer, which is unlikely given the physicaland laboratory findings in this case.
