Quiz 59

Question 1

An anxious 62-year-old white male comes to the emergency department complaining of extreme shortness of breath and a cough producing blood-tinged sputum. The patient denies chest pain and fever. On examination he is afebrile and has expiratory wheezes and a few rales throughout the chest. The heart is normal except for a rapid rate and an S3 gallop. A chest radiograph reveals a right pleural effusion with enlargement of the cardiac silhouette and redistribution of blood flow to the upper lobes. Which one of the following tests would be best for confirming the diagnosis?   (check one)
 A. Troponin I 
 B. BNP 
 C. D-dimer 
 D. CT angiography of the chest 
 E. Arterial blood gases

Answer 1

This patient has heart failure with a bronchospastic component. The S3 gallop occurs with a dilated left ventricle and a right-sided pleural effusion, which are common in heart failure. A BNP level is useful in differentiating cardiac and pulmonary diseases, while a troponin I level is helpful in assessing for cardiac ischemia. Arterial blood gasses are not useful in confirming the diagnosis. A CT angiogram of the chest would be useful for diagnosing pulmonary embolism. A d-dimer test is helpful to rule out venous thromboembolic disease.

Question 2

A study finds that the positive predictive value of a new test for breast cancer is 75%, which means:

Answer 2

75% of patients who test positive actually have breast cancer

Question 3

A 49-year-old white female comes to your office complaining of painful, cold finger tips which turn white when she is hanging out her laundry. While there is no approved treatment for this condition at this time, which one of the following drugs has been shown to be useful?

Answer 3

Nifedipine

At present there is no approved treatment for Raynaud’s disease. However, patients with this disorder reportedly experience subjective symptomatic improvement with calcium channel antagonists, with nifedipine being the calcium channel blocker of choice

Question 4

A 30-year-old female who had a deep venous thrombosis in her left leg during pregnancy has an uneventful delivery. During the pregnancy she was treated with low molecular weight heparin. Just after delivery her left leg is pain free and is not swollen. She plans to resume normal activities soon.

Which one of the following would be most appropriate with regard to anticoagulation?

Answer 4

The risk of pulmonary embolism continues in the postpartum period, and may actually increase during that time. For patients who have had a deep-vein thrombosis during pregnancy, treatment should be continued for 6 weeks after delivery, with either warfarin or low molecular weight heparin.

Question 5

An overweight 11-year-old male with acanthosis nigricans is found to have a fasting plasma glucose level of 175 mg/dL on two occasions. Over the next 6 months, despite reasonable adherence to a diet and exercise regimen, he has preprandial and bedtime finger-stick blood glucose levels that average 180 mg/dL. His hemoglobin A1c is 9.0%.
Which one of the following oral agents would be most appropriate at this time?

Answer 5

Metformin and insulin are the only agents approved for treatment of type 2 diabetes mellitus in children.

Question 6

A 32-year-old female experiences an episode of unresponsiveness associated with jerking movements of her arms and legs. Which one of the following presentations would make a diagnosis of true seizure more likely? (check one)
A. Post-event confusion
B. Eye closure during the event
C. A history of fibromyalgia
D. A history of chronic back pain
E. A normal serum prolactin level after the event

Answer 6

Post-event confusion

Up to 20% of patients diagnosed with epilepsy actually have pseudoseizures. Eye closure throughout the event is uncommon in true seizures, and a history of fibromyalgia or chronic pain syndrome is predictive of pseudoseizures. If obtained within 20 minutes of the event, a serum prolactin level may be useful in differentiating a true seizure from a pseudoseizure. An elevated level has a sensitivity of 60% for generalized tonic-clonic seizures and 46% for complex partial seizures. Other features suggestive of seizure activity include tongue biting, the presence of an aura, postictal confusion, and focal neurologic signs.

Question 7

A patient dying of cancer is suffering from pain in spite of his narcotic regimen. You increase his dosage of morphine, knowing it will probably hasten his death.

Which ethical principle are you following?
(check one)

Answer 7

Double effect