Quiz 63

Question 1

Panic Attack or MI? What do you do?

Answer 1

Obtain a troponin I measurement and an EKG

The patient should neither be admitted nor given a benzodiazepine until the EKG is performed.

Question 2

The most common identifiable cause of skin and soft-tissue infections presenting to metropolitan emergency departments is: (check one)
A. Staphylococcus epidermidis
B. Streptococcus pneumoniae
C. Pseudomonas aeruginosa
D. methicillin-resistant Staphylococcus aureus (MRSA)
E. Bacillus cereus

Answer 2

methicillin-resistant Staphylococcus aureus (MRSA)

Question 3

A 16-year-old male accompanied by his mother presents to your outpatient clinic with concerns about his short stature and “boyish” looks. He is a sophomore in high school but is frequently mistaken for someone much younger. Radiographs reveal a bone age of 14.7 years.
Which one of the following would suggest the need for further evaluation?
(check one)
A. A family history of delayed growth
B. Height below the fifth percentile for age
C. Weight below the fifth percentile for age
D. Prepubescent testicular size

Answer 3

Most cases of short stature are due to constitutional growth delay, a term which implies that the child is normal but delayed in his development. A hallmark of this condition is being below the fifth percentile for height for most of childhood. Usually these children are thin and have a family history of delayed development. Bone age would be expected to be at least 2.5 standard deviations below the mean for agematched peers of the same chronologic age. However, most experts agree that if no signs of puberty are seen by 14 years of age (no breast development in girls, no testicular enlargement in boys), then further workup for a more serious condition should be sought. Other indications for evaluation would be no menarche in a girl by 16 years of age and underdeveloped genitalia in a boy 5 years after his first pubertal changes.

Question 4

Which one of the following nutritional interventions should be recommended to accelerate pressure ulcer healing in the elderly?  (check one)
 A. Supplemental arginine 
 B. Oral vitamin C and zinc 
 C. High-dose multivitamins 
 D. Adequate protein intake

Answer 4

Adequate protein intake

Very few nutritional interventions have been shown to accelerate pressure ulcer healing in the elderly.
Maintaining a protein intake of at least 1.2–1.5 g/kg/day is recommended, and some authorities
recommend 2 g/kg/day with stage III or IV ulcers. Increased caloric intake is also necessary to promote
healing.

Question 5

According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), in which situation would a physician be allowed to disclose personal information without the patient’s written authorization? (check one)
A. The patient makes a verbal request to release information
B. The patient’s spouse requests information
C. The adult children of the patient request written information
D. A lawyer who claims to represent the patient requests information
E. Another physician involved in the patient’s care requests information

Answer 5

Another physician involved in the patient’s care requests information

HIPAA legislation states that a patient’s personal medical and financial information cannot be released
unless the patient authorizes such a release in writing. The exceptions to this standard are the following:
(1) coordination of care between providers and those involved in the patient’s case (i.e., caretakers, nurses, consulting physicians); (2) arranging payment for medical services rendered; and (3) health-care operations such as evaluating a provider or system’s competency or quality.

Question 6

A 20-year-old college wrestler is seen for an examination prior to the wrestling season. He tells you that some friends have told him he should start taking dehydroepiandrosterone (DHEA), and he asks for your advice.

Which one of the following is true about the effects of this drug?
(check one)
A. It enhances performance but not muscle strength
B. It enhances muscle strength but not performance
C. It enhances both performance and muscle strength
D. It does not enhance either performance or muscle strength

Answer 6

It does not enhance either performance or muscle strength

Dehydroepiandrosterone (DHEA) is illegal under the Anabolic Steroid Control Act of 2004, and is prohibited by the NCAA and the International Olympic Committee. Like androstenedione, DHEA is a precursor to testosterone, but neither of these substances has been shown to enhance either performance or strength. In fact, they increase serum estrogen and luteinizing hormone levels.