Quiz 9 Flashcards
A 40-year-old male respiratory therapist presents for a health examination prior to hospital
employment. His history indicates that as a child he lived on a farm in Iowa. His examination
is unremarkable, but a chest radiograph shows that both lung fields have BB-sized calcifications
in a miliary pattern. No other findings are noted. A PPD skin test is negative.
Histoplasmosis.
A 43-year-old female complains of easy bruising. She is otherwise asymptomatic. A CBC
reveals a platelet count of 23,000/mm3 (N 150,000–450,000). A peripheral smear reveals giant
platelets. A workup is negative for autoimmune causes, including Graves disease, HIV,
Epstein-Barr virus, cytomegalovirus, varicella zoster, hepatitis C, and Helicobacter pylori. She
is on no prescription or over-the-counter medications and denies alcohol or drug use.
Which one of the following would be the most appropriate initial management?
Immune (idiopathic) thrombocytopenic purpura is an acquired immune-mediated disorder defined as
isolated thrombocytopenia not found to have another cause. Treatment is usually restricted to severe
thrombocytopenic cases (platelet count <50,000/mm3) unless there is evidence of acute bleeding.
Corticosteroids are considered the first-line therapy (SOR C). Intravenous immunoglobulin and rituximab
have also been used as first-line agents
pertussis
Azithromycin (
A 14-year-old male presents to your office with a high fever that began suddenly. He has a
diffuse petechial rash and some nuchal rigidity on examination. A lumbar puncture is performed,
and gram-negative diplococci are found. You admit him to the hospital for treatment.
Which one of the following would be most appropriate for prevention of secondary disease at this time? (check one)
A. Immediate chemoprophylaxis for his entire school
B. Immediate vaccination of all contacts
C. Chemoprophylaxis for family members and very close contacts only
D. Isolation of all family members for 1 week
E. No preventive measures until culture results are available
Chemoprophylaxis for family members and very close contacts only
Meningococcal disease remains a leading cause of sepsis and meningitis. Those in close contact with
patients who have presumptive meningococcal disease are at heightened risk.
A 58-year-old male with COPD presents with a 5-day history of increased dyspnea and purulent
sputum production. He is afebrile. His respiratory rate is 24/min, heart rate 90 beats/min, blood
pressure 140/80 mm Hg, and oxygen saturation 90% on room air. Breath sounds are equal, and
diffuse bilateral rhonchi are noted. He is currently using albuterol/ipratropium by metered-dose
inhaler three times daily.
In addition to antibiotics, which one of the following would be most appropriate for treating this
exacerbation? (check one)
A. A single dose of intramuscular dexamethasone
B. Oral prednisone for 5 days
C. Daily inhaled fluticasone (Flovent)
D. Hospital admission for intravenous methylprednisolone sodium succinate (Solu-Medrol)
E. No corticosteroids at this time
Oral prednisone for 5 days
His vital signs do not indicate a
serious condition at this time, so he can be treated as an outpatient. Since he is already on a reasonable
dose of an inhaled bronchodilator/anticholinergic combination, he should be treated with an oral antibiotic
and an oral corticosteroid.
Daycare workers with symptoms including bloating, flatulence, and
foul-smelling stools.
are susceptible to giardiasis,
This can be treated with metronidazole.
Patients who become ill after an event where food is served and several attendees have similar symptoms
if the symptoms include bloody diarrhea.
Campylobacter infectionThis
should also be treated with ciprofloxacin.
Travelers to less developed countries often
develop travelers’ diarrhea from ingesting contaminated food or water.
Escherichia coli, although travelers can also have Norovirus infections. The most
appropriate antibiotic choice in this situation is ciprofloxacin.
