Quiz 2 questions Flashcards
1) What is the correct treatment for a male patient with acute urinary retention with who has experienced trauma to their urethra?
a. Urethral Catheterization.
b. Nothing, treat the trauma and worry about the urinary retention later.
c. Supra Pubic Catheterization.
d. Condom-catheter.
e. I&O Catheter.
c. Supra Pubic Catheterization.
2) A 62-year-old female presents to the ED with a chief complaint of worsening dyspnea for about a month. She has had an associated cough and hoarseness as well. She has no significant PMH. Her vitals are as follows: BP 121/67, RR 20, HR 88 and regular, Temperature 98.2 degrees Fahrenheit. On physical exam, diffuse edema is present in her neck as well as her left upper extremity. All of the following are appropriate steps to take EXCEPT:
a) CXR
b) Place a central IV catheter
c) CT with contrast
d) IV Dexamethasone
e) IV Furosemide
b) Place a central IV catheter
3) An 18 year old female comes in complaining that since being on the pill she has been getting a lot of acne. She was hoping to be able to switch to a different birth control pill. Which progestin option would help decrease her symptoms? A. Norgestrel B. Levonorgestrel C. Drosperinone D. Norethindrone E. Norethindrone acetate
C. Drosperinone
4) A 63-year-old Female presents with a history of Breast cancer. She says she feels general malaise and has been experiencing constipation and nausea the last couple of days with intermittent back pain. An EKG was order which revealed an elongated PR interval with low voltage. All of the following could be potential treatment options for this patient EXCEPT? A. IV Hydration B. IV Pamindronate C. Sub Q Calcitonin D. IM Calcitonin E. Oral Phosphates
E. Oral Phosphates
5) All of the following are non-contraceptive benefits of hormonal contraception except:
A. Treatment of menorrhagia
B. Improved bone mineral density
C. Treatment of pelvic pain due to endometriosis
D. Decrease in risk of breast cancer
E. Prevention of menstrual migraines
D. Decrease in risk of breast cancer
6) A 69-year-old financial manager had what his co-workers think was a stroke while he was at his desk. They called EMS and he presents to your Emergency Department. Upon checking his past medical history, you see this patient came in 2 years ago and was diagnosed with Atrial Fibrillation and CKD with a CrCl of 20 ml/min. What would be is the most appropriate prophylactic treatment for this patient to avoid future strokes?
CT SCAN: Large middle cerebral artery infarct, with no acute hemorrhage
A. Administer Aspirin 325 mg
B. Administer Ticagrelor 90 mg BID
C. ASA + Dypyridamole 200mg BID
D. Rivaroxaban 20mg QD
E. Warfarin
E. Warfarin
7) A 16-year-old female presents to the ER via EMS with her brother who claims she couldn’t stop vomiting when he found her in the bathroom half an hour ago with an empty Tylenol bottle next to her. She’s pale, diaphoretic, and nauseous upon arrival. Upon questioning, she didn’t count how many pills she took, just “the rest of it” about an hour ago. All of the following options are appropriate for the management of this patient at this time EXCEPT: Ipecac Activated charcoal NAC Gastric lavage
NAC
8) Ms. B is a 67 year old female with past medical history of HTN, DM, chronic kidney disease (CrCl = 40), and newly diagnosed atrial fibrillation who we would like to initiate on antithrombotic therapy for prevention of ischemic CVA. Calculate Ms. B’s CHA2DS2-VASc score, and select the corresponding appropriate best therapy option for her at this time.
CHA2DS2-VASc score of 3, ASA 81 mg QD
CHA2DS2-VASc score of 3, Clopidogrel 75 mg QD
CHA2DS2-VASc score of 4, Warfarin - dose to INR of 2-3
CHA2DS2-VASc score of 4, Rivaroxaban 20 mg QD
Ms. B is not a candidate for antithrombotic therapy at this time
CHA2DS2-VASc score of 4, Warfarin - dose to INR of 2-3
9) A 27 year-old female started combo OCPs 3 months ago. She has been having breakthrough bleeding (BTB) on days 1-9 of her cycle. What hormonal effect is causing the BTB on these days? Increased estrogen Decreased estrogen Increased progestin Decreased progestin
Decreased estrogen
10) A 28-year-old woman presents with her husband to discuss methods of temporary contraception. They plan to have children in the future but would like to wait a few years. They are both healthy. The patient’s routine pelvic and physical examinations show a healthy young woman; her past medical history is unremarkable. She is a non-smoker and there is no family history of breast, ovarian, or uterine cancer.
What would be the most effective means of temporary contraception for this couple?
A. Levonorgestrel (Plan B)
B. Oral contraceptives
C. Intrauterine device
D. Condoms
E. Cervical cap
Answer: C. IUD efficacy is similar to sterilization, and is reversible
11.) Which of the following is false when managing a stable patient being treated for an upper GI bleed?
A. Deliver high dose Omeprazole IV
B. Encourage patient to drink clear liquids only, as tolerated, for fluid resuscitation
C. Begin monitoring urine output and watching for signs of fluid overload
D. Contact GI for early endoscopy
B. Encourage patient to drink clear liquids only, as tolerated, for fluid resuscitation
12) A 55 y/o male is brought into the ED by his wife who reports that he experienced a brief 3-minute episode of slurred speech, right-sided facial drooping, and inability to lift his right arm. The patient’s symptoms began about 15 minutes ago and he has since returned to baseline. The patient has a history of HTN and HLD. He currently is taking ASA 325 mg PO once daily, lisinopril 40 mg once daily, and atorvastatin 40 mg once daily. Based on the patient’s symptoms and medical history, what treatment do you recommend at this time?
A) do nothing- the patient’s symptoms were transient and returned to baseline so no further intervention needed
B) increase ASA dose to 650 mg PO once daily
C) d/c ASA, start Aggrenox (ASA 25 mg + dipyridamole 200 mg) PO BID
D) d/c ASA, start Aggrenox (ASA 25 mg + dipyridamole 200 mg) PO BID, and increase atorvastatin dose to 80 mg PO once daily
E) d/c ASA, begin rivaroxaban 20 mg PO once daily
D) d/c ASA, start Aggrenox (ASA 25 mg + dipyridamole 200 mg) PO BID, and increase atorvastatin dose to 80 mg PO once daily
13) A 55-year old male presents to the ED with 2-days of colicky abdominal pain that radiates to the groin and testes. He also complains of increased urinary frequency. You suspect a kidney stone. Where is the stone most likely located?
a. ureteropelvic junction
b. ureterovesicular junction
c. mid-ureter
d. urethra
e. bladder
b. ureterovesicular junction
14) All of the following diagnostic studies are recommended by AHA/ASA in the evaluation of a patient with a suspected stroke. All of the below diagnostics are recommended, but should NOT delay IV rtPA. Which one MUST precede the initiation of rtPA? Baseline EKG Baseline troponin assessment Blood glucose level CXR Noninvasive intracranial vascular study
Blood glucose level
15) A 26-year-old female presents to the clinic complaining of fatigue and weight gain ever since she started her birth control 3 months ago. She is currently on a combined OCP. How can you as a provider manage the unwanted side effects?
Fatigue and weight gain are probably not due to the medication. Counsel her on a healthy diet and exercise plan.
Fatigue and weight gain are caused by an estrogen excess. Switch her to a progestin only pill.
Fatigue and weight gain are caused by a progesterone excess. Switch her to a combined OCP that contains less progesterone.
Fatigue and weight gain are caused by an estrogen deficiency. Switch her to a combined OCP that contains more estrogen.
Fatigue and weight gain are caused by a progesterone deficiency. Switch her to a combined OCP that contains more progesterone.
Fatigue and weight gain are caused by a progesterone excess. Switch her to a combined OCP that contains less progesterone.
16) Which one of the following statements regarding contraception is true?
A. Monophasic OCPs are more effective than 4-phasic
B. Norgestrel has low androgenic potential
C. First day start is the preferred method for starting a patient on OCPs
D. The paraguard is the most effective form of emergency contraception
E. Progestin only pills are very effective at suppressing follicular cysts
D. The paraguard is the most effective form of emergency contraception
17.) A 16-year-old female with a BMI of 32 presents to your office because she is interested in starting birth control and wants to know more about the Orthoevra patch. Which of the following points is important to counsel your patient on?
A.) Smoking prevention or cessation B.) Return of fertility is delayed C.) It may be less effective in obese patients D.) All of the above E.) A & C
E.) A & C
18.) A 17 year old female comes into your office with the request to start birth control, as she is newly sexually active with her boyfriend. After hearing horror stories about weight gain from her friend who just started birth control, she demands an option with low risk. The patient smokes socially on occasion and states that she has a hard time remembering to take her multivitamin each morning. The patient has a history of irregular and heavy menses and would like this to be a target for treatment. What is the best treatment option for this patient?
a. OCP (Not preferred due to noncompliance with daily multivitamin)
b. Nexplanon implant (Not preferred due to irregular bleeding patterns)
C. Skylena IUD (TREATMENT CHOICE = lighter, and shorter menses, no daily dosing)
d. Depo-provera (Not preferred due to risk of weight gain)
e. Orthoevra (Not preferred due to BBW for smokers due to increased clot risk)
C. Skylena IUD (TREATMENT CHOICE = lighter, and shorter menses, no daily dosing)
19.) Which of the following is not a related life-threatening concern that must be corrected with Acute Tumor Lysis Syndrome? A. Hyperkalemia B. Hyperuricemia C. Hyperphosphatemia D. Hypocalcemia E. Hypernatremia
E. Hypernatremia
20.) A 60-year-old male presents to the ED because about 1 hour ago he experienced weakness in his right arm and dizziness, which resolved in the car ride here. The patient has a past medical history of hypertension, CKD, and atrial fibrillation. His current medications include Lisinopril 40mg PO once daily and Metoprolol 100mg PO BID. What is the best next step in this patient’s management? Initiate Aspirin 81mg PO once daily Initiate Clopidogrel 75mg once daily Initiate Warfarin PO dosed to INR 2-3 Initiate Apixiban 5mg PO BID Initiate rt-PA 0.9mg/kg IV
Initiate Warfarin PO dosed to INR 2-3
21.) A 27 year old woman presents to your office complaining that since she has stopped her OCPs last month her menstrual cycle has not come back. She is concerned since this is the first time she’s ever been off birth control. What is the best way to counsel this patient?
A. Inform her that this is an unnatural occurrence and refer her to the OBGYN office.
B. Inform the patient that it will take 3 months for her cycle to normalize after stopping OCPs.
C. Encourage the patient to go on a different form of OCPs to get back her regular menstrual cycle.
D. Perform an immediate pregnancy test because the patient is pregnant.
E. Reassure the patient that it can take about 90 days for her menses to return after stopping OCPs.
E. Reassure the patient that it can take about 90 days for her menses to return after stopping OCPs.
22.) A 54-year-old male presents with abdominal pain and mentions that he has gained considerable weight over the past 2 months. The patient also explains that he has been consuming alcohol heavily for the past 25 years. On physical exam, you note scleral icterus, bilateral lower extremity edema, and a markedly distended abdomen with a transmitted thrill. How will this patient most likely be managed? A. Salt restriction B. Diuretic therapy C. Large volume paracentesis D. A&B E. A, B, and C
E. A, B, and C
23) Your patient is a 62 year old male who presents to the ED via EMS with a 2 hour long history of confusion and hemiparesis on the left side. The patient’s wife says he was doing yard work and when she went to bring him some lemonade she found him laying on the grass confused and mumbling. His wife is concerned as he had a concussion one week ago caused by a high speed baseball strike to the head which resulted in syncope and concussion. She wants to know if his current state is a relapse of his concussion. His BP is 170/100, 20RR, pulse of 80, and pulse ox of 98%. A brain CT shows no hemorrhage and an infarct of the middle cerebral artery (MCA). What is the most appropriate treatment?
A. Labetalol 10–20 mg IV over 1–2 min to reduce blood pressure then administer rt-PA.
B. Aspirin 325mg PO
C. No treatment as his condition is only due to his concussion and will get better on his own
D. Immediately administer rt-PA.
B. Aspirin 325mg PO (head injury=CI to rt-PA!)
24.) Which of the following drugs are more effective than warfarin in patients with TIA/Stroke A.) dabigatran B.) Clopidigrel C.) apixaban d.) both A & C E.) all of the above
d.) both A & C
25.) Mr. Johnson, a 65-year-old male, presents to urgent care with urinary urgency and dribbling that started two days ago after getting over a bad cold. He currently takes Atorvastatin, Metformin, Liraglutide, and Viagra to manage his hyperlipidemia, Type II Diabetes, and erectile dysfunction. After you complete his bedside ultrasound of the bladder, you find that he has 600cc urine in his bladder. You decide to place a Foley catheter and initiate further treatment. Which of the following is the BEST medication to use in this patient?
A) Terazosin (Hytrin) B) Doxazosin (Cardura) C) Alfuzosin (Uroxatral) D) Finesteride (Proscar) E) Dutasteride (Avodart)
C) Alfuzosin (Uroxatral)
26.) A 76yo male presents to the ED stating “he cannot pee enough and his belly is getting larger”. You gather a history and discover he is relatively healthy. He admits to taking Benadryl for the last 7 nights to help him sleep through his allergy symptoms. On physical exam, you note a mildly uncomfortable man with a distended abdomen that is nontender to palpation. His medications include Benadryl PRN for allergies and Albuterol PRN for asthma. His vitals are: BP 156/76, HR 108 regular, T 98.9 F oral, RR 20, SpO2 99% RA, Pain 0/10. You decide to bladder scan his abdomen and note 800cc of urine. What is the next best immediate step?
A. Obtain CT abdomen/pelvis to rule out obstruction
B. Straight cath to empty the bladder
C. Advise patient he will be fine and to just wait it out. Eventually, his body will release all the urine in his bladder.
D. Begin Finasteride 5mg PO daily and Lasix 20mg IV immediately
E. Start Tamsulosin 1mg PO daily as long as he has not taken any PDE-5 inhibitors in the last 24 hours
B. Straight cath to empty the bladder
27) A 31 year old female, 1 month postpartum comes into the office today to re-evaluate use of contraception. She tells you she wants something that won’t make her gain any more weight and that she also plans to be pregnant again within the next year. Which of the following would be an appropriate option for contraception?
A. Ask her if she is exclusively breastfeeding, as she may meet criteria for lactational amenorrhea method of contraception.
B. Prescribe her Cryselle, a combination oral contraceptive and if breastfeeding, continue with caution.
C. Prescribe progestin only oral contraception, counsel her to take them at the same time every day.
D. Prescribe and inject Depo-Provera, as it is highly effective and progesterone only.
E. A and C are both possible contraception options.
E. A and C are both possible contraception options.
28) A 31 y/o woman was diagnosed with lung cancer 1 year ago and has been undergoing chemotherapy treatment. She presents to her oncology PA today feeling more fatigued than usual and complains of pain while urinating. Her vitals are: T = 101.4 degree F, HR 102, RR 18, BP 120/80, O2 sat 97%. You run a CBC and a urine culture. The CBC reveals an ANC of 800
and the urine culture reveals no bacteria in the urine. What is NOT recommended for her treatment?
a) Admit and administer Vancomycin and Cefepime
b) Admit and perform vaginal exam and then administer Vancomycin and Cefepime
c) Admit and administer Vancomycin and Cefepime as well as G-CSF
d) Admit and administer Vancomycin and Cefepime and do blood culture
b) Admit and perform vaginal exam and then administer Vancomycin and Cefepime
29) A 24 year of female with at BMI of 27 comes to see you in clinic today. She tells you she is going away for a “girls trip” in 2 weeks. She plans on using condoms but also wants an additional back up method. While taking her history she tells you, she smokes around a pack of cigarettes a week and she has previously used an IUD, which was taken out a year ago and refuses to use it again because of the heavy bleeding she experienced. She also wants something she doesn’t have to deal with changing or taking a pill. Patient says she should be getting her period in 7 days. What form of birth control would you recommend for this patient? A. Depo-provera B. Ortho-Evra C. Nuva-ring D. Nexplanon E. Skyla
D. Nexplanon
30) A 74 year old man with a history of HTN and Parkinson’s disease presents from his nursing home due to staff concern that he has not urinated in the past 24 hours. They said he is usually incontinent. His current medications include HCTZ, aspirin, Sinamet and oxybutynin. You get a bladder ultrasound and find there is 1400cc of urine in his bladder. What is the best next step?
A. Place a suprapubic catheter
B. Discontinue oxybutynin
C. Check serum Cr to rule out serious obstructive pathologies
D. Place a foley catheter
E. Start treatment with tamsulosin
D. Place a foley catheter
31) Your patient is a 72 year old male who suffered acute urinary retention due to BPH 2 months ago. He was started on Tamsulosin .4mg daily. He returns today and you want to start him on Finasteride, to help to further shrink his prostate. Which of the following statements are important to remember when starting a patient on an alpha- reductase inhibitor?
A. Alpha reductase inhibitors work very quickly so you should warn your patients about polyuria
B. Patients on Finasteride experience irreversible erectile dysfunction and depression
C. You must consider the effect that finasteride has on PSA levels when screening for prostate cancer
D. The patient should have been started on this medication immediately in the setting of Acute Urinary retention 2 months ago
E. Alpha reductase inhibitors assert their actions by Relaxing the muscle of the prostate and bladder neck
C. You must consider the effect that finasteride has on PSA levels when screening for prostate cancer
- Mrs. S is a 38 year old female patient started on sertraline (Zoloft) by her primary care provider 10 days ago. She is presenting today with concerns about some mild diarrhea, nausea, headache, and weight gain. You should:
A. Switch her to escitalopram (Lexapro).
B. Switch her to vilazodone (Viibrid).
C. Reduce her dose of sertraline (Zoloft).
D. Make no changes to her regimen at this time, provide reassurance, and continue to monitor side effects.
Correct answer: D
Mild diarrhea, nausea, headache, and weight gain are normal initial responses to SSRIs and should subside after being on these medications for 4-6 weeks.
Incorrect answers:
A - no indication to change her medication regimen at this time, although this would be the second best choice because escitalopram has lower rates of diarrhea, nausea, headache, and weight gain than sertraline.
B - vilazodone is no more efficacious than sertraline and has higher rates of side effects.
C - no indication to change her medication regimen at this time. Mild diarrhea, nausea, headache, and weight gain are normal initial responses to SSRIs and should subside after being on this medication for 4-6 weeks.
33) A 46 yo Female with a history of breast cancer presents to the clinic complaining of progressive dyspnea. On exam, she has muffled heart sounds and jugular venous distention. Low voltage was also noted on the ECG. The patient states she just finished a chemo regimen last week . What diagnostic tool would be the BEST first option?
A) CT angiogram B) Chest CT w/ contrast C) Chest CT w/o contrast D) Echocardiogram E) Bronchoscopy
D) Echocardiogram
- A 20-year-old female seeks your medical advice for contraception. She is not on any medications, past medical history and family history is healthy. She has a regular and normal menstrual cycle (23 days between each menses, menses lasting 5 days, light/ average menstrual flow). You can discuss and recommend:
A.) Combined oral contraceptive pills B.) Nuvaring vaginal insert C.) Depo- provera injection D.) IUD E.) All of the above
E.) All of the above
- A 50 year old male patient with a history of diabetes presents to your ER with suspicion of Fournier’s Gangrene. You confirm the diagnosis and are looking to treat him ASAP. What would NOT be an acceptable option to be part of treatment regiment for a patient with Fournier’s Gangrene?
A. Debridement
B. Triple therapy- Zosyn/Vanco/Clindamycin
C. Clindamycin ONLY because it targets strep and staph, which are the only bacteria that cause FG
D. IVF
E. none of the above
C. Clindamycin ONLY because it targets strep and staph, which are the only bacteria that cause FG
