Quiz 65 Flashcards
A patient in the first trimester of pregnancy has just learned that her husband has acute hepatitis B. She feels well, and her screening test for hepatitis B surface antigen (HBsAg) was negative last month. She has not been immunized against hepatitis B.
Which one of the following would be the most appropriate management of this patient?
Administration of both HBIG and hepatitis B vaccine now
A 55-year-old white male notices a nodular thickening over the flexor tendons in his medial palm. He has no difficulty using his hand, and he is able to lay his palm flat on a tabletop. You suspect Dupuytren’s disease.
Which one of the following is true regarding this condition?
shortening and thickening of the palmar fascia.
There is a strong association with diabetes mellitu
A series of cortisone injections over a period of months may lead to disease regression, and is useful in patients with mild to moderate symptoms. Surgery is indicated if a metacarpal joint contracture reaches 30°, or with a proximal interphalangeal joint contracture of any degree
A 29-year-old white female is hospitalized following a right middle cerebral artery stroke confirmed by MRI.
a second-trimester miscarriage 3 years ago.
normal hematocrit and hemoglobin levels, a normal prothrombin time, and a platelet count of 200,000/mm3 (N 140,000–440,000). The activated partial thromboplastin time is 95 sec (N 23.6–34.6), and it does not normalize when the patient’s serum is mixed with normal plasma. A serum VDRL is positive, and a serum FTA-ABS is nonreactive.
Antiphospholipid syndrome
Clinical features include venous and arterial thrombosis, fetal wastage, thrombocytopenia, and the presence of an activated partial thromboplastin time (aPTT) inhibitor.
The antiphospholipid syndrome is due to the appearance of a heterogeneous group of circulating antibodies to negatively charged phospholipids, including most commonly a lupus anticoagulant and anticardiolipin antibodies.
The antibodies are usually detected by a false-positive serologic test for syphilis.
It is an important diagnostic consideration in all patients with unexplained thrombosis or cerebral infarction, particularly in young patients.
Although hemophilia would also be associated with a prolonged aPTT, the PTT would normalize when
the patient’s serum was mixed with normal plasma. Neurosyphilis is excluded by the negative serum FTAABS result. Thrombotic thrombocytopenic purpura is not associated with prolongation of the aPTT and is associated with a hemolytic anemia. Although protein C deficiency is a hypercoagulable state that can lead to stroke, none of the laboratory abnormalities suggests this diagnosis.
A 12-year-old male uses a short-acting bronchodilator three times per week to control his asthma. Lately he has been waking up about twice a week due to his symptoms.
Which one of the following medications would be most appropriate?
Inhaled low-dose corticosteroids
In the United States, the number of deaths has increased in recent years for which one of the following vaccine-preventable illnesses?
Pertussis
Tdap vaccine is recommended as a single booster for patients age 19–65, and those between the ages of 11 and 18 years should receive Tdap rather than a Td booster. The Tdap vaccine protects against pertussis, in addition to tetanus and diphtheria. Tetanus and rubella deaths are not increasing. There are no vaccines for hepatitis C or West Nile virus.
An 80-year-old female is seen for progressive weakness over the past 8 weeks. She says she now has difficulty with normal activities such as getting out of a chair and brushing her teeth.
Her medications include simvastatin
erythrocyte sedimentation rate is normal.
her creatine kinase level is 1200 U/L (N 40–150).
Statin-induced myopathy
Polymyalgia rheumatica is usually associated with an elevated erythrocyte sedimentation rate.
Which one of the following has the best evidence of effectiveness for preventing fractures in postmenopausal women with osteoporosis?
Treatment with alendronate (Fosamax)
To be eligible for Medicare hospice benefits, a patient must
To be eligible for Medicare hospice benefits, a patient must be eligible for Medicare Part A (hospital
insurance). Although most hospice referrals come from physicians, nurses, and social workers, a patient’s
family members can also make a hospice referral. The patient must sign a statement choosing hospice,
and both the patient’s physician and the hospice medical director must certify that the patient has a terminal illness with an estimated life expectancy of less than 6 months. There is no requirement that the patient be debilitated or moribund.
A 39-year-old female presents with lower abdominal/pelvic pain. On examination, with the patient in a supine position, you palpate the tender area of her abdomen. When you have her raise both legs off the table while you palpate the abdomen, her pain intensifies.
Which one of the following is the most likely diagnosis?
Abdominal Wall problem
Carnett’s sign is the easing of the pain of abdominal palpation with tightening of the abdominal muscles. If the cause is visceral, the taut abdominal muscles could guard the source of pain from the examining hand. In contrast, intensification of pain with this maneuver points to a source of pain within the abdominal wall itself.
