TEST-3 QUESTIONS

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Analysis of Bacterial Species

Escherichia coli: Contains nitrate reductase and efficiently converts nitrates to nitrites. Will typically produce positive nitrite test.

Klebsiella: Contains nitrate reductase and converts nitrates to nitrites. Will typically produce positive nitrite test.

Proteus: Contains nitrate reductase and efficiently converts nitrates to nitrites. Will typically produce positive nitrite test.

Enterococcus: Does NOT contain nitrate reductase. Cannot convert nitrates to nitrites, resulting in a negative nitrite test despite the presence of bacteria.

Conclusion

The correct answer is: A female who has a urinary tract infection caused by Enterococcus

Enterococcus species lack nitrate reductase enzyme, so they cannot convert urinary nitrates to nitrites. This results in a negative nitrite test on urinalysis despite an active urinary tract infection. The other three bacteria (E. coli, Klebsiella, and Proteus) all possess nitrate reductase and would typically produce positive nitrite tests in UTIs.

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Answer 5

In summary, ACR in spot samples is convenient and quick, making it ideal for routine monitoring, while 24-hour urine albumin measurement provides a more accurate and comprehensive assessment but is less practical for regular use.

correct answer spot AM urine protein/creatinine

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Got this question wrong

Answer 8

sulfamethoxazole- thats a sulfa can’t give because she is allergic
phenazopyridine- that is a bladder analgesic
Nitrofurantoin- best option- answer
Ciprofloxacin- this causes achilles tendon rupture!! Try to avoid

Other options that would be a good option would be cephalosporin, and penicillin

Question 9

Answer 9

To determine the most appropriate medication for an 81-year-old female with mixed incontinence while minimizing cognitive adverse effects, I need to evaluate each option:

Analysis of Options

Tamsulosin: An alpha-1 adrenergic antagonist primarily used for BPH in males. Not typically indicated for female incontinence.

Mirabegron: A beta-3 adrenergic receptor agonist that relaxes the detrusor muscle. Unlike anticholinergics, it does not cross the blood-brain barrier significantly and has minimal cognitive effects.

Tolterodine: An anticholinergic medication (muscarinic receptor antagonist) with moderate blood-brain barrier penetration. Has some risk of cognitive side effects, though less than oxybutynin.

Oxybutynin: An anticholinergic medication with high blood-brain barrier penetration. Associated with significant cognitive side effects in elderly patients, including confusion, memory impairment, and potential contribution to dementia risk.

ans

For elderly patients, medications with anticholinergic properties (tolterodine and oxybutynin) pose greater risk of cognitive impairment. Among these options, mirabegron has a distinct mechanism of action that avoids anticholinergic effects and has minimal central nervous system penetration, making it the safest option regarding cognitive function in older adults.

Mirabegron is the most appropriate choice to limit the risk of adverse cognitive effects in this elderly patient with mixed incontinence.

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Answer 12

The best option is to switch to nitro

Levo-
Systemic fluoroquinolones, including levofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all age groups. [ref]

fluoroquinolones, including ciprofloxacin, associated with disabling and potentially irreversible serious adverse reactions (e.g., tendinitis and tendon rupture, peripheral neuropathy, CNS effects) that can occur together in the same patient. [ref] May occur within hours to weeks after systemic fluoroquinolone initiated;

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Answer 13

Recommend daily cranberry supplements: While cranberry supplements are sometimes suggested for UTI prevention, their efficacy is not well-established, and they are not the most appropriate next step for recurrent UTIs.

Initiate prophylactic antibiotic therapy: This is a common and effective strategy for managing recurrent UTIs. Prophylactic antibiotics can be taken continuously, post-coital, or at the onset of symptoms to prevent future infections.

Refer to a urologist for further evaluation: Referral to a specialist may be considered if there are complicating factors or if initial management strategies fail, but it is not the immediate next step in this scenario.

Prescribe a longer course of antibiotics for the current infection: This option addresses the current infection but does not prevent future episodes, which is the primary concern in recurrent UTIs.

The correct answer is to initiate prophylactic antibiotic therapy.

because ciprofloxacin hydrochloride is used to treat the infection itself, while phenazopyridine is used to alleviate the pain and discomfort associated with the urinary tract infection.— maybe cipro?

ANSWER- Refer to a urologist for further evaluation- this is the answer because the patient has been experiencing this issue for awhile

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It should only be performed in those 40 years of age and up who have at least one risk factor for prostate cancer
This is overly restrictive and doesn’t align with current guidelines.
Major guidelines don’t limit screening only to those with risk factors starting at age 40.

It is an informed decision between the provider and patient with a discussion of benefits versus risks
This reflects current guidelines from organizations like the USPSTF, ACS, and AUA.
Shared decision-making is emphasized due to the balance of potential benefits (early detection) versus harms (overdiagnosis, complications from treatment).

It should only be performed in those 50 years of age and up who have at least one risk factor for prostate cancer
Similar to option 1, this is too restrictive and doesn’t match current recommendations.
While age 50 is often when average-risk men might begin considering screening, it’s not limited only to those with risk factors.

It is no longer recommended
This is incorrect. Prostate cancer screening hasn’t been universally abandoned.
Rather, the approach has shifted from routine screening to individualized decision-making.

It is an informed decision between the provider and patient with a discussion of benefits versus risks

This answer is correct because current guidelines from major organizations (USPSTF, ACS, AUA) recommend shared decision-making for prostate cancer screening. The potential benefits of PSA screening (reduced mortality from prostate cancer) must be weighed against potential harms (false positives, overdiagnosis, complications from unnecessary treatment).

The decision should be individualized based on the patient’s values, preferences, and risk factors after a thorough discussion with their healthcare provider.

Question 17

Answer 17

The class of drug that can cause kidney injury is ace inhibitors and angiotensin receptors blockers some of the medication examples that can cause kidney injury are Benazepril (Lotensin) ,Captopril (Capoten). Enalapril (Vasotec), Lisinopril (Prinivil, Zestril) Moexipril (Univasc) ,Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace), Trandolapril (Mavik),Azilsartan (Edarbi) Candesartan (Atacand),Eprosartan (Teveten),Ibesartan (Avapro) Losartan (Cozaar), Olmesartan (Benicar),Telmisartan (Micardis), Valsartan (Diovan).

Acetaminophen relieves fever and headaches, and other common aches and pains. It does not contribute in causing kidney injury .

Lasix (furosemide) is a loop diuretic that works by inhibiting the sodium-potassium-chloride cotransporter in the ascending loop of Henle, leading to decreased reabsorption of sodium, chloride, and water.

The relationship between Lasix and kidney damage requires careful consideration:

Direct nephrotoxicity: Lasix itself is not directly nephrotoxic to kidney cells when used at appropriate therapeutic doses.

Indirect effects that can impact kidney function:
Volume depletion: Excessive diuresis can lead to hypovolemia, decreased renal perfusion, and pre-renal acute kidney injury
Electrolyte imbalances: Can cause hypokalemia, hyponatremia, and metabolic alkalosis
Interstitial nephritis: Rarely, Lasix can cause allergic interstitial nephritis

Context of use:
In heart failure: Lasix improves symptoms and can preserve kidney function by reducing congestion
In acute kidney injury: Appropriate use may help manage fluid overload
In chronic kidney disease: Can help manage symptoms but requires careful dosing

Lasix (furosemide) does not directly cause kidney damage when used appropriately. However, it can indirectly contribute to kidney injury through volume depletion and electrolyte disturbances if used inappropriately or in excessive doses. The risk-benefit profile depends on the clinical context, underlying conditions, dosing, and monitoring. Proper medical supervision and appropriate dosing are essential to minimize potential adverse effects on kidney function.

ANSWER- TYLENOL IS LEAST LIKELY TO DAMAGE THE KIDNEY. TYLENOL CAN CAUSE HEPATIC ISSUES- MORE DAMAGE TO THE LIVER THAN THE KIDNEYS!!

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PROSTATE ENLARGED ANSWER- REFER TO UROLOGY- BECAUSE IT IS ASYMMETRICAL

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A is the correct answer - contraindication read the question- Do not give an injection on a red hot swollen joint!!! DO NOT GIVE INJECTIONS ON ANY OF THESE!! Absolute: none [2] Relative [1][2] Overlying cellulitis [3] Known bacteremia Bleeding diatheses Prosthetic joint Only perform arthrocentesis on prosthetic joints if infection is suspected, as prosthetics are at high risk for infection. [1]

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Celecoxib (Celebrex) ans greater cardiovascular risk. Increased risk of serious adverse cardiovascular thrombotic events Increased risk of MI and stroke observed in patients receiving a selective COX-2 inhibitor for analgesia in first 10–14 days following CABG surgery. Known hypersensitivity (e.g., anaphylaxis, serious dermatologic reactions) to the drug, sulfonamides, or any ingredient in the formulation. [ref] History of asthma, urticaria, or other sensitivity reactions after taking aspirin or other NSAIAs. [ref] Contraindicated in the setting of CABG surgery. [ref]

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ans. referral to PT- because= ankle laxity most likely a Sprain: Pain, swelling, bruising, instability in the joint. BUT if it is twisted ankle with pain get x-ray then referral to ortho

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A. They increase resp depression if given with opioids Baclofen is the least likely muscle relaxant to cause depression

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ans. polymyalgia rheumatica Not RA & Lupus because these markers would be positive. Fibromyalgia no lab work associated with it.

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