Test 40

Question 1

Menopausal hormone therapy

Answer 1

Patients who develop venous thrombosis while on menopausal hormone therapy (MHT) should discontinue MHT and begin an alternate treatment such as selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor.

Question 2

Diabetes mellitus

Answer 2

Statin therapy is recommended for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in all patients age greater than or equal to 40 with type 1 or type 2 diabetes mellitus. The intensity depends on the overall 10-year ASCVD risk, with high-intensity statin therapy recommended for those with an estimated risk greater than or equal 20%.

Question 3

Delirium

Answer 3

Elderly patients with thyrotoxicosis may not have classic manifestations. Apathetic thyrotoxicosis is an atypical presentation of hyperthyroidism in older patients that’s is characterized by lethargy, confusion, and depression. It is often misdiagnosed as dementia.

Question 4

Catheter related bloodstream infection

Answer 4

Central line-associated bloodstream infections (CLABSI) are usually caused by skin organisms such as coagulase-negative staphylococci, Staphylococcus aureus, Candida species, and aerobic gram-negative bacilli. Risk of CLABSI can be reduced by cleaning the insertion site with chlorhexidine, using maximal barrier precautions (large sterile drape, mask) during insertion, and promptly removing the catheter when it is no longer needed.

Question 5

Alzheimer disease

Answer 5

Neuropsychiatric symptoms are common among patients with dementia; treatment include behavioral interventions, antidementia drugs, and antidepressants. Antipsychotics are sometimes used but are associated with increased mortality and multiple side effects, including extrapyramidal symptoms. If possible, antipsychotics should be discontinued in patients who develop side effects.