Nokea
A 78-year-old woman with cardiovascular disease declines creating an advance directive. Which characteristic is necessary for a healthcare agent?
- A. Geographic proximity to the patient’s home
- B. Knows how the patient defines quality of life
- C. Is a member of the patient’s immediate family
- D. Has medical training or experience
Correct Answer: B
Rationale: The correct answer is B because knowing how the patient defines quality of life is crucial for making healthcare decisions aligned with the patient's values and preferences. This ensures the healthcare agent can advocate for the patient's wishes effectively. Geographic proximity (A) is not necessary as communication can be maintained remotely. Being a family member (C) may create biases, and medical training (D) is not essential for understanding the patient's values.
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You want to start pharmacologic treatment for depression in an older patient who is taking numerous medications. Which of the following antidepressants is the least likely to cause drug-drug interactions?
- A. Citalopram
- B. Fluoxetine
- C. Paroxetine
- D. Venlafaxine
Correct Answer: E
Rationale: I believe you made a typo in listing the correct answer as "E" while there is no "E" option in the choices provided. Could you please confirm the correct answer choice so I can provide you with a detailed explanation and summary of why the correct answer is correct and why the other choices are incorrect?
Which of the following is an early sign of dehydration in older adults?
- A. Weight gain
- B. Dry mouth and skin
- C. Decreased urine output
- D. Increased thirst
Correct Answer: B
Rationale: The correct answer is B: Dry mouth and skin. Dehydration in older adults can lead to dry mouth and skin due to the lack of proper hydration. This is an early sign as the body starts to lose water. Weight gain (A) is not indicative of dehydration, as it typically occurs with fluid retention. Decreased urine output (C) is a later sign of dehydration, as the body conserves water. Increased thirst (D) is a response to dehydration but not an early sign. Therefore, dry mouth and skin are the most relevant early indicators of dehydration in older adults.
You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be?
- A. Call a medevac helicopter
- B. Drive him to the city (4 hours away)
- C. Press on his sternum and spine simultaneously
- D. Examine him for tenderness over the injured area
Correct Answer: D
Rationale: The correct answer is D: Examine him for tenderness over the injured area.
Rationale:
1. Start with a physical examination to assess for tenderness directly over the injured area.
2. Rib fractures often present with localized tenderness upon palpation.
3. If tenderness is present, suspect a rib fracture and advise immobilization.
4. Advise against unnecessary movement to prevent further injury.
Summary:
- Choice A: Calling a medevac helicopter is premature without assessing the severity of the injury.
- Choice B: Driving him 4 hours away could worsen his condition without proper assessment.
- Choice C: Pressing on the sternum and spine simultaneously is not recommended as it can cause further harm.
The most appropriate medication indicated for reversing the anticoagulated effects of dabigatran etexilate (Pradaxa) is:
- A. Idarucizumab (Praxbind)
- B. Vitamin K
- C. Protamine sulfate
- D. Fondaparinux (Arixtra)
Correct Answer: A
Rationale: Step-by-step rationale:
1. Idarucizumab is a specific reversal agent for dabigatran, directly binding to dabigatran to neutralize its anticoagulant effects.
2. Vitamin K is ineffective for dabigatran reversal, as it mainly works on reversing the effects of vitamin K antagonist anticoagulants like warfarin.
3. Protamine sulfate is used for heparin reversal, not for direct thrombin inhibitor reversal like dabigatran.
4. Fondaparinux is a factor Xa inhibitor and not effective for reversing the effects of dabigatran.
When examining the breast, the "tail of Spence" would be located:
- A. In the upper inner quadrant
- B. In the lower inner quadrant
- C. In the lower outer quadrant
- D. Laterally across the anterior axillary fold
Correct Answer: D
Rationale: The "tail of Spence" is an extension of breast tissue into the axilla. To locate it, visualize an imaginary line extending laterally from the breast towards the arm, crossing the anterior axillary fold. This is where the tail of Spence is found.
A: Incorrect. The upper inner quadrant is closer to the sternum.
B: Incorrect. The lower inner quadrant is below the nipple.
C: Incorrect. The lower outer quadrant is towards the armpit but not in the axilla like the tail of Spence.
Therefore, choice D is correct because the tail of Spence extends laterally across the anterior axillary fold.