Nokea
A pregnant patient presents for a routine 16-week prenatal visit. Her BP has decreased from 119/78 mmHg at her 12-week visit to 110/69 mmHg. What hemodynamic factor accounts for the decrease in BP?
- A. Decrease preload
- B. Decrease in stroke volume
- C. Decrease cardiac output
- D. Decrease in systemic vascular resistance
Correct Answer: D
Rationale: Pregnancy typically leads to a decrease in systemic vascular resistance, which results in a lower blood pressure.
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On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and obvious pain. The patient has no children and had lived alone until recently, when a neighbor became concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew living in another city eventually came to take care of the situation and arranged for the admission. The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs. The medical history is negative for any serious illnesses. She was able to drive her own car until shortly before this admission. The nephew does not wish to authorize hospice “right now.” A positron-emission tomography scan was negative for metastatic disease. In addition to determining the cause of her delirium, which of the following is the best way to address the breast mass?
- A. Tamoxifen should be initiated immediately. If no response is seen in 3 months, the patient should receive chemotherapy.
- B. The mass should be biopsied to study hormone receptor and HER2/neu antigen status.
- C. The patient should undergo surgery as initial treatment.
- D. The initial treatment should be radiation therapy.
Correct Answer: E
Rationale: Given the patient's age and condition, the best approach is to avoid aggressive treatment and focus on symptom management.
George Hall is a 91-year-old man. If the physician agrees with his daughter and does not inform George of bad news, which ethical principle might this violate?
- A. Paternalism
- B. Autonomy
- C. Authenticity
- D. None of the above
Correct Answer: B
Rationale: Autonomy is violated when the patient is not informed about his medical condition.
In which conflict did the US military first utilize X-ray technology for medical purposes?
- A. World War I
- B. Spanish-American War
- C. World War II
- D. Korean War
Correct Answer: A
Rationale: X-ray technology was first utilized for medical purposes during World War I to diagnose injuries and illnesses.
Which of the following is the most appropriate description of “personhood” as it relates to people with dementia?
- A. Personhood is a universal concept that is defined the same way in all cultures.
- B. The ability to relate to others as people, rather than preserving cognitive independence, is an important aspect of “personhood.”
- C. The ability to recognize family members by name is an important aspect of “personhood.”
- D. A deterioration in cognitive function demonstrates the decreasing value of older adults in society.
Correct Answer: B
Rationale: Personhood focuses on maintaining human connections, even when cognitive decline occurs.
Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
- A. Sex therapy
- B. Testosterone
- C. Yohimbine
- D. Sildenafil
Correct Answer: B
Rationale: Testosterone therapy should be considered first if a deficiency is identified, as low testosterone can contribute to erectile dysfunction.