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An elderly male with benign prostate hyperplasia (BPH) should be advised to avoid antihistamines. What is the reason for this?
- A. Urinary incontinence
- B. Constipation
- C. Orthostatic hypotension
- D. Urinary retention
Correct Answer: D
Rationale: Antihistamines can cause urinary retention, worsening BPH symptoms.
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A 7-year-old child has been diagnosed with acute sinusitis. The drug class that should be avoided is:
- A. Antihistamines
- B. Expectorants
- C. Decongestants
- D. Nasal steroids
Correct Answer: A
Rationale: Antihistamines should be avoided in children with sinusitis, as they can dry secretions and worsen symptoms.
A 67-year-old female with a history of congestive heart failure and myocardial infarction is admitted to the hospital because of increasing altered mental status and decreased arousal over the last week. Which one of the following features best distinguishes delirium from depression or dementia?
- A. Irritability
- B. Inattention
- C. Paranoia
- D. Aggressiveness
Correct Answer: B
Rationale: Inattention and waxing and waning of alertness are key features distinguishing delirium from depression or dementia.
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 The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs.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.
How many chains of lymph nodes should be assessed during a clinical examination?
- A. Five chains
- B. Seven chains
- C. Nine chains
- D. Eleven chains
Correct Answer: B
Rationale: Seven chains of lymph nodes are typically assessed during a clinical examination, including cervical, axillary, and inguinal regions.
Ophthalmoscopic examination of a 40-year-old carpenter reveals a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. This condition is termed:
- A. Corneal arcus
- B. Corneal scar
- C. Pterygium
- D. Cataract
Correct Answer: C
Rationale: A pterygium is a growth of the conjunctiva over the cornea.