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Rapid Human Immunodeficiency virus (HIV) testing would be appropriate for a patient with complaints of:
- A. Painful bowel movement, anal itching, and painful or swollen testicles or abnormal menstrual bleeding
- B. Painful urination, dyspareunia, and vaginal or penile discharge
- C. Fever, headache, and lymphadenopathy
- D. None of the above
Correct Answer: C
Rationale: Acute HIV symptoms may include fever, headache, sore throat, and lymphadenopathy.
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A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and acetaminophen. What would be your first step in therapy?
- A. Stop glyburide
- B. Stop chlorthalidone
- C. Stop acetaminophen
- D. Start topical vaginal lubricant
Correct Answer: D
Rationale: Topical vaginal lubricants can help alleviate vaginal dryness and improve sexual function.
A patient calls the nurse practitioner and states that he missed his morning daily dose of warfarin, 5 mg, yesterday and today. The nurse practitioner instructs the patient to:
- A. Wait until tomorrow and resume daily dosing of warfarin 5 mg
- B. Take warfarin 10 mg now
- C. Take warfarin 5 mg now, warfarin 5 mg at 5 pm today, and resume the daily warfarin 5 mg dose in the morning as scheduled
- D. Take warfarin 5 mg now and resume the warfarin 5 mg daily dose in the morning as scheduled
Correct Answer: D
Rationale: The patient should resume the usual warfarin dose and avoid doubling it.
Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.
An older woman who is cared for by a concerned family is particularly likely to suffer from which of the following complications after an episode of gastroenteritis?
- A. Immobility related to overconcern
- B. Continued vomiting caused by too-rapid feeding
- C. Diarrhea resulting from administration of milk products
- D. Constipation related to overtreatment of diarrhea
Correct Answer: D
Rationale: Overtreatment of diarrhea can lead to constipation, especially in older adults.
Which of the following is a typical sign of diabetic ketoacidosis (DKA)?
- A. Excessive urination
- B. Ketone bodies in the urine
- C. High blood pressure
- D. Slow heart rate
Correct Answer: B
Rationale: Diabetic ketoacidosis often results in the presence of ketone bodies in the urine, along with hyperglycemia.