Nokea
The lymphatic ducts drain into the:
- A. Arterial system
- B. Venous system
- C. Vertebral bodies of the spine
- D. Shoulder
Correct Answer: B
Rationale: The lymphatic ducts drain into the venous system, specifically at the junction of the subclavian and internal jugular veins.
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Two years later Mr. Hunter reports progression of his urinary symptoms and desires “a pill to make this better.” His current IPSS is 17, with a bother score of 3 indicating moderate voiding symptoms with moderate impact on his quality of life. On review of systems he notes that his vision has worsened, especially in his left eye. His ophthalmologist has recommended cataract surgery. For which of the following medications would initiation of therapy be delayed until after cataract surgery?
- A. Finasteride
- B. Tamsulosin
- C. Tadalafil
- D. Oxybutynin
Correct Answer: B
Rationale: Tamsulosin may cause intraoperative floppy iris syndrome, so it is often delayed until after cataract surgery.
Risk factors for elder mistreatment include all except:
- A. Physical disability of patient
- B. Dementia of patient
- C. Caregiver burden
- D. Substance abuse of caregiver
Correct Answer: E
Rationale: Financial independence of the caregiver is not a recognized risk factor for elder mistreatment.
This contagious disease causes fever, headache, stiff neck, photophobia, nausea, vomiting, and altered mental status. What immunization prevents this?
- A. Meningococcal vaccine
- B. Pneumococcal vaccine
- C. Measles, Mumps, and Rubella (MMR) vaccine
- D. Varicella vaccine
Correct Answer: A
Rationale: The meningococcal vaccine prevents infections that cause meningitis.
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 The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs.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.
An 84-year-old male with a history of stroke without residual deficit, systolic heart failure, and type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement community and still works part-time on a golf course. He currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily. He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He states he has had over three sexual partners in the last year with intermittent condom use.
- A. Urine testing
- B. Urine testing, blood testing
- C. Urine testing, blood testing, anal swab
- D. Urine testing, blood testing, anal swab, and oropharyngeal swab
Correct Answer: D
Rationale: Comprehensive STI testing is essential for anyone with multiple sexual partners and inconsistent condom use.