Nokea
Which immunization reduces a patient’s risk for infection with the virus that causes painful localized blistering rash?
- A. Smallpox vaccine
- B. Varicella vaccine (chicken pox)
- C. Shingles (herpes zoster) vaccine
- D. Meningococcal vaccine
Correct Answer: C
Rationale: Shingles vaccine reduces the risk of herpes zoster, which causes painful rash.
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What is an appropriate step in the initial management of the seven patients receiving atypical antipsychotics?
- A. No action is necessary, because one potential indication for atypical antipsychotic use is refractory behavioral disturbance in persons with significant dementia.
- B. Taper to discontinue the atypical antipsychotic; after a 2-week washout, begin therapy with zolpidem.
- C. Taper to discontinue the atypical antipsychotic, and create day programs that allow patients to develop a sleep deficit/need through the morning/afternoon/early evening.
- D. Start modafinil or a similar short-acting stimulant to minimize daytime sleepiness.
Correct Answer: C
Rationale: Creating day programs that help establish a sleep deficit and discontinuing antipsychotics is appropriate for managing the patients’ sleep issues.
Joyce Mitchell is a 73-year-old frail female with a history of frequent falls, presenting with nausea, vomiting, sweating, and horizontal nystagmus. She is diagnosed with vestibular neuritis. What is the best initial course of treatment?
- A. Vestibular rehabilitation
- B. Supportive care with anti-nausea and anti-vertigo medication
- C. Fluids
- D. Epley maneuver
Correct Answer: B
Rationale: Supportive care with anti-nausea and anti-vertigo medication is appropriate for vestibular neuritis.
A patient presents with an elongated head with bony prominence of the forehead, nose, and lower jaw. These facial features could be suggestive of:
- A. Nephrotic syndrome
- B. Acromegaly
- C. Cushing’s syndrome
- D. Parkinson’s disease
Correct Answer: B
Rationale: Acromegaly is characterized by enlargement of bones and soft tissues, leading to features like a prominent jaw and forehead.
Examination of the hair reveals a fine silky appearance. This finding may be seen in patients that have:
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Type 2 diabetes
- D. Celiac disease
Correct Answer: B
Rationale: Hyperthyroidism can lead to fine, silky hair due to the effects of thyroid hormones.
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should have chemotherapy. Should he?
- A. Yes because without knowing his complete staging it would be safer.
- B. No because he can be followed with serial carcinoembryonic antigens and CT scans.
- C. Yes because the severe bleeding indicates advanced disease.
- D. No because he is too old and will not likely have any problems during his lifetime.
Correct Answer: B
Rationale: Follow-up with serial carcinoembryonic antigens and CT scans is appropriate after resection of localized disease.