Nokea
Which of the following anatomic landmark associations is correct?
- A. 2nd intercostal space for needle insertion in tension pneumothorax
- B. T6 for lower margin of endotracheal tube
- C. Sternal angle marks the 4th rib
- D. 5th intercostal space for chest tube insertion
Correct Answer: D
Rationale: The correct answer is D because the 5th intercostal space is the recommended location for chest tube insertion to drain the pleural space effectively. This space is ideal as it allows for adequate drainage without causing injury to vital structures.
A: The 2nd intercostal space is actually used for needle decompression in tension pneumothorax.
B: T6 is the level at which the tip of the endotracheal tube should ideally lie to ensure proper placement and ventilation.
C: The sternal angle corresponds to the 2nd rib, not the 4th rib, making this association incorrect.
In summary, choice D is correct as it aligns with the standard practice for chest tube insertion, while choices A, B, and C are incorrect due to their association with different anatomic landmarks and procedures.
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Which one of the following is most true about the rule of fourths?
- A. One-fourth of geriatric problems are iatrogenic.
- B. Little can be done to prevent three-fourths of the problems of aging.
- C. For every medical complaint a patient presents with, a careful assessment can identify three other diagnoses.
- D. What used to be called normal aging can be largely explained by processes that are not normal.
Correct Answer: A
Rationale: Step 1: The rule of fourths states that one-fourth of geriatric problems are iatrogenic, meaning they are caused by medical treatment.
Step 2: This statement is true because iatrogenic problems in the elderly are common due to multiple medications, procedures, etc.
Step 3: A careful assessment can indeed identify iatrogenic issues, making this statement accurate.
Summary:
A is correct because it aligns with the concept of iatrogenic problems in the elderly.
B is incorrect because interventions can help prevent many problems of aging.
C is incorrect as it does not specifically address iatrogenic problems.
D is incorrect as it does not focus on the iatrogenic aspect of geriatric problems.
A 69-year-old female presents to your office for routine primary care. Her elder sister was recently diagnosed with Alzheimer's disease, and she wonders what steps she can take to reduce her own risk of developing dementia. Which of the following statements is true about the prevention of dementia?
- A. There is moderate quality evidence to support daily use of vitamin B12 and fish oil to prevent cognitive decline.
- B. Risk of dementia is modulated by non-modifiable risk factors, such as genetics, family history, and educational attainment, and there are no behavioral interventions that can reduce the risk of dementia.
- C. There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce risk of dementia.
- D. There is moderate to low quality evidence supporting cannabinoids may reduce rates of progression from mild cognitive impairment to dementia.
Correct Answer: C
Rationale: The correct answer is C: There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce the risk of dementia. This statement is true because studies have shown that managing cardiovascular and metabolic risk factors can help reduce the risk of developing dementia. High blood pressure, obesity, and diabetes have been linked to an increased risk of cognitive decline and dementia. By controlling these risk factors through lifestyle changes or medication, individuals can potentially lower their risk of developing dementia.
Choice A is incorrect because while vitamin B12 and fish oil may have some benefits for cognitive health, the evidence supporting their use in preventing dementia is not strong.
Choice B is incorrect because while genetics and family history play a role in dementia risk, there are behavioral interventions, such as maintaining a healthy lifestyle and managing risk factors, that can help reduce the risk of dementia.
Choice D is incorrect because there is not enough strong evidence to support the claim that cannabinoids can reduce rates
A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is an aching located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or injury. He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs or incontinence. He was moving furniture for a friend over the weekend. On physical examination, you note muscle spasm, with normal deep tendon reflexes and muscle strength. What is the most likely cause of this patient's low back pain?
- A. Herniated disc
- B. Compression fracture
- C. Mechanical low back pain
- D. Ankylosing spondylitis
Correct Answer: C
Rationale: The correct answer is C: Mechanical low back pain. This is the most likely cause as the patient's pain is aching, located in the lumbosacral region, intermittent for years, with no radiation, numbness, tingling, or incontinence. The physical exam findings of muscle spasm, normal reflexes, and muscle strength support this diagnosis. Mechanical low back pain is common and often related to muscle strain or overuse, as seen in this construction worker who was moving furniture.
Choice A (Herniated disc) is incorrect as the patient does not have radiation of pain or neurological symptoms. Choice B (Compression fracture) is unlikely without a history of trauma or injury. Choice D (Ankylosing spondylitis) is less likely given the lack of inflammatory symptoms and typical age of onset.
Which of the following medication is not indicated for the treatment of muscle spasms?
- A. Baclofen (Lioresal)
- B. Tizanidine (Zanaflex)
- C. Cyclobenzaprine (Flexeril)
- D. Carisoprodol (Soma)
Correct Answer: A
Rationale: Step-by-step rationale for why A is correct:
1. Baclofen is a muscle relaxant primarily used for treating muscle spasticity, not muscle spasms.
2. Baclofen acts on GABA receptors in the spinal cord to reduce muscle hyperactivity.
3. Tizanidine, Cyclobenzaprine, and Carisoprodol are all indicated for the treatment of muscle spasms.
4. Tizanidine acts centrally to inhibit excitatory neurotransmitter release, Cyclobenzaprine is a muscle relaxant with sedative effects, and Carisoprodol is a centrally acting skeletal muscle relaxant.
Summary: Baclofen is not indicated for the treatment of muscle spasms because it is primarily used for muscle spasticity. Tizanidine, Cyclobenzaprine, and Carisoprodol are more commonly prescribed for muscle spasms due to their mechanisms of action.
Which of the following drug classes is not indicated for the treatment of depression?
- A. Buspirone (Buspar)
- B. Selective Serotonin Reuptake Inhibitor (SSRI)
- C. Tricyclic antidepressant (TCA)
- D. Bupropion (Wellbutrin)
Correct Answer: A
Rationale: The correct answer is A: Buspirone (Buspar). Buspirone is not indicated for the treatment of depression; it is primarily used to treat anxiety disorders. SSRIs and TCAs are commonly prescribed for depression due to their ability to increase serotonin levels. Bupropion is an atypical antidepressant that works on norepinephrine and dopamine, making it a suitable option for depression treatment. Buspirone's mechanism of action differs from antidepressants, focusing on serotonin and dopamine receptors rather than directly targeting depression symptoms. Therefore, Buspirone is not a recommended drug class for depression treatment.