Nokea
Which of the following drugs is not contraindicated for concurrent use with warfarin (Coumadin)?
- A. Amoxicillin (Amoxil)
- B. Trimethoprim/sulfamethoxazole (Bactrim)
- C. Ciprofloxacin (Cipro)
- D. Clarithromycin (Biaxin)
Correct Answer: A
Rationale: Rationale for correct answer (A): Amoxicillin does not significantly interact with warfarin. It is an antibiotic that works through a different mechanism than warfarin and is not known to affect its anticoagulant activity.
Summary of incorrect choices:
B (Trimethoprim/sulfamethoxazole): This drug combination can enhance the effects of warfarin, increasing the risk of bleeding.
C (Ciprofloxacin): Ciprofloxacin can increase warfarin's effects, leading to a higher risk of bleeding.
D (Clarithromycin): Clarithromycin can interact with warfarin, potentially increasing the risk of bleeding.
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Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman?
- A. Hirsutism
- B. Gynecomastia
- C. Oligomenorrhea
- D. Acne
Correct Answer: D
Rationale: Rationale for correct answer D: Acne is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman because hyperprolactinemia usually presents with symptoms related to hormonal imbalance, such as irregular menstrual cycles (oligomenorrhea), breast changes (gynecomastia), and excess body hair (hirsutism). Acne is not directly associated with elevated prolactin levels.
Summary of incorrect choices:
A: Hirsutism - Hirsutism is a common finding in hyperprolactinemia due to hormonal imbalances.
B: Gynecomastia - Gynecomastia can occur in hyperprolactinemia due to the suppression of testosterone.
C: Oligomenorrhea - Oligomenorrhea is a typical finding in hyperprolactinemia due to disruptions in the menstrual cycle.
What clinical finding in a funduscopic examination is indicative of increased intracranial pressure?
- A. Pulsating veins
- B. Indistinct disk edge
- C. Clear disk edge
- D. Normal retinal appearance
Correct Answer: B
Rationale: The correct answer is B: Indistinct disk edge. Increased intracranial pressure causes papilledema, resulting in swelling and elevation of the optic disk. This leads to a blurred or indistinct disk edge. Pulsating veins (choice A) are seen in conditions like arteriovenous malformations, not specifically indicative of increased intracranial pressure. Clear disk edge (choice C) and normal retinal appearance (choice D) are not consistent with the findings associated with increased intracranial pressure.
When treating a patient with asthma who is experiencing acute wheezing, which medication should be given to relieve the symptoms?
- A. Short acting bronchodilator
- B. Long acting bronchodilator
- C. Inhaled corticosteroid
- D. Combination of methylxanthine and long acting bronchodilator
Correct Answer: A
Rationale: The correct answer is A: Short acting bronchodilator. During an acute asthma attack, a short-acting bronchodilator (such as albuterol) is the preferred medication to relieve symptoms quickly by dilating the airways. This medication acts rapidly to open up the airways and provide immediate relief of wheezing and shortness of breath. Long-acting bronchodilators (choice B) are not recommended for acute symptom relief. Inhaled corticosteroids (choice C) are used for long-term control of asthma symptoms and not for immediate relief during an acute attack. Combining methylxanthine and long-acting bronchodilator (choice D) is not the standard treatment for acute wheezing in asthma.
When examining the breast, the "tail of Spence" would be located:
- A. In the upper inner quadrant
- B. In the lower inner quadrant
- C. In the lower outer quadrant
- D. Laterally across the anterior axillary fold
Correct Answer: D
Rationale: The "tail of Spence" is an extension of breast tissue into the axilla. To locate it, visualize an imaginary line extending laterally from the breast towards the arm, crossing the anterior axillary fold. This is where the tail of Spence is found.
A: Incorrect. The upper inner quadrant is closer to the sternum.
B: Incorrect. The lower inner quadrant is below the nipple.
C: Incorrect. The lower outer quadrant is towards the armpit but not in the axilla like the tail of Spence.
Therefore, choice D is correct because the tail of Spence extends laterally across the anterior axillary fold.
A 29-year-old computer programmer comes to the office for evaluation of a headache. The tightening sensation of moderate intensity is located all over the head. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain, but not taken it away. Based on this description, what is the most likely diagnosis?
- A. Cluster
- B. Analgesic rebound
- C. Tension
- D. Migraine
Correct Answer: C
Rationale: The correct answer is C: Tension headache. The key features in the scenario are the bilateral location of the headache, duration of 5 days, absence of nausea and photophobia, and the patient's occupation as a computer programmer. Tension headaches are typically bilateral, mild to moderate in intensity, and often related to stress, posture, and prolonged screen time. The fact that over-the-counter medication only dulled the pain supports the diagnosis of tension headache.
Summary of other choices:
A: Cluster headaches typically have a unilateral location, severe intensity, and are associated with autonomic symptoms like tearing of the eye.
B: Analgesic rebound headaches occur due to overuse of pain medications, leading to worsening of headaches when the medication wears off.
D: Migraine headaches often present with unilateral throbbing pain, nausea, and sensitivity to light and sound, which are not present in this case.