Nokea
Which one of the following is most true about aging changes?
- A. Stage 3 and 4 sleep decreases.
- B. Renal perfusion is not reduced, but renal function is reduced.
- C. Hearing acuity declines beginning in middle age.
- D. Prostatic enlargement occurs only in a minority of men.
Correct Answer: A
Rationale: Aging leads to a decrease in the deeper stages of sleep (Stage 3 and 4).
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A characteristic lesion observed in a male with primary syphilis is a:
- A. Group of small scattered vesicles
- B. Chancre
- C. Papule of many shapes
- D. Non-tender penile indurated nodule
Correct Answer: B
Rationale: A chancre is the hallmark of primary syphilis, typically appearing as a painless, solitary lesion.
A pulsating mass may be an indication of...
- A. Strangulated hernia
- B. Incarcerated hernia
- C. AAA
- D. All of the above
Correct Answer: C
Rationale: A pulsating mass can indicate an abdominal aortic aneurysm (AAA), which is a critical condition.
Which of the following is NOT a common safety concern for adult patients?
- A. Physical health risks
- B. Occupational safety
- C. Substance abuse
- D. Childhood vaccinations
Correct Answer: D
Rationale: Childhood vaccinations are not a common safety concern for adult patients.
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.
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.