Nokea
You want to start pharmacologic treatment for depression in an older patient who is taking numerous medications. Which of the following antidepressants is the least likely to cause drug-drug interactions?
- A. Citalopram
- B. Fluoxetine
- C. Paroxetine
- D. Venlafaxine
Correct Answer: E
Rationale: I believe you made a typo in listing the correct answer as "E" while there is no "E" option in the choices provided. Could you please confirm the correct answer choice so I can provide you with a detailed explanation and summary of why the correct answer is correct and why the other choices are incorrect?
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You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be?
- A. Call a medevac helicopter
- B. Drive him to the city (4 hours away)
- C. Press on his sternum and spine simultaneously
- D. Examine him for tenderness over the injured area
Correct Answer: D
Rationale: The correct answer is D: Examine him for tenderness over the injured area.
Rationale:
1. Start with a physical examination to assess for tenderness directly over the injured area.
2. Rib fractures often present with localized tenderness upon palpation.
3. If tenderness is present, suspect a rib fracture and advise immobilization.
4. Advise against unnecessary movement to prevent further injury.
Summary:
- Choice A: Calling a medevac helicopter is premature without assessing the severity of the injury.
- Choice B: Driving him 4 hours away could worsen his condition without proper assessment.
- Choice C: Pressing on the sternum and spine simultaneously is not recommended as it can cause further harm.
A 79-year-old woman was admitted to the hospital a month ago with an acute ischemic stroke. Which would be the next best step in management?
- A. Start escitalopram 5 mg orally daily.
- B. Start eszopiclone 1 mg orally at bedtime.
- C. Start a high-calorie supplement twice a day.
- D. Change the time at which she gets physical therapy.
Correct Answer: C
Rationale: The correct answer is C: Start a high-calorie supplement twice a day. After an acute ischemic stroke, nutritional support is crucial for recovery and prevention of complications. Malnutrition is common post-stroke due to swallowing difficulties and decreased appetite. High-calorie supplements can help meet the patient's nutritional needs.
Choice A (escitalopram) is a selective serotonin reuptake inhibitor used for depression and anxiety, which may not be the immediate priority in this case. Choice B (eszopiclone) is a nonbenzodiazepine hypnotic used for insomnia, which is not directly related to managing the patient's stroke. Choice D (changing the time of physical therapy) may be beneficial, but ensuring adequate nutrition is more critical in the acute phase of stroke recovery.
All of the statements about Medicare are true except:
- A. All of the funding for Medicare comes from federal taxes.
- B. Durable medical equipment has no out-of-pocket cost to the patient.
- C. Part B covers outpatient services and all physician professional fees whether inpatient or outpatient.
- D. Patients are generally responsible for 20% of Part B bills.
Correct Answer: B
Rationale: The correct answer is B because durable medical equipment under Medicare typically requires the patient to pay 20% of the Medicare-approved amount.
A is incorrect because Medicare funding also comes from payroll taxes and individual premiums.
C is incorrect as Part B covers outpatient services and physician fees only in outpatient settings.
D is incorrect as patients are generally responsible for 20% of Part B bills, not no out-of-pocket cost for durable medical equipment.
You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position?
- A. Aortic
- B. Pulmonic
- C. Mitral
- D. Tricuspid
Correct Answer: C
Rationale: The correct answer is C: Mitral valve defect. This is because the mitral valve is best heard in the left lateral decubitus position. In this position, the heart rotates, bringing the mitral valve closer to the chest wall, making it easier to auscultate any abnormalities such as murmurs. Aortic (A), pulmonic (B), and tricuspid (D) valve defects are not typically better heard in the left lateral decubitus position, so they are incorrect choices.
A 45-year-old electrical engineer presents to your clinic, complaining of spots on his scrotum. He first noticed the spots several months ago, and they have gotten bigger. He denies any pain with urination or with sexual intercourse. He has had no fever, night sweats, weight gain, or weight loss. His past medical history consists of a vasectomy 10 years ago and mild obesity. He is on medication for hyperlipidemia. He denies any tobacco or illegal drug use and drinks alcohol socially. His mother has Alzheimer's disease and his father died of leukemia. On examination he appears relaxed and has unremarkable vital signs. On visualization of his penis, he is circumcised and has no lesions on his penis. Visualization of his scrotum shows three yellow nodules 2-3 millimeters in diameter. During palpation they are firm and nontender. What abnormality of the male genitalia is this most likely to be?
- A. Condylomata acuminata
- B. Syphilitic chancre
- C. Peyronie's disease
- D. Epidermoid cysts
Correct Answer: D
Rationale: The correct answer is D: Epidermoid cysts. These cysts typically present as firm, non-tender nodules on the scrotum, consistent with the patient's presentation. The history of gradual growth without associated symptoms supports this diagnosis. Additionally, the lack of pain with urination or sexual intercourse rules out sexually transmitted infections like condylomata acuminata (choice A) and syphilitic chancre (choice B). Peyronie's disease (choice C) involves penile curvature and fibrous plaques, not scrotal nodules. In summary, the patient's presentation, physical examination findings, and absence of specific symptoms point towards epidermoid cysts as the most likely diagnosis.