A 75-year-old man is admitted to a nursing home after having a stroke 2 weeks ago. The patient has residual right-sided paralysis, aphasia and urinary incontinence. He can respond to verbal commands but cannot speak well enough to make his needs known. His ability to walk is greatly impaired, and he spends most of the day in bed or in a chair. He is unable to change position independently and needs assistance with all activities of daily living. The patient has a poor appetite, cannot use his right arm to feed himself, and is eating only half his meals. He also has intermittent urinary incontinence. Which of the following is the most appropriate intervention for preventing pressure ulcers in this patient?

Massage of skin over pressure points

An 84-year-old man is evaluated for a 6-month history of slow urinary stream, urinary hesitancy, postvoid dribbling, and a need to get up an average of three times each night to urinate. He has chronic obstructive pulmonary disease and is on inhaled albuterol as needed and 2 L/min of home oxygen. On physical examination, temperature is normal, blood pressure is 140/76 mm Hg, and pulse rate is 76/min. Abdominal examination is normal without tenderness or masses or evidence of a distended bladder. Digital rectal examination reveals a symmetrically enlarged prostate without any discrete nodules or tenderness. Which of the following is the most useful test for evaluating this patient’s urinary symptoms?

Postvoid residual urine volume measurement

A 34-year-old man is evaluated at the urging of his wife because of a 3-month history of nightmares, increased irritability, outbursts of anger, and social isolation. He recently returned from reserve duty in Iraq. The nightmares are especially frequent and troubling around the time of his monthly weekend reserve duty, and he has started to drink heavily at these times to try to block out the dreams. The patient has lost interest in his usual activities, does not play with his children, spends much time alone, won’t watch the news on television, and is very uncomfortable in crowded places, such as restaurants. He has avoided repeated efforts by his wife to talk about his experiences in Iraq. Findings on physical examination are unremarkable. Which of the following is the most effective treatment for this patient?

Refer for cognitive-behavioral therapy

Prescribe zolpidem and alcohol counseling

Provide brief counseling for the patient and his wife

Refer for cognitive-behavioral therapy

Refer for psychodynamic therapy

A 70-year-old man with severe disability due to claudication in his right leg and a 2-month history of increasingly frequent chest pain undergoes preoperative cardiovascular evaluation prior to elective right femoropopliteal bypass graft surgery. The patient can only walk one block because of claudication and chest pain despite adequate medical treatment. Medical history is significant for coronary artery disease, a myocardial infarction 4 years ago, hypertension, and type 2 diabetes mellitus. The patient underwent left femoropopliteal bypass graft surgery 2 years ago under general anesthesia without complications. He has a 55 pack-year smoking history but stopped smoking 2 years ago. Current medications are metoprolol, atorvastatin, amlodipine, fosinopril, isosorbide mononitrate, insulin glargine, insulin aspart, and aspirin. Vital signs are normal. There is no jugular venous distention. Cardiopulmonary examination is normal. Pulses in the right calf are decreased. There is no calf tenderness and no peripheral edema. An electrocardiogram shows Q waves in the inferior leads. Which of the following is the best preoperative management?

Dipyridamole nuclear imaging stress testing

Dobutamine stress echocardiography

Two-dimensional echocardiography

A 64-year-old woman is evaluated during a health maintenance examination. She has hypertension and hypercholesterolemia. She has no symptoms to report. She is a current smoker, with a 20 pack-year history. Current medications are atenolol and hydrochlorothiazide. Vital signs are normal. BMI is 28. Funduscopic examination reveals bright, yellow, refractile deposits scattered in the retina of the right eye, with approximately five deposits seen on direct ophthalmoscopy. The left fundus appears normal. On visual acuity testing, near vision is 20/20 with reading glasses, and distance vision is 20/25 for both eyes. The remainder of the physical examination is normal. A lipid panel obtained prior to today’s visit reveals a total cholesterol of 190 mg/dL (4.92 mmol/L); LDL cholesterol of 120 mg/dL (3.11 mmol/L); HDL cholesterol of 40 mg/dL (1.04 mmol/L); and triglycerides of 150 mg/dL (1.70 mmol/L). Which of the following is the most effective management option for this patient’s ocular findings?

Lower blood pressure to below 130/85 mm Hg

.A 78-year-old woman is evaluated because of concerns about her ability to drive. She has trouble seeing on bright, sunny days and also at night because of the glare from headlights of oncoming cars. The patient has type 2 diabetes mellitus and a 55-pack-year smoking history. Her current medications include metformin and glipizide. This patient’s history is most suggestive of which of the following ophthalmologic disorders?

Age-related macular degeneration

Proliferative diabetic retinopathy

A 21-year-old female college student is referred by the student health center for evaluation of a possible eating disorder. The patient acknowledges that she sometimes eats very large amounts of food and is unable to stop herself until she has consumed an entire container of ice cream or a bag of potato chips. She says that this eating behavior occurs almost daily while preparing for final examinations but may only occur once or twice weekly during less stressful times. She has never induced vomiting but does take laxatives and exercises for hours after one of these eating episodes. She also feels that her hips are too wide. Her older sister has required hospitalization several times for anorexia nervosa. Findings on physical examination are unremarkable. BMI is 22. Which of the following is the most likely diagnosis?

Anorexia nervosa, binge-eating/purging type

Anorexia nervosa, restricting type

A 54-year-old woman is evaluated for pain in the right posterior hip and pelvic area that she noticed upon awakening 3 days ago. She had been moving and lifting boxes the day before the onset of pain. She has experienced similar pain several times over the last 2 years, but it has never lasted so long. On physical examination, BMI is 30. The FABER test (Flexion, ABduction, and External Rotation of the hip) elicits pain in the right posterior pelvis. There is tenderness on palpation over the right posterior pelvic girdle. Flexing the hip is painful. There is no tenderness in the right groin, the right trochanter, or the right gluteal notch. Passive range of motion of the right hip reveals no pain. Straight-leg-raising test is negative, and deep tendon reflexes are normal. Which of the following is the most likely diagnosis?

Osteoarthritis of the right hip

July 2012 - Gim

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| Written by Dstevens

Dstevens

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Quizzes Created: 5 | Total Attempts: 2,577

Questions: 12 | Attempts: 87 | Updated: Mar 19, 2023

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