brooklynmed
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72 yo woman 3 yr. hx. of small amt. urine loss when coughs or sneezes. no pain on urination. HTN tx. w/ HCTZ. Appendectomy at age of 10. 3 children, uncomplicated pregnancies. exam shows moderate cystocele. most likely cause of urinary symptoms?
1. chronic incfection, 2. large intravesical calculus, 3. obstetric trauma, 4. PCKD, 5. spastic neurogenci bladder.
Pat. in chronic pain. Too much pain meds causes resp. depression. Pat. asks to be given lethal dose of pain meds. Increasing narcotics needed to control pain. What do you do?
1. reduce dosage to not impair respiration 2. give nec. amt pain meds despite resp. impairment 3. give dose nec. to control pain and add centrally acting stimulant 4. appeal to faily to convince pat. to tolerate a bit more pain
62 yo female pain and swelling x 1 day of right knee. no hx. trauma or joint disease. HTN tx. with HCTZ and DM2 tx. w/ glyburide. Sexually active w/ husband only. temp. 98.6, bp: 140/84, pulse 80. exam shows edema, erythema and tenderness to light touch. Effusion is presnet. Likely mechanism?
1. immune complex deposition 2. inflamm. rxn to antisynovial AB 3. inflamm. rxn to monosodiium urate crystals 4. Gonorrhea infxn, 5 Strep. pneumo. infextion
19 yo woman 39 weeks gestation in labor. contraction every 2-3 min. 4cm dilated 80% effaced. requests epidural for pain. Ten min. after epidural pat. becomes nauseated, diaphretic and vomits. BP 60/palpable. Fetal heart shows sustained fetal deceleration. Cervix is now 8cm dilated. Next best step?
1. ephedrine, 2. mag. phos, 3. nifedipine, 4. oxytocin, 5. terbutaline
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