lq2006
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1>A 47-year-old man is admitted to the hospital after threatening to harm a radio announcer he believed was broadcasting his thoughts. Over the past 20 years, he has had multiple psychiatric hospitalizations for threatening people who he believed were plotting against him, trying to control his mind, or causing him to hear voices by implanting devices in his head. Past symptoms improved with neuroleptic therapy; after discharge, he discontinued the medication and his symptoms worsened. Which of the following is the most appropriate pharmacotherapy to decrease this patient's risk for future hospitalization?
A
) Clozapine
B
) Fluphenazine hydrochloride
C
) Haloperidol decanoate
D
) Risperidone
E
) Trifluoperazine hydrochloride
2>.A 62-year-old woman comes to the physician because of bloating and cramping abdominal pain and intermittent diarrhea over the past 5 years. Her symptoms have increased over the past month since she started a new diet that emphasizes yogurt and cottage cheese as low-fat sources of calcium and protein. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound tenderness; there are no masses or organomegaly. Bowel sounds are increased. Test of the stool for occult blood is negative. Which of the following is the best explanation for this patient's diarrhea?
A
) Impaired intestinal motility
B
) Inflammatory process
C
) Malabsorption
D
) Secretory process
3>.A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2 months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro murmur in the second left intercostal space, a loud S2, bounding peripheral pulses, and a widened pulse pressure. Which of the following is the most likely diagnosis?
A
) Atrial septal defect (ostium primum type)
B
) Atrial septal defect (ostium secundum type)
C
) Atrioventricular canal
D
) Coarctation of the aorta
E
) Hypoplastic left heart syndrome
F
) Patent ductus arteriosus
G
) Tetralogy of Fallot
H
) Transposition of the great arteries
I
) Tricuspid atresia
J
) Ventricular septal defect
4>.A 42-year-old man comes to the physician because of progressive swelling of the legs over the past 2 months. He has a history of stage IIA Hodgkin's disease treated 1 year ago with radiation therapy to the neck and chest. His temperature is 37 C (98.6 F), blood pressure is 102/80 mm Hg, pulse is 110/min, and respirations are 22/min. Examination shows jugular venous distention that increases with inspiration. The lungs are clear to auscultation. Cardiac examination shows a nondisplaced point of maximal impulse; heart sounds are distant. An early diastolic sound is heard at the apex. Abdominal examination shows mild distention with shifting dullness. The liver is pulsatile, and its edge is palpated 4 cm below the right costal margin. There is 2+ peripheral edema extending up to the knees. Which of the following is the most likely mechanism of this patient's increased central venous pressure?
A
) Constrictive pericarditis
B
) Cor pulmonale
C
) Left-sided congestive heart failure
D
) Mitral stenosis
E
) Tricuspid stenosis
5>.After an uncomplicated laparoscopic cholecystectomy, a 62-year-old man has not had any urine output since the Foley catheter was removed 12 hours ago. During the hour before the operation, the 40 minutes of operating room time, and the 2 hours in the recovery room, his fluid input was 2.5 L and urine output was 1 L. Since that time, he has been receiving intravenous 5% dextrose in water with 0.45% saline and morphine. He is awake and alert and has a moderate amount of abdominal pain. Preoperative serum studies showed:
Na+ 137 mEq/L
K+ 4.2 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.2 mg/dL
One hour after receiving an intravenous bolus of 0.9% saline, the patient does not produce any urine. Which of the following is the most appropriate next step in management?
A
) Increase in the dose of morphine
B
) Intravenous administration of an additional bolus of 0.9% saline
C
) Intravenous administration of doxazosin
D
) Intravenous administration of furosemide
E
) Reinsertion of a Foley catheter
6>.A 37-year-old woman comes to the physician because of progressive shortness of breath over the past 5 years; she now has fatigue and shortness of breath with mild exertion. She has a history of mitral stenosis secondary to rheumatic fever at the age of 15 years. She was asymptomatic until 5 years ago when she developed severe shortness of breath during pregnancy. She was treated with diuretics, low-sodium diet, and bed rest, and she was able to deliver the baby at term. Her only medication is hydrochlorothiazide. Her temperature is 37 C (98.6 F), blood pressure is 110/80 mm Hg, pulse is 100/min and regular, and respirations are 26/min. Cardiac examination shows an obvious opening snap in S2. A grade 3/6, late diastolic murmur is heard at the apex. A right ventricular lift is palpated along the left sternal border. Which of the following is most likely increased in this patient?
A
) Blood flow to the lower lung fields
B
) Diastolic filling time
C
) Left-to-right shunt of blood
D
) Left ventricular end-diastolic pressure
E
) Pulmonary artery pressure
Many thanks in advanced!! Please explain briefly your answer, thanks!!!
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| Vietnamese
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Posts: 285
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1. E- Trifluoperazine HCL. This drug kills cell, then persistent effect.
2. ?
3. F- PDA. "Mechanic-like" murmur (to-and-fro murmur)
4. A- Constrictive pericarditis. Presents right heart failure, cause: radiation therapy
5. E- Reinsertion of Foley. Patient presents overflow incontinence due to morphine
6. E- Pulmonary artery pressure. The key is right ventricular lift palpable (hyperdynamic
of pulmonary hypertension)
Edited by Vietnamese on 05/23/08 - 08:17 PM
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| peter90036
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#1 = maintenance tx schizo w/ compliance issues = depot - long-acting inj meds = flufenazine decanoate or haldol decanoate
#2 lactase deficit --> malabsorbtion of lactose, chronic diarrhea
#3 not cyanotic, murmur, bounding pulses, wide pulse pressure = PDA
Edited by peter90036 on 05/24/08 - 01:09 PM
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| hir
Forum Elite
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Posts: 363
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1) B
2) C
3) F
4) A (because of radiation)
5) A (pt in moderate pain)
6) E (MS> increase lt atrial pressure> increase PCWP > increase pulmonary artery pressure
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| peter90036
Forum Elite
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hir: alot of fluid in, no/ low urine out,
morphine will do more urine retention....
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| hir
Forum Elite
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  ........but if its overflow incontinence, there isnt any incontince, output is nill??????
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| peter90036
Forum Elite
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pt on morphine not peeing
bun, crea are at higher limit so that could be post-renal obstruction , retention
Edited by peter90036 on 05/24/08 - 03:49 PM
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| hir
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but foley's was removed 12 hrs ago.........
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| peter90036
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 i forgot the exact wording, was writing from memory :P
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| hir
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| Vietnamese
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Posts: 285
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@hir
Overflow incontinence gives rise to nill or a little bit in urine. This moderate amount of abdominal pain is from constipation of morphine. If increase morphine dose, pain will increase.
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| xthine
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Doesnt morphine cause urinary retention?
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| hir
Forum Elite
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yup, got it , thanks guy.......but i guess, xthine is right, morphine cause urinary retention,
so its because of overflow incontinence or retension ????
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| Vietnamese
Forum Elite
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Under overflow incontinence, retention is overlapped. Morphine is "culprit".
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| hir
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thanks!!!!!!!!
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| Al Durra
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