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hawaiii
Forum Senior  Topics: 19 Posts: 103 |
-The following vignette applies to the next 2 items. A 6-month-old African-American girl is brought to the office in January for a well-child visit. She was born at 32 weeks' gestation after a pregnancy complicated by an incompetent cervix and premature labor. She has a 3-year-old brother. Her birth weight was 2700 g (6 lb). At birth, she had mild respiratory distress syndrome and required mechanical ventilation for 36 hours. She also has gastroesophageal reflux disease for which she is given ranitidine, daily. Vaccinations are up-to-date. Developmental milestones are appropriate for her adjusted chronological age. Head circumference and growth charts are shown. Item 1 of 2 Regarding the results on the head circumference chart, which of the following is the most appropriate conclusion? A ) The growth pattern is most likely due to neonatal intraventricular hemorrhage B ) Her growth is normal for a premature infant C ) An MRI should be done to rule out a brain tumor D ) The parents' head circumferences should be measured to evaluate the infant for familial macrocephaly E ) She should be examined for possible papilledema to rule out hydrocephalus Item 2 of 2 6 Two weeks later the girl is brought back by her mother because of a runny nose and difficulty breathing for the past 3 days. The mother says, "She's up every 2 hours now, and last night she had a fever. I think her brother picked up a cold from preschool and gave it to her. I can't keep him away from her." Vital signs now are temperature 38.5°C (101.3°F), pulse 144/min, and respirations 60/min. On physical examination she is alert but in mild respiratory distress with slight nasal flaring. Auscultation of the chest discloses fine expiratory wheezes bilaterally, and mild intercostal retractions. Which of the following is the most likely cause of the infant's illness? A ) Aspiration pneumonia B ) Asthma C ) Bronchopulmonary dysplasia D ) Mycoplasma pneumoniae E ) Respiratory syncytial virus 7 -- A 52-year-old Hispanic computer technician comes to the office because of a 3-week history of substernal chest discomfort when she climbs stairs or eats a heavy meal. She first noticed the discomfort after climbing two flights of stairs. The discomfort is nonradiating and sometimes only involves the left side of the chest. She has hypertension and type 2 diabetes mellitus. Current medications include metformin and an ACE inhibitor. She has recently had increased stress because her company is experiencing financial difficulty. Her husband receives medical disability benefits, and they are dependent on her income. Physical examination shows no abnormalities. Which of the following risk factors is most important to consider when assessing her chest pain? A ) Age B ) Diabetes mellitus C ) Gender D ) Hypertension E ) Stress level 8--A 38-year-old woman with systemic lupus erythematosus but no evidence of nephritis comes to the office because of a 3-week history of mood swings with crying spells, irritability and insomnia. She is especially upset because she has been yelling at her children "over small, everyday things." One month ago she started corticosteroid therapy. She is currently taking prednisone, 60 mg/day. Her other medications include an oral contraceptive (the same one for the past 6 years) and ibuprofen. She smokes one-half pack of cigarettes daily, drinks one to two beers 5 nights weekly and three cups of coffee each morning. Which of the following is the most appropriate intervention for her mood disturbance? A ) Add amitriptyline at bedtime B ) Discontinue the oral contraceptive C ) Reduce the prednisone dosage D ) Replace ibuprofen with acetaminophen E ) Urge her to stop smoking and to reduce her alcohol and caffeine intake 9--- A 20-year-old man comes to the health center because of ankle pain. Two days ago he sustained an inversion injury of his left ankle in a basketball game. He has been able to walk unassisted since the injury. Today he has pain and moderate swelling and discoloration over the lateral malleolus. Physical examination shows tenderness on palpation over the anterolateral corner of the ankle joint. He has had two similar injuries in the past. Which of the following is the most appropriate initial management? A ) An ankle-strengthening exercise program B ) Application of a long-leg cast for 3 weeks C ) Application of a short-leg cast for 3 weeks D ) Protected weight bearing E ) Surgical repair of the ankle ligaments
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