Starting this week, will post five questions at a time as many of you suggested. Thanks Here we go! 1. A 56-year-old white male has New York Heart Association (NYHA) class III chronic heart failure. Despite conventional therapy with appropriate dosages of a diuretic, an ACE inhibitor, and a 6-adrenergic blocker, his left ventricular ejection fraction hovers around 35%, and he continues to have dyspnea on exertion. At a recent office visit his electrolytes were within normal limits. After you obtain an EKG during an office visit today, you consider adding digoxin to his treatment regimen. Which one of the following is true regarding digoxin therapy in this situation? A) It is the treatment of choice if the patient’s EKG shows atrioventricular block B) It is not likely to improve the ejection fraction C) A loading dose will be necessary D) Serial drug levels are generally not necessary E) A reasonable dosage is 0.50 mg/day orally 2. A 15-year-old white male complains of bilateral foot pain. He does not recall any injury, and the pain improves with rest. Examination reveals tenderness over the lateral and anterior ankle, along with a rigid flatfoot, peroneal tightness, and pain on foot inversion. The most likely diagnosis is A) tarsal coalition B) stress fracture C) plantar fasciitis D) turf toe E) foot sprain 3. A 35-year-old white female presents to your office with a history of three episodes of intense right upper quadrant pain over the last few weeks. Each attack developed a few hours after her evening meal, lasted 1–2 hours, and was accompanied by nausea. Between episodes she feels fine. She went to the emergency department after the third episode, and blood tests and a sonogram of the gallbladder were negative. Which one of the following would you recommend? A) Weight loss through a combination of diet and exercise B) A low-fat diet C) A nuclear scan of the gallbladder D) A CT scan of the abdomen E) Endoscopic retrograde cholangiopancreatography (ERCP) 4. An elderly female who has been your patient for several years is discovered lying on the floor of her kitchen by a Meals-on-Wheels volunteer. She is transported to the hospital in an unresponsive state. After a thorough evaluation, you diagnose a massive cerebral infarct. On several previous occasions the patient verbalized to you her desire to not be subjected to life-prolonging treatments should she ever be rendered incapacitated; however, she declined your suggestion that she confirm this in writing. The patient is admitted to the hospital with “do not resuscitate” (DNR) orders and supportive measures are instituted. A neurology consultant evaluates her and agrees that her condition is terminal and irreversible. The patient’s nephew is angered by the DNR status and, noting that she has Medicare coverage, demands every medical treatment that might prolong his aunt’s life, including resuscitation. Which one of the following would be the best course of action in terms of legality and ethics? A) Institution of aggressive medical therapies, including full resuscitation in the event of cardiac arrest and ventilator support in the event of respiratory arrest B) Continuation of a supportive treatment plan, provided full resuscitation is initiated in the event of cardiac arrest and ventilator support is provided in the event of respiratory arrest C) Performance of full CPR for cardiopulmonary arrest, but no ventilator support for respiratory failure D) Continuation of the current treatment plan 5. Which one of the following is characteristic of osteoarthritis of the knee? A) Greater frequency in men than in women B) Increased pain with rest C) A direct correlation between radiographic changes and pain severity D) Reduction of pain with repair of associated meniscal tears E) Reduction of pain with muscle strengthening NYHA Classification of heart failure Functional Capacity: How a patient with cardiac disease feels during physical activity I Patients with cardiac disease but resulting in no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain. II Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain. III Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain. IV Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases.
Posted on: Mon, 03 Nov 2014 11:24:31 +0000
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