Answer and explanation 10

10.  Choice C is the correct answer.  This patient has temporal arteritis.  Definitive diagnosis is made by temporal artery biopsy in surgery.  This patient needs to be started on high dose steroids as soon as possible to help prevent vision loss.  Hydrocodone and fioricet with codeine would help with the pain but would not address the underlying problem.  Imitrex would be appropriate if the patient just simply had a migraine.  A patient with a migraine would not have a ESR of 130.

Question 10

10.  Your patient is a 55 year old male that presents with a headache in the left temporal area with visual disturbance in the left eye only.  His ESR is 130.  He has no history of glaucoma or prior vision problems.  His slit lamp exam is normal.  His MRI of his brain is normal.  Based upon this data, which of the following is the best therapeutic intervention?

A.  Hydrocodone

B. Fioricet with codeine

C.  Prednisone

D.  Imitrex

 

Answer and Explanation 9

9.  B is the correct answer.  Ativan 0.5 mg IV, Valium 1mg, and Valium 2.5 mg IV are much too low of doses to abort a seizure.  The dose for Valium is 5 mg IV.

Question 9

9. You are working on the hospitalist service and your are called to a patient room that is a 35 year old male that is having tonic clonic seizures.  The nurse says this is the first seizure activity that they have witnessed since he was admitted.  Which of the following therapeutic interventions would be most helpful for aborting this seizure?

A.  Ativan 0.5 mg IV

B.  Ativan 2 mg IV

C.  Valium 1 mg IV

D. Valium 2.5 mg IV

Answer and Explanation 8

8.  Choice B is the correct answer.  This patient has pseudotumor cerebri (idiopathic intracranial hypertension).  This diagnosis is made by spinal tap with manometry.  The fact the patient has recurrent headaches and papilledema in both eyes, should raise the suspicion for this.  It is more common in females than males.  Also it usually occurs in late teens to early 40's.  While an MRI of the head needs to be performed, it will not give you the diagnosis.  An EEG and myelogram will not be helpful in diagnosing this patient.

Question 8

8.   Your patient is a 17 year old female that presents with recurrent headaches and blurry vision out of both eyes.  Physical exam reveals papilledema in both eyes.   Based upon this data, which of the following studies would be the most helpful in her diagnosis?

A.  MRI of her head

B.  Spinal Tap

C.  Myelogram

D. EEG

Answer and Explanation 7

7.  Choice C is the correct answer.  This patient has malignant hyperthermia.  This typically happens minutes to hours after receiving the offending medication.  Treatment is discontinuing the medication as well as dantrolene.  Main offending agents are succinylcholine and halothane.  Giving tylenol and Motrin may help a little but this can potentially be life threatening if dantrolene is not instituted.  Unasyn would be appropriate if a post op gynecologic infection was suspected but the symptoms would not begin this fast.

Question 7

7.  Your patient is a 31 year old female you are asked to see in the recovery room following a total abdominal hysterectomy that was done for menorrhagia.  Your patient has the following vital signs Temp 40 degrees Celsius, HR 151, and is sweaty. Her BP is 176/80.  Based upon this information, what is the best therapeutic intervention?

A.  Tylenol 975 PR

B.  Motrin 800 mg PR

C.  Dantrolene

D.  Unasyn 3.0 grams IV Piggy Back

Answer and Explanation 6

6.  Choice D is the correct answer.  Patients with mid shaft humerus fractures can get injuries of the radial nerve that can lead to wrist drop.  The median nerve provides sensory innervation and some motor to digits 1-3 and lateral half of the 4th on the volar surface.  It also provides innervation to the tips  of the fingers.  This is the nerve afflicted with carpal tunnel syndrome.  The ulnar nerve supplies the fifth digit and the medial half of the forth digit on the volar and dorsal surface.

Question 6

6.  Your patient is a 24 year old male that presents with the following x ray below. Which of the following nerve injuries have been associated with this type of injury?

A.  Median Nerve

B.  Ulnar Nerve

C.  Axillary Nerve

D.  Radial Nerve