Multiple Choice Questions (MCQ)

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Category: Medicine--->Hospital-Based Medicine
Page: 2

Question 6# Print Question

An 84-year-old woman develops confusion and agitation after surgery for hip fracture. Her family reports that prior to her hospitalization she functioned independently at home, but sometimes needed help balancing her checkbook and paying bills. Her current medications include intravenous fentanyl for pain control, lorazepam for control of her agitation, and DVT prophylaxis. She has also been started on ciprofloxacin for pyuria (culture pending). In addition to frequent reorientation of the patient, which of the following series of actions would best manage this patient’s delirium?

A. Increase lorazepam to more effective dose, repeat urinalysis
B. Discontinue lorazepam, remove Foley catheter, add haloperidol for severe agitation, and change to nonfluoroquinolone antibiotic
C. Continue lorazepam at current dose, discontinue fentanyl, add soft restraints
D. Continue lorazepam at current dose, add alprazolam 0.25 mg for severe agitation, repeat urinalysis, restrain patient to prevent self harm
E. Discontinue lorazepam, remove Foley catheter, add alprazolam 0.25 mg for severe agitation, place the patient on telemetry

Question 7# Print Question

You are caring for a 72-year-old man admitted to the hospital with an exacerbation of congestive heart failure. Two weeks prior to admission, he was able to ambulate two blocks before stopping because of dyspnea. He has now returned to baseline and is ready for discharge. His preadmission medications include aspirin, metoprolol, and furosemide. Systolic blood pressure has ranged from 110 to128 mm Hg over the course of his hospitalization. Heart rate was in 120s at the time of presentation, but has been consistently around 70/minute over the past 24 hours. An echocardiogram performed during this hospitalization revealed global hypokinesis with an ejection fraction of 30%. Which of the following medications, when added to his preadmission regimen, would be most likely to decrease his risk of subsequent mortality?

A. Digoxin
B. Enalapril
C. Hydrochlorothiazide
D. Propranolol
E. Spironolactone

Question 8# Print Question

A 64-year-old woman presents to the emergency room with flank pain and fever. She noted dysuria over the past 3 days. Blood and urine cultures are obtained, and she is started on intravenous ciprofloxacin. Six hours after admission, she becomes tachycardic and her blood pressure drops. Her intravenous fluid is NS at 100 mL/h. Her current blood pressure is 79/43 mm Hg, heart rate is 128/minute, respiratory rate is 26/minute and temperature is 39.2°C (102.5°F). She seems drowsy yet uncomfortable. Extremities are warm with trace edema. What is the best next course of action? 

A. Administer IV hydrocortisone at stress dose
B. Begin norepinephrine infusion and titrate to mean arterial pressure greater than 65 mm Hg
C. Add vancomycin to her antibiotic regimen for improved gram-positive coverage
D. Administer a bolus of normal saline
E. Place a central venous line to monitor central venous oxygen saturation

Question 9# Print Question

An 84-year-old woman presents to the ED with shortness of breath. She has been coughing for the past 2 to 3 days. The patient has a history of mild dementia, but has been able to maintain independent living at home with the assistance of her daughters and a home health agency. Her daughter denies any fever at home. Vital signs include a heart rate of 102/minute, respiratory rate of 24/minute, blood pressure 142/58 mmHg, and temperature of 37.8°C with a weight of 52 kg. Oxygen saturation is 93% on room air. Upon examination, she appears to be in mild respiratory distress. She is pleasant but oriented only to self. Chest auscultation reveals few crackles in the left upper lung field. WBC count is 12,500, BUN is 30 mg/dL, and creatinine is 1.3 mg/dL. A chest radiograph shows an infiltrate in the left upper lung lobe. What is the best initial course of therapy for this patient?

A. Begin a third-generation cephalosporin and admit her to the hospital
B. Begin a renal-dosed third-generation cephalosporin and a macrolide, and admit her to the hospital
C. Begin a respiratory fluoroquinolone and discharge her home for follow-up
D. Begin a loop diuretic and monitor her oxygen saturation
E. Begin bronchodilator therapy with an inhaled beta-agonist

Question 10# Print Question

A 78-year-old man presents to the emergency department with acute onset of bright red blood per rectum. Symptoms started 2 hours earlier, and he has had three bowel movements since then with copious amounts of blood. He denies prior episodes of rectal bleeding. He notes dizziness with standing but denies abdominal pain. He has had no vomiting or nausea. A nasogastric lavage is performed and shows no coffee ground emesis or blood. Lab evaluation reveals hemoglobin of 10.5 g/dL. What is the most likely source of the bleeding?

A. Internal hemorrhoids
B. Dieulafoy lesion
C. Diverticulosis
D. Mallory-Weiss tear
E. Sessile polyp

Category: Medicine--->Hospital-Based Medicine
Page: 2 of 3