QUESTION: 109

A premature infant is born with a patent ductus arteriosus. In closure can be stimulated by administration of:

Prostaglandin inhibitors
Anti-estrogen compounds
Estrogen
Prostaglandin analogue

Answer(s): A

Explanation:

Prostaglandin inhibitors Normally ductus arteriosus closes soon after birth. Vasodilatory effect of prostaglandin is what maintains to ductus arteriosus in intrauterine life. Hence in cases of delayed closure of ductus arteriosus, we can use p inhibitors to induce its closure.

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QUESTION: 110

A 31-year-old woman presents to the ED with a sudden onset of left-sided chest pain and difficulty breathing. She states her only medication is birth control pills.
She has smoked 1 pack of cigarettes per day for 10 years. She is tachypneic (24 BrPM) and her heart rate is 120 beats per minute. Physical examination reveals diminished breath sounds on the left and the trachea deviated to the right.
What is the most likely diagnosis?

Tension pneumothorax
Pulmonary embolus
Pericardial tamponade

Answer(s): A

Explanation:

Tension pneumothorax presents with decreased breath sound on one side and tracheal deviation PE does not give tracheal deviation, although it does have chest pain and tachycardia. Muffled heart sounds are seen typically in pericardial tamponade. This patient's risk for pneumothorax is that she is a smoker. It is likely she has a pleural bleb that burst due to her smoking history.

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QUESTION: 111

A 76-year-old woman is brought in for respiratory distress and altered mental status. Her medical history records right-sided hemiplegia from a stroke several years ago. She has blood pressure 86/52; heart rate 123 BPM, breathing rate 33 Br PM, temperature 102.3ֲ°F, and O2 sat 84%. Exam reveals rhonchi bilaterally with `E to Ah` changes and warm extremities with faint pulses. Chest x-ray shows bilateral infiltrates.
What is the likely etiology of this patient's hypotension?

Neurogenic shock
Cardiogenic shock
Septic shock
Hypovolemic shock

Answer(s): C

Explanation:

This patient is presenting with 3 SIRS criteria: hypotension, altered mental status, and a source of infection (pneumonia). The physical exam is also consistent with septic shock: Massive vasodilation has yielded warm extremities and faint pulses. Both hypovolemic shock and cardiogenic shock would have pale and cool extremities. There is no mention of bleeding, ruling out hemorrhagic shock.

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QUESTION: 112

60 years old patient has only HTN best drug to start with:

Diuretics
ACEI
ARB
Beta blocker E-Alpha blocker

Answer(s): A

Explanation:

Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low- dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.

Reference:

http://www.aafp.org/afp/2005/0201/p469.html

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QUESTION: 109

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