CME|221 questions| with complete solutions

Which conditions classically leads to the development of diastolic heart failure? CORRECT ANSWERS: left ventricular hypertrophy - secondary to chronic, poorly-controlled hypertension manifest as ventricular wall hypertrophy decreases the lumen of the LV and reduces left ventricular wall compliance -- diastolic filling A patient from a house fire presents with thermal burns involving the entire left upper extremity (anteriorly and posteriorly) as well as circumferential burns of the left thigh, the buttocks and the lower back ipsilaterally. Per the formula defined by the "Rule of 9's" what is the percentage of body surface area affected? CORRECT ANSWERS: 27% - Upper extremity (arm) anterior and posterior = 9%; thigh anteriorly and posteriorly = 9% (entire lower extremity would be 18%); buttocks and lower back = 9%. What is the accumulation of ectopic glandular (endometrial) tissue in the myometrial (muscular) wall of the uterus under the effects of estrogen? CORRECT ANSWERS: adenomyosis How do you treat adenomyosis? CORRECT ANSWERS: hysterectomy A 41-year-old female experienced increasing pelvic discomfort and vaginal bleeding. She has not missed any of her periods. She had a tubal ligation 9 years ago. Her uterus is noted to be soft, mildly enlarged in size, and symmetrically globular in shape. The adnexa are normal. She reports notable tenderness during the exam. Which of the following is the most likely diagnosis? CORRECT ANSWERS: adenomyosis (uterine fibroid would has palpable mass, uterine cancer does not have dysmenorrhea) A 21-year-old male with a history of asthma since childhood presents to the ED for an acute exacerbation of his asthma. He has an initial, maximal peak flow of 50% predicted and a pulse oximetry of 91% on room air. He is treated with nebulized albuterol/ipratropium. He feels somewhat better; his peak flow improves to 55% predicted. He is treated a second time and noted to have better airflow with fewer wheezes; his peak flow remains at 55%; a third treatment improves his symptoms further, and pulse oximetry reading improves to 96% with peak flow at 65% predicted. Which of the following elements of the patient's history would make it MOST appropriate to admit him to the hospital rather than discharge him to home? CORRECT ANSWERS: The patient has a history of severe asthma episodes requiring admission to the ICU on several occasions and was intubated twice A 66-year-old woman presents to the clinic, speaking words that are recognizable but make no sense. When questioned, she starts to answer but then rapidly forgets what she has just been asked. She knows where she is, but has no idea of time, month or year. She does not appear to recognize her current mental state as altered. She denies visual and auditory hallucinations. Her family is present and concerned as she has never exhibitWhich conditions classically leads to the development of diastolic heart failure? CORRECT ANSWERS: left ventricular hypertrophy - secondary to chronic, poorly-controlled hypertension manifest as ventricular wall hypertrophy decreases the lumen of the LV and reduces left ventricular wall compliance -- diastolic filling A patient from a house fire presents with thermal burns involving the entire left upper extremity (anteriorly and posteriorly) as well as circumferential burns of the left thigh, the buttocks and the lower back ipsilaterally. Per the formula defined by the "Rule of 9's" what is the percentage of body surface area affected? CORRECT ANSWERS: 27% - Upper extremity (arm) anterior and posterior = 9%; thigh anteriorly and posteriorly = 9% (entire lower extremity would be 18%); buttocks and lower back = 9%. What is the accumulation of ectopic glandular (endometrial) tissue in the myometrial (muscular) wall of the uterus under the effects of estrogen? CORRECT ANSWERS: adenomyosis How do you treat adenomyosis? CORRECT ANSWERS: hysterectomy A 41-year-old female experienced increasing pelvic discomfort and vaginal bleeding. She has not missed any of her periods. She had a tubal ligation 9 years ago. Her uterus is noted to be soft, mildly enlarged in size, and symmetrically globular in shape. The adnexa are normal. She reports notable tenderness during the exam. Which of the following is the most likely diagnosis? CORRECT ANSWERS: adenomyosis (uterine fibroid would has palpable mass, uterine cancer does not have dysmenorrhea) A 21-year-old male with a history of asthma since childhood presents to the ED for an acute exacerbation of his asthma. He has an initial, maximal peak flow of 50% predicted and a pulse oximetry of 91% on room air. He is treated with nebulized albuterol/ipratropium. He feels somewhat better; his peak flow improves to 55% predicted. He is treated a second time and noted to have better airflow with fewer wheezes; his peak flow remains at 55%; a third treatment improves his symptoms further, and pulse oximetry reading improves to 96% with peak flow at 65% predicted. Which of the following elements of the patient's history would make it MOST appropriate to admit him to the hospital rather than discharge him to home? CORRECT ANSWERS: The patient has a history of severe asthma episodes requiring admission to the ICU on several occasions and was intubated twice A 66-year-old woman presents to the clinic, speaking words that are recognizable but make no sense. When questioned, she starts to answer but then rapidly forgets what she has just been asked. She knows where she is, but has no idea of time, month or year. She does not appear to recognize her current mental state as altered. She denies visual and auditory hallucinations. Her family is present and concerned as she has never exhibited comparable signs or symptoms in the past. Which of the following is the most likely diagnosis? CORRECT ANSWERS: Delirium ed comparable signs or symptoms in the past. Which of the following is the most likely diagnosis? CORRECT ANSWERS: Delirium