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Mr. Jones, who has been on pravastatin (Pravachol) 20 mg at bedtime for the past few months,
complains of lately feeling extremely fatigued. The patient also noticed that his urine has been
a darker color during the past 2 weeks. Which of the following is the best treatment plan to
follow?
A) Discontinue his pravastatin and order a liver function profile
B) Continue the pravastatin but on half the dose
C) Schedule him for a complete physical exam
D) Schedule him for a liver function profile A) Discontinue his pravastatin and order a liver
function profile
Side effects of statin drugs include myalgia, fatigue, and elevated liver enzymes. Routine labs
should include liver enzymes to assess the effects on the liver.
The Phalen test is used to evaluate:
A) Inflammation of the median nerve
B) Rheumatoid arthritis
C) Degenerative joint changes
D) Chronic tenosynovitis A) Inflammation of the median nerve
The Phalen test is used to identify inflammation of the median nerve seen with carpal tunnel
syndrome. Phalen's test is performed by examining the wrist with full flexion of the wrist for 60
seconds. Positive findings are reproduction of the symptoms such as numbness and tin- gling of
the thumb, index finger, and middle finger areas.
Which of the following viral infections is associated with occasional abnormal forms of
lymphocytes during an acute infection?
A) Cytomegalovirus (CMV)
B) Epstein-Barr virus (EBV)
,C) Human papilloma virus (HPV)
D) Coxsackie virus B) Epstein-Barr virus (EBV)
A test for an acute infection of the Epstein-Barr virus will show abnormal forms of lymphocytes.
Jenny, a 21-year-old, complains to you of a 1-week episode of dysuria, frequency, and a strong
odor to her urine. This is her second episode of the year. What is the most appropriate follow-
up for this patient?
A) Order a urinalysis and urine for culture and sensitivity (C&S) and treat the patient with
antibiotics
B) Order a urine C&S and hold treatment until you get the results from the lab
C) Treat the patient with a 7-day course of antibiotics and order a urine for cultureand
sensitivity (urine C&S) now and after she completes her antibiotics
D) Treat the patient with a stronger drug such as ofloxacin (Floxin) for 10 days A) Order a
urinalysis and urine for culture and sensitivity (C&S) and treat the patient with antibiotics
The best treatment for this patient is to order the urinalysis and urine C&S to identify the
organism causing the infection. Treatment may begin while waiting for the culture results.
However, occasionally treatment may have to be changed after the culture/sensitivity results
return, due to resistance to the antibiotic used.
You are following up a 65-year-old male who has been on a new prescription of fluvastatin
(Lescol) for 6 weeks. During a follow-up visit, he reports feeling extremely fatigued and having
dark-colored urine. He denies any generalized muscle soreness. Which of the following is the
most appropriate treatment plan?
A) Order a CBC with differential
B) Order a liver function profile
C) Recommend an increase in fluid intake and rest
D) Order a urine for C&S test B) Order a liver function profile
, Statin medications, such as Lescol, can affect liver function and increase liver enzymes, as well
as cause the patient to feel weak, fatigued, and have muscle aches. Therefore, checking the
liver function profile is recommended.
A positive straight-leg raising test is indicative of which of the following?
A) Myasthenia gravis
B) Inflammation of the sciatic nerve/herniated disc
C) Multiple sclerosis
D) Parkinson's disease B) Inflammation of the sciatic nerve/herniated disc
A lab technician has a 10.5-mm area of redness and induration in his left forearm after getting a
Mantoux test 72 hours ago. The last test, which was done 12 months ago, was negative. He
denies cough, night sweats, and weight loss. What is the next best intervention?
A) Obtain a sputum culture and a chest x-ray
B) Obtain a chest x-ray
C) Obtain a sputum for C&S and an acid fast stain
D) Obtain a CBC and chest x-ray B) Obtain a chest x-ray
A lipid profile done on a newly diagnosed hypertensive patient shows a triglyceride level of 650
mg/dL, total cholesterol 240 mg/dL, LDL 145 mg/dL, and an HDL of 35 mg/dL. What is the best
intervention for this patient?
A) Educate the patient about lifestyle changes that will help lower cholesterol levels
B) Initiate a prescription of pravastatin (Pravachol)
C) Recommend that the patient exercise at least every other day and avoid eatingfatty or fried
foods
D) Initiate a prescription of nicotinic acid (Niacin, Niaspan) D) Initiate a prescription of
nicotinic acid (Niacin, Niaspan)