SAEM 241 - 390 exam questions and 100% correct answers

A 32 year old male, intravenous heroin abuser, presents with a one-day history of mid-back pain, progressive weakness of his legs, and an inability to urinate. He has a temperature of 38.3° C (100.8° F). On exam, absent patellar deep tendon reflexes are noted, he cannot stand or walk, a distended bladder is palpable, and he has tenderness to palpation over his T10 and T11 vertebrae. Which of the following is not an acceptable next step? A. MRI of the spine B. Analgesia C. Foley catheter to drain the bladder D. Hospital admission for neurosurgical consultation in the morning E. Antibiotics to cover a broad spectrum of organism - correct answer D. Hospital admission for neurosurgical consultation in the morning he answer is D. A spinal epidural abscess is a neurosurgical emergency, with the outcome being dependent on the speed of diagnosis and surgical decompression. Consequently, urgent neurosurgical evaluation is required. Although an uncommon disease, intravenous drug abuse, diabetes mellitus, chronic renal failure, and immunosuppression are risk factors for its development. Antibiotics to cover Staph. aureus, the most common cause, gram negative bacteria, and anaerobes are needed. Bladder decompression for symptomatic relief is important, as is analgesia Which of the following is true about myasthenia gravis? A. It typically presents as an ascending weakness of the peripheral nervous system. B. A myasthenic crisis involves an exacerbation of weakness, especially of respiratory muscles, often necessitating intubation. C. Weakness improves as the involved muscles are used repeatedly. D. The "atropine test" is diagnostic when 0.5 mg of atropine is given intravenously and the patient's symptoms improve within two minutes. E. Cooling exacerbates the symptoms, and heat alleviates them. - correct answer B. A myasthenic crisis involves an exacerbation of weakness, especially of respiratory muscles, often necessitating intubation.