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A 55-year-old woman who has type 2 diabetes is concerned about her kidneys.
She has a history of 3 urinary tract infections within the past 8 months. She denies
dysuria and frequency at this visit. Which of the following is the best initial course
to follow?
A) Recheck the patient's urine and order a urine for culture and sensitivity
B) Order an IVP (intravenous pyelogram)
C) Advise the patient to follow up with a urologist
D) Evaluate the patient for a possible kidney infection ---------CORRECT ANSWER---
--------------A) Recheck the patient's urine and order a urine for culture and
sensitivity
A urinary tract infection is defined as the presence of 100,000 organisms per mL
of urine in asymptomatic patients or greater than 100 organisms per mL or urine
with pyuria (more than 7 WBCs/mL) in a symptomatic patient
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 ---------CORRECT ANSWER-----------------
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 ---------CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------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 -----
----CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------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 ---------CORRECT ANSWER-----------------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?