CME resources exams 1

1. A 60 year old smoker presents to the clinic with complaint of cough for six months. The patient brings a container from home with sputum for analysis which you transfer to a sterile container and send to the lab. Lab reports > 50 squamous epithelial cells and no WBCs on the gross microscopic. The culture grows mixed gram positive and gram negative flora. Which of the following statements is true? a. This is an adequate sample with plenty of squamous cells. b. This is an adequate sample of bronchial flora and should be sent for culture and sensitivity. c. This is an inadequate sample, but you should send it for culture anyway to see what grows. d. This is an inadequate sample and you should have the patient correct another sample early in the morning at the hospital by respiratory therapy. e. This is an adequate sample, but should have been collected in a sterile container. - Answer- d. Sputum samples must contain few epithelial cells and many WBCs in order to be considered a "good" sample. Appropriate sputum collection is difficult, often performed by respiratory therapy (with inhaled saline or provocative agents) and even when "good" as described above, usually results in multiple mouth organisms. 2. A 35 year old patient who is brought to your rural clinic from a mountain climbing expedition is experiencing pernio. He has violaceous skin with itching and which appear almost hive-like. The severe vasospasm that has caused this pernio reaction is most effectively treated with: a. Methotrexate b. Amitriptyline c. Nifedipine d. Propranolol e. Lisinopril - Answer- c. Nifedipine is a fast- acting vasodilator which can be used in pernio; also prophylactically in Raynaud's phenomenon and Primzmetal's angina. 3. Which of the following is a cause of diastolic heart failure? a. Dilated cardiomyopathy b. Left ventricular hypertrophy c. Beriberi (thiamine deficiency) d. Aortic regurgitation/ insufficiency e. Severe anemia - Answer- b.