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1. A 70-year-old man has completed a 14-day course of sulfamethoxazole/trimethoprim for Escherichia coli cystourethritis. The patient has a Foley catheter. A urine culture obtained 24 hours after the last antibiotic dose shows Candida albicans > 10x3 cfu/mL, RBC > 100 cells/hpf, and WBC = 10-20 cells/hpf. The patient is asymptomatic. What is the most appropriate management?
A) Posaconazole orally daily for 5-10 days
B) Fluconazole orally daily for 5-10 days
C) No anti-infective needed
D) Amphotericin bladder irrigation for 5-10 days
2. Which of the following disease states has been associated with stress-related mucosal bleeding and is an indication for initiation of stress ulcer prophylaxis?
A) Diabetes mellitus
B) Gastric carcinoma
C) Ulcerative Colitis
D) Coagulopathy
3. A 65-year-old woman on chronic hemodialysis presents with difficulty breathing and inability to sleep. The patient has had shortness of breath, diaphoresis, and nausea, but has not vomited.
She denies having abdominal pain, diarrhea, or chest pain. She has tachycardia and tachypnea, and exhibits peaked T waves with occasional PVCs on the ECG. Serum chemistry values are:
* Sodium: 137 mEq/L
* BUN: 125 mg/dL
* Potassium: 7.2 mEq/L
* Creatinine: 12.8 mg/dL
* Chloride: 97 mEq/L
* Glucose: 95 mg/dL
* HCO3- : 11 mEq/L
* Calcium: 8.5 mg/dL
* Albumin: 3.1 g/dL
* Phosphorus: 1.7 mg/dL
Which of the following should the pharmacotherapy specialist recommend for immediate therapy?
A) Hemodialysis
B) Calcium gluconate intravenously
C) Sodium polystyrene sulfonate with sorbitol orally
D) Sodium bicarbonate intravenously
4. A 50-year-old patient is admitted for acute coronary syndrome with a past medical history of hyperlipidemia and diabetes. The patient was transferred to the cardiac care unit for intubation because of worsening condition with increased shortness of breath. Physical examination and laboratory results reveal:
* BP: 140/90 mm Hg
* HR: 90 bpm
* RR:27 bpm
* O2 Sat: 90% on 2L
* Nasal cannula general: moderate distress
* Chest: bibasilar rales noted
* CV: S1, S2 present, + JVD 11 cm
* EXT. bilateral pulses, 2+ pitting edema, warm extremities
* BUN: 40 mg/dL
* Serum creatinine: 2.1 mg/dL
* Brain natriuretic peptide: 1120 pg/mL
Which of the following is the most appropriate first-line intravenous therapy for this patient?
A) Milrinone
B) Metolazone
C) Nitroprusside
D) Furosemide
5. A 65-year-old man presents to the internal medicine clinic with decreased exercise tolerance, lower extremity edema, and shortness of breath.
He has a history of diastolic dysfunction (ejection fraction of 60%) and hypertension; BP =
150/90 mm Hg, HR = 86 bpm.
Current medications include digoxin 125 mcg daily, furosemide 40 mg daily, enalapril 10 mg twice daily, aspirin 325 mg daily, and potassium 10 mEq twice daily. The digoxin concentration is 0.4 ng/mL.
After resolution of this exacerbation, which of the following should the pharmacotherapy specialist recommend to the internist regarding this patient's maintenance drug therapy?
A) Increase digoxin.
B) Increase furosemide.
C) Discontinue digoxin and add amlodipine.
D) Discontinue digoxin and add metoprolol.
問題與答案:
問題 #1 答案: C | 問題 #2 答案: B | 問題 #3 答案: B | 問題 #4 答案: C | 問題 #5 答案: D |
211.100.42.* -
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