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Old 08-17-2012
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Question Questions for Thought ... possibly HY

Thought I would start a thread to get some opinions...

[Question 1] A teenager presents for routine check up, admits to having tried marijuana before with her friends, asks that you don't tell her mom. Do you...
(a) get a urine tox screen?
(b) schedule a follow up in appointment


[Question 2] If an elderly patient is acutely sick and develops increasing BUN/Cr (with a ratio of 15/1). In an effort to protect their kidney's, do you discontinue the ACE-Inhibitor that they are on or do you protect the kidney's by maintaining hydration with IVF's?


[Question 3] In an acute gout flare-up, if made to choose between one of two drugs to give, do you give Indomethacin or Prednisone?

[Question 4] In a patient with tennis elbow with pain that is not diminished by NSAIDS, do you give a steroid injection or put them in a forearm splint?

[Question 5] In a patient with h/o osteoarthritis who has mild swelling in one knee, then gets worse with severe pain after exercising. On exam there is fluid wave on anterior knee and no joint line tenderness. What is the next step? (knee MRI, knee Xray, Arthrocentesis, check a CRP?)

[Question 6] Man with a long-standing h/o GERD presents with intermittent difficulty swallowing solid foods. He says it gets stuck going down, but is relieved when he drinks liquid. What is the next best step? (barium swallow, endoscopy, manometry, pH?)

[Question 7] Does a 25yo women who is monogamous and only sexually-active with her husband need to be screened every year for GC/Chlamydia (given that her previous screens have all been negative)?

[Question 8] Female patient has purulent urethral discharge. Urine PCR is (+) for Chlamydia. Do you (a) Treat sexual partner with Abx or (b) swab and culture the urethral discharge?

Thanks.
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Old 08-17-2012
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Quote:
Originally Posted by doc412 View Post
Thought I would start a thread to get some opinions...

[Question 1] A teenager presents for routine check up, admits to having tried marijuana before with her friends, asks that you don't tell her mom. Do you...
(a) get a urine tox screen?
(b) schedule a follow up in appointment

Marijuana isn't really something you need to be concerned about unless its affecting this patients condition in this case. Besides, patient has told you he has smoked, what's the point of getting a tox screen?


[Question 2] If an elderly patient is acutely sick and develops increasing BUN/Cr (with a ratio of 15/1). In an effort to protect their kidney's, do you discontinue the ACE-Inhibitor that they are on or do you protect the kidney's by maintaining hydration with IVF's?

I would say Hydrate, not sure.

[Question 3] In an acute gout flare-up, if made to choose between one of two drugs to give, do you give Indomethacin or Prednisone?

Indomethacin

[Question 4] In a patient with tennis elbow with pain that is not diminished by NSAIDS, do you give a steroid injection or put them in a forearm splint?

Steroid

[Question 5] In a patient with h/o osteoarthritis who has mild swelling in one knee, then gets worse with severe pain after exercising. On exam there is fluid wave on anterior knee and no joint line tenderness. What is the next step? (knee MRI, knee Xray, Arthrocentesis, check a CRP?)

Joint effusion, so probably Arthocentesis?

[Question 6] Man with a long-standing h/o GERD presents with intermittent difficulty swallowing solid foods. He says it gets stuck going down, but is relieved when he drinks liquid. What is the next best step? (barium swallow, endoscopy, manometry, pH?)

Scope, just to rule out Ca or Barrets etc.

[Question 7] Does a 25yo women who is monogamous and only sexually-active with her husband need to be screened every year for GC/Chlamydia (given that her previous screens have all been negative)?

I would say no, this isn't a high risk situation.


[Question 8] Female patient has purulent urethral discharge. Urine PCR is (+) for Chlamydia. Do you (a) Treat sexual partner with Abx or (b) swab and culture the urethral discharge?

Treat Partner

Thanks.
I highlighted my answers.
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Old 08-17-2012
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Good luck on you exam PatelMD. I'll be taking my 2CK shortly after.
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