Med management 3 67 qcm q201 to 267

201) A 22-year-old woman is brought to the emergency department by her father because she is demonstrating "strange, disorganized behavior." Earlier that day, she had insisted that the television news anchorman was talking directly to her about the risks of "poison rays" from the moon. She was also apparently attempting to re-organize her bedroom closet when her father found her mumbling incoherently and counting the same pair of socks over and over. She is agitated when examined in the emergency department and the decision is made to admit her to the psychiatric ward. There, after a detailed interview, the diagnosis of schizophrenia is made. She is stabilized with antipsychotics and then discharged home. Her father asks what can be done to ease her return to everyday life and to decrease the likelihood of re-hospitalization. Which of the following measures would be most helpful in this regard?

. Restrict the patient to home as much as possible

. Encourage the patient to return to work

. Minimize the patient's social interaction with others

. Keep family stresses and conflicts to a minimum

. Strongly encourage the patient to make new friends

202) A middle-aged Asian American married couple comes to clinic for a routine examination. Both the husband and wife have been known patients of yours for many years. The husband is being treated for coronary artery disease and tension headaches. Today, he mentions that he "cannot get an erection" even when he feels sexual desire. He adds that he still finds his wife physically attractive and that they are mutually compatible in every respect. This recent development has been causing him significant anxiety and has been a source of concern for his wife. After ruling out medical and psychological causes for his erectile dysfunction by taking a detailed history and pursuing a thorough workup, you agree to his request that he be started on sildenafil. One week later, his wife places an urgent call to your office, reporting that her husband developed severe chest pain "after taking the new medication you prescribed." An EKG done in the emergency department reveals new inferior wall ischemia. You immediately realize that you should not have written him the prescription for sildenafil because he was alrea

. Withhold this information as it could result in a lawsuit

. Admit to the patient and his wife that you made a mistake

. Tell the patient and his wife that you were not aware of this cross-reaction between the two drugs

. Tell the patient and his wife that his chest pain was probably precipitated by anxiety

. Remove yourself as the patient's physician immediately

203) A 38-year-old male with a chronic history of schizophrenia is admitted to the hospital for deterioration in his condition. He is a known patient and was stable on risperidone for the past few years. Today, the patient does not respond when spoken to and he sits motionlessly. He makes no eye contact and his face remains expressionless. Vital signs include temperature of 37.0°C (98.6°F), blood pressure of 132/80 mm Hg, pulse of 88/min, and respirations of 14/min. Physical examination demonstrates diffuse muscle rigidity but is otherwise unremarkable. Which of the following would be the most appropriate next step?

. Increase risperidone dose

. Initiate therapy with dantrolene sodium

. Replace risperidone with quetiapine

. Continue same dose of risperidone and add clozapine

. Administer lorazepam

204) A 7-year-old boy is brought to the pediatrician by his mother for a routine check-up. Physical examination is normal, but during the exam the mother reveals that her son's behavior has been poor. She says that he is always running around (even during dinner), doesn't listen, and keeps his room a mess. She hopes he will grow out of this soon. Upon further questioning, the pediatrician learns that the patient's second-grade teacher has reported that he answers questions impulsively and out of turn, and that he cannot sit at his desk for a very long time without fidgeting. He also frequently forgets to bring in his homework. The mother states that her son has had these symptoms for about a year, and that his grades have been falling over the past six months. The diagnosis of attention deficit hyperactivity disorder is made and the boy is started on methylphenidate. Which of the following side effects is most likely to occur in patients who take methylphenidate?

205) A 16-year-old boy presents to his pediatrician with scattered petechiae and a three-week history of fatigue. Laboratory evaluation and a bone marrow biopsy confirm the diagnosis of acute lymphoblastic leukemia. The boy's parents are divorced and have joint custody of him. His mother consents to the proposed chemotherapy and blood transfusion and requests that his treatment be started immediately. The father, however, refuses to agree to the treatment because of his religious beliefs. What is the most appropriate means of handling this situation?

. Withhold the proposed treatment

. Proceed with the proposed treatment

. Ask the patient his wishes

. Obtain a court order to proceed

. Consult the hospital's ethics committee

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