Author: Anonymous

(Vandiver Stroke)  Fibrinolytic therapy would be MOST appropriate in which of the following patients presenting to the emergency department at your hospital?

JJ is a 73-year-old male with acute myelogenous leukemia. He attends the infusion clinic where he receives chemotherapy treatment.  Following his chemotherapy treatment this time he experiences a significant rise in his serum uric acid to 22 mg/dL (this is high). Which of the following is true regarding the best management of his tumor lysis syndrome (TLS)?

Amifostine is given in combination with which of the following medications to counteract one of its toxic effects?

TB is a 19-year-old healthy female seeking oral contraception (OC).  She has no history of thromboembolism, cerebrovascular disease or cancer.  After completing an appropriate and normal physical exam with her primary care provider, you recommend she begin the following type of contraceptive therapy: 

PM is a 43-year-old non-obese female newly diagnosed with rheumatoid arthritis with poor prognosis. She has been experiencing symptoms for the past 4 months of joint pain in her first metacarpals. The only notable lab abnormalities are elevated liver function tests (AST/ALT) which are 3 times the upper limit of normal. Vitals are WNL. PMH: Past (10 years prior) alcohol abuse, cirrhosis, and hypertension Home medications: Amlodipine 5 mg PO daily Which of the following is the most appropriate initial therapy for PM?

MM is a 22-year-old male who has acute lymphoblastic leukemia. He is on the CALGB 10701 regimen (tyrosine kinase inhibitor, dexamethasone, vincristine, daunorubicin, methotrexate, etoposide, and cytarabine). Which test should be completed before and periodically during therapy to monitor for daunorubicin’s toxic effect?

(Mann Nutrition) RP is a 43 year old critically ill (mod/severely stressed) mildly malnourished patient who is in the ICU following a motor vehicle accident – he was admitted 2 days ago to the ICU. RP has not been awake enough to take in sufficient calories by mouth since admission and this is not expected to change in the coming days.  RP has been fluid resuscitated and is considered hemodynamically stable and is considered to have a functional GI tract that is free of any obstructions, abnormalities, or bleeding. Which of the following nutrition approaches is most appropriate for this patient at this time?

RM is a 54 year old Caucasian woman who presents for follow-up for blood pressure management.  She has concerns about osteoporosis because her mother had a history of it, including multiple fractures.  She did have her bone density tested recently at the local health fair.  She smokes 1 ppd x 30 years, rides her bike 2 miles on 3 days per week and does swim when it’s too icy to ride her bike.  Her medications include HCTZ 25mg once daily, Lisinopril 10mg once daily, Levothyroxine 150mcg once daily, Centrum Vitamin once daily, Calcium carbonate 600mg with Vitamin D twice daily. What non-pharmacologic recommendations would you make to RM at this time?   

MR is a 24-year-old female being seen in clinic for a follow-up appointment related to migraines.  She has a history of headaches and migraines without aura for 6 years.  She complains that her symptoms worsened after graduating college and starting her first “real” job where her stress level has been significantly higher.  Approximately three months ago, her provider prescribed topiramate 25mg by mouth daily, with a schedule to titrate weekly until a goal dose of 100mg twice daily. She feels she tolerated this new medication quite well, but is now having a significant amount of spotting during the month, even a day or two of bleeding during the middle of her cycle and she doesn’t feel like having sex with her husband.  Today’s vital signs are: BP 122/72 HR 70 O2 94% RR 18.  She is 5’ 6” tall and weighs 228#.  Her current medications include topiramate 100mg twice daily, vitamin D 2,000 IU once daily, Aviane (ethinyl estradiol 20mcg/levonorgestrel 0.1mg) once daily, and sumatriptan 50mg at onset of migraine, may repeat x1 in 24-hour period.  What is your assessment of her current situation?

TT, a 25-year-old comes to clinic today for her annual well woman exam.  She has a history of migraine headaches x6 years and would like to discuss contraception today.  She reports that her migraines have been much better in the past year since she switched from topiramate to Aimovig.  She feels this is because she “hates taking pills and forgets to take them a lot – so much easier to do a shot once a month”.  She is married to her husband for 2 years and admits they are tired of using condoms.  She works full time as a high school science teacher and enjoys her job but looks forward to having kids in the next 3-5 years and staying home with them. Today’s vital signs are: BP 122/72 HR 70 O2 94% RR 18.  She is 5’ 4” tall and weighs 217#.  Which form of contraception would best meet TT’s needs today?