Blog

A 56-year-old male automotive mechanic presents to your Internal Medicine office for a routine exam and states that “my wife made me come in to see you.”  His last office visit was 6 years ago for a broken toe, and he has had no laboratory testing or other diagnostic evaluation in the past 10 years.  HPI and the review of systems are negative except that he currently smokes cigarettes 1 pack-per-day (40 pack-year history).  The patient reports dyspnea on exertion during the past year, and hears audible wheezing at times.  He denies chest pain or pressure and is without other concerns today.  On exam, you hear faint end-expiratory wheezes in the bilateral lung bases.  The remainder of the examination is negative. Height: 5 feet 10 inches Weight: 210 lbs. BMI: 30 BP: 148/86 HR: 84 RR: 14/min T: 98.0°F O2 sat (room air): 93%   Which of the following screening tests would NOT be indicated at this time?

A 36-year-old software consultant complains of burning sensation in his chest, which has occurred almost daily for the last two weeks.  He has had similar symptoms intermittently for the past 6 months and states that the symptoms are now increasing in frequency and severity. His wife has noticed episodes of regurgitation and coughing at night. There is no dysphagia, weight loss, hematemesis, or melena. He has no other past medical history. He is a nonsmoker and does not drink alcohol. Family history is significant only for HTN in father.  On examination, BP is 120/80 mm Hg, HR 76/min, pulse ox (room air) 98%, height 6’4, weight 242 pounds. Physical examination is unremarkable. What would be the most appropriate treatment for this patient?

A 65-year-old female is admitted to the ER with a 3-hour history of cyanosis, shortness of breath, and substernal chest pain.  She had been discharged 5 days earlier after having a total hip replacement due to severe osteoarthritis.  The hip surgery was uneventful.  On examination, the patient is in obvious acute respiratory distress.  Her respiratory rate is 40/min and her breathing is labored.  The patient’s room air oxygen saturation level is 86%.  Her blood pressure is 100/70 mm Hg.  Cyanosis is present.  Cardiac examination reveals increased pulmonic component of the second heart sound (S2).  Abnormal lung sounds, including rales and wheezes, are present bilaterally.  Based on the information provided, which of the following tests will be the preferred intervention to establish the diagnosis?

A 42-year-old male with chronic complaints of heartburn and regurgitation, presents for follow up after undergoing upper endoscopy which revealed Barrett’s esophagus.  Which of the following is the most serious potential medical complication in this patient?

List the 4 consumer rights.  Consumers have a right to….

Just after intubating a patient, what must be checked immediately? I. Bilateral breathsounds II. Bilateral chest rise III. Chest radiograph IV. Colorimetric capnometer

What must be considered when a patient needs to be orally intubated with an endotracheal tube?   I. Using a Magill forcep II. Securing the tube 20-25 cm at the oral III. Using a lubricating gel during intubation IV. Securing the tube > 25 cm at the oral

When delivering acetylcysteine (Mucomyst), what must accompany it?

Which of the following is an anti-inflammatory corticosteroid?

Patient has bilateral wheezes and diminished with course crackles in the RLL Chest percussion is resonant with dullness in the RLL  Patient has a strong productive cough with moderate amount of yellow thick secretions Patient has a temperature of 39oc Patient complains of chest pain Vitals : HR 120 bpm, Respiratory rate 25 breaths/min, BP        145/90 mmHg, SpO2 90% on 28% FIO2 VM at 8 LPM Based on all objective data gathered, the physician would like to know what other diagnostic information you would like to recommend?   Select as MANY as indicated