1.You examine a woman who has been a patient of yours for many years. You now have concerns that she is not competent to drive an automobile. Which one of the following should you do?
Discuss your concerns with her.
Document your concerns in the chart with a copy to the patient.
Notify the provincial motor vehicle licensing authority.
Notify the local police force.
Notify her auto insurance company.
2.A 24-year-old woman presents to your office for a routine examination and sexually transmitted disease screening. She is healthy, asymptomatic, and takes oral contraceptives and occasionally acetaminophen with codeine for headaches. Chlamydia testing is positive. The vaginal swab shows yeast. Which one of the following information should you give her about the treatment for chlamydia?
Drinking alcohol during treatment may cause vomiting and weakness.
Chlamydia treatment will not treat yeast as well.
Treatment may potentiate headache.
The yeast infection should be treated prior to treating chlamydia.
Stop the oral contraceptive during the treatment cycle.
3.A 70-year-old man presents to the Emergency Department with a 6-day history of worsening left, lower abdominal pain. He is anorexic and nauseated. His temperature is 38.5° C, pulse 110 per minute, and blood pressure 90/60 mm Hg. Physical examination shows abdominal distention with diffuse tenderness and guarding over the entire abdomen. His white blood cell count is 28 x 109/L and hemoglobin 120 g/L. Abdominal series show mild distention of the small and large bowel with air/fluid levels. There is no free air. After fluid resuscitation, he is not improving. Which one of the following is the most appropriate initial management?
Bowel rest and antibiotics
Intravenous corticosteroid
Laparotomy and lysis of adhesions
Laparoscopy
Laparotomy and resection of diseased colon
4.A 70-year-old patient is brought to the Emergency Department because he vomited “about 500 mL” of bright red blood at home. During the night, while under observation, he vomits a total of 500 mL of blood. Pulse is 116/minute and blood pressure is 110/95 mm Hg. Which one of the following actions is most appropriate at this time?
Schedule surgery as soon as possible.
Request urgent endoscopy.
Start anti-H2 medication immediately.
Perform gastric lavage with iced saline.
Start I.V. vasopressin and ask for endoscopy next morning.