The most common identifiable cause of skin and soft-tissue infections presenting to metropolitan emergency departments is:
Correct Answer D:
Recent clinical experience has shown that methicillin-resistant Staphylococcus aureus (MRSA) is the most common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments. The other responses should be considered in evaluating these infections, but they are not as common as MRSA infections.
The most effective daily doses of vitamin D and calcium for hip fracture prevention in postmenopausal women are:
The most effective daily dose of vitamin D for hip fracture prevention in postmenopausal women is 800 IU, and the recommended daily dose of calcium is 1200 mg (choice D).
NIH recommended daily intake, Elemental calcium and vitamin D:
A 45-year-old male presents to your office in extreme agitation after a verbal altercation with his boss, during which he was fired. He feels overwhelmed and very angry, and states that he is going to “get” his boss and then “who knows what.”
Which one of the following is true regarding this situation?
Correct Answer A:
It has been legally established that physicians have a duty to warn and protect intended victims of a patient. Evaluation of suicide and homicide risks in a crisis situation, including direct questioning of the patient about suicidal and homicidal tendencies, is important and does not lead to further harm. If a suicidal or homicidal patient who needs hospitalization refuses, law enforcement authorities should be contacted. Policies should be in place to ensure the safety of clinic staff in crisis situations. The patient’s family may be at risk for harm, and plans to ensure their safety, if needed, are appropriate.
Which one of the following is a physiologic difference between males and females that can affect the pharmacokinetics of medications with a narrow therapeutic index?
Correct Answer E:
There are key physiologic differences between women and men that can have important implications for drug activity. Gastrointestinal transit times are slower in women than in men, which can diminish the absorption of medications such as metoprolol, theophylline, and verapamil. In addition, women should wait longer after eating before taking medications that should be administered on an empty stomach, such as ampicillin, captopril, levothyroxine, loratadine, and tetracycline.
Women also secrete less gastric acid than men, so they may need to drink an acidic beverage to aid in absorption of medications that require an acidic environment, such as ketoconazole. Women usually have lower BMIs than men, and may need smaller loading or bolus dosages of medications to avoid unnecessary adverse reactions. Women typically have higher fat stores than men, so lipophilic drugs such as benzodiazepines and neuromuscular blockers have a longer duration of action. Women also have lower glomerular filtration rates than men, resulting in slower clearance of medications that are eliminated renally, such as digoxin and methotrexate.
Which one of the following is an appropriate rationale for antibiotic treatment of Bordetella pertussis infections?
Antibiotic treatment for pertussis will decrease infectivity and symptom severity but not change course of illness. Antimicrobial therapy is indicated if B. pertussis is isolated, or symptoms are present for <21 days.
The CDC recommends macrolides for primary treatment of pertussis. The preferred antimicrobial regimen is azithromycin for 3-5 days or clarithromycin for 7 days. These regimens are as effective as longer therapy with erythromycin and have fewer side effects. Children under 1 month of age should be treated with azithromycin. There is an association between erythromycin and hypertrophic pyloric stenosis in young infants.
Trimethoprim/sulfamethoxazole can be used in patients who are unable to take macrolides or where macrolide resistance may be an issue, but should not be used in children under the age of 2 months. Fluoroquinolones have been shown to reduce pertussis in vitro but have not been shown to be clinically effective (SOR A).
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