An 82-year-old woman with severe uncontrolled diabetes develops gangrene of her right leg. She will need an amputation of her leg but states she does not want the operation. A day later she becomes drowsy, unconscious, disoriented, develops sepsis and goes into a coma. Her family tells you do this operation.
What do you do?
Correct Answer C:
Legal and ethical issues are often difficult to deal with. The physician however should follow this general series of events:
The best measure to prevent hepatitis A in the community is?
Correct Answer D:
Hepatitis A is spread primarily from the stool of one person to the mouth of another, usually because of poor hygiene. For example, when an infected person prepares food with unwashed hands. Hepatitis A is sometimes spread in day care centers, where caregivers and children can come in contact with infected stool in diapers.
Epidemics, usually linked to contamination of water supplies by stool, are common, especially in developing countries.
Good hygiene in handling food and avoiding contamination of water supplies is important. Vaccination against hepatitis A is recommended for all children. It is also recommended for adults at high risk of exposure to the infection.
Hepatitis B, C and D are transmitted parenterally and their prevention is with answer choices a), b) and c).
Which one of the following patients should be screened for hepatitis C virus (HCV) infection?
Hepatitis C (HCV) screening is indicated for recipients of a transfusion prior to July 1992, patients with needle stick or mucosal exposure to HCV, and children born to mothers with HCV infection.
A nurse who completed a hepatitis B vaccine series a year ago is accidentally stuck by a needle that has just been used on a dialysis patient. The patient is known to be HbsAg-positive.
Your first response should be to:
Correct Answer B:
Postexposure prophylaxis after hepatitis B exposure via the percutaneous route depends upon the source of the exposure and the vaccination state of the exposed person. In the case described, a vaccinated person has been exposed to a known positive individual. The exposed person should be tested for hepatitis B antibodies; if antibody levels are inadequate (< 10 IU/L by radioimmunoassay, negative by enzyme immunoassay) HBIG should be administered immediately, as well as hepatitis B vaccine booster dose. An unvaccinated individual in this same setting should receive HBIG immediately (preferably within 24 hours after exposure) followed by the hepatitis B vaccine series (injection in 1 week or less, followed by a second dose in 1 month and a third dose in 6 months).
Which of the following is true regarding most cases of elderly abuse?
Correct Answer E:
Elder abuse is an extremely complex problem. Caring for a non-well older adult suffering from a mental or physical impairment is highly stressful. Individuals who do not have the requisite skills, information, resources, etc. and who are otherwise ill-prepared for the caregiving role may experience extreme stress and frustration. This may lead to elder abuse and/or neglect.
It has been argued that as an older adult’s dependency increases so does the resentment and stress of the caregiver. Studies have found that individuals in poor health are more likely to be abused than individuals who are in relatively good health. In addition, caregivers who are dependent on the elder financially are also more likely to perpetrate abuse (choice E). Women are believed to be the most common victims of abuse, perhaps because they report abuse at higher rates or because the severity of injury in women typically is greater than in men.
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