Q1 A 19-year-old woman with anorexia nervosa undergoes surgery for acute appendicitis. The postoperative course is complicated by acute respiratory distress syndrome, and she remains intubated for 10 days. She develops wound dehiscence on postoperative day 10. Laboratory data show a white blood cell count of 4000/ µL, hematocrit 35%, albumin 2.1 g/dL, total protein 5.8 g/dL, transferrin 54 mg/dL, and iron-binding capacity 88 mg/dL. You are considering initiating nutritional therapy on hospital day 11. Which of the following is true regarding the etiology and treatment of malnutrition in this patient? A.She has marasmus, and nutritional support should be started slowly. B. She has kwashiorkor, and nutritional support should be aggressive. C.She has marasmic kwashiorkor, kwashiorkor predominant, and nutritional support should be aggressive. D.She has marasmic kwashiorkor, marasmus predominant, and nutritional support should be slow
Ans is c
Q2 You are seeing a patient in follow-up 2 weeks after hospitalization. The patient is recovering from nosocomial pneumonia due to a resistant Pseudomonas spp. His hospital course was complicated by a deep venous thrombosis. The patient is currently on IV piperacillin/ tazobactam and tobramycin via a tunneled catheter, warfarin, lisinopril, hydrochlorothiazide, and metoprolol. Laboratory data this morning show an INR of 8.2. At hospital discharge his INR was stable at 2.5. He has no history of liver disease. What is the most likely cause of the elevated INR?
A.The patient has inadvertently overdosed.
B. The patient has developed a recurrent deep venous thrombosis, which has affected the laboratory data.
C.The patient is deficient in vitamin K and needs supplementation.
D.The warfarin prescription was written incorrectly at the time of discharge.
Ans is c
Q 3 A 51-year-old alcoholic man is admitted to the hospital for upper gastrointestinal bleeding. From further history and physical examination, it becomes apparent that his bleeding is from gingival membranes. He is intoxicated and complains of fatigue. Reviewing his chart you f ind that he had a hemarthrosis evacuated 6 months ago and has been lost to follow-up since then. He takes no medications. Laboratory data show platelets of 250,000, INR of 0.9. He has a diffuse hemorrhagic eruption on his legs . What is the recommended treatment for this patient’s underlying disorder?
E. Vitamin K
Ans is D
Q 4 While working in the intensive care unit, you admit a 57-year-old woman with acute pancreatitis and oliguric renal failure. Respiratory rate is 26 breaths/min, heart rate is 125 beats/min, and temperature is 37.2°C. Physical examination shows marked abdominal tenderness with normoactive bowel sounds. A CT scan shows an inflamed pancreas without hemorrhage. You calculate her APACHE-I score to be 28. When deciding on when to initiate nutritional replacement in this patient, which of the following statements is true?
A.Bowel rest is the cornerstone of treatment for acute pancreatitis.
B. Administering parenteral nutrition within 24 h will decrease the risk of infection and mortality.
C.Enteral feeding supports gut function by secretion of gastrointestinal hormones that stimulate gut trophic activity.
D.In severe systemic response to inflammation, feeding can be withheld initially because the patient is likely to have adequate, spontaneous oral intake in the first 7 days
Ans is C
Q 5 The resting energy expenditure is a rough estimate of total caloric needs in a state of energy balance. Of these two patients with stable weights, which person has the highest resting energy expenditure (REE): Patient A, a 40-year-old man who weighs 90 kg and is sedentary, or Patient B, a 40year-old man who weighs 70 kg and is very active?
A.40-year-old man who weighs 90 kg and is sedentary
B. 40-year-old man who weighs 70 kg and is very active
C.REE is the same
D.Not enough information given to calculate the REE
Ans is B
Q 6 All of the following clinical features are common in patients with anorexia nervosa except
A.Avoid food-related occupations
B. Distorted body image
C.Engage in binge eating
E. Rarely complain of hunger
F. Socially withdrawn
Ans is A
Q 7 You diagnose anorexia nervosa in one of your new clinic patients. When coordinating a treatment program with the psychiatrist, what characteristics should prompt consideration for inpatient treatment instead of scheduling an outpatient assessment?
B. Exaggeration of food intake
C.Irrational fear of gaining weight
E. Weight <75% of expected body weight
Ans is E
Q 8 It is hospital day 16 for a 49-year-old homeless patient who is recovering from alcohol withdrawal and delirium tremens. She spent the first 9 days of this hospitalization in the intensive care unit but is now awake, alert, and conversant. She has a healing decubitus ulcer, and her body mass index is 19 kg/m2. Laboratory data show an albumin of 2.9 g/dL and a prothrombin time of 18 s (normal range). Is this patient malnourished?
A.Cannot be determined, need more information.
B. No. Given her heavy alcohol intake, her prothrombin time is expected to be delayed.
C.No. She has a low resting energy expenditure and her intact mental state argues against malnutrition.
D.Yes, this degree of hypoalbuminemia is uncommon in cirrhosis and is likely due to malnutrition
Ans is A
Q 9 A 42-year-old male patient wants your opinion about vitamin E supplements. He has read that taking high doses of vitamin E can improve his sexual performance and slow the aging process. He is not vitamin E deficient. You explain to him that these claims are not based on good evidence. What other potential side effect should he be concerned about?
A.Deep venous thrombosis
C. Night blindness
Ans is B
Q 10 Doing rounds in the oncology center, you are see a patient with carcinoid syndrome. Due to the increased conversion of tryptophan to serotonin, this patient has developed niacin deficiency. All of the following are components of the pellagra syndrome except
Ans is D