MSN 611 FINAL EXAM WITH CORRECT
ANSWERS
A 65-year-old man presents to the office with
increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also
complains of pain in ejaculation. He has no flank
pain, dysuria, hematuria, or fever. He is in a
monogamous relationship and uses condoms
regularly. His temperature is 98.6 F (37 C), pulse
rate is 77 beats/ minute, respiration is 14
breaths/minute, and blood pressure is 130/80
mmHg. There is no costovertebral angle
tenderness or suprapubic tenderness, and external
genitalia examination is normal. Digital rectal
examination shows normal sphincter tone and
reflexes with slightly enlarged and tender
prostate. Urinalysis shows many WBCs with no
RBCs or casts. Urine culture grows E. coli. Serum
prostate-specific antigen is 8ng/mL (reference
range of less than 3.5 ng/mL). Which of the
following drug class can be used to treat the
patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days
pregnant presents for late prenatal testing. She is
found to have IgM-positive antibodies for HSV-2.
,The patient desires to deliver vaginally. Which of
the following statements is correct regarding the
treatment of choice for this patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with
complaints of frequent burning micturition and
suprapubic discomfort from the past two days. The
patient is sexually active and has no significant
past medical history. Urinalysis reveals the
presence of leukocyte esterase and a high level of
nitrites. The clinician prescribes her a combination
antibiotic that inhibits two steps in the bacterial
biosynthesis of tetrahydrofolate. Which of the
following is a contraindication to the use of this
medication?
pregnancy
A 35-year-old woman comes to the office for pain
and burning during urination for the past few days.
She denies fever, abdominal or flank pain, bloody
urine, or passing any stones while urinating. She
has a medical history of gastroesophageal reflux
disease, diabetes mellitus type 2, and
hyperlipidemia. She takes over-the-counter
antacids, pantoprazole, metformin, and
atorvastatin. She is para 2 with both normal
vaginal delivery and her last menstrual period was
three weeks ago. She uses oral contraceptive pills
for contraception. Her temperature is 37.2 C, her
,pulse is 70 beats/min, her respiratory rate is 12
breaths/min, and her blood pressure is 130/80
mmHg. On examination, she denies suprapubic
pain or costovertebral angle tenderness. Urinalysis
reveals white blood cells of 20-25/hpf and red
blood cells of 5-10/hpf with no casts. Urinary
nitrites and leukocyte esterase are positive, and
glucose and ketone are absent. White blood cell
count is 7800/mm3. Serum creatinine is 1.1 mg/dL
and blood urea nitrogen is 17 mg/dL. Urine culture
grows Escherichia coli. The patient is started on a
drug that inhibits an enzyme required in bacterial
DNA replication. The patient is counseled about
adherence and the adverse effect of this drug.
About which of her other medications should she
be counseled?
antacid
A 27-year-old male with a past medical history of
tuberculosis presents to the outpatient clinic with
complaints of diarrhea and crampy abdominal pain.
The patient was diagnosed with tuberculosis 16
weeks ago and is currently on treatment with
isoniazid and rifampicin. Complete blood count
shows an elevated WBC count. Blood testing shows
that liver function tests are normal. Which of the
following is the best next step in the management
of this patient?
testing for clostridium difficle
, A 5-year-old boy presents with a worsening cough
and thick yellow-green nasal discharge for the past
two weeks. He has no chronic medical conditions
and is not taking any medication. His
immunizations are up to date. Vital signs show a
temperature of 39.2 C (102.6 F), blood pressure of
120/80 mmHg, pulse of 92/min, and respiratory
rate of 20/min. On examination, nasal turbinates
are swollen and erythematous, and there is a thick
purulent discharge from the nares. Lungs are clear
on auscultation. Amoxicillin-clavulanate is
prescribed for acute bacterial sinusitis. What is the
role of the clavulanate component in amoxicillin-
clavulanate?
Clavulanate inhibits beta-lactamase produced by bacteria
to prevent the inactivation of amoxicillin
A 65-year-old man starts treatment with linezolid
for methicillin-resistant Staphylococcus
aureus (MRSA) infection. Two days later, he
complains of fever, sweating, confusion, and
agitation. His blood pressure is 150/91 mmHg, and
his heart rate is 110/minute. A physical exam
reveals diaphoresis, shivering, and hyperreflexia.
The patient has a history of allergic rhinitis,
hypercholesterolemia, depression, and peptic ulcer
disease. His usual medications include lovastatin,
astemizole, phenelzine, and famotidine. Which of
the following most likely caused a drug interaction
with linezolid?
ANSWERS
A 65-year-old man presents to the office with
increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also
complains of pain in ejaculation. He has no flank
pain, dysuria, hematuria, or fever. He is in a
monogamous relationship and uses condoms
regularly. His temperature is 98.6 F (37 C), pulse
rate is 77 beats/ minute, respiration is 14
breaths/minute, and blood pressure is 130/80
mmHg. There is no costovertebral angle
tenderness or suprapubic tenderness, and external
genitalia examination is normal. Digital rectal
examination shows normal sphincter tone and
reflexes with slightly enlarged and tender
prostate. Urinalysis shows many WBCs with no
RBCs or casts. Urine culture grows E. coli. Serum
prostate-specific antigen is 8ng/mL (reference
range of less than 3.5 ng/mL). Which of the
following drug class can be used to treat the
patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days
pregnant presents for late prenatal testing. She is
found to have IgM-positive antibodies for HSV-2.
,The patient desires to deliver vaginally. Which of
the following statements is correct regarding the
treatment of choice for this patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with
complaints of frequent burning micturition and
suprapubic discomfort from the past two days. The
patient is sexually active and has no significant
past medical history. Urinalysis reveals the
presence of leukocyte esterase and a high level of
nitrites. The clinician prescribes her a combination
antibiotic that inhibits two steps in the bacterial
biosynthesis of tetrahydrofolate. Which of the
following is a contraindication to the use of this
medication?
pregnancy
A 35-year-old woman comes to the office for pain
and burning during urination for the past few days.
She denies fever, abdominal or flank pain, bloody
urine, or passing any stones while urinating. She
has a medical history of gastroesophageal reflux
disease, diabetes mellitus type 2, and
hyperlipidemia. She takes over-the-counter
antacids, pantoprazole, metformin, and
atorvastatin. She is para 2 with both normal
vaginal delivery and her last menstrual period was
three weeks ago. She uses oral contraceptive pills
for contraception. Her temperature is 37.2 C, her
,pulse is 70 beats/min, her respiratory rate is 12
breaths/min, and her blood pressure is 130/80
mmHg. On examination, she denies suprapubic
pain or costovertebral angle tenderness. Urinalysis
reveals white blood cells of 20-25/hpf and red
blood cells of 5-10/hpf with no casts. Urinary
nitrites and leukocyte esterase are positive, and
glucose and ketone are absent. White blood cell
count is 7800/mm3. Serum creatinine is 1.1 mg/dL
and blood urea nitrogen is 17 mg/dL. Urine culture
grows Escherichia coli. The patient is started on a
drug that inhibits an enzyme required in bacterial
DNA replication. The patient is counseled about
adherence and the adverse effect of this drug.
About which of her other medications should she
be counseled?
antacid
A 27-year-old male with a past medical history of
tuberculosis presents to the outpatient clinic with
complaints of diarrhea and crampy abdominal pain.
The patient was diagnosed with tuberculosis 16
weeks ago and is currently on treatment with
isoniazid and rifampicin. Complete blood count
shows an elevated WBC count. Blood testing shows
that liver function tests are normal. Which of the
following is the best next step in the management
of this patient?
testing for clostridium difficle
, A 5-year-old boy presents with a worsening cough
and thick yellow-green nasal discharge for the past
two weeks. He has no chronic medical conditions
and is not taking any medication. His
immunizations are up to date. Vital signs show a
temperature of 39.2 C (102.6 F), blood pressure of
120/80 mmHg, pulse of 92/min, and respiratory
rate of 20/min. On examination, nasal turbinates
are swollen and erythematous, and there is a thick
purulent discharge from the nares. Lungs are clear
on auscultation. Amoxicillin-clavulanate is
prescribed for acute bacterial sinusitis. What is the
role of the clavulanate component in amoxicillin-
clavulanate?
Clavulanate inhibits beta-lactamase produced by bacteria
to prevent the inactivation of amoxicillin
A 65-year-old man starts treatment with linezolid
for methicillin-resistant Staphylococcus
aureus (MRSA) infection. Two days later, he
complains of fever, sweating, confusion, and
agitation. His blood pressure is 150/91 mmHg, and
his heart rate is 110/minute. A physical exam
reveals diaphoresis, shivering, and hyperreflexia.
The patient has a history of allergic rhinitis,
hypercholesterolemia, depression, and peptic ulcer
disease. His usual medications include lovastatin,
astemizole, phenelzine, and famotidine. Which of
the following most likely caused a drug interaction
with linezolid?
