A 65-year-old has a history of one kidney with early renal insufficiency. He is diagnosed with pneumonia and will require:

Correct Answer: C

Rationale: The correct answer is C: Lower dose of antibiotics. The rationale is that the patient has early renal insufficiency, which means the kidney may have difficulty clearing medications from the body. Therefore, a lower dose of antibiotics is needed to prevent potential drug toxicity. A shorter course of antibiotics (choice A) may not be effective in treating pneumonia adequately. A longer course of antibiotics (choice B) may increase the risk of drug accumulation in the body. A higher dose of antibiotics (choice D) can lead to increased toxicity in a patient with renal insufficiency. Thus, the most appropriate option is to reduce the dose to ensure safe and effective treatment.

Correct Answer: A

Rationale: The correct answer is A because in an older adult with an indwelling urinary catheter, a fever >100°F can be a sign of urinary tract infection (UTI) or urosepsis. Given her acute decline in mental status and fever, empiric antibiotic therapy is warranted to treat a potential infection. Choice B is incorrect because older adults with indwelling catheters are at increased risk for UTIs and bloodstream infections. Choice C is incorrect as obtaining a urine culture is important to confirm the diagnosis and guide appropriate antibiotic therapy. Choice D is incorrect as the duration of antibiotic treatment for a UTI is typically longer than 3 days.

Correct Answer: B

Rationale: The correct answer is B: Spinal stenosis. The symptoms described suggest neurogenic claudication, which is a hallmark of spinal stenosis. Pain worsening with ambulation and improving with lumbar flexion is characteristic of spinal stenosis due to narrowing of the spinal canal leading to compression of nerves. Ankylosing spondylitis (A) presents with inflammatory back pain and stiffness, not neurogenic claudication. Bursitis (C) involves inflammation of bursae, not typically associated with leg pain and numbness. Cauda equina syndrome (D) presents with sudden-onset severe back pain, urinary retention, and saddle anesthesia, which are not consistent with the described symptoms.

Correct Answer: C

Rationale: The correct answer is C because cultural humility emphasizes recognizing power imbalances and fostering interpersonal sensitivity through partnerships with and learning from patients. This approach encourages self-awareness, openness, and willingness to engage in respectful dialogues. Option A is incorrect because cultural humility is not solely achieved through professional development courses. Option B is incorrect as anyone, regardless of their background, can practice cultural humility. Option D is incorrect as cultural humility does consider the impacts of structural factors on health disparities, including biological, socioeconomic, and racial influences.

Correct Answer: B

Rationale: The correct answer is B: Funnel chest (pectus excavatum). Pectus excavatum is characterized by a depressed or sunken appearance of the sternum, which matches the description provided in the case. In this condition, the chest wall is abnormally shaped inward. This can be a congenital condition or develop during growth spurts in adolescence. The lack of symptoms such as shortness of breath, chest pain, or lightheadedness on exertion is consistent with pectus excavatum, as these symptoms are not typically associated with this condition. The other choices (A: Barrel chest, C: Pigeon chest, D: Thoracic kyphoscoliosis) do not match the specific findings described in the case and are not associated with the characteristic sternal depression seen in pectus excavatum.

Correct Answer: D

Rationale: The correct answer is D: Take it with food. Glucocorticosteroids can irritate the stomach lining, leading to gastritis or ulcers. Taking them with food helps reduce stomach irritation and the risk of gastrointestinal side effects. Crushing it in applesauce (A) or chewing it prior to a high-fat meal (B) can exacerbate stomach irritation. Taking it on an empty stomach (C) can increase the risk of stomach upset and decrease absorption. Therefore, taking it with food (D) is the best option to minimize stomach irritation and improve medication effectiveness.

Correct Answer: A

Rationale: The correct answer is A because dopamine, serotonin, and norepinephrine are neurotransmitters commonly associated with mood regulation. Medications that affect these neurotransmitters can lead to symptoms of depression as a side effect. B: Gabapentin is not primarily associated with mood regulation. C: Milnacipran is an SNRI used to treat depression, not cause it. D: Cortisol is a stress hormone, not a neurotransmitter directly linked to depression symptoms.

Correct Answer: C

Rationale: The purpose of the expanded assessment when using the LAPSS is to determine whether there are other possible causes of the patient's signs and symptoms. This is because LAPSS primarily focuses on identifying stroke symptoms, so the expanded assessment helps rule out other potential conditions. Option A is incorrect because LAPSS does not primarily assess circulation. Option B is incorrect because LAPSS is not specifically designed to determine compartment syndrome. Option D is incomplete and does not provide any information to support it as the correct answer.

Correct Answer: A

Rationale: The correct answer is A: It is moderately loud. A grade 4-intensity murmur indicates a moderately loud murmur that is readily heard with the stethoscope lightly on the chest. This intensity suggests a significant level of turbulence in blood flow, typically indicating a more pronounced cardiac abnormality. Explanation for why other choices are incorrect: B: It can be heard with the stethoscope off the chest - This is incorrect because a murmur would not be audible without the stethoscope. C: It can be heard with the stethoscope partially off the chest - This is incorrect as a murmur would still require direct contact with the chest for auscultation. D: It is associated with a "thrill" - This is incorrect as a thrill is a palpable vibration indicating turbulent blood flow and is not directly related to murmur intensity.