NMS Q&A Family Medicine

222 NMS Q&A Family Medicine(C) Diphenhydramine, 50 mg, injected intramuscularly(D) Epinephrine, 1:1,000, injected intramuscularly(E) Cromolyn/nedocromil by nasal inhalation5 Which of the following might be a cause for accidentallyincreasing the dosage of epinephrine in an emergencysituation?(A) Increased body mass index of the patient(B) Blood pressure rising to 170/110(C) Current medications being taken by the patientinclude propranolol.(D) Patient has a history of frequent attacks ofallergic symptoms.(E) The patient is Celtic ethnicity6 Twelve hours after successful epinephrine treatment ofanaphylaxis, a 35-year-old woman manifests angioneuroticedema and urticaria. Which of the following isthe most reasonable approach for treatment of thisdevelopment?(A) Diphenhydramine 25 to 50 mg given orallyevery 6 hours(B) Repeated injections of epinephrine(C) Increase the volume of fluid therapy per unittime by 50%(D) Theophylline, 0.5 mg/kg/hour, after a loadingdose(E) Beta-adrenergic medication given orally7 A 35-year-old female patient has begun experiencinghives at various times, usually within 30 minutes aftera meal. If you were to actuate a trial of food eliminations,adding back one eliminated food every 5 daysuntil the occurrence of allergic symptoms, which ofthe following groups of four foods would you choosefirst, to obtain the earliest conclusion as to cause?(A) Beef, rice, apples, bananas(B) Tomatoes, peaches, wheat, potatoes(C) Peanuts, tree nuts, vertebrate fish, shellfish(D) Chicken, green beans, peas, corn(E) Kidney beans, lima beans, lettuce, radishes8 A white 18-year-old young woman who lives in theMidwest (Ohio Valley; northwest of the Appalachianmountains, east of the Mississippi River) complainsof rhinorrhea and sneezing that begins during themonths of May and June, peaks at about July 4, andthen tapers off in September and October. Which ofthe following is true regarding this condition?(A) The condition is precipitated by exposure toCladosporium (previously known asHormodendrum ) and Alternaria moldspores.(B) The symptoms are caused by exposure to ragweedpollen.(C) The peak age for symptoms is between 10 and15 years.(D) Females are twice as likely to be affected as males.(E) Symptoms will respond to antibiotics.9 A 35-year-old man has been your patient since movinginto the area from his lifelong home in California.He comes to you in the first week of September complainingof coryza and occasional wheezing thatseems not to evolve through the various stages of acold. It occurred about this time last year, but it isnow more severe; it has lasted more than 2 weekssince its onset in the last half of August. The nasaldischarge is thin and watery, without yellowish mucusor mucosanguinous characteristics. He has triedtaking the antihistamine loratidine (Claritin), whichdid not give him significant relief; you prescribedcetirizine (Zyrtec), which also failed to relieve thesymptoms. You then suggested over-the-counterdiphenhydramine (Benadryl) and chlorpheniramine.These two antihistamines relieved the symptoms butcaused intolerable drowsiness. Which of the followingis the most practical approach for his acute symptoms,assuming he has no other significant medicalproblems?(A) Skin testing to confirm the offending allergen,followed by allergen immunotherapy(desensitization)(B) Prescription of clarithromycin, 500 mg, XLtablets, twice daily for 7 days(C) Prescription of prednisone, given orally at astarting dosage of 40 mg daily, reduced every2 days to taper off over a 2-week period(D) An increase in the dosage of Benadryl(E) Counseling the patient to remain indoors in anair-conditioned environment for the durationof the allergy season10 A patient with medically refractory allergic rhinitiswas found to be reactive to ragweed and you plan oninitiating desensitization in the coming year. Meanwhile,which of the following foods, if any, would youadvise him to avoid while attempting other means togive relief of symptoms?(A) Peanuts(B) Shellfish(C) Vertebrate fish(D) Chocolate(E) Bananas