Items 738 through 741

A 22-year-old woman presents to the emergency room with an episode of acute painful loss of vision in the right eye. On examination there is right afferent pupillary defect, and papillitis is seen on fundoscopic examination. The patient has no history of neurologic symptoms. MRI shows a few foci of T2 signal increase in a periventricu-lar distribution.

7-38. Appropriate treatment for presumed optic neuritis in this patient is a. Oral prednisone b. Intravenous methylprednisolone c. Cyclophosphamide d. Plasma exchange e. Intravenous gammaglobulin

7-39. Six months later the patient again presents to the ER. Her vision has recovered. She now complains of brief, sharp pain radiating into the left side of her face. The vision in her right eye has largely recovered, and there is no evidence of sensory loss on the right side of her face. She describes the pain as "icepick-like" and grimaces with each attack. She is most likely to have symptomatic relief from her facial pain if she is managed with a. Aspirin b. Acetaminophen c. Ibuprofen d. Carbamazepine e. Codeine

7-40. On further questioning, the patient reveals that she has had recurrent episodes of bed-wetting (enuresis) over the preceding month. This would decrease with the administration of a. Imipramine b. Phenytoin c. Carbamazepine d. Baclofen e. Methacholine

7-41. Over the course of the next few months, the patient develops painful spasticity in her left leg that interferes with flexion of the leg. The spasticity progresses to the point of interfering with her sleep. She should now be treated with a. Imipramine b. Phenytoin c. Carbamazepine d. Baclofen e. Methacholine

7-42. A 26-year-old gravida 3 woman has a history of gestational diabetes and a delivery of two previous infants at term that were greater than 4000 g, each of whom had severe hypoglycemia. Which of the following maneuvers is least likely to reduce the chance of the next child's having hyperglycemia?

a. Careful control of maternal blood glucose levels during pregnancy b. Maternal intravenous loading with 10% glucose beginning 2 to 4 h prior to the expected time of delivery c. Careful glucose monitoring of the infant d. Early feedings of the infant e. Maintenance of the infant in a neutral thermal environment

7-43. A 52-year-old woman presents to your office for her annual gynecological examination. She stopped menstruating about 6 mo ago and is getting some hot flashes. Her history reveals that she drinks one glass of wine per day and smokes about 10 cigarettes per day. She does not exercise much and is overweight. Her most important risk factor for developing osteoporosis is a. Smoking b. Alcohol use c. Lack of physical activity d. Age e. Obesity

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