Question

10 Orem is a 68-year old male who has been volunteering for Meals on Wheels as a driver He is complaining of left shoulder and elbow pain. What would you order for this patient for testing? For medication? Write his prescriptions Grace had a lumpectomy of her right breast 3 years ago. She is experiencing increasing frequency and duration of menopausal symptoms. She would like to go on hormone replacement therapy. What do you prescribe for her? Write her prescriptions 12 Tony, 72-year-old male, has scheduled this visit for difficulty in urination and increased frequency, especially at night. What tests and/or medications would you order? Write his prescriptions 13 Mrs. Smith is an African-American woman of 76 years. Her daughter has scheduled this visit for increasing lethargy, insomnia, and uncontrolled weeping. What is your initial impression? How would you treat Mrs. Smith? Write her prescriptions Mary is a resident of a long-term skilled nursing facility. She has a fever of 101 'F and her skin is dry to the touch. She has a small amount of urine output that is dark and foul smelling. What test(s) and treatments would you prescribe? Write her prescriptions 15 Kelly is a 67-year-old female complaining of spinal pain. Two compression fractures of the lumbar spine are present and the patient is osteoporotic. What medications would you recommend for this patient? Write her prescription

Answer 1

10Ans: Since Orem is 68 years old and has been a voluntary driver for meals on wheels for a long period of time he may have Rotator cuff injury. The tests required to confirm if there has been a rotator cuff injury is an MRI (to see detailed pictures of his shoulder), X ray (to see if the top of his arm bone (humeral head) is pushing into his rotator cuff space) and ultrasound (to see the soft tissues (tendons and muscles and the bursas) in your shoulder). Since Orem is an elderly patient we could suggest conservative treatments such as rest, ice and physical therapy. OTC pain relievers such as ibuprofen, naproxen sodium or acetaminophen may be helpful to reduce the pain. If the tear is severe, Orem would have to undergo a surgery and get his tendons fixed.

11Ans: I would suggest that Grace proceeds for Hormone replacement therapy if her symptoms do not reduce after a course of medicines that I would prescribe to her. The medicines to be prescribed are Tamoxifen or Fulvestrant. This medicines would help her restore the estrogen levels in her body.

12Ans: Tony, 72 year old male has Benign prostrate enlargement. The tests that would be advised are rectal examination, abdominal ultrasound, cystoscopy, cystometry, testerone check, urodynamic testing, prostrate biopsy, transrectal ultrasonography and intravenous pyelogram. The medicines that he could use are alpha blockers like alfuzosin and tamsulosin. These medicines would not cure an enlarged prostate but they can help to relieve symptoms.

13Ans:Mrs.Smith is either suffering from depression or pseudobulbar affect (PBA). Insomnia is a sign of depression. So, anti-depressants would be prescribed to her and also I would suggest that she joins a group where all the participants would be seated in a circle to socialize and speak out. Few of her problems would be solved if she joins a group to overcome depression.

14Ans: Mary is suffering from Urinary Tract Infection. A urine test for Urine Culture and Sensitivity would be done to see the bacteria that is causing the urine infection. Also if there is any infection, drugs would be displayed in this test to see what drug is the bacteria is sensitive to and thus the bacteria causing the UTI could be killed by consumption of this drug. I would advise Mary to have plenty of fluids so that the bacteria causing the infection would be flushed out from her body.

15Ans: The medicines that would be prescribed for Kelly are bisphosphonates alendronate , risedronate, and ibandronate since these are osteoporosis drugs. Also we could give her mild pain killers like NSAIDS.