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A 68-year-old male presents to the emergency department with sudden onset of right-sided weakness and difficulty speaking. The symptoms resolved after 20 minutes. Which of the following are appropriate actions and considerations for this patient who has experienced a transient ischemic attack (TIA)?
(Select All that Apply.)

Assume the episode was a migraine and schedule a neurology follow-up for a later date.

Discharge the patient immediately since the symptoms resolved.

Initiate antiplatelet therapy, such as aspirin, to reduce the risk of future strokes.

Order a CT scan of the head to rule out intracranial hemorrhage.

Start anticoagulation therapy immediately without further evaluation.

Conduct a carotid ultrasound to assess for stenosis.

Refer the patient for lifestyle modifications, including smoking cessation and diet changes.

Answer and Explanation

Correct Answer : C,D,F,G

A.   Assuming the episode was a migraine and scheduling a follow-up is not appropriate. TIAs are serious warning signs of potential future strokes and require immediate attention and evaluation.
B.   Discharging the patient immediately after symptoms resolve is not appropriate. Even though symptoms resolve, TIAs are medical emergencies, and further evaluation is necessary to reduce the risk of a full-blown stroke.
C.   Initiating antiplatelet therapy, such as aspirin, is an appropriate action to reduce the risk of future strokes in patients who have had a TIA.
D.   Ordering a CT scan of the head is appropriate to rule out an intracranial hemorrhage and other causes of the symptoms.

E.   Starting anticoagulation therapy immediately without further evaluation is not recommended. The patient must be properly assessed before starting anticoagulation to determine the cause of the TIA and if anticoagulation is appropriate.
F.   Conducting a carotid ultrasound is appropriate to assess for stenosis, which could be contributing to the TIA.
G.   Referring the patient for lifestyle modifications, including smoking cessation and diet changes, is crucial to reduce future stroke risk. These interventions help prevent the recurrence of TIAs and strokes.

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Correct Answer is D

Explanation

A. Increased creatinine levels may indicate kidney dysfunction, but it is not specifically related to liver metastasis.
B. Elevated serum amylase is typically associated with pancreatic conditions and not directly with liver metastasis.
C. Decreased albumin levels may occur with liver dysfunction but is not specific to liver metastasis.
D. Elevated serum bilirubin levels are a key indicator of liver dysfunction, and when seen in the context of jaundice and a history of colon cancer, they strongly suggest liver metastasis as the underlying cause.

A. Klebsiella pneumoniae B. Streptococcus pneumoniae C. Escherichia coli D. Staphylococcus aureus

Correct Answer is D

Explanation

A. Klebsiella pneumoniae is a Gram-negative bacterium and is typically associated with more severe pneumonia, particularly in patients with underlying lung disease, but it does not form clusters.
B. Streptococcus pneumoniae is a common cause of pneumonia but typically appears as Gram-positive cocci in pairs or chains, not clusters.
C. Escherichia coli is a Gram-negative bacterium that generally causes urinary tract infections and is not a common cause of pneumonia with Gram-positive cocci in clusters.
D. Staphylococcus aureus is a Gram-positive bacterium that forms clusters and is a common cause of pneumonia, particularly in young, otherwise healthy individuals, and can present with fever, chills, and productive cough. This fits the presentation and sputum findings in this patient.

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Naxlex Comprehensive Predictor Exams

A 58-year-old male patient with a history of colon cancer has developed jaundice. Which laboratory finding would most likely suggest liver metastasis as the cause of the jaundice?

Correct Answer is D

Explanation

A 25-year-old female patient presents with fever, chills, and a productive cough. Sputum culture reveals Gram-positive cocci in clusters. Which of the following bacterial organisms is most likely responsible for this infection?

Correct Answer is D

Explanation

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