A multicentric, ambidirectional cohort study (i.e. a study that combines elements of both prospective and retrospective cohort studies) was designed in order to evaluate the relationship between nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) and exposure to patients in intensive-care units of several tertiary hospital centers. The sample included 1,000 physicians who worked in the hospital environment and who willingly underwent swabbing of their nasal vestibule and nasopharynx for active surveillance. Data of their working location was obtained from hospital administrative services. Of those who worked in the intensive care unit, 350 were colonized with MRSA, while 250 were not. Whereas in those that worked in other hospital wards, 100 were colonized with MRSA, and 300 were not. What is the relative risk of MRSA colonization in relation to working in the intensive-care unit?
A3.22
B2.33
C0.43
D1.66
E0.18
A 57-year-old man comes to the physician because of generalized malaise, yellowish discoloration of the eyes, and pruritus on the back of his hands that worsens when exposed to sunlight for the past several months. He has not seen a physician in 15 years. Physical examination shows scleral icterus and mild jaundice. There is a purpuric rash with several small vesicles and hyperpigmented lesions on the dorsum of both hands. The causal pathogen of this patient's underlying condition was most likely acquired in which of the following ways?
AIngestion of raw shellfish
BInhalation of spores
CNeedlestick injury
DBathing in freshwater
ESexual contact
A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient appears to be in severe distress. Vital signs are within normal limits. On physical examination, the spine is nontender without paravertebral muscle spasms. Range of motion is normal. A straight-leg raise test is negative. After the physical examination has been completed, the patient asks for a letter to his employer attesting to his inability to work as a storekeeper. Which of the following is the most appropriate response?
A“Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”
BYou say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing.
CI understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job.
DThe physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional.
EThe physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy.
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