an 82 year old man comes to the physician for evaluation of chest pain.he lives with his daughter's family.he has numerous welts and abrasions and appears to be malnurished.he says his diet is fine.which of the following is the most appropriate next step in patient care?
a)confront his family about the abuse
b)enroll the family in counseling
c)notify social services for potential abuse
d)place him in a nursing home
e)refer him to a residential community

q2.a homeless 38 year old man has a 3 month history of decresed appetite,generalised wasting,a low grade fever,worsening cough productive,bloody,mucupurulent sputum.he has a 3 year history of alcohol abuse.xray of film of the chest shows consolidation and cavitatory lesion in apices of the lungs.which of the following is the most likely inflammatory or immune response in the lung?
a)endothelial cell proliferation,vascular budding,fibroblasts
b)epitheloid cells,multinucleated giant cells,caseous necrosis
c)fibroblast,collagen deposition,replacement of intrinsic tissue
d)macrophages,lymphocytes,hypergammagloubulinemia
e)neutrophils,vasular congestion,exudate

for the first question: there is no doubt this is elderly abuse....management for this is next(i hope i remember well):
1.treat the pt for any injuries he/she might have(bruises,bleeding,etc)
2.look for possible complications(internal bleeding,broken bones,etc) by doing CT/MRI,xrays,etc
3.notice social services for abuse; from this point i think your correct answer is C.

in the history taking we should ask the pt about abuse.....i think we never should confront the family for abuse(here i am not 100% sure...sorry)


for the second question: from the description given this is most likely pulmonary TB....under the microscope TB is a granuloma with caseous necrosis(as long as i know for the step 1 caseous granuloma means TB; in real life could be other etilogies but for the exam caseous necrosis means TB).....from this point of view your correct answer is B.

I agree with both answers.....for question 1. all cases of suspected abuse should be reported....for question 2. also the location of the lesion is important...apex/upper lobe of the lung
edited by aquresh1 on 3/15/2011
edited by aquresh1 on 3/15/2011

Agree both answers .. but,for q.2 > if in lower lobe, it can also be lung abscess (he is alcohol abuser and found cavitatory lesion and consolidation in X.ray )then ,answer will be E.

thanx for your explanation...