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NEW QUESTION: 1
Your patient is a 43-year-old male who is experiencing post-operative voiding difficulty after an elective inguinal hernia repair. His post void residual volume was 280 cc.
Which of the following medications is the most appropriate choice of therapy for this patient?
A. Finasteride
B. Oxybutynin
C. Imipramine
D. Phenylephrine
E. Bethanechol
Answer: E
Explanation:
Explanation
The patient is experiencing a common complication of low abdominal surgery. Post-operative urinary retention occurs in almost 25% of patients after low abdominal surgical procedures. A normal post-void residual volume is less than 50 cc or urine. The effects of anesthesia and analgesia both contribute to bladder distension, decreased micturition reflex, reduction of contractility of the detrusor muscle of the bladder, and incomplete voiding. The detrusor muscle of the bladder is stimulated to contract by muscarinic cholinergic agonists. Bethanechol is a muscarinic agonist and is frequently used in this setting to improve bladder emptying. Finasteride is a drug that is a 5 alpha reductase inhibitor indicated for use in patients with bladder outlet obstruction as a result of prostatic hypertrophy. The inhibition of 5 alpha reductase decreases local conversion of testosterone to dihydrotestosterone in the prostate gland, which results in gradual shrinkage over a period of six to twelve months. Phenylephrine is an alpha-adrenergic agonist that is selective for alpha-1 receptors. Activation of the alpha 1 receptors in the bladder results in contraction of the trigone muscle and sphincter.
This promotes urinary retention. Oxybutynin is an antimuscarinic agent that is useful for treatment of urge incontinence, and would have a detrimental effect on this patient's bladder disorder. Imipramine is a medication with anticholinergic properties that would also cause worsening of the patient's condition. Take home message: Post-operative urinary retention with concomitant incomplete voiding is a complication that results from a decreased micturition reflex, increased vesical sphincter tone, or decreased contractility of the detrusor muscle of the bladder. It can be successfully treated with a muscarinic agonist, such as bethanechol, or with an alpha-1 adrenergic antagonist.

NEW QUESTION: 2
Users need to provision a complex application that includes Virtual, Physical, and Cloud servers.
What should an administrator do to allow users to request all of the servers for this application in a single request?
A. Create a blueprint for each machine that is part of the application.
Create a multi-machine blueprint and add each machine blueprint from the applicable global and local blueprints.
Create a Business Group for users in the department and configure Catalog Management.
B. Create a multi-machine global blueprint specifying each machine that is part of the application.
Create a Business Group for users in the department and configure Catalog Management.
C. Create a blueprint for each machine that is part of the application.
Create a multi-machine blueprint and add each machine blueprint from the applicable local blueprints.
Create a Business Group for users in the department and configure Catalog Management.
D. Create a multi-machine local or global blueprint specifying each machine that is part of the application.
Create a Business Group for users in the department and configure Catalog Management.
Answer: C

NEW QUESTION: 3
You develop a Microsoft SQL Server 2012 database. You create a view that performs the following tasks:
Joins 8 tables that contain up to 500,000 records each.

Performs aggregations on 5 fields.

The view is frequently used in several reports.
You need to improve the performance of the reports.
What should you do?
A. Convert the view into a table-valued function.
B. Convert the view into an indexed view.
C. Convert the view into a stored procedure and retrieve the result from the stored procedure into a temporary table.
D. Convert the view into a Common Table Expression (CTE).
Answer: B
Explanation:
Explanation/Reference:
Reference: http://msdn.microsoft.com/en-us/library/ms191432.aspx