Day 20 Flashcards
Q1-A 26-year-old primipara in her 39th week of pregnancy presents with intense abdominal pain that is intermittent. She claims that she felt a gush of fluid from her vagina almost 3 hours ago. On physical exam her cervix is 3 cm dilated and 50% effaced, and the fetus’s head is felt at the –2 station. For the next 3 hours she continues to progress so that her cervix is 5 cm dilated, 60% effaced, and fetal head is felt at –1 station. Six hours after presentation, her cervix is 5 cm dilated and 60% effaced, and fetal head is felt at 0 station. Which of the following is the most likely diagnosis?
A-Prolonged latent stage
B-Protracted cervical dilation
C-Arrest of descent
D-Arrest of cervical dilation
Ans: D. Arrest of cervical dilation is when there is no dilation of the cervix for more than 2 hours. Patients who are more than 4 cm dilated are considered to be in active stage 1 labor. Patients with prolonged latent stage take more than 20 hours (in primipara) to reach 4 cm of dilation. Protracted cervical dilation occurs when the primipara’s cervix does not dilate more than 1.2 cm in one hour. It is dilating slowly, but still dilating. Arrest of descent is when the fetal head does not move down into the canal.
Q2-A 27-year-old woman in her 35th week of gestation presents for a routine prenatal check up. She has no complaints. On physical examination her temperature is 98°F, blood pressure 130/90 mm Hg, heart rate 87 bpm, and respiratory rate 12 per minute. Her abdomen is gravid. On palpation of the abdomen, a hard circular surface is felt in the proximal part of the uterus. Which of the following is the next step in the management of this patient?
A-External cephalic version
BUltrasound
C- CT scan
D-X-ray
Ans: B. This patient is showing signs of a possible breech presentation on physical exam (the hard circular surface is the fetal head). Breech presentation should be confirmed via ultrasound before therapeutic measures such as external cephalic version are implemented. X-ray and CT scan are avoided during pregnancy secondary to the radiation exposure.
Q3-A 21-year-old woman presents for vaginal pruritus and discharge for one week. She complains that the discharge is green and profuse. She has had multiple sexual partners in the past 2 months. Her last menstrual period was 2 weeks ago. On wet mount, the vaginal discharge has motile flagellates present. Which of the following is the most likely diagnosis?
A-Chlamydia B-Bacterial vaginosis C-Neisseria gonorrhoeae D-Trichomonas vaginalis E-Candidiasis
Ans: D. Trichomonas presents with a profuse, green, frothy discharge. Neisseria is a bacterial infection that is identified by culture. Chlamydia is diagnosed by serology DNA probe. Candidiasis is associated with white, cheesy vaginal discharge. Bacterial vaginosis is associated with vaginal discharge and a fishy odor, without pruritus.
Q4-Gabriel is a healthy 2-year-old boy whose parents have taken him to the pediatrician. His problems started at 18 months of age, when he did not speak much. He does not have much attachment to his parents and seems aggressive toward other children. What is the most likely diagnosis?
A-Deafness B-Schizophrenia, childhood onset C-Rett disorder D-Autism E-Learning deficit
Ans: D. Autism is seen more frequently in boys and usually starts by the age of 3. Children with autism tend to have problems with language and aggression, lack separation anxiety, and are withdrawn. Deafness should be ruled out if parents report that a child does not respond when his or her name is called.
Q5-A 12-year-old boy was seen by a school counselor after the teachers complained of his behavior in school. He frequently becomes angry towards others and loses his temper in class. His parents report that at home, he refuses to comply with house rules, often stays up later than he is supposed to, and frequently talks back to them.
What is the most likely diagnosis?
A-Conduct disorder B-Tourette disorder C-Adjustment disorder D-Oppositional defiant disorder E-Learning disorder, not otherwise specified
Ans: D. Children with oppositional defiant disorder usually have problems with authority figures such as parents and teachers. Unlike children with conduct disorder, they do not break rules of society and do not commit crimes.
Q6-A 43-year-old woman was recently seen by her primary care physician due to complaints of depressed mood, lack of pleasure, sleep problems, decreased appetite and weight, decreased energy, and problems with concentration. She states that these symptoms started when she was fired from her job about 4 weeks ago, and that since then, she has been unable to function. What is the most indicated treatment at this time?
A-Alprazolam B-Paroxetine C-Bupropion D-Venlafaxine E-Trazodone F-Electroconvulsive therapy
Ans: B. She has a diagnosis of major depression and the first-line treatment is the use of an SSRI medication because of a better side-effect profile compared to the other therapies. All others, except alprazolam and electroconvulsive therapy, would be useful but not the first choice. Alprazolam is simply a benzodiazepine and acts as an anxiolytic, not an antidepressant. Electroconvulsive therapy might be useful if initial therapy did not work or the depression was far more severe and was associated with psychotic features.
Q7-A 21-year-old college student was taken to the university clinic after she was noted to be acting bizarrely in class. She is talking fast and reported that she has not slept for over 4 days. She appears to be giggling and not paying attention in class. Her roommate reported that she has been drinking alcohol excessively over the last few days and has had many sexual contacts with unknown men.
What is the most likely diagnosis?
A-Alcohol-induced mood disorder B-Bipolar disorder type I C-Bipolar disorder type II D-Major depression with psychosis E-Cyclothymia
Ans: B. The patient is exhibiting mania, as shown by her pressured speech, decreased sleep, increased libido, and inappropriate behavior. The symptoms are severe enough that her level of functioning is affected. Bipolar disorder occurs more frequently in young individuals.
Q8-A 33-year-old man was taken to the emergency room by the police after neighbors complained about his behavior. His family informed the doctor that he has been diagnosed with bipolar disorder and was recently started on lithium. While in the emergency room, he became combative and punched a nurse on the mouth.
What is the next step in the management of this patient?
A-Obtain lithium level B-Admit to psychiatric unit C-Refer to psychiatry D-Add valproic acid E-Olanzapine
Ans: E. The patient is exhibiting mania and you do not need to verify the lithium level given that his symptoms are acute. He apparently has been noncompliant with medications and obtaining a level is not the correct answer. He needs to be medicated, and antipsychotics are considered first-line treatment for bipolar patients, especially if acutely and severely manic. Admitting an agitated patient to the psychiatric unit is not as important as administering adequate treatment. “Refer to psychiatry” is never the correct answer on Step 2 CK.
Q9-A 67-year-old man was brought to the office by his daughter after she became concerned about him. He has been hopeless and helpless since his wife died 3 months ago. His daughter is worried about his isolative behavior and lack of appetite. He has lost over 30 pounds. He does not seem interested in getting better and believes he should have died with his wife. What is the most likely diagnosis?
A-Bereavement B-Dysthymia C-Major depression D-Adjustment disorder E-Bipolar disorder
Ans: C. Although it has been less than 6 months since his wife died, his symptoms are severe enough to warrant a diagnosis of major depression. He has no interest in things, has lost weight, feels hopeless and helpless, and believes he should have died as well. He needs to be treated with antidepressants, and you must ensure that he is not suicidal since he is at high risk.
Q10-What is the single most effective treatment for depression?
A-Electroconvulsive therapy B-Fluoxetine C-Venlafaxine D-Imipramine E-Phenelzine
Ans: A. Although electroconvulsive therapy (ECT) is usually used for suicidal patients or those who do not respond to treatment, it is considered the best treatment for depression. All others are equally efficacious, but the SSRIs are used more frequently due to side-effect profiles.
Q11-A 24-year-old woman was recently diagnosed with schizophrenia. She is 30 pounds’ overweight and suffers from diabetes Type 2. She is concerned about her medications and asks for your advice.
Which of the following would be most indicated in this patient?
A-Aripiprazole B-Olanzapine C-Quetiapine D-Clozapine E-Risperidone
Ans: A. Aripiprazole and ziprasidone are the least likely to cause weight gain, diabetes, and metabolic syndrome. Clozapine and olanzapine have the highest risk of metabolic abnormalities. Risperidone and quetiapine have medium risk.
Q12-You have recently diagnosed a 26-year man with schizophrenia and started him on haloperidol. Within a few hours he develops muscle stiffness, and his eyes roll upward and he cannot move them down.
What is the most likely diagnosis?
A-Tardive dyskinesia B-Neuroleptic malignant syndrome C-Akathisia D-Acute dystonic reaction E- Seretonin syndrome
Ans: D. Acute dystonic reactions develop within hours of the use of medications. This side effect is typical for haloperidol. The treatment of choice is benztropine or diphenhydramine, which can be given with the haloperidol or after should side effects occur.
Q13-Which is considered to be first-line treatment for panic disorder?
A-Alprazolam B-Buspirone C-Sertraline D-Imipramine E-Fluvoxamine
Ans: C. SSRIs are considered to be first-line treatment. If the question is panic attack, then alprazolam is the correct answer; if a single panic attack is the diagnosis, a benzodiazepine is the treatment. If panic disorder is the diagnosis, then pick the SSRI.
Q14- A 45-year-old man was referred to a psychiatrist by his physician because he is “too shy.” He has problems going to parties, feels anxious about getting close to others, and stays at home in fear that others would laugh at him. When confronted by others, he develops severe anxiety as well as hyperventilation and increased sweating.
Which is the most likely diagnosis?
A-Panic disorder B-Social anxiety C-Generalized anxiety disorder D-Specific phobia E-Acute stress disorder
Ans: B. Social anxiety is characterized by fear of embarrassment in social situations. These patients have problems going out in fear that others will laugh at them.
Q15- A 37-year-old woman has complained of palpitations, dizziness, and increased sweating for at least 8 months. She has visited numerous physicians and none have been helpful. Her husband is concerned because she cannot relax and worries about everything. She worries about her parents’ health even though they are healthy. She worries about her finances, although her husband assures her they are financially secure. What is the most likely diagnosis?
A-Generalized anxiety disorder B-Phobias C-Panic disorder D-Adjustment disorder E-Social anxiety
Ans: A. The main feature of generalized anxiety disorder is the chronic worrying about things that do not merit concern. It is also accompanied by other symptoms of anxiety, as well as sleep and concentration problems.
