IM

Question 1

IM Key Points

Answer 1

patients aged 20 years or older with an LDL cholesterol level of 190 mg/dL (4.92 mmol/L) or higher should receive high-intensity statin therapy for primary prevention of atherosclerotic cardiovascular disease.

Question 2

IM Key points

Answer 2

The decision to initiate breast cancer screening in women aged 40 to 49 years should be an individualized one based on patient context and values regarding specific benefits and harms.

Question 3

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Answer 3

For patients undergoing orthopedic surgery without increased bleeding risk, postoperative dual venous thromboembolism prophylaxis low-molecular-weight heparin should be continued for up to 35 days.

Question 4

IM Key points

Answer 4

Gabapentinoids and serotonin-norepinephrine reuptake inhibitors are first-line therapy for neuropathic pain syndromes.

Question 5

IM Key points

Answer 5

Methylphenidate is a rapid-acting psychostimulant that is well tolerated and effective in the treatment of depression at the end of life; results can be seen as quickly as 24 to 48 hours after initiation.

Question 6

IM Key points

Answer 6

Bacterial conjunctivitis is characterized by redness of the conjunctival membrane obscuring the tarsal vessels, matting of both eyes in the morning, and thin mucopurulent discharge; treatment may include topical antibiotics, such as trimethoprim–polymyxin B or erythromycin.

Because of concerns about antimicrobial resistance and cost, topical fluoroquinolones (such as levofloxacin) are not first-line therapy

Question 7

IM Key points

Answer 7

The acceptability of the number needed to treat as a means of comparing one treatment with another depends on the risks associated with the condition, the cost and side effects of the treatment, and other treatments available.

(NNT = 1/absolute risk reduction)

Question 8

IM Key points

Answer 8

The most common infectious cause of acute bacterial prostatitis is Escherichia coli or other gram-negative bacilli; the treatment of choice is a prolonged course of trimethoprim-sulfamethoxazole or ciprofloxacin.

Question 9

IM Keypoints

Answer 9

Men younger than 35 years who are sexually active and men older than 35 years who engage in high-risk sexual behavior should be treated with regimens that cover Neisseria gonorrhoeae and Chlamydia trachomatis. Ceftriaxone and doxycycline, or ceftriaxone and azithromycin, would be appropriate treatment choices

Question 10

IM Key points

Answer 10

Health care workers are at increased risk for acquiring and transmitting measles, mumps, and rubella and should receive a second dose of the MMR (measles, mumps, and rubella) vaccine.

Health care workers born after 1957 are at increased risk for acquiring and transmitting measles, mumps, and rubella and should receive a second dose of the MMR vaccine at least 28 days after the first dose.

Question 11

IM Key points

Answer 11

Nerve root involvement of the cauda equina requires immediate imaging, preferably with MRI, and surgical intervention to prevent permanent neurologic damage.

Question 12

IM Key points

Answer 12

For women younger than 30 years with a low-risk breast mass, ultrasonography is usually the only imaging required.

Question 13

IM Key points

Answer 13

More than half of patients with bipolar disorder initially present with a depressive episode; however, recognition of previous manic or hypomanic episodes is crucial because the treatment of bipolar disorder requires mood stabilizers, either alone or in combination with antidepressants.

Question 14

IM Key points

Answer 14

Bariatric surgery should be considered in patients who do not lose weight with lifestyle modifications and have a BMI of 40 or greater, or a BMI of 35 or greater with obesity-related comorbid conditions, such as type 2 diabetes mellitus, coronary artery disease, obstructive sleep apnea, or osteoarthritis.

Question 15

IM Key points

Answer 15

In patients with chronic cough who have a normal chest radiograph and are taking an ACE inhibitor, the first intervention is discontinuation of the ACE inhibitor.

Question 16

IM Key points

Answer 16

Patients who undergo direct-to-consumer genetic testing should be advised of the risks and limitations of these tests, including the possibility for misinterpretation.

Question 17

IM Key points

Answer 17

Tinnitus associated with unilateral sensorineural hearing loss suggests acoustic neuroma and requires advanced imaging with MRI.

Question 18

IM Key points

Answer 18

Pulmonary rehabilitation can provide significant benefits for patients with chronic lung disease and has been shown to improve subjective dyspnea in patients with severe COPD and following an acute exacerbation of COPD.

Question 19

IM Key points

Answer 19

Patients with decompensated liver disease should avoid elective surgery and be referred for liver transplant evaluation.

Question 20

IM Key points

Answer 20

A discharge summary that includes the evaluations performed, medication reconciliation, pending test results, required follow-up tests, and follow-up appointments is an important tool in the communication between the hospital and the follow-up clinician.

Question 21

IM Key points

Answer 21

Adhesive capsulitis is characterized by loss of shoulder movement accompanied by pain; examination discloses significant loss of both active and passive range of motion.

Patients with acromioclavicular joint degeneration typically report pain localized to the acromioclavicular joint. Physical examination findings include tenderness to palpation of the joint

Rotator cuff disease would not be expected to cause pain with both active and passive movement of the shoulder;

Question 22

IM Key points

Answer 22

The most effective pharmacologic options for premature ejaculation is the combination of a selective serotonin reuptake inhibitor plus a phosphodiesterase-5 inhibitor and topical anesthetics.

Question 23

IM Key points

Answer 23

Stress urinary incontinence is characterized by urine leakage associated with activities that cause increased intra-abdominal pressure, such as coughing, laughing, or sneezing; it is best managed with pelvic floor muscle training exercises.

Bladder training and suppressive therapy are recommended by the ACP for urgency and mixed incontinence.

Oxybutynin is a treatment for urgency urinary incontinence when bladder training is only partially successful or has failed

Question 24

IM Key points

Question 25

IM Key point

Answer 25

Bisphosphonates can cause muscle pain

Question 26

IM Key point

Answer 26

Simvastatin and Amlodipine causes elevavted in stsatin levels

Question 27

IM Key point

Answer 27

Pioglitazones can cause lower extremity edema

Question 28

IM Key point

Answer 28

DEXA Scan, women over 65, and those under 65 with risk factors and those over 50 who have had fractures

Question 29

IM Key point

Answer 29

T score of less than 2.5 is osteoporosis

-1 to -2.5 is osteopenia

Normal, more than -1

Question 30

IM Key point

Answer 30

A bile acid sequestrant, such as cholestyramine, may be considered as an optional alternative agent for patients with ezetimibe intolerance and a triglyceride level less than 300 m

Question 31

IM Key points

Answer 31

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and ezetimibe are the preferred nonstatin drugs for patients with clinical atherosclerotic cardiovascular disease who do not achieve goal LDL cholesterol reduction with maximally tolerated statin therapy.

Question 32

IM Key points

Answer 32

2016 USPSTF guideline recommends sensitive gFOBT or FIT annually or multitargeted stool DNA testing every 3 years.

CT colonography can be performed every 5 years.

Flexible sigmoidoscopy is recommended every 5 years, but if combined with FIT (or possibly gFOBT), the interval can be increased to every 10 years,

Question 33

IM Key points

Question 34

IM Key points

Answer 34

Preoperative electrocardiography is reasonable for patients with known atherosclerotic cardiovascular disease, including coronary artery disease, arrhythmia, peripheral artery disease, cerebrovascular disease, or significant structural heart disease, who are undergoing moderate- to high-risk surgeries; cardiac stress testing should generally be reserved for patients at elevated risk for major adverse cardiac event with a functional capacity less than 4 metabolic equivalents, but only if the results of the test will change perioperative management.

Question 35

IM Key

Answer 35

Ulnar nerve entrapment, also known as cubital tunnel syndrome, is caused by impingement of the ulnar nerve at the elbow by bone spurs, fibrous tissue, ganglion cysts, or ulnar nerve subluxation; characteristics include pain at the elbow that worsens with flexion, paresthesias and numbness of the fourth and fifth fingers, and weakness of the interosseous muscles.

Carpal tunnel syndrome is associated with wrist pain and symptoms of median nerve dysfunction, namely numbness in the first three fingers and pain that radiates into the forearm and hand.

Question 36

IM Key points

Answer 36

Estrogen-containing hormonal contraceptives are contraindicated in women older than 35 years who smoke more than 15 cigarettes a day because of an increased risk for venous thromboembolism.

Contraindications to estrogen-containing preparations (including oral contraceptives and estrogen-progestin vaginal rings) include breast cancer, liver disease, migraine with aura, uncontrolled hypertension, and venous thromboembolism. They are also contraindicated in women older than age 35 years who smoke more than 15 cigarettes per day, such as this patient, because of an increased risk for venous thromboembolism

Question 37

IM Key points

Answer 37

Weight-loss medications are recommended when a trial of comprehensive lifestyle modification, including reduced dietary intake, exercise, and behavioral therapy, fails to achieve a 5% to 10% reduction in weight after 3 to 6 months.

Bariatric surgery is recommended for patients with BMI of 40 or greater, and for patients with BMI of 35 or greater who have obesity-related comorbidities and who have tried all other weight loss therapies without achieving significant weight loss or improvements in comorbid conditions.

Question 38

IM Key points

Answer 38

Low serum ferritin levels are strongly correlated with restless legs syndrome

Question 39

IM Key points

Answer 39

The initial evaluation of chronic insomnia involves obtaining a sleep diary to identify adverse environmental factors, inappropriate exposure to electronic screens before bedtime, and sleep patterns.

Question 40

IM Key points

Answer 40

The hallmarks of optic neuritis are acute vision loss, eye pain with movement, color perception change, and afferent pupillary defect; results of a funduscopic examination may be normal.

Question 41

IM Key points

Answer 41

all PDE-5 inhibitors (viagra, etc) are contraindicated with nitrates

Question 42

IM Key points

Answer 42

OCPs can have a side effect of daily headaches

Question 43

IM Key points

Answer 43

Patients with postoperative urinary retention and residual bladder volume of 800 mL or more should be treated with bladder decompression and urinary catheterization.

Question 44

IM Key points

Answer 44

The USPSTF defines adequate screening as three consecutive negative cytology (Pap smear) results or two consecutive negative cytology plus human papillomavirus (HPV) test results within the last 10 years, with the most recent test occurring within 5 years.

Question 45

IM Key points

Answer 45

Following diagnosis and treatment of a woman with Trichomonas vaginalis infection, the sexual partner should be treated and both individuals should be screened for other sexually transmitted infections; retesting of women for T. vaginalis infection within 3 months of treatment is also recommended.

Question 46

IM Key points

Answer 46

Pregabalin is a calcium channel blocker and likely produces edema by the same mechanism as other calcium channel blockers; it is associated with peripheral edema in up t

Question 47

IM Key points

Answer 47

The diagnosis of systemic exertion intolerance disease requires the presence of fatigue of at least 6 months’ duration with substantial reduction in preillness activities, postexertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance.

Question 48

IM Key points

Answer 48

The diagnosis of systemic exertion intolerance disease requires the presence of fatigue of at least 6 months’ duration with substantial reduction in preillness activities, postexertional malaise, unrefreshing sleep, and either cognitive impairment or orthostatic intolerance.

Question 49

IM Key points

Answer 49

A positive Prehn sign (relief of pain with scrotal elevation) suggests a diagnosis of epididymitis, although it does not rule out other possibilities, such as testicular torsion.

A transillumination study, which is performed to identify a hydrocele

Question 50

IM Key points

Question 51

IM Key points

Answer 51

In patients taking dual antiplatelet therapy, if the risk of surgical delay exceeds the risk for stent thrombosis, discontinuation of the P2Y12 inhibitor can be considered after a minimum of 30 days in the case of bare metal stent placement or 3 months after drug-eluting stent placement.

Question 52

IM Key points

Answer 52

In patients taking dual antiplatelet therapy, if the risk of surgical delay exceeds the risk for stent thrombosis, discontinuation of the P2Y12 inhibitor can be considered after a minimum of 30 days in the case of bare metal stent placement or 3 months after drug-eluting stent placement.

Question 53

IM Key points

Answer 53

Cyclic mastalgia is often related to hormonal changes that occur with ovulation, resulting in diffuse premenstrual breast pain that resolves with the menstrual cycle; the most appropriate management is education, reassurance, and appropriate breast support.

Question 54

IM Key points

Answer 54

In patients with central vertigo, the Dix-Hallpike maneuver produces nystagmus with an immediate onset (no latency), longer duration (>1 minute), no fatigability, and vertical or horizontal directionality without a torsional component.

Dix-Hallpike maneuver results that suggest peripheral vertigo include nystagmus that is delayed in onset (presence of latency), is of short duration (<1 minute), exhibits fatigability (habituation), and is primarily unidirectional

Question 55

IM Key points

Answer 55

An advanced static mattress or mattress overlay made of specialized sheepskin, foam, or gel provides the best protection against the development of pressure injuries in hospitalized patients.

Question 56

IM Key points

Answer 56

Sexually active gay, bisexual, and other men who have sex with men and injection drug users should be screened for HIV infection at least annually.

Question 57

IM Key points

Answer 57

The U.S. Preventive Services Task Force (USPSTF) recommends low- to moderate-intensity statin therapy in asymptomatic adults aged 40 to 75 years without ASCVD who have at least one ASCVD risk factor (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year ASCVD event risk of 10% or higher.

In patients with a fasting triglyceride level of 500 mg/dL (5.65 mmol/L) or higher, triglyceride-lowering drug therapy is useful to prevent pancreatitis.

Question 58

IM Key points

Answer 58

A postvoid residual urine volume, determined by ultrasonography, can confirm a suspected case of overflow urinary incontinence.

Botulinum toxin injection is used in the treatment of urgency urinary incontinence that persists despite behavioral and pharmacologic therapies.

Oxybutynin is an anticholinergic agent used in the treatment of urgency incontinence. Anticholinergic drugs (oxybutynin, darifenacin, fesoterodine, solifenacin, tolterodine, trospium) block the muscarinic cholinergic receptors and decrease bladder contractility.

Question 59

IM Key points

Answer 59

Treatment of chronic pelvic pain syndrome demands a multimodal approach, with options including both pharmacologic and nonpharmacologic strategies; among the pharmacologic options are neuromodulatory agents, such as pregabalin, gabapentin, and nortriptyline.

Question 60

IM Key points

Answer 60

Central retinal artery occlusion presents as acute, profound, and painless loss of monocular vision associated with an afferent pupillary defect and cherry red fovea.

Acute angle-closure glaucoma typically presents with severe eye pain and visual loss.

etinal detachment most commonly presents with photopsias (flashes of light); patients may also report seeing cobwebs and large floaters.

Question 61

IM Key points

Answer 61

In the primary and secondary prevention of cardiovascular events, the addition of aspirin to long-term anticoagulation is associated with significantly increased bleeding events and is not routinely recommended.

Question 62

IM Key points

Answer 62

Achilles tendon rupture most commonly results from sudden, forceful plantar flexion, such as occurs with jumping and sprinting. Patients report sudden onset of heel pain and often hear a popping sound at the time of the injury. On examination, patients have weak or absent plantar flexion. Absent plantar flexion with calf squeezing (Thompson test) also suggests the diagnosis. This

Question 63

IM Key points

Answer 63

Topical antifungal imidazole therapy, such as intravaginal clotrimazole, is an effective treatment for uncomplicated vulvovaginal candidiasis, which is usually caused by Candida albicans.

Oral metronidazole is used to treat bacterial vaginosis, the most common cause of vaginal discharge, as well as to treat trichomoniasis. Accepted clinical criteria for diagnosing bacterial vaginosis include the presence of three of four characteristics: vaginal pH greater than 4.5, amine (“fishy”) odor on the application of 10% potassium hydroxide to vaginal secretions (whiff test), the presence of a thin homogeneous vaginal discharge, and the finding of at least 20% clue cells on a microscopic saline wet mount examination.

Question 64

IM Key points

Answer 64

Transthoracic echocardiography to evaluate preoperative cardiac risk is appropriate for patients with moderate to severe valvular stenosis or regurgitation in the absence of an assessment in the previous year or for those whose clinical status has changed or who have referable symptoms.

Question 65

IM Key points

Answer 65

Selective serotonin reuptake inhibitors are generally well tolerated among patients with major depressive disorder, but sexual side effects (such as anorgasmia, delayed orgasm, and reduced libido) are common

Question 66

IM Key points

Answer 66

Varenicline is an effective therapy for smoking cessation and should be considered in smokers with a recent cardiac event.

Bupropion, a norepinephrine and dopamine reuptake inhibitor with nicotinic receptor activity, effectively increases smoking cessation rates. Bupropion should not be used in patients with a history of seizure disorders, stroke, brain tumor, brain surgery, or head trauma.

Question 67

IM Key points

Answer 67

Frailty is a quantifiable geriatric syndrome that may predict a patient’s response to medical treatment.

The Timed Up and Go test is used to identify patients at risk for falls. The individual components of the test (rising from the chair, gait, walking speed, balance maintenance while turning, and sitting) offer insight into the various mechanics of mobility and can guide a more focused evaluation and intervention.

Question 68

IM Key points

Answer 68

Stimulants, such as methylphenidate, are first-line pharmacologic therapy for attention-deficit/hyperactivity disorder; when stimulants are contraindicated, atomoxetine, bupropion, and tricyclic antidepressants can be used.

Question 69

IM Key points

Answer 69

Patients with noncyclic mastalgia with focal breast pain but no palpable mass should undergo targeted breast ultrasonography because approximately 1% of such patients may have breast cancer at the site of pain.

Reassurance, coupled with the regular use of a fitted support bra, would be appropriate management for a patient with cyclic mastalgia and a normal physical examination.

Question 70

IM Key points

Answer 70

Likelihood ratios (LRs) are a statistical indicator of how much the result of a diagnostic test will increase or decrease the pretest probability of a disease in a specific patient; a clinical rule of thumb is that positive LRs of 2, 5, and 10 correspond to an increase in disease probability of 15%, 30%, and 45%, respectively.

With a pretest probability of 50%, a positive result on treadmill stress echocardiography would increase the likelihood of disease by approximately 45%, leading to a posttest probability in the range of 95%;

Question 71

IM Key points

Answer 71

For patients undergoing nonorthopedic surgery who are at high risk for postoperative venous thromboembolism as defined by the Caprini score, pharmacologic prophylaxis with low-molecular-weight heparin or low-dose unfractionated heparin and the addition of mechanical prophylaxis are recommended.

Question 72

IM key points

Answer 72

Male patients with urgency urinary incontinence who have not achieved satisfactory relief of symptoms with behavioral therapy may benefit from the use of anticholinergic agents or mirabegron.

Dutasteride is a 5α-reductase inhibitor used to treat benign prostatic hyperplasia. In this patient who is already being treated with tamsulosin and in whom postvoid residual bladder volume suggests that bladder outlet obstruction has been adequately addressed, there is no additional benefit from adding another therapy for benign prostatic hyperplasia;

Question 73

IM key points

Answer 73

In adult patients, first-line therapy for symptomatic left-sided varicocele that is not associated with testicular atrophy or infertility is analgesic agents and scrotal support.

Treatment with ceftriaxone plus doxycycline is recommended for infectious epididymitis.

Question 74

IM Keypoints

Answer 74

Rheumatoid arthritis is one of the most common diseases associated with scleritis, which can be vision-threatening and lead to thinning of the sclera and perforation.

Episcleritis is an abrupt inflammation of the superficial vessels of the episclera, a thin membrane that lies just beneath the conjunctiva. The cause is often unclear; rarely, it is associated with systemic rheumatologic disease. Patients with episcleritis frequently present without pain or decreased visual acuity

Question 75

IM Key points

Answer 75

The treatment of systemic exertion intolerance disease involves a structured, multimodal, nonpharmacologic approach that includes regularly scheduled office visits, cognitive behavioral therapy, and sleep hygiene education.

Question 76

IM Key points

Answer 76

Before initiating hormonal contraception, a negative pregnancy test result must be documented if 7 days have passed since the onset of the last menstrual period.

Question 77

IM Key points

Answer 77

Patients with diabetes mellitus are at significantly increased lifetime risk for cardiovascular events and should receive statin therapy for primary prevention.

Question 78

IM Key points

Answer 78

Symptoms of neurogenic thoracic outlet syndrome include paresthesias and pain that typically worsen with activities that involve continued use of the arm or hand, especially those that include elevation of the arm; first-line therapy includes improving posture and strengthening the shoulder girdle muscles.

Surgical decompression is not considered to be first-line therapy for neurogenic TOS, especially in patients who lack neurologic abnormalities. The procedure is reserved for patients who do not respond to conservative measures or for those with progressive or disabling neurologic symptoms.

Question 79

IM Key points

Answer 79

All patients with sudden sensorineural hearing loss should undergo audiometric evaluation, and most patients will require MRI.

Meniere disease, which is associated with endolymphatic hydrops (excess fluid in the endolymphatic spaces), can cause unilateral sensorineural hearing loss, but its presentation is characterized by episodic vertigo (lasting between 20 minutes and 24 hours) and tinnitus,

Question 80

IM Key points

Answer 80

Hydrocolloid or foam dressings are superior to standard gauze dressings in the treatment of pressure injuries; protein supplements and the use of electrical stimulation to accelerate wound healing are also recommended treatment strategies.

Question 81

IM Key points

Answer 81

In older men and persons who practice insertive anal intercourse, infectious epididymitis should be treated with ceftriaxone and a fluoroquinolone, such as levofloxacin.

In younger patients (age <35 years), the most common infectious etiologies of acute epididymitis include Chlamydia trachomatis and Neisseria gonorrhoeae. Ceftriaxone is adequate coverage for N. gonorrhoeae but not C. trachomatis infection, and would not be an appropriate choice in a younger patient. In these men, and in the absence of risk factors for gram-negative infection (anal intercourse, urologic instrumentation), empirically treating with ceftriaxone and doxycycline (or azithromycin, if the patient is intolerant to doxycycline) would be appropriate.

Question 82

IM Key points

Answer 82

For evaluation of palpable breast abnormalities in women aged 40 years or older, mammography, followed in most cases by ultrasonography, is recommended.

Ultrasonography is often preferred in women younger than age 30 years because the increased density of breast tissue in younger women limits the usefulness of mammography.

Question 83

IM Key points

Answer 83

In patients on warfarin who are undergoing surgery, bridging anticoagulation is typically reserved for patients at highest risk for thromboembolism.

Anticoagulant therapy increases the risk for perioperative hemorrhage and should be discontinued in most patients before surgery. Bridging anticoagulation is the administration of therapeutic doses of short-acting parenteral therapy, usually heparin, when anticoagulant therapy is being withheld during the perioperative period in patients with elevated thrombotic risk. This patient is undergoing a procedure associated with elevated bleeding risk, and she has no history of stroke, transient ischemic attack (TIA), or intracardiac thrombus. Therefore, the risks of bridging anticoagulation outweigh the thrombotic risk,

Question 84

IM Key points

Answer 84

Hormone therapy is an option for women with moderate to severe vasomotor symptoms of menopause who are younger than 60 years and within 10 years of menopause onset, provided they are at low risk for breast cancer, coronary heart disease, stroke, and thromboembolic disease.

For women who have had a hysterectomy, estrogen alone would be the preferred hormone therapy but would be inappropriate for this patient.

Question 85

IM Key points

Answer 85

Labyrinthitis is characterized by sudden-onset, severe, persistent peripheral vertigo accompanied by hearing loss; it is most often preceded by a viral infection affecting both branches of the vestibulocochlear nerve (cranial nerve VIII).

Vestibular neuronitis is similar but has NO hearing loss

Question 86

IM Key points

Answer 86

Hydromorphone is the preferred opioid to treat cancer-related pain in patients with chronic kidney disease.

Morphine is a prototypical opioid agonist, but its active metabolites accumulate in the setting of kidney failure and increase the risk for adverse neuroexcitatory effects with aggressive titration.

Question 87

IM Key points

Answer 87

Preoperative cardiac stress testing should be considered in patients at elevated risk for a major adverse cardiac event or if functional capacity cannot be determined, but only if the results of stress testing will change perioperative management.

Question 88

IM Key points

Answer 88

Erectile dysfunction in a patient who experiences nocturnal penile tumescence is most likely situational or mood related; cognitive behavioral therapy, biofeedback, or sensory awareness exercises with a psychotherapist are first-line therapies.

testosterone therapy should be avoided in patients with untreated obstructive sleep apnea.

Question 89

IM Key points

Answer 89

Hallmarks of a Morton neuroma are pain between the metatarsal heads, the sensation of walking on a pebble, and no obvious abnormalities of the foot upon clinical examination or palpation.

Plantar fasciitis typically causes pain localized to the medial inferior heel at the insertion of the plantar fascia in the medial calcaneal tubercle. Pain is usually present at activity initiation following prolonged rest and improves with further walking

Question 90

IM Key points

Answer 90

Characteristic features of acute angle-closure glaucoma include the sudden onset of headache, nausea, vomiting, and vision changes; the appearance of halos around lights; and the presence of a mid-dilated, nonreactive pupil.

Central retinal vein occlusion, which is often caused by a thrombus in the retinal vein, presents as painless onset of blurry vision or vision loss. It is not usually associated with redness or pupillary changes; ho

Question 91

IM Key points

Answer 91

For women with anovulatory abnormal uterine bleeding and contraindications to combination oral contraceptive use, a progestin-containing intrauterine device will likely reduce blood loss and maintain the stability of the endometrium, thereby reducing the risk for uterine cancer.

Question 92

IM Key points

Answer 92

The treatments of choice for persistent postural-perceptual dizziness are vestibular and balance rehabilitation therapy and medical therapy with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.

The canalith repositioning maneuver (Epley maneuver) is used to treat benign paroxysmal positional vertigo (BPPV). Patients with BPPV have brief episodes of vertigo (10-30 seconds) precipitated by abrupt head movement. T

Question 93

IM Key points

Answer 93

Lead-time bias occurs when survival time (time from diagnosis to death) appears to be lengthened because the screened patient is diagnosed earlier during the preclinical phase but does not live longer in actuality. To guard against this bias, disease-specific mortality rates rather than survival time should be used as an outcome derived from randomized clinical trials.

Question 94

IM keypoint

Answer 94

Naltrexone, which is available in both oral and long-acting injectable forms, is associated with a substantial decrease in 30-day readmission and emergency department visits when prescribed to patients with alcohol dependence at the time of hospital discharge.

Acamprosate cant be used in CKD

Disulfuram- is a deterrent- does not decrease motitvation to drink but causes unpleaant sick feeling if drinking

Question 95

IM key point

Answer 95

In patients in whom statin therapy is being considered, an alanine aminotransferase level should be obtained at baseline to evaluate for liver dysfunction; further hepatic monitoring is unnecessary if the baseline level is normal.

Question 96

IM key point

Answer 96

Clinical diagnosis of bacterial vaginosis requires three of the following four features: vaginal pH greater than 4.5, thin and homogenous vaginal discharge, positive whiff test result, and clue cells comprising at least 20% of all squamous cells on saline microscopy; culture is not a reasonable test to confirm the diagnosis of bacterial vaginosis and would also be costly and inefficient compared with an office-based diagnosis.

Vulvovaginal candidiasis is typically characterized by vaginal itching, irritation, and discharge and may be associated with dysuria and dyspareunia. Examination reveals vulvar edema and excoriation, with thick, white, curdy vaginal discharge. The diagnosis can be made when a saline or 10% potassium hydroxide wet mount of vaginal discharge shows yeast, hyphae, or pseudohyphae.

Question 97

IM key point

Answer 97

For patients with concomitant benign prostatic hyperplasia and erectile dysfunction, a trial of tadalafil (a phosphodiesterase-5 inhibitor) has been shown to be effective and is the only FDA-approved option to treat both conditions.

Tamsulosin and other α-blocking agents are first-line medical therapy for symptomatic BPH. However, α-blockers have numerous side effects, including hypotension, orthostasis, and sexual dysfunction. Tamsulosin could worsen this patient’s erectile dysfunction and thus would not be the most appropriate treatment choice.

Question 98

IM key point

Answer 98

In patients undergoing noncardiac surgery, β-blockers and statins should be continued in those who have been taking the drugs long term, and aspirin generally should be continued in patients with coronary stents unless the bleeding risk is prohibitively high.

Question 99

IM key point

Answer 99

In patients with findings concerning for centrally mediated vertigo (nystagmus, dysphagia, dysarthria, diplopia, ataxia, postural instability, hemiparesis, or mental status changes), or in patients with acute sustained vertigo and risk factors for vertebrobasilar stroke (advanced age, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, atrial fibrillation), urgent evaluation with MRI is strongly recommended.

Question 100

IM key point

Answer 100

Genitourinary syndrome of menopause is a clinical diagnosis characterized by vulvar itching, vaginal dryness, and dyspareunia; pelvic examination findings include pale, shiny vaginal walls; decreased rugae; and petechiae.

Lichen sclerosus is an inflammatory condition that often presents as white, atrophic patches on the genital and perianal skin. It differs from lichen planus in its clinical presentation of white patches that circumferentially involve the vaginal introitus and perianal area (“figure 8” appearance).

Question 101

IM key point

Answer 101

When it is necessary to discontinue anticoagulant therapy for surgery, non–vitamin K antagonist oral anticoagulants can be stopped 2 to 3 days preoperatively because of their short half-lives.

Discontinuing apixaban 5 or 7 days before surgery would expose this patient to a small but increased thrombotic risk during that time frame.

Question 102

Name the concept: The ability of a test to detect a disease when it is truly present

Answer 102

Sensitivity

Question 103

Name the concept: is the ability of a test to exclude disease when it is truly absent.

Answer 103

specificity

Question 104

How does the positive predictive value of a condition change with an increase in prevalence?

Answer 104

As the prevalence of a condition increases, the positive predictive value increases and the negative predictive value decreases.

Question 105

How does changes in prevalence alter the sensitivity or specificity ?

Answer 105

Changes in prevalence do not alter the sensitivity or specificity but do alter the predictive values.

Question 106

How often should the flu vaccine be given?

Answer 106

One dose annually (for all persons 218 y), including pregnant women and those with HIV infection

Question 107

For pregnant women, which vaccines should be avoided?

Answer 107

For pregnant women, do not select live vaccines, including MMR, intranasal influenza, yellow fever, varicella, and zoster vaccines

Question 108

How often should TDAP and TD booster be given?

Answer 108

One dose TDap, then Td booster every 10 y for all adults

Question 109

When should TDAP be given in pregnant women?

Answer 109

one dose Tap each between 27 to 36 weeks’ gestation

Question 110

Who should receive the varicella vaccine?

Answer 110

Anybody who is immunocompetent and has not had it

Question 111

who should get thew herpes zoster (shingles) vaccine?

Answer 111

all immunocompetent over age 50

Question 112

who should get the HPV vaccine?

Answer 112

Women aged 19-26 yo, men aged 11-21 yo; men aged 22-26 yo who are HIGH RISK, immunocompromised or who have sex with other men

Question 113

who should get the HPV vaccine?

Answer 113

Women aged 19-26 yo, men aged 11-21 yo; men aged 22-26 yo who are HIGH RISK, immunocompromised or who have sex with other men

Question 113

who should get the HPV vaccine?

Answer 113

Ages 19-26 y

Ages 27-45 y based on shared clinical decision-making

Question 114

who should get the MMR vaccine?

Answer 114

Adults born after 1957 who do not have immunity. It is live, so avoid in pregnant

Question 114

who should get the MMR vaccine?

Answer 114

Adults born after 1957 who do not have immunity. It is live, so avoid in pregnant

Question 115

which vaccines are live vaccines?

Answer 115

Nasal influenza, MMR, yellow fever, varicella, zoster

Question 116

who should receive the meningococcal vaccine?

Answer 116

First-year college students residing in dormitories, travelers to endemic areas, military recruits, and exposed persons; asplenia or complement deficiencies; boost every 5 years if risks remains.

Question 117

Are flu vaccines safe in patients with egg allergies?

Answer 117

all flu vaccines are safe in those with egg allergies

Question 118

When is the PCV13 vaccine recommended compared with the PPSV23 vaccine for immunocompetent adults?

Answer 118

Age 65, and PCV13 once, followed by PPSV23 ONE YEAR AFTER pcv13. Can give PPSV23 again at 5 years after first dose.

Question 119

how long after should immunocompetent adults receive the PPSV23 wafter getting the PCV13 ?

Answer 119

one year

Question 120

Which PNA vaccine is recommended for immunocompetent people with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking

Answer 120

PPSV23

Question 120

Which PNA vaccine is recommended for immunocompetent people with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking

Answer 120

PPSV23

Question 121

Which PNA vaccine is recommended for immunocompetent people with chronic heart, lung, or liver disease, diabetes mellitus, alcoholism, cigarette smoking

Answer 121

PPSV23

Question 122

Which PNA Vaccine should someone with sickle cell, hemoglobinopathy or anatomic asplenia receive?

Answer 122

both PCV13 and PPSV23

Question 123

Which PNA Vaccine should Immunocompromised persons with EITHER HIV, chronic kidney disease, nephrotic syndrome, leukemia, lymphoma, Hodgkin Ssesse, multiple myeloma, generalized malignancy, taking immunosuppressant drugs, congenital immunodeficiencies,
solid organ transplant RECEIVE?

Answer 123

Both PCV13 and PPSV23

Question 124

Which PNA Vaccine should SOMEONE with a PMH CSF leaks or cochlear implants receive?

Answer 124

Both PCV13 and PPSV23

Question 124

What are the 5 recommended scenarios in which aspirin is used as a primary prevention of ASCV and colon cancer?

Answer 124

• adults aged 50-59 years
• 10-year CVD risk >10%
• life expectancy >10 years
• no increased risk for bleeding
• willing to take low dose aspirin daily ≥10 years

Question 124

Who should be screened for One -time abdominal ultrasonography?

Answer 124

One-time abdominal ultrasonography in all men ages 65-75 y who have ever smoked.

Question 125

Who should be screened for diabetes?

Answer 125

Ages 40-70 y who are overweight or obese as part of risk assessment for cardiovascular disease.

Question 125

Who should be screened for lipid disorders?

Answer 125

Ages 40-70 y who are overweight or obese as part of risk assessment for cardiovascular disease.

Question 125

Who should be treated for HTN?

Answer 125

You have to get measurements outside of the clinical setting for diagnostic confirmation and before you start treatment

Question 126

what demographic should be screened for osteoporosis?

Answer 126

Women age >65 y; postmenopausal women less than 65 y of age when 10-year fracture risk is greater than 9.3%

Question 127

What is the age recommendation for ASA primary
prevention of ASCVD?

Answer 127

The ACC/AHA and the ADA recommend that aspirin may be considered for primary
prevention of ASCVD in adults aged 40 to 70 years who are at higher ASCVD risk but
not at increased bleeding risk.

Question 128

What is the recommended screening for HIV?

Answer 128

HIV infection One-time screening for all adults aged 15-65 y; at least annually for adults at high risk

Question 129

Who should be screened for HBV, syphilis, and
latent TB?

Answer 129

Only All adults at high risk

Question 130

What is the recommended screening for mammography?

Answer 130

Biennial (taking place every other year) screening mammography for women aged 50-74 y; initiation of screening before age 50 y should be individualized

Question 131

Who should be screened for chlamydia and gonorrhea?

Answer 131

All sexually active women aged ≤24 y; all sexually active older women at increased risk of infection

Question 132

What is the screening recommendation for cervical cancer ?

Answer 132

Women aged 21-65 y with cytology (Pap smear) every 3 y; in women aged 30-65 y who want to lengthen screening, screen with cytology and HPV testing every 5 y or high-risk HPV testing alone every 5 y

Question 133

Should you screen women for cervical cancer following hysterectomy and cervix removal for benign disease?

Answer 133

Do not screen women following hysterectomy and cervix removal for benign disease

Question 134

Who should be screened for colon cancer?

Answer 134

All adults aged 45-75 y. USPSTF recommendations do not support one form of screening test over another for
detecting early stage CRC in average-risk patients.

Question 135

Who should be screened for lung cancer with annual CT?

Answer 135

Annual low-dose CT scan in high-risk patients (adults aged 50-80 y with a 20-pack-year smoking history, including former smokers who have quit in the last 15 years)

Question 136

Who should be screened for prostate cancer?

Answer 136

Men aged 55-69 years should make an informed decision about prostate cancer screening with their physician.
Physicians should not screen men unless they express a preference for screening, and routine screening for men

Question 137

For average risk colon cancer screening, how often should you screen if you are using Guaiac fecal occult blood test (FOBT)?

Answer 137

Annually

Question 138

For average risk colon cancer screening, how often should you screen if you are using Fecal immunochemical test (FIT)?

Answer 138

Annually

Question 139

For average risk colon cancer screening, how often should you screen if you are using flex sig ?

Answer 139

q 5 years

Question 140

For average risk colon cancer screening, how often should you screen if you are using Flexible sigmoidoscopy plus annual FIT ?

Answer 140

q 10 years

Question 141

For average risk colon cancer screening, how often should you screen if you are using FIT-DNA?

Answer 141

Every 1 or 3 years

Question 142

For average risk colon cancer screening, how often should you screen if you are using Colonoscopy ?

Answer 142

q 10 years

Question 143

For average risk colon cancer screening, how often should you screen if you are using CT colonography ?

Answer 143

q 5 years

Question 144

what are the 3 most common causes of abnormal uterine bleeding?

Answer 144

• PCOS
• hypothyroidism or hyperthyroidism
• hyperprolactinemia

Question 145

for postmenopausal women, what is the required test for abnormal uterine bleeding?

Answer 145

Endometrial biopsy is indicated in postmenopausal women.

Question 146

Besides endometrial biopsy what other option is available to assess for structural abnormalities in the uterus and to determine endometrial thickness?

Answer 146

Pelvic ultrasonography is
an option to assess for structural abnormalities in the uterus and to determine
endometrial thickness.

Question 146

Besides endometrial biopsy what other option is available to assess for structural abnormalities in the uterus and to determine endometrial thickness?

Answer 146

Pelvic ultrasonography is
an option to assess for structural abnormalities in the uterus and to determine
endometrial thickness.

Question 147

What size is endometrial biopsy indicated when
endometrial thickness is found on ultrasound?

Answer 147

In postmenopausal women, endometrial biopsy is indicated if
the endometrial thickness is >4 mm on ultrasound.

Question 148

For women with abnormal uterine bleeding and anovulatory cycles who wish to preserve fertility, what is the best treatment AUB?

Answer 148

For women with anovulatory cycles who wish to preserve fertility medroxyprogesterone acetate used for the second half of the menstrual cycle
will restore cyclic withdrawal bleeding.

Question 149

For women with AUB who are interested in contraception, what is the treatment for their AUB?

Answer 149

For women interested in contraception:
* combined oral contraceptive pills or
* levonorgestrel intrauterine device may be used

Question 150

Which clinical syndrome is a chronic inflammatory skin disorder that affects the cheeks and nose and
usually occurs after the age of 30 years?

Answer 150

Rosacea

Question 151

In early stages, rosacea can resemble the malar rash of SLE. How can you differentiate the two?

Answer 151

The rash of SLE spares the nasolabial folds. The development of papules, pustules, and flushing is
inconsistent with SLE and supports the diagnosis of rosacea.

Question 152

which clinical syndrome is this?

Answer 152

Rosacea

Question 153

Which clinical condition is common in athletes and consists of follicular papules; pustules; occasional furuncles on any hair-bearing area, especially scalp, buttocks, and thighs. Most common cause is S. aureus?

Answer 153

Bacterial
folliculitis

Question 154

which clinical condition includes discrete papules and pustules on an erythematous base around the mouth, but typically sparing the skin directly around the lips?

Answer 154

Perioral
dermatitis.

Question 155

What clinical syndrome is this?

Answer 155

Perioral dermatitis.

Question 155

Which ACNE retinoids can be used in pregnancy?

Answer 155

All topical retinoids and oral isotretinoin are contraindicated in pregnancy.

Question 156

Which topical meds can be used safe in pregnancy?

Answer 156

Topical clindamycin, azelaic acid, and erythromycin are safe in pregnancy.

Question 157

How does the treatment for erythrotelangiectatic rosacea differ from Treatment of papulopustular rosacea?

Answer 157

Treatment of erythrotelangiectatic rosacea focuses primarily on behavioral modifications, such as avoidance of identified triggers of flushing, proper use of sun protection, and use of gentle skin cleansers. Treatment for papulopustular rosacea includes topical metronidazole, an azelaic acid
formulation, and topical ivermectin. Topical glucocorticoids should be avoided.

Question 158

How does the treatment for erythrotelangiectatic rosacea differ from Treatment of papulopustular rosacea?

Answer 158

Treatment of erythrotelangiectatic rosacea focuses primarily on behavioral modifications, such as avoidance of identified triggers of flushing, proper use of sun protection, and use of gentle skin cleansers. Treatment for papulopustular rosacea includes topical metronidazole, an azelaic acid
formulation, and topical ivermectin. Topical glucocorticoids should be avoided.

Question 159

For treatment of moderate to severe
acne can oral or topical antibiotic monotherapy be used?

Answer 159

Avoid oral or topical antibiotic monotherapy for treatment of moderate to severe
acne because of increased antibiotic resistance; combine with topical benzoyl
peroxide.

Question 160

For MILD noninflammatory acne (comedones), which is the recommended treatment?

Answer 160

Comedolytic agent (topical retinoid such as tretinoin, adapalene, and tazarotene). For mild, topical is the best

Question 161

For moderate to severe inflammatory acne what is the recommended treatment ?

Answer 161

Topical retinoid, topical antibiotic, and an oral antibiotic (tetracycline or others)

Question 162

For moderate noninflammatory acne what is the recommended treatment?

Answer 162

Topical retinoid and benzoyl peroxide or azelaic acid

Question 163

For women with Severe recalcitrant nodular acne, what is the recommended treatment?

Answer 163

Oral isotretinoin (women require two forms of birth control when taking this drug because it is teratogenic)

Question 164

which clinical syndrome includes lesions located on sun-exposed sites and appear as 2- to 3-mm, elevated, flesh-
= colored or red papules with adherent, whitish scale or “rough spots”?

Answer 164

Actinic keratosis

Question 165

what is the clinical significance or implications of Actinic keratosis?

Answer 165

Actinic keratosis is a precursor to SCC.

Question 166

which clinical syndrome is shown in the pic?

Answer 166

Actinic keratosis

Question 167

What is the difference in treatment for actinic Keratoses for those with a single lesions vs those with numerous lesions?

Answer 167

Destruction by liquid nitrogen or curettage is the preferred treatment for most single lesions.
Topical 5-FU or imiquimod cream is used for the treatment of numerous lesions.

Question 168

which clinical syndrome is associated with fever, chills, dysuria, pelvic pain, cloudy urine,
obstructive symptoms, and blood in the semen?

Answer 168

acute prostatitis

Question 169

How is acute prostatitis diagnosed?

Answer 169

The diagnosis is established by finding a tender prostate on physical examination and a positive urine culture.

Question 170

What is the recommended treatment for acute prostatitis for patients who appear toxic?

Answer 170

For patients who appear toxic, hospitalize and add gentamicin to a fluoroquinolone, cefotaxime, ceftazidime, or piperacillin/tazobactam.

Question 171

What is the recommended treatment for acute prostatitis?

Answer 171

Begin empiric antibiotics that cover gram-negative organisms (trimethoprim-sulfamethoxazole, fluoroquinolone) for 2 to 6 weeks.

Question 172

The absence of the cremasteric reflex on the affected side is nearly 99% sensitive for what condition?

Answer 172

testicular torsion

Question 173

In patients with testicular torsion does testicular elevation relieve pain?

Answer 173

Testicular elevation will not
relieve pain.

Question 174

What does Doppler flow ultrasonography
demonstrates in Testicular torsion?

Answer 174

Doppler flow ultrasonography
demonstrates diminished blood flow to the affected testicle.

Question 175

Which clinical syndrome is associated with pain localizing to the posterior and superior aspects of the testicle with dysuria, pyuria, and fever?

Answer 175

Epididymitis

Question 176

With Epididymitis how does the pain change with testicular elevation?

Answer 176

Pain may decrease with testicular
elevation.

Question 177

In which condition, associated with mumps, does ultrasonography demonstrates normal or increased blood flow to the testicle ?

Answer 177

In epididymitis and orchitis

Question 178

What is the treatment of testicular torsion?

Answer 178

Treatment of testicular torsion is immediate surgical exploration and reduction.

Question 179

In men younger than 35 years with epididymitis what is the treatment and what conditions are you covering?

Answer 179

In men younger than 35 years with epididymitis, treat for gonorrhea and chlamydial
infection (ceftriaxone and doxycycline).

Question 180

In men older than 35 years at low risk for STIs,
what is the treatment for epididymitis?

Answer 180

In men older than 35 years at low risk for STIs,
treat with levofloxacin

Question 181

In men engaging in anal intercourse, what is the treatment for epididymitis?

Answer 181

For all men engaging in anal intercourse, treat with ceftriaxone and oral levofloxacin.

Question 182

Which clinical syndrome is associated with sudden onset of acute pain and swelling of the affected salivary gland, which may be accompanied by fever?

Answer 182

Sialadenitis

Question 183

What is the most common bacterial cause of Sialadenitis?

Answer 183

Sialadenitis typically has a bacterial cause,
most commonly Staphylococcus aureus;

Question 184

What is the treatment for sialadenitis?

Answer 184

Warm compresses and sialagogues (sour candies or vitamin C lozenges); salivary gland
massage; increased fluid intake; oral hygiene; and, in cases of bacterial sialadenitis,
antibiotics are indicated.

Question 185

Elevations in which lab values are suggestive of alcohol use disorder?

Answer 185

Laboratory clues such as an elevated MCV, γ-glutamyl transferase level, and AST-ALT ratio >2 are
suggestive

Question 186

what is the first step in Screening for alcohol use disorder ?

Answer 186

Screening for alcohol use disorder begins with quantifying the amount of alcohol
consumed, not CAGE or AUDIT-C questions.

Question 187

what is the tx indicated for hospitalized patients with previous alcohol-related seizures or delirium?

Answer 187

Benzodiazepines

Question 188

Which medication can be used IN ACTIVE drinkers to prevent relapse of alcohol abuse and dependence?

Answer 188

Naltrexone

Question 189

In what two main conditions is Naltrexone contraindicated?

Answer 189

Naltrexone is contraindicated in patients receiving or withdrawing from any opioid and in those with liver failure or hepatitis.

Question 190

Which alcohol dependence treatment is contraindicated in kidney disease?

Answer 190

Acamprosate
.

Question 191

Which alcohol dependence treatment is a second-
line treatment that causes the accumulation of acetaldehyde if alcohol is consumed, resulting in flushing, headache, emesis, and the need to avoid all additional alcohol-containing items?

Answer 191

Disulfiram

Question 192

For alcohol withdrawal, which us preferred long term or short term benzos?

Answer 192

Long-acting benzodiazepines are typically preferred.

Question 193

Is a continuous infusion therapy with short-acting
benzodiazepines better than oral therapy for acute alcohol withdrawal?

Answer 193

No evidence supports that continuous infusion therapy with short-acting
benzodiazepines provides better outcomes than oral therapy for acute alcohol
withdrawal.

Question 194

In treating alcohol withdrawal, should thiamine or glucose be given first?

Answer 194

Give thiamine replacement before administering glucose.

Question 195

Which clinical syndrome is associated with a young person, nasal polyposis, chronic sinusitis, malnourishment, infertility, and chronic or recurrent bronchitis?

Answer 195

Cystic fibrosis

Question 196

Which clinical syndrome is associated with rhinitis, nasal polyps, asthma, and aspirin intolerance (respiratory symptoms)?

Answer 196

Aspirin-exacerbated respiratory disease (triad
asthma or Samter syndrome)

Question 197

What is first-line therapy for allergic rhinitis+?

Answer 197

Intranasal glucocorticoids are first-line therapy.

Question 198

Which clinical syndrome is associated with refractory congestion after chronic use of topical nasal decongestants?

Answer 198

Rhinitis medicamentosa

Question 199

What is the recommended treatment for SEVERE allergic rhinitis?

Answer 199

Combination intranasal glucocorticoids
and intranasal antihistamine are indicated for severe symptoms.

Question 200

If treatment for SEVERE allergic rhinitis does not work, what is the next best step in evaluation?

Answer 200

Choose skin testing and allergen immunotherapy if symptoms are not well controlled
by intranasal glucocorticoids with supplemental antihistamines or decongestants.

Question 201

What is the treatment for ADHD?

Answer 201

Treat ADHD with stimulants (e.g., amphetamine or methylphenidate)

Question 202

Which SNRI is approved for treatment of ADHD in adults?

Answer 202

Atomoxetine is an SNRI approved for treatment of ADHD in adults. CBT may be
beneficial alone or used as an adjunctive therapy.

Question 202

What conditions should you beware of before deciding to treat for ADH with stimulants?

Answer 202

Use with caution in patients with hypertension or cardiovascular disease.

Question 203

Which clinical syndrome is associated with pink, pearly, translucent papule or nodule with
telangiectasias, rolled borders, and central depression with ulceration?

Answer 203

Basal Cell Carcinoma

Question 204

Which clinical syndrome is shown in this photo?

Answer 204

Basal Cell Carcinoma

Question 204

What is the treatment for most BCCs?

Answer 204

Most BCCs are treated with simple excision.
Ill-defined lesions, high-risk histologic types, and tumors on the face and hands areoften best
treated with Mohs micrographic surgery.

Question 204

Which basal cell carcinomas are treated with Mohs micrographic surgery?

Answer 204

Ill-defined lesions, high-risk histologic types, and tumors on the face and hands are often best treated with Mohs micrographic surgery.

Question 205

Which clinical syndrome is associated with grouped, itchy papules in close configuration (“breakfast, lunch, and dinner”) on exposed body areas? These Bites are typically noticed in the morning

Answer 205

Bed bugs

Question 206

Which clinical syndrome is associated with the image?

Answer 206

bed bugs

Question 207

Clinical syndrome associated with (urinary urgency, frequency, and nocturia) and
obstructive symptoms (decreased urinary stream, intermittency, incomplete emptying,
and straining)?

Answer 207

BPH

Question 208

What are the two major classes of BPH drugs?

Answer 208

The two major BPH drug classes
include:
* α-adrenergic blockers (terazosin, tamsulosin, doxazosin, alfuzosin, and prazosin)
* 5-α reductase inhibitors (finasteride, dutasteride)

Question 209

which BPH drug class (α-Adrenergic blockers or 5-α reductase inhibitors) is more effective?

Answer 209

α-Adrenergic blockers are superior to 5-α reductase inhibitors. α-Adrenergic blockers
plus finasteride are more effective than either drug alone but are associated with
increased adverse effects.

Question 210

For patients with concomitant BPH and erectile dysfunction what is the best treatment for BPH?

Answer 210

Tadalafil, a PDE-5 inhibitor, improves lower urinary tract symptoms and may be used in
patients with concomitant BPH and erectile dysfunction.

Question 211

What is the next best tx for patients with severe urinary symptoms, urinary retention, persistent hematuria, recurrent UTIs, or kidney disease clearly attributable to BPH?

Answer 211

Surgical treatment is indicated in patients with severe urinary symptoms, urinary
retention, persistent hematuria, recurrent UTIs, or kidney disease clearly attributable to
BPH.

Question 212

what is the most effective mood stabilizer for bipolar disorder?

Answer 212

Lithium is the most effective mood stabilizer, but long-term therapy carries significant
side effects, including kidney disease, hypothyroidism, and DI.

Question 213

What is the potential issue with Monotherapy
with SSRIs in pts with bipolar disorder?

Answer 213

Monotherapy
with SSRIs may unmask mania in patients with untreated bipolar disorder.

Question 214

what is the next step for women who test positive for BRCA?

Answer 214

Women with a positive result on the risk
assessment tool should receive genetic counseling and, if indicated after counseling,
genetic testing.

Question 215

Which patients should be evaluated with an
appropriate brief familial risk assessment tool for breast cancer?.

Answer 215

The USPSTF recommends that women with a personal or family history of breast,
ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast
cancer susceptibility 1 and 2 (BRCA1/2) gene mutations be evaluated with an
appropriate brief familial risk assessment tool.

Question 216

What medications are used for pre-menopausal women vs post menopausal women for breast cancer prevention?

Answer 216

• tamoxifen before menopause
• tamoxifen and raloxifene, or exemestane after menopause

Question 217

In a patient under 30 with a Palpable breast lump or mass what work up should you choose?

Answer 217

Choose ultrasonography

Question 218

In a patient under 30 with a Palpable breast lump or mass, If simple cyst is found on ultrasound, what should the next step in evaluation be?

Answer 218

If simple cyst on ultrasound, aspirate and repeat clinical breast examination in 4-6 weeks

Question 219

In a patient under 30 with a Palpable breast lump or mass , If complex cyst is found on ultrasound, what is the next step in evaluation?

Answer 219

If complex cyst on ultrasound, biopsy

Question 220

In a patient under 30 with a Palpable breast lump or mass, If solid breast cyst is found on ultrasound, what is the next step in evaluation?

Answer 220

If solid on ultrasound, biopsy or excise

Question 221

In a patient OVER 30, with a Palpable lump or mass, what is the next step in evaluation?

Answer 221

Mammogram

Question 222

In a patient of any age, who comes in with bilateral nipple MILKLY discharge, no mass, What is the next step in evaluation

Answer 222

Start with a pregnancy test, if negative, choose endocrine evaluation.

Question 223

In a patient of any age, who comes in with persistent, unilateral, one duct, or serous/bloody: what is the next step in evaluation?

Answer 223

choose mammography and surgical referral for duct exploration

Question 224

In a patient with skin changes (erythema, peau
d’orange, scaling, nipple excoriation,
eczema) who is LESS than age <30 years, what is the likely diagnosis and treatment?

Answer 224

Consider mastitis and treat with antibiotics if appropriate and reevaluate in 2 weeks;

Question 225

In a patient with skin changes (erythema, peau
d’orange, scaling, nipple excoriation,
eczema) who is OVER age <30 years, what is the likely diagnosis and treatment?

Answer 225

Perform bilateral mammography: if normal, obtain skin biopsy; if abnormal or
indeterminate, obtain needle biopsy or excision

Question 226

What findings on a breast mass are
suspicious for malignant disease?

Answer 226

On mammography, an irregular mass with microcalcifications or spiculation is
suspicious for malignant disease, and biopsy is mandatory.

Question 227

What is the age interval and screening recommendation for cervical cancer?

Answer 227

The USPSTF recommends screening women aged 21 to 65 years every 3 years with
cytology (Pap test). In women aged 30 to 65 years who want to lengthen the screening
interval, high-risk HPV testing (preferred) or cytology combined with high-risk HPV
testing can be performed every 5 years (cotesting).

Question 228

When can screening for cervical cancer be discontinued?

Answer 228

Screening can be discontinued at age 65 years in non–high-risk women with adequate
previous screening:
* three consecutive negative cytology results, or
* two consecutive negative cytology plus HPV test results within the last 10 years,
with the most recent test occurring within 5 years

Question 229

Can HPV vaccine be given to patients who are HIV positive or otherwise immunosuppressed?

Answer 229

HPV vaccine can be given to patients who are HIV positive and otherwise
immunosuppressed.

Question 230

Should you screen women following a hysterectomy with cervix removal for benign
disease (e.g., fibroids) for cervical cancer?

Answer 230

no

Question 231

Which clinical syndrome is associated with postnasal drainage, frequent throat clearing, nasal discharge, COBBLESTONE appearance of the oropharyngeal mucosa, or mucus dripping down the oropharynx?

Answer 231

Upper airways cough syndrome

Question 232

For patients with Upper airways cough syndrome, what should be done before evaluated?

Answer 232

All patients should undergo chest x-ray. Smoking cessation and discontinuation of ACE
inhibitors are indicated for 4 weeks before additional evaluation.

Question 233

what is the recommended treatment for patients with Upper airways cough syndrome?

Answer 233

First-generation antihistamine-
decongestant combination or intranasal glucocorticoid (for allergic rhinitis)

Question 234

What clinical syndrome is associated with Asthma, cough with exercise or exposure to cold?

Answer 234

Cough-variant
asthma

Question 235

How is Cough-variant asthma diagnosed?

Answer 235

Methacholine or exercise challenge if
diagnosis is uncertain Standard asthma therapy

Question 236

In a patient with normal chest x-ray findings, normal spirometry, and negative
methacholine challenge test; failed empiric PPI therapy what diagnosis should be considered?

Answer 236

Possible nonasthmatic eosinophilic bronchitis

Sputum induction or bronchial wash for
eosinophils or exhaled nitric oxide testing
Treat with inhaled glucocorticoids; avoid
sensitizer

Question 237

Which clinical syndrome is associated with chronic pelvic pain worse before and during menses associated with dysmenorrhea?

Answer 237

Endometriosis

Question 238

Which clinical syndrome is associated with a history of sexual abuse and normal physical examination and ultrasonography but with pelvic pain?

Answer 238

Chronic pelvic pain syndrome

Question 239

Which clinical syndrome is associated with urinary frequency, urgency, nocturia, and dysuria; suprapubic pain possibly relieved with voiding; and
examination that shows vestibular and suprapubic tenderness?

Answer 239

Interstitial cystitis

Question 240

In a woman with chronic pelvic pain, what are the first two things to do to work it up?

Answer 240

A urine pregnancy test and pelvic/transvaginal ultrasonography are used to evaluate
women with chronic pelvic pain.

Question 241

For a patient with chronic pelvic pain who has a
sudden increase in pain intensity, which potential diagnosis should be indicated?

Answer 241

patient with chronic pelvic pain who has a
sudden increase in pain intensity, which may indicate a superimposed acute
process such as appendicitis.

Question 242

What is the first and second line therapy for endometriosis?

Answer 242

NSAIDs are first-line therapy for endometriosis, followed by oral contraceptives if
pregnancy is not desired.

Question 243

What is the gold standard for diagnosis for endometriosis?

Answer 243

The lesions can be visualized by laparoscopy, the gold standard for diagnosis,

Question 244

Should endometriosis be considered in a patient with chronic pelvic pain, fever or vaginal discharge?

Answer 244

Endometriosis does not cause fever or vaginal discharge.

Question 245

What are First-line therapy for Chronic Venous Insufficiency?

Answer 245

First-line therapy includes compression (stockings, wraps, pumps) and leg elevation.

Question 246

Which clinical syndrome is associated with
* leg heaviness, tiredness
* dependent leg edema
* hyperpigmentation, especially at medial ankle
* pruritus and eczema
* varicose or reticular veins
* venous ulceration

Answer 246

Chronic Venous Insufficiency

Question 247

Can loop diuretic therapy be used as first-line therapy for edema from chronic venous insufficiency?

Answer 247

Loop diuretic therapy is not recommended as first-line therapy for edema from chronic venous insufficiency.

Question 248

What is the advantage of using a Combined (estrogen-progesterone) transdermal patch for birth control?

Answer 248

It is a single patch changed weekly

Question 249

What is the disadvantage of using a Combined (estrogen-progesterone) transdermal patch for birth control?

Answer 249

Higher levels of estrogen, increased VTE risk

Question 250

What is the advantage of using a Combined (estrogen-progesterone) vaginal ring for birth control?

Answer 250

Vaginal ring Ring is changed every 3 weeks

Question 251

What is the advantage of using Progesterone-only
Oral contraceptive pill for BC?

Answer 251

It is Safe when estrogen is contraindicated

Question 252

What is the Disadvantage of using Progesterone-only Oral contraceptive pill for BC?

Answer 252

Irregular bleeding,
breakthrough bleeding

Question 253

What is the advantage of using Progesterone-only Depot medroxyprogesterone acetate for BC?

Answer 253

Administered every 3 months, Decreases menstrual frequency

Question 254

What is the disadvantage of using Progesterone-only Depot medroxyprogesterone acetate for BC?

Answer 254

Irregular bleeding, Delayed return to fertility
(up to 10 months), Weight gain, decreased bone mineral density

Question 255

What is the advantage of the copper IUD?

Answer 255

Effective up to 10 years

Question 256

What is the advantage of the Levonorgestrel IUD?

Answer 256

Effective 3 to 5 years

Question 257

What are the contraindications to combination hormonal products for BC?

Answer 257

Contraindications to combination hormonal products include:
* uncontrolled hypertension
* breast cancer
* VTE
* liver disease
* migraine with aura

Question 258

In what age and polulation of women is Estrogen-containing preparations contraindicated?

Answer 258

Estrogen-containing preparations are contraindicated in women >35 years who smoke
more than 15 cigarettes per day.

Question 259

What are the two options for Emergency contraception ?

Answer 259

Emergency contraception is postcoital hormonal contraception used to prevent
pregnancy after inadequately protected coitus. Options include:
* over-the-counter levonorgestrel
* prescription ulipristal

Question 260

which clinical syndrome should be diagnosed when depression is accompanied by previous or current manic symptoms?

Answer 260

Select bipolar disorder if depression is accompanied by previous or current manic symptoms.

Question 261

Which 2nd gen (first line) anti-depressant is safe for patients with cardiovascular disease?

Answer 261

Sertraline

Question 262

Which anti-depressant has fewest effects on sexual function and weight gain?

Answer 262

Bupropion has fewer effects on sexual function and weight gain.

Question 263

Which anti-depressant causes sedation and weight gain?

Answer 263

Mirtazapine causes sedation and weight gain (useful for patients with insomnia

Question 264

Which SSRI has the highest rate of sexual dysfunction among SSRIs, a higher rate of weight gain, and the highest rate of discontinuation syndrome ?

Answer 264

Paroxetine is classified as pregnancy category D (do

Question 265

Which SSRI is classified as pregnancy category D (and should not be used?

Answer 265

Paroxetine is classified as pregnancy category D (do

Question 266

If a patient does not have greater than a 50% reduction in symptoms after starting an SSRI, what should be done next?

Answer 266

In nonresponding patients, modify treatment
(increase dose, switch, or add another drug) if the patient does not have ≥50% reduction in symptom score with pharmacotherapy within several weeks.

Question 266

If a patient does not have greater than a 50% reduction in symptoms after starting an SSRI, what should be done next?

Answer 266

In nonresponding patients, modify treatment
(increase dose, switch, or add another drug) if the patient does not have ≥50% reduction in symptom score with pharmacotherapy within several weeks.

Question 267

At what point should long-term maintenance therapy foer depression be considered?

Answer 267

After Three or more recurrences of depression,
recurrence within 1 year of successful
treatment, or suicide attempt

Question 268

Can Antidepressant drugs should be stopped abruptly?

Answer 268

NO

Question 269

In patients taking SSRIs, particularly with concurrent use of other SSRIs, MAOIs, St. John’s wort, trazodone, dextromethorphan, linezolid,
tramadol, or buspirone, what syndrome can be precipitated?

Answer 269

serotonin syndrome

Question 270

which clinical syndrome is associated with nausea, vomiting, flushing, and diaphoresis, hyperreflexia, myoclonus, muscular rigidity, and hyperthermia.

Answer 270

serotonin syndrome

Question 271

which clinical syndrome is associated with redness and a “tile-like” pattern on dry skin with evidence of trauma because of scratching?

Answer 271

Xerotic dermatitis

Question 272

Which syndrome is shown in this pic

Answer 272

Xerotic dermatitis

Question 273

Which clinical syndrome is associated with ITCHY purpuric macules or patches, most commonly on the forearms, due to minor trauma?
damage.

Answer 273

Actinic purpura There is no
treatment for actinic purpura, but sun protection is recommended to prevent further
damage.

Question 273

Which clinical syndrome is associated with ITCHY purpuric macules or patches, most commonly on the forearms, due to minor trauma?
damage.

Answer 273

Actinic purpura There is no
treatment for actinic purpura, but sun protection is recommended to prevent further
damage.

Question 274

Which clinical syndrome is associated with this picture?

Answer 274

Actinic purpura

Question 275

Which clinical syndrome is associated with tan or light brown, 1- to 3-cm well-defined macules on sun- exposed areas of older adults?

Answer 275

Solar lentigines
And when they are larger than 1 cm or irregular in shape, melanoma is in the differential diagnosis, and biopsy should be considered.

Question 276

which clinical syndrome is associated with this pic

Answer 276

Solar lentigines

Question 277

There are some Dermatologic Signs of Systemic Disease such as Porphyria cutanea tarda and palpable purpura that are associated with which condition?

Answer 277

hep c

Question 278

There are some Dermatologic Signs of Systemic Disease such as Severe or recalcitrant seborrheic
dermatitis or abrupt onset of severe
psoriasis that are associated with which condition?

Answer 278

Initial HIV

Question 279

There are some Dermatologic Signs of Systemic Disease such as Erythema nodosum that are associated with which conditionS?

Answer 279

IBD, TB, sarcoidosis, coccidioidomycosis, streptococcal infection; look particularly for
Löfgren syndrome

Question 280

Which condition is associated with bilateral hilar lymphadenopathy, erythema nodosum, and lower
extremity arthralgia?

Answer 280

Löfgren syndrome

Question 281

There are some Dermatologic Signs of Systemic Disease such as Dermatitis herpetiformis that are associated with which conditionS?

Answer 281

Celiac disease

Question 282

There are some Dermatologic Signs of Systemic Disease such as Livedo reticularis that are associated with which conditionS?

Answer 282

Atheroemboli (previous vascular catheterization), thrombophilia, hyperviscosity
syndrome, vasculitis

Question 283

There are some Dermatologic Signs of Systemic Disease such as Pyoderma gangrenosum that are associated with which conditionS?

Answer 283

IBD, inflammatory arthritis, lymphoproliferative disorders

Question 284

There are some Dermatologic Signs of Systemic Disease such as Mechanic’s hands (hyperkeratotic,
fissured skin on the palms) that are associated with which conditions?

Answer 284

Dermatomyositis/antisynthetase syndrome (myositis, Raynaud syndrome, interstitial
lung disease with anti–Jo-1 antibodies)

Question 285

what is the main Yeast infection infecting humans?

Answer 285

Yeast infections include Candida, the main yeast species infecting humans

Question 286

Which fungus causes pityriasis versicolor?

Answer 286

Malassezia

Question 287

How is the Diagnosis of dermatophyte infection is made?

Answer 287

Diagnosis of dermatophyte infection is made by examination of the scale or subungual
debris with KOH demonstrating the presence of branching hyphae.

Question 288

Which clinical condition is associated with yeast spores characterized by “spaghetti
and meatballs” microscopic appearance?

Answer 288

Pityriasis (tinea) versicolor

Question 289

Which clinical condition is associated with pseudohyphae and spores?

Answer 289

Candida is associated with pseudohyphae and spores.

Question 290

What clinical condition is associated with the photo?

Answer 290

Pityriasis Versicolor

Question 291

What is the MAIN difference between Tinea cruris and intertrigo?.

Answer 291

Tinea cruris spares the scrotum, whereas intertrigo does not.

Question 292

Which clinical condition is associaTED WITH THIS PIC?

Answer 292

Tinea Infection

Question 293

Which clinical condition is associated with a round or oval erythematous scaling patch that
spreads centrifugally with central clearing. It has an active border that is raised,
consisting of tiny papules or vesicles and scale

Answer 293

Tinea Infection:

Question 294

Which clinical syndrome is associated with this pic?

Answer 294

Chronic Tinea Pedis:

Question 295

Which clinical condition is associated with the pic?

Question 296

Which clinical condition is associated with aright red papules, vesicles, pustules, and patches with satellite papules and pustules?

Answer 296

andidiasis.

Question 297

Which clinical syndrome is associated with this pic?

Answer 297

Onychomycosis

Question 298

What is the recommended treatment of pityriasis versicolor?

Answer 298

Topical ketoconazole, selenium sulfide

Question 299

What is the recommended tx for Confirmed onychomycosis, tinea capitis, extensive tinea corporis, or treatment-resistant dermatophytosis?

Answer 299

Oral terbinafine or itraconazole

Question 300

Whare ate most Most dermatophyte infections except tinea capitis and
onychomycosis tx with?

Answer 300

Topical terbinafine or imidazole creams, such as miconazole, clotrimazole, and ketoconazole

Question 301

What are Candida infections typically tx with?

Answer 301

Candida infections Topical nystatin, miconazole, clotrimazole, ketoconazole, econazole

Question 302

When is Treatment of onychomycosis required?

Answer 302

Treatment of onychomycosis is typically not necessary but is recommended for
patients with peripheral vascular disease or diabetes to prevent the development of
cellulitis.

Question 303

If a patient has thick, yellow, and crumbling toenails without KOH scraping or positive culture for dermatophytes, do they require tx?

Answer 303

Do not select antifungal treatment for thick, yellow, and crumbling toenails
without KOH scraping or positive culture for dermatophytes.

Question 304

When is tx with a combination of a topical antifungal agent and a glucocorticoid for
of an unknown skin rash or dermatophyte infection acceptable?

Answer 304

Never select a combination of a topical antifungal agent and a glucocorticoid for
treatment of an unknown skin rash or dermatophyte infection.

Question 304

When is tx with a combination of a topical antifungal agent and a glucocorticoid for
of an unknown skin rash or dermatophyte infection acceptable?

Answer 304

Never select a combination of a topical antifungal agent and a glucocorticoid for
treatment of an unknown skin rash or dermatophyte infection.

Question 305

When is oral ketoconazole as initial antifungal treatment indicated?

Answer 305

Do not choose oral ketoconazole as initial antifungal treatment because of the
risk of severe hepatotoxicity.

Question 306

which clinical conditions can present as a
hypopigmented, scaly macules present on the chest?

Answer 306

Pityriasis Versicolor:

Question 307

Which clinical syndrome is associated with acute onset of generalized papular eruption, facial edema, fever, arthralgia, generalized
lymphadenopathy, elevated serum aminotransferase levels, eosinophilia, and lymphocytosis?

Answer 307

Drug-induced hypersensitivity syndrome (also known as DRESS)

Question 308

What is the difference in percent coverage for
SJS vs TEN ?

Answer 308

Spectrum ranges from classic target lesions (EM), to involvement of mucous membranes with

systemic symptoms (SJS), to a life-threatening loss of epidermis (TEN)
SJS involves <10%, SJS/TEN overlap involves 10%-30%, and TEN involves >30% skin
detachment

Question 309

Which clinical syndrome is associated with body flushing, hypotension, and muscle pain associated with vancomycin and ciprofloxacin?

Answer 309

Red man syndrome

Question 310

Which clinical syndrome is associated with tender subcutaneous nodules on lower leg; often preceded by a prodrome of fever, malaise,
and/or arthralgia?

Answer 310

Erythema nodosum

Question 311

What is the most common type of drug reaction; symmetric distribution, usually truncal, hardly ever on palms or soles, and associated with fever and pruritus?

Answer 311

Maculopapular and morbilliform

Question 311

What is the most common type of drug reaction; symmetric distribution, usually truncal, hardly ever on palms or soles, and associated with fever and pruritus?

Answer 311

Maculopapular and morbilliform

Question 312

Does The absence of eosinophilia does not rule out drug reaction or DRESS?

Answer 312

No

Question 313

what is the treatment for drug-induced hypersensitivity syndrome ?

Answer 313

Treat drug-induced hypersensitivity syndrome with systemic glucocorticoids.

Question 314

What is the tx for SJS/TEN?

Answer 314

SJS/TEN treatment is supportive (fluid and electrolyte management, wound care); the
effectiveness of IVIG and glucocorticoids is uncertain.

Question 315

Discrete round to oval lesions are characteristic of which rx?

Answer 315

Discrete round to oval lesions are characteristic of a fixed drug eruption.

Question 316

Which clinical syndrome is associated with this pic?

Answer 316

Fixed Drug Eruption

Question 317

Which clinical syndrome is associated with this pic?

Answer 317

Drug-Induced Hypersensitivity Syndrome

Question 318

Which clinical syndrome is associated with this pic?

Answer 318

Morbilliform Drug Eruption

Question 319

Which clinical syndrome is associated with of symmetrically arranged erythematous
macules and papules—some discrete and others confluent.?

Answer 319

Morbilliform Drug Eruption:

Question 320

Which clinical syndrome is associated with the appearance of a maculopapular rash and with the use of ampicillin?

Answer 320

The appearance of a maculopapular rash is associated with the use of ampicillin in EBV
and CMV infections or underlying ALL. This is not a drug allergy.

Question 321

who should be screened for high cholesterol?

Answer 321

The USPSTF recommends universal lipid screening in adults aged 40 to 75 years to calculate risk for ASCVD using the AHA/ACC Pooled Cohort Equations.

Question 322

When is it appropriate to obtain lipoprotein(a), apolipoprotein B, or LDL particles in the evaluation
of dyslipidemia?

Answer 322

Do not obtain lipoprotein(a), apolipoprotein B, or LDL particles in the evaluation
of dyslipidemia.

Question 323

When should adults use a low- to moderate-dose statin for the primary prevention of CVD events and mortality ?

Answer 323

The USPSTF recommends that adults use a low- to moderate-dose statin for the
primary prevention of CVD events and mortality when all of the following criteria are
met:
* age 40 to 75 years
* ≥1 CVD risk factors (e.g., dyslipidemia, diabetes, hypertension, smoking)
* calculated 10-year risk of a cardiovascular event of ≥10%

Question 324

When should patients be evaluated for familial
hypercholesterolemia?

Answer 324

Patients with an LDL cholesterol level of ≥190 mg/dL and those with an ST-segment
elevation myocardial infarction at age ≤50 years should be evaluated for familial
hypercholesterolemia.

Question 325

When should Ezetimibe be used for primary prevention of ASCVD ?

Answer 325

Ezetimibe may be used for primary prevention of ASCVD in patients with an LDL cholesterol level ≥190 mg/dL who do not achieve a 50% reduction and/or have an LDL cholesterol level ≥100 mg/dL while taking maximally tolerated statin therapy.

Question 326

In which conditions should patients use statins for for secondary prevention of ASCVD?

Answer 326

• acute coronary syndrome
• history of MI, stable or unstable angina, coronary or other arterial
  revascularization
• stroke or TIA
• PAD or abdominal aortic aneurysm

Question 327

Which baseline labs should be obtained prior in patients starting a statin?

Answer 327

Baseline laboratory studies and monitoring:
* baseline fasting lipid panel and ALT level

Question 328

In patients starting a statin, when should MONITOR ALT and CK ?

Answer 328

monitor ALT and CK only if a patient develops symptoms of hepatic or muscle
disease

Question 329

At what level are Fibrates are indicated in patients with severe hypertriglyceridemia?

Answer 329

Fibrates are indicated in patients with severe hypertriglyceridemia (≥500 mg/dL) to prevent acute pancreatitis.

Question 330

What potential complication can occur with hypertriglyceridemia (≥500 mg/dL)?

Answer 330

acute pancreatitis.

Question 331

In patients with persistently elevated triglyceride levels despite statin therapy who have
ASCVD or diabetes and several other risk factors, what else can be added to decrease the risk for cardiovascular events?

Answer 331

the addition of icosapent ethyl may
decrease the risk for cardiovascular events.

Question 332

What are two options for first line treatment of primary dysmenorrhea?

Answer 332

Primary dysmenorrhea is treated symptomatically without further testing with NSAIDs
and COX-2 inhibitors.

Question 333

What are two options for second line treatment of primary dysmenorrhea?

Answer 333

Second-line therapy includes combined hormonal contraceptive therapy.

Question 334

What are effective first-line treatments for PMS and PMDD?

Answer 334

Fluoxetine, sertraline, and paroxetine are effective first-line treatments for PMS and
PMDD.

Question 335

What clinical syndrome is associated with the pic?

Answer 335

Dysplastic Nevi

Question 336

When should be the next step when Dysplastic nevi develop increased characteristics associated with melanoma (fuzzy or ill-defined borders,
multiple colors, diameter ≥5 mm), have otherwise changed, or stand out from other nevi ?

Answer 336

must be removed and sent for pathology.

Question 337

Which diagnostic clues suggest the restricting type of anorexia ?

Answer 337

• low BMI
• fear of weight gain
• distorted body image
• amenorrhea

Question 338

Which two electrolyte abnormalities can be seen in those with anorexia and refeeding syndrome?

Answer 338

During the first few weeks of eating, patients are at risk for the refeeding syndrome, which can include cardiac arrest and delirium caused by
exacerbation of hypophosphatemia and hypokalemia.

Question 339

Can you consider bupropion as an option for eating disorders?

Answer 339

Do not choose bupropion for eating disorders because of the increased
incidence of seizures.

Question 340

Which type of anprexia has episodes of binging with loss of control followed by purging (vomiting, diuretic or laxative abuse), fasting, or excessive exercise WITH normal weight?

Answer 340

bulimia nervosa

Question 341

Which electrolyte abnormalities can be seen in those with bulimia nervosa?

Answer 341

electrolyte
derangements (low chloride and potassium), and metabolic alkalosis.

Question 342

What is the difference in treatment for anorexia nervosa, compared to bulimia ?

Answer 342

For anorexia nervosa, psychotherapy is considered first-line treatment. Psychotropic
drugs do not work.
Patients with bulimia respond to CBT; antidepressants may be beneficial.

Question 343

Which clinical syndrome is associated with dry skin, intense pruritus with erythematous papules and vesicles, crusting, and oozing, skin thickening from chronic scratching, with scaling and fissuring?

Answer 343

Acute eczematous dermatitis

Question 344

which clinical syndrome is associated with development of eczema in patients with allergic rhinitis, asthma?

Answer 344

Atopic dermatitis

Question 345

Which infection is most associated with atopic dermatitis?

Answer 345

complicating S. aureus infection evidenced by pustules, crusting, and erosions

Question 346

Which type of hypersensitivity is associated with contact dermatitis?

Answer 346

Contact dermatitis includes allergic contact dermatitis (type IV hypersensitivity
reaction)

Question 347

which clinical syndrome is characterized by pruritic, erythematous plaques
on the palmar and dorsal hands, which can lead to fissuring and lichenification?

Answer 347

hand dermatitis

Question 348

Which clinical syndrome is associated with inflammatory, scaling, itchy dermatosis that most
commonly affects the scalp but can also involve the eyebrows, nasolabial folds, chin,
central chest, and perineum?.

Answer 348

Seborrheic dermatitis

Question 349

Explosive onset of WHICH CLINICAL DERM SYNDROME may be a sign of HIV infection?

Answer 349

Seborrheic dermatitis

Question 350

A 28-year-old man is evaluated for severe seborrheic dermatitis of acute onset. What should be the next step?

Answer 350

Answer: For evaluation, order HIV testing.

Question 351

Which two ointments, commonly used for wound care, can cause an allergic contact dermatitis that mimics a wound infection?

Answer 351

Neomycin and bacitracin, commonly used for wound care, can cause an allergic
contact dermatitis that mimics a wound infection.

Question 352

Which clinical syndrome is associated with discretely grouped red vesicles and bullae in a linear distribution ?

Answer 352

Discretely grouped red vesicles and bullae in a linear distribution are characteristic of
contact dermatitis caused by poison ivy.

Question 353

which clinical syndrome is associated with this pic?

Answer 353

Contact Dermatitis

Question 354

which clinical syndrome is associated with this pic?

Answer 354

Atopic Dermatitis

Question 355

which clinical syndrome is associated with the antecubital fossae, with lichenification and surrounding excoriations?

Answer 355

Atopic Dermatitis

Question 356

What is the recommended treatment for Seborrheic dermatitis?

Answer 356

Seborrheic dermatitis:
* selenium sulfide or zinc pyrithione shampoos
* ketoconazole shampoo (not oral ketoconazole)

Question 357

which clinical syndrome is associated with this pic?

Answer 357

Seborrheic Dermatitis

Question 358

For facial eczema, is it reasonable select potent glucocorticoids for the face?

Answer 358

Do not select potent glucocorticoids for the face because of the risk of steroid-
induced acne and cutaneous atrophy.

Question 359

Where do Ninety percent of epistaxis cases originate?.

Answer 359

Ninety percent of epistaxis cases originate in the anterior nasal septum.

Question 360

Which cases of epistaxis are more likely to result in significant hemorrhage?

Answer 360

Posterior
bleeds are more likely to result in significant hemorrhage.

Question 361

What is the initial management of Anterior nose bleeds vs for continued nose bleeding ?

Answer 361

Anterior bleeds can be managed with compression of the lower one third of the nose. If
anterior rhinoscopy can identify the bleeding site, topical vasoconstrictors (e.g.,
oxymetazoline) and nasal cautery are used for continued bleeding.

Question 362

In a patient with erectile dysfunction WHO has the ability to achieve nocturnal and early morning erections, which alternate cause should be considered?

Answer 362

Erectile dysfunction occurring with preserved ability to achieve nocturnal and early morning
erections should raise suspicion for psychogenic cause.

Question 363

What testing should be obtained in all patients with suspected erectile dysfunction?

Answer 363

Obtain a morning total testosterone level for all patients.

Question 364

In a patient with ED, when should you suspect overuse of steroids?

Answer 364

Suspect androgen steroid
abuse in patients with infertility, muscular hypertrophy, testicular atrophy, and acne;
laboratory data show elevated hemoglobin and suppressed LH and FSH levels.

Question 365

What options are First-line pharmacotherapy for erectile
dysfunction ?

Answer 365

First-line pharmacotherapy for erectile dysfunction is oral PDE-5 inhibitors (sildenafil, vardenafil [on demand], or tadalafil
[daily]).

Question 366

What are the two main contraindications to use of oral PDE-5 inhibitors (sildenafil, vardenafil, tadalafil)?

Answer 366

These drugs are contraindicated in men who receive nitrate therapy in any form and in men with a history of nonarteritic anterior ischemic optic neuropathy.

Question 367

What are the potential caution ramification for taking α-blockers along with PDE-5 inhibitors (sildenafil, vardenafil, tadalafil) for ED?

Answer 367

They
should be used with caution in men taking α-blockers because of the risk of
hypotension.

Question 368

For men who can not take PDE-5 inhibitors for treatment of ED, Whatt is the second line option?

Answer 368

Intraurethral or intracavernous alprostadil is a second-line therapy for men who cannot take PDE-5 inhibitors.

Question 369

which clinical syndrome is associated with this pic?

Answer 369

Erythema Multiforme

Question 370

which clinical syndrome is associated with a target-like lesions with outer rings around a violaceous or dark center, blister,
or erosion?

Answer 370

Erythema Multiforme

Question 371

What is the most common inciting factor for Erythema Multiforme?

Answer 371

Recurrent HSV infection is the most common inciting factor.

Question 372

For Recurrent episodes of EM, what is the best next step in management?

Answer 372

Recurrent episodes of Erythema Multiforme may be managed with antiviral suppressive therapy for HSV
infection.

Question 373

Should acute EM-associated HSV with antivirals?

Answer 373

Do not treat acute EM-associated HSV with antivirals.

Question 374

What is the difference between EM and erythema migrans?

Answer 374

Do not confuse EM with erythema migrans, the rash of Lyme disease (red macule
with central clearing as the macule expands).

Question 375

which clinical syndrome is associated with with otalgia, ear discharge, pruritus, and
conductive hearing loss?

Answer 375

typical external otitis

Question 376

what is the different in patients who have malignant external otitis vs typical external otitis?

Answer 376

Malignant external otitis is characterized by systemic toxicity and evidence of
infection spread beyond the ear canal (mastoid bone, cellulitis) and is typically found in older adult patients with type 2 diabetes

Question 377

What is the most common cause of malignant external otitis in older adult patients with type 2 diabetes or patients who are
immunocompromised?

Answer 377

It is most commonly caused by Pseudomonas aeruginosa.

Question 378

Which clinical syndrome is caused by varicella-zoster viral infection and characterized by facial nerve paralysis, sensorineural hearing loss, and vesicular lesions on and in the ear canal?

Answer 378

Ramsay Hunt syndrome

Question 379

which clinical syndrome is associated with this pic?

Answer 379

Ramsay Hunt Syndrome:

Question 380

What is the recommended treatment for malignant
external otitis vs Ramsay Hunt syndrome?

Answer 380

Select systemic antipseudomonal antibiotics and hospitalization for malignant external otitis, and antiviral agents for Ramsay Hunt syndrome.

Question 381

What is the next step for any patient with combination of red eye, ocular pain, and visual loss ?

Answer 381

The combination of red eye, ocular pain, and visual loss warrants emergent referral to
an ophthalmologist.

Question 382

Which clinical syndrome is associated with unilateral then bilateral mucoid/purulent discharge without pain
or visual disturbance?

Answer 382

Bacterial
conjunctivitis

Question 383

What is the treatment for bacterial
conjunctivitis?

Answer 383

Topical trimethoprim-polymyxin B or erythromycin for immunocompromised
patients.

Question 384

Which clinical syndrome is associated with eye inflammation associated with herpes zoster rash involving ophthalmic division of fifth cranial nerve?

Answer 384

Herpes
zoster
conjunctivitis

Question 385

What is the treatment for Herpes
zoster conjunctivitis?

Answer 385

Emergency ophthalmology referral

Question 386

which clinical syndrome is associated with Acute hyper purulent discharge in a sexually active adult?

Answer 386

Neisseria
gonorrhoeae
conjunctivitis

Answer 387

Topical and systemic antibiotics and
emergency ophthalmology referral

Question 388

which clinical syndrome is associated with Unilateral then bilateral conjunctivitis with daytime watery or mucoid discharge? and how is it treated?

Answer 388

Viral conjunctivitis and supportive care

Question 389

Which clinical syndrome is associated with Itching and tearing of the eyes, nasal congestion ?

Answer 389

Allergic
conjunctivitis

Question 390

What is the clinical syndrome associated with Severe eye discomfort with difficulty keeping the affected eye open, blurred or diminished vision, photophobia, circumferential redness (ciliary flush) at the corneal limbus (junction of the cornea and sclera)?

Answer 390

Keratitis

Question 391

which clinical syndrome is associated with Unilateral deep ocular pain, nausea, vomiting, fixed nonreactive
pupil, shallow anterior chamber?

Answer 391

Acute angle closure glaucoma

Question 392

which clinical syndrome is associated with Severe ocular pain that worsens WITH eye movement and light exposure;?

Answer 392

Scleritis

Question 393

which clinical syndrome is associated with ankylosing spondylitis and reactive arthritis, has Circumferential redness (ciliary flush) at the corneal limbus
(junction of the cornea and sclera), hypopyon may be visible?

Answer 393

Iritis (anterior uveitis)

Question 394

What is the difference between episcleritis and scleritis?

Answer 394

episcleritis is non painful, Localized nonpainful red, flat, superficial lesion that allows
visualization of the underlying vasculature

Question 395

Should you ever treat a red eye with topical glucocorticoids?

Answer 395

Do not treat a red eye with topical glucocorticoids.

Question 396

which clinical syndrome is associated with this pic?

Answer 396

Bacterial Conjunctivitis

Question 397

which clinical syndrome is associated with this pic?

Answer 397

Herpes Zoster

Question 398

which clinical syndrome is associated with this pic?

Answer 398

Viral Conjunctivitis

Question 399

which clinical syndrome is associated with this pic?

Answer 399

Allergic Conjunctivitis:
Allergic conjunctivitis with prominent cobble stoning of the palpebral conjunctiva is
shown.

Question 400

which clinical syndrome is associated with this pic?

Answer 400

Episcleritis

Question 401

which clinical syndrome is associated with this pic?

Answer 401

Iritis:

Question 402

Which clinical syndrome is associated with floaters, flashes of
light (photopsias), and squiggly lines, followed by a sudden, peripheral visual field defect that resembles a black curtain and progresses across the entire visual field?

Answer 402

Retinal Detachment

Question 403

which clinical syndrome is associated with glare sensitivity and vision impairment, particularly at night?

Answer 403

Cataracts

Question 404

which clinical syndrome is associated with bilateral ocular pain, foreign-body sensation, light sensitivity, tearing, and irritation/redness.?

Answer 404

Dry eye (keratoconjunctivitis sicca)

Question 405

which clinical syndrome is associated with peripheral visual field loss, progression to central vision loss ?

Answer 405

Primary Open-Angle Glaucoma

Question 406

What associated condition should be considered in patients with dry eye (keratoconjunctivitis sicca?

Answer 406

Consider Sjögren syndrome.

Question 407

which clinical syndrome is associated with include severe eye pain, foreign-body
sensation, light sensitivity, and tearing FOLLOWING mechanical trauma?

Answer 407

Corneal Abrasions

Question 408

In a patient with a history of one fall in the past year or those who feel unsteady or unbalanced what evaluation should they have next?

Answer 408

Patients with a history of one fall in the past year or those who feel unsteady or
unbalanced should be evaluated for balance or gait disturbance with a Timed Up and
Go test.

Question 409

What is an abnormal Timed Up and Go test?

Answer 409

Timed Up and Go test. A time of longer than 12 seconds is abnormal, and the patient should be referred for full fall evaluation.

Question 410

In a woman with sexual dysfunction, what other condition should be screened for?

Answer 410

Screening for concurrent
depression is indicated because sexual dysfunction and depression often coexist.

Question 411

what is the first-line therapy to alleviate dyspareunia from vaginal atrophy?

Answer 411

Use lubricants

Question 412

What is second-line therapy for women with female sexual dysfunction and sx

Answer 412

Low-dose vaginal estrogen is second-line therapy for women without contraindications to

estrogen.

Question 413

which med can be used to treat women with low sexual desire?

Answer 413

Flibanserin may be used to treat women with low sexual desire; however, its use is
limited by side effects.

Question 414

Benzos should be avoided in patients with what disorder?

Answer 414

Benzodiazepines should be avoided in patients with a history
of substance use disorder.

Question 415

In patients with conductive hearing loss, how does the weber test result?

Answer 415

Louder in the affected ear. Wbber is loud and affected.

Question 416

In patients with Sensorineural hearing loss, how does the weber test result?

Answer 416

Louder in the good ear

Question 417

In patients with Sensorineural hearing loss, how does the rinne test result?

Answer 417

As loud or louder in the
affected ear (air conduction >
bone conduction)

Question 418

For patients with
progressive AAAAsymmetric sensorineural hearing loss, which test should be next in evaluation?

Answer 418

For patients with
progressive asymmetric sensorineural hearing loss, select MRI or CT to evaluate for
acoustic neuroma.

Question 419

Who should get the recombinant zoster vaccine ?

Answer 419

Administer the recombinant zoster vaccine to adults 50 years and older to prevent or
attenuate illness caused by herpes zoster infection and to reduce the risk of postherpetic neuralgia.

Question 420

Which clinical syndrome is associated with localized pain and a vesicular rash in a dermatomal distribution are characteristic
features?

Answer 420

Herpes Zoster

Question 421

For patients with severe, complicated, or recurrent herpes zoster what testing should be considered next?.

Answer 421

Severe, complicated, or recurrent herpes zoster should trigger testing for possible
associated HIV infection.

Question 422

Which clinical syndrome is associated with vesicles in the ears, diminished taste on the anterior two thirds of the tongue,
and ipsilateral facial paralysis? What is the next step?

Answer 422

(Ramsay Hunt syndrome), require referral to an ENT
specialist.

Question 423

What is the treatment for Herpes zoster?

Answer 423

Give valacyclovir, famciclovir, or acyclovir if lesion onset is within 72 hours of
contemplated treatment.

Question 424

How do you diagnose Herpes zoster ?

Answer 424

Typically a clinical diagnosis; Obtain rapid tests, such as direct-
fluorescent antibody and PCR studies on scrapings from active vesicular skin lesions that have not yet crusted, or viral culture from a vesicle when the diagnosis is unclear.

Question 425

How does the treatment for Disseminated zoster differ?

Answer 425

Disseminated zoster requires IV therapy and both contact and airborne precautions.

Question 426

What are the treatment options for postherpetic neuralgia?

Answer 426

Treat postherpetic neuralgia with gabapentin, pregabalin, tricyclic antidepressants, or
topical lidocaine or capsaicin.

Question 427

Should you Administer recombinant varicella-zoster vaccine to patients 50 years and older if no previous history of varicella infection or previous immunization with live attenuated vaccine?

Answer 427

Administer recombinant varicella-zoster vaccine to patients 50 years and older
regardless of previous history of varicella infection or previous immunization with
live attenuated vaccine.

Question 428

Can you use topical acyclovir or penciclovir for the treatment of herpes zoster?

Answer 428

Do not select topical acyclovir or penciclovir for the treatment of herpes zoster.

Question 429

Which clinical syndrome is associated with this pic?

Answer 429

34. Herpes Zoster

Question 430

For what two conditions should we obtain polysomnography?

Answer 430

Obtain polysomnography only
for suspected sleep apnea or periodic limb movement disorder.

Question 431

Which clinical syndrome is associated with An uncomfortable or restless feeling in the legs most prominent at night and at rest, associated with an
urge to move and alleviated by movement?

Answer 431

Restless legs
syndrome

Question 432

Which deficiency is associated with Restless legs syndrome?

Answer 432

Look for iron deficiency

Question 433

Which clinical syndrome is associated with repetitive pauses in breathing during sleep without upper airway occlusion?

Answer 433

Central sleep apnea

Question 434

In Central sleep apnea
syndrome, what other conditions are associated with this?

Answer 434

history of HF or CNS disease

Question 435

Which clinical syndrome is associated with upper airway obstruction during inspiration in sleep, history of snoring, witnessed pauses in respiration, large shirt collar size, and daytime sleepiness?

Answer 435

Obstructive sleep apnea syndrome

Question 436

Which clinical syndrome is associated with daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently coexisting with other sleep disorders?

Answer 436

Narcolepsy

Question 436

Which clinical syndrome is associated with daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently coexisting with other sleep disorders?

Answer 436

Narcolepsy

Question 436

Which clinical syndrome is associated with daytime sleepiness with cataplexy, hypnagogic hallucinations, and sleep paralysis frequently coexisting with other sleep disorders?

Answer 436

Narcolepsy

Question 437

What is the first line vs second treatment for insomnia ?

Answer 437

CBT for insomnia (first-line therapy), and pharmacologic therapy is second-line treatment for insomnia. Nonbenzodiazepine
drugs (zolpidem, zaleplon, eszopiclone) are preferred to benzodiazepines; sedation,

Question 438

What is the treatment for restless legs syndrome?

Answer 438

Restless legs syndrome is treated with dopaminergic agents (pramipexole or ropinirole)
or with levodopa-carbidopa.

Question 439

When do you prescribe supplemental iron for patients with restless legs
syndrome ?

Answer 439

Prescribe supplemental iron for patients with restless legs
syndrome when the serum ferritin level is <75 ng/mL.

Question 440

Which nutrient deficiency is associated with Ecchymosis?

Answer 440

Vitamins C and K

Question 441

Which nutrient deficiency is associated with Petechiae, perifollicular hemorrhage, gingival bleeding?

Answer 441

Vitamin C

Question 442

Which nutrient deficiency is associated with Angular stomatitis and cheilosis?

Answer 442

Vitamin B complex, iron, and protein

Question 443

Which nutrient deficiency is associated with Acro-orificial dermatitis (erythematous, vesiculobullous, and pustular)?

Answer 443

Zinc

Question 444

Which nutrient deficiency is associated with Skin pigmentation, cracking, and crusting?

Answer 444

Niacin

Question 445

Which nutrient deficiency is associated with memory disturb?

Answer 445

Vitamin B12

Question 446

Which nutrient deficiency is associated with Ophthalmoplegia and foot drop?

Answer 446

Thiamine

Question 447

Which nutrient deficiency is associated with Glossitis?

Answer 447

Niacin and vitamin B12

Question 448

Which nutrient deficiency is associated with Wernicke-Korsakoff syndrome?

Answer 448

Severe thiamine deficiency

Question 449

Which nutrient deficiency is associated with Night blindness?

Answer 449

Vitamin A

Question 450

Which nutrient deficiency is associated with depression?

Answer 450

vitamin c

Question 451

Which clinical syndrome is associated with this pic?

Answer 451

Lentigo Maligna

Question 452

Which skin cancer appears as a brown patch on sun-exposed skin?

Answer 452

Lentigo Maligna. This melanoma in situ appears as a brown patch on sun-exposed skin.

Question 453

Which clinical syndrome is associated with asymmetric pigmented skin lesion has irregular, scalloped, notched, and
indistinct borders with variegated coloration.?

Answer 453

Melanoma

Question 454

Which clinical syndrome is associated with this pic?

Answer 454

Melanoma

Question 455

Which clinical syndrome is associated with this pic?

Answer 455

Acral Melanoma

Question 456

Which clinical syndrome is associated with skin cancer on the toe?

Answer 456

Acral Melanoma

Question 457

What is the preferred biopsy technique for most varieties of melanoma?

Answer 457

Complete excision is the preferred biopsy technique for most varieties of melanoma

Question 458

When is sentinel lymph node biopsy is indicated for melanomas ?

Answer 458

Sentinel lymph node biopsy is indicated for melanomas >1 mm thick. The extent of
the surgical excision depends on the thickness of the primary melanoma.

Question 459

Should you order hormone levels to diagnose menopause.?

Answer 459

no

Question 460

What are the most Common contraindications to hormone therapy for menopause?

Answer 460

Common contraindications to hormone therapy include pregnancy, unexplained vaginal
bleeding, liver disease, CAD, stroke, VTE, breast cancer, and endometrial cancer.

Question 461

Which clinical conditions is associated with inflammation of a bursa that lies in the posterior aspect of the elbow and presents
as a fluid-filled mass, may result from repetitive trauma, infection, or systemic inflammatory conditions.?

Answer 461

Olecranon bursitis

Question 462

what is the man physical exam difference between Olecranon bursitis and MSK joint related
issues?

Answer 462

Olecranon bursitis does not
cause restricted movement with range of motion of the elbow, whereas joint pathology
causes pain and restricted movement.

Question 463

Under what circumstances should you aspirate a bursa?

Answer 463

Aspirate a bursa if tender or warm to analyze fluid for crystals and infection.

Question 464

What is the first-line treatment for Olecranon bursitis?

Answer 464

NSAIDs, elbow protection pads, and rest (if noninfectious) are first-line treatments.

Question 465

Should you obtain imaging studies in patients with findings compatible with epicondylitis?

Answer 465

Do not obtain imaging studies in patients with findings compatible with
epicondylitis.

Question 466

Which clinical syndrome is associated with involves pain and tenderness at either the insertion of the extensor radii
tendons or the flexor carpi radialis tendons?

Answer 466

Epicondylitis involves pain and tenderness at either the insertion of the extensor radii
tendons (lateral epicondylitis) or the flexor carpi radialis tendons (medial epicondylitis).

Question 466

Which clinical syndrome is associated with involves pain and tenderness at either the insertion of the extensor radii
tendons or the flexor carpi radialis tendons?

Answer 466

Epicondylitis involves pain and tenderness at either the insertion of the extensor radii
tendons (lateral epicondylitis) or the flexor carpi radialis tendons (medial epicondylitis).

Question 467

Which back pain red flags suggest the need for early imaging?

Answer 467

malignancy (history of cancer, weight loss)
* spinal infection (localized pain, fever, injection drug use, UTI)
* fracture (trauma)
* cauda equina syndrome (bilateral leg weakness, urinary retention, saddle anesthesia)

Question 468

Which are signs of hernated disk that require imaging?

Answer 468

• positive straight leg raise test
• weakness of the ankle and great toe dorsiflexion (L5)
• loss of ankle reflexes (S1)
• less commonly, loss of knee reflex (L4)

Question 469

which two exam findings are most suggestive of spinal stenosis?

Answer 469

A wide-based gait and/or abnormal Romberg test is >90% specific for spinal stenosis.

Question 470

which type of back pain requires urgent surgery?

Answer 470

Neoplastic epidural spinal cord compression, including cauda equina syndrome, is a
surgical emergency.

Question 471

What is the next best step in management for a patient with spinal cord compression, including cauda equina syndrome?

Answer 471

Begin management by administering dexamethasone and
obtaining immediate MRI of the entire spine.

Question 472

what is The most common cause of knee pain in patients aged <45 years, especially women?

Answer 472

The most common cause of knee pain in patients aged <45 years, especially women, is
the patellofemoral pain syndrome.

Question 473

Which clinical syndrome is associated with knee pain exacerbated by overuse (running), by descending stairs, or after prolonged sitting?

Answer 473

patellofemoral pain syndrome.

Question 474

what is the physical exam finding to confirm patellofemoral pain syndrome?

Answer 474

Diagnosis is confirmed by firmly compressing the patella against the femur and moving it up and
down along the groove of the femur, reproducing pain.

Question 475

Which clinical syndrome is associated with anterior knee pain and swelling anterior to the
patella, caused by trauma
or repetitive kneeling?

Answer 475

Prepatellar bursitis

Question 476

Which clinical syndrome is associated with of knife-like lateral knee pain that occurs with vigorous flexion-extension activities of the knee (running)?

Answer 476

Iliotibial band syndrome

Question 477

Which clinical syndrome is associated with knee pain that is worse with activity and at night, located medially about 6 cm below the joint line?

Answer 477

Anserine bursitis