MKSAP IM III

Question 1

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

Answer 1

epididymitis

Question 2

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment; ____ can be considered in patients who have had an inadequate response to nonpharmacologic therapy.

Answer 2

NSAIDs (APAP has not shown any effect in acute/chronic back pain)

Question 3

Recurrent unilateral epistaxis may be a sign of neoplasm and warrants referral for ___.

Answer 3

nasal endoscopy

Question 4

Signs of opioid-induced toxicity

Answer 4

Cognitive slowing, hyperreflexia, and myoclonus as a result of the neuroexcitatory effects of long-term opioid use

Question 5

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 _________ in the case of bare metal stent placement or ______ after drug-eluting stent placement.

Answer 5

minimum of 30 days;3 months

If there is surgery, then hold 5-7 days prior.

Question 6

The 23-valent pneumococcal polysaccharide vaccine should be administered to select immunocompetent patients aged 19 to 64 years, including those with _____ (8).

Answer 6

1. chronic heart
2. liver
3. lung disease
4. diabetes mellitus
5. cochlear implants
6. cerebrospinal fluid leak
7. alcoholism
8. cigarette smoking

Question 7

In adults aged 19 to 64 years with _____ (3) PCV13 should be administered

Answer 7

1. with immunocompromise
2. cochlear implants
3. history of cerebrospinal fluid leaks

Question 8

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. The direction of nystagmus may vary depending on the direction of the patient’s gaze.

Answer 8

Central vertigo (indicative of vertebrobasilar ischemia, hemorrhage of cerebellum or brainstem)

Question 9

nystagmus that is delayed in onset (presence of latency), is of short duration (<1 minute), exhibits fatigability (habituation), and is primarily unidirectional (usually up-beating and torsional [rotary phenomenon]).

Answer 9

Peripheral vertigo (labyrinthitis if hearing is affected), vestibular neuronitis, Meniere disease, acoustic neuroma)

Question 10

Prepatellar bursitis can be caused by repetitive trauma, infection, or gout; ___ and subsequent analysis should be performed in all patients.

Answer 10

fluid aspiration

Question 11

Patients present with anterior knee pain and swelling. Physical examination reveals a palpable fluid collection with preserved active and passive range of motion of the knee.

Answer 11

Prepatellar bursitis

Question 12

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

Answer 12

advanced static mattress

Question 13

In patients aged ____ to _____ years with no atherosclerotic cardiovascular disease or diabetes mellitus and with a 10-year ASCVD risk of ____ or higher accompanied by the presence of ASCVD risk enhancers, recommend MODERATE-intensity statin.

Answer 13

40 to 75; 7.5%

Question 14

In patients with a fasting triglyceride level of ____ or higher, triglyceride-lowering drug therapy is useful to prevent pancreatitis. ____, result in an average reduction in triglyceride levels of 30% to 50%, but this patient does not have an indication for fibrate therapy.

Answer 14

500; Fibrates (gemfibrozil)

Question 15

A _____, determined by ultrasonography, can confirm a suspected case of overflow urinary incontinence.

Answer 15

postvoid residual urine volume

Question 16

chronic pelvic pain and intermittent voiding symptoms without evidence of infection.

Answer 16

Chronic pelvic pain syndrome (treatment with both pharmacologic and nonpharmacologic strategies; among the pharmacologic options are neuromodulatory agents, such as pregabalin, gabapentin, and nortriptyline)

Question 17

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

Answer 17

Central retinal artery occlusion

Question 18

Is nebulized morphine a thing?

Answer 18

No

Question 19

Do you give ASA for ASCVD primary prevention in someone with afib an on AC?

Answer 19

No, bleed risk too high