Quiz 42 Flashcards
Which one of the following is NOT considered a first-line treatment for head lice? (check one)
A. Lindane 1%
B. Malathion 0.5% (Ovide)
C. Permethrin 1% (Nix)
D. Pyrethrins 0.33%/pipernyl butoxide 4% (RID)
Lindane’s efficacy has waned over the years and it is inconsistently ovicidal. Because of its neurotoxicity, lindane carries a black box warning and is specifically recommended only as second-line treatment by the FDA. Pyrethroid resistance is widespread, but permethrin is still considered to be a first-line treatment because of its favorable safety profile. The efficacy of malathion is attributed to its triple action with isopropyl alcohol and terpineol, likely making this a resistance-breaking formulation. The probability of simultaneously developing resistance to all three substances is small. Malathion is both ovicidal and pediculicidal.
Which one of the following is a frequent cause of cross-reactive food-allergy symptoms in latex-allergic individuals? (check one) A. Avocadoes B. Goat’s milk C. Pecans D. Pastrami E. Peppermint
The majority of patients who are latex-allergic are believed to develop IgE antibodies that cross-react with some proteins in plant-derived foods.
Avocadoes
A 42-year-old female is found to have a thyroid nodule during her annual physical examination. Her TSH level is normal. Ultrasonography of her thyroid gland shows a solitary nodule measuring 1.2 cm.
Which one of the following would be most appropriate at this point?
All patients who are found to have a thyroid nodule on a physical examination should have their TSH measured. Patients with a suppressed TSH should be evaluated with a radionuclide thyroid scan; nodules that are “hot” (show increased isotope uptake) are almost never malignant and fine-needle aspiration biopsy is not needed. For all other nodules, the next step in the workup is a fine-needle aspiration biopsy to determine whether the lesion is malignant
A fine-needle aspiration biopsy of the nodule
A 19-year-old female high-school student is brought to your office by a friend who is concerned about the patient having cut her wrists. The patient denies that she was trying to kill herself, and states that she did this because she “just got so angry” at her boyfriend when she caught him sending a text message to another woman. She denies having a depressed mood or anhedonia, and blames her fluctuating mood on everyone who “keeps abandoning her,” making her feel like she’s “nothing.” She admits that she has difficulty controlling her anger. Her sleep quality and pattern appear normal, as does her appetite. She denies hallucinations or delusions. The wounds on her wrists appear superficial and there is evidence of previous cutting behavior on her forearms. Her vital signs are stable.
Which one of the following would be most beneficial for this patient? (check one)
A. Clonazepam (Klonopin)
B. Fluoxetine (Prozac)
C. Quetiapine (Seroquel)
D. Inpatient psychiatric admission
E. Psychotherapy
Borderline personality disorder is defined by high emotional lability, intense anger, unstable relationships, frantic efforts to avoid a feeling of abandonment, and an internal sense of emptiness.
Nearly every patient with this disorder engages in self-injurious behavior (cutting, suicidal gestures and attempts), and about 1 in 10 patients eventually succeeds in committing suicide
psychotherapy is considered the mainstay of therapy
A 4-year-old male is brought to your office by his parents who are concerned that he is
increasingly “knock-kneed.” His uncle required leg braces as a child, and the parents are
worried about long-term gait abnormalities. On examination, the patient’s knees touch when he
stands and there is a 15° valgus angle at the knee. He walks with a stable gait.
This case is consistent with physiologic genu valgus, and the parents should be reassured. Toddlers under
2 years of age typically have a varus angle at the knee (bowlegs). This transitions to physiologic genu
valgus, which gradually normalizes by around 6 years of age. As this condition is physiologic, therapies
such as surgical intervention, special bracing, and exercise programs are not indicated.
An 8-year-old female is brought to your office with a 3-day history of bilateral knee pain. She has had no associated upper respiratory symptoms. On examination she is afebrile. Her knees have full range of motion and no effusion, but she has a purpuric papular rash on both lower extremities.
Which one of the following is the most likely cause of her symptoms?
The combination of arthritis with a typical palpable purpuric rash is consistent with a diagnosis of Henoch-Schönlein purpura. This most often occurs in children from 2 to 8 years old. Arthritis is present in about two-thirds of those affected. Gastrointestinal and renal involvement are also common.
Rocky Mountain spotted fever presents with a rash, but arthralgias are not typical. These patients are usually sick with a fever and headache. Juvenile rheumatoid arthritis is associated with a salmon-pink maculopapular rash, but not purpura. The rash associated with Lyme disease is erythema migrans, which is a bull’s-eye lesion at the site of a tick bite. The rash associated with rheumatic fever is erythema marginatum, which is a pink, raised, macular rash with sharply demarcated borders.
Which one of the following hospitalized patients is the most appropriate candidate for thromboembolism prophylaxis with enoxaparin (Lovenox)? (check one)
A. An ambulatory 22-year-old obese male admitted for an appendectomy
B. A 48-year-old male with atrial fibrillation on chronic therapeutic anticoagulation, admitted for cellulitis
C. A 48-year-old male with end-stage liver disease and coagulopathy
D. A 52-year-old female on chronic estrogen therapy, admitted with severe thrombocytopenia
E. A 67-year-old female with hemiparesis, admitted for community-acquired pneumonia
E. A 67-year-old female with hemiparesis, admitted for community-acquirProphylaxis is generally recommended for patients over the age of 40 who have limited mobility for 3 days or more and have at least one of the following risk factors: acute infectious disease, New York Heart Association class III or IV heart failure, acute myocardial infarction, acute respiratory disease, stroke, rheumatic disease, inflammatory bowel disease, previous venous thromboembolism, older age (especially >75 years), recent surgery or trauma, immobility or paresis, obesity (BMI >30 kg/m2), central venouscatheterization, inherited or acquired thrombophilic disorders, varicose veins, or estrogen therapy.ed pneumonia
Pharmacologic therapy with an anticoagulant such as enoxaparin is clearly indicated in the 67-year-old who has limited mobility secondary to hemiparesis and is being admitted for an acute infectious disease. The patient on chronic anticoagulation, the patient with severe thrombocytopenia, and the patient with coagulopathy are at high risk for bleeding if given anticoagulants, and are better candidates for nonpharmacologic therapies such as foot extension exercises, graduated compression stockings, or pneumatic compression devices. Although the 22-year-old is obese and recently had surgery, his young age and ambulatory status make anticoagulant prophylaxis less necessary.
A 25-year-old white male who has a poorly controlled major seizure disorder and a 6-week history of recurrent fever, anorexia, and persistent, productive coughing visits your office. On physical examination he is noted to have a temperature of 38.3°C (101.0°F), a respiratory rate of 16/min, gingival hyperplasia, and a fetid odor to his breath. Auscultation of the lungs reveals rales in the mid-portion of the right lung posteriorly.
Which one of the following is most likely to be found on a chest radiograph?
Anaerobic lung abscesses are most often found in a person predisposed to aspiration who complains of a productive cough associated with fever, anorexia, and weakness. Physical examination usually reveals poor dental hygiene, a fetid odor to the breath and sputum, rales, and pulmonary findings consistent with consolidation.
Patients who have sarcoidosis usually do not have a productive cough and have bilateral physical findings. A persistent productive cough is not a striking finding in disseminated tuberculosis, which would be suggested by miliary calcifications on a chest film. The clinical presentation and physical findings are not consistent with a simple mass in the right hilum nor with a right pleural effusion.
Which one of the following should be given intravenously in the initial treatment of status epilepticus? (check one) A. Propofol (Diprivan) B. Phenobarbital C. Lorazepam (Ativan) D. Midazolam (Versed)
Status epilepticus refers to continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period. It is an emergency and must be treated immediately, since cardiopulmonary dysfunction, hyperthermia, and metabolic derangement can develop, leading to irreversible neuronal damage. Lorazepam, 0.1–0.15 mg/kg intravenously, should be given as anticonvulsant therapy after cardiopulmonary resuscitation. This is followed by phenytoin, given via a dedicated peripheral intravenous line.
