Quiz 43 Flashcards
Which one of the following findings on examination of the head, oral cavity, and neck is associated with diabetes mellitus? (check one) A. Parotid enlargement B. Tooth erosion C. Diffuse melanin pigmentation D. Cobblestone oral mucosa E. Painful oral ulcers
Parotid enlargement
Sialadenosis, bilateral noninflammatory enlargement of the parotid gland, is associated with diabetes mellitus. Periodontal bleeding and inflammation, candidiasis, and delayed wound healing also are associated with diabetes mellitus.
Tooth erosion can be an oral manifestation of gastroesophageal reflux disease or bulimia. Cobblestone oral mucosa is seen in Crohn’s disease. Diffuse melanin pigmentation is an oral finding of Addison’s disease. Painful oral ulcers occur in several conditions, including Behçet syndrome, aphthous ulcers, pemphigus, and pemphigoid.
An anxious and agitated 18-year-old white male presents to your office with a 2-hour history of severe muscle spasms in the neck and back. He was seen 2 days ago in a local emergency department with symptoms of gastroenteritis, treated with intravenous fluids, and sent home with a prescription for prochlorperazine (Compazine) suppositories. The best therapy for this problem is intravenous administration of: (check one) A. atropine B. diphenhydramine (Benadryl) C. haloperidol D. succinylcholine (Anectine) E. carbamazepine (Tegretol)
While rarely life threatening, an acute dystonic reaction can be frightening and painful to the patient and confusing to the treating physician who may be unaware of what medications the patient is taking. Dystonia can be caused by any agent that blocks dopamine, including prochlorperazine, metoclopramide, and typical neuroleptic agents such as haloperidol. The acute treatment of choice is diphenhydramine or benztropine.
A 19-year-old college student comes to your office with significant pain in his right great toe that is making it difficult for him to walk. He has never had this problem before.
When you examine him you find increased swelling with marked erythema and seropurulent drainage and ulceration of the medial nail fold. The toe is very tender to touch, particularly when pressure is applied to the tip of the toe. The most appropriate initial management would be: (check one)
partial avulsion of the medial nail plate and phenolization of the matrix at this visit
This ingrown nail meets the criteria for moderate severity: increased swelling, seropurulent drainage, infection, and ulceration of the nail fold.
Either immediate partial nail avulsion followed by phenolization, or direct surgical excision of the nail matrix is effective for the treatment of ingrown nails (SOR B). Pretreatment with soaking and antibiotics has not been demonstrated to add therapeutic benefit or to speed resolution. Several studies demonstrate that once the ingrown portion of the nail is removed and matricectomy is performed, the localized infection will resolve without the need for antibiotic therapy. Bilateral partial matricectomy maintains the functional role of the nail plate (although it narrows the nail plate) and should be considered in patients with a severe ingrown toenail or to manage recurrences.
intraosseous drug administration
The current American Heart Association ACLS guidelines state that intraosseous access can be obtained in almost all age groups rapidly, and is preferred over the endotracheal route. Any drug that can be administered intravenously can be administered intraosseously. Many drugs administered via an endotracheal tube are poorly absorbed, and drug levels vary widely.
Ultrasonography shows a complete placenta previa in a 23-year-old primigravida at 20 weeks gestation. She has not experienced any vaginal bleeding. Which one of the following would be the most appropriate management for this patient?
Placenta previa is a relatively common incidental finding on second trimester ultrasonography. Approximately 4% of ultrasound studies at 20–24 weeks gestation show a placenta previa, but it occurs in only 0.4% of pregnancies at term, because of migration of the placenta away from the lower uterine segment. Therefore, in the absence of bleeding, the most appropriate management is to repeat the ultrasonography in the third trimester
Corticosteroids are indicated at 24–34 weeks gestation if the patient has bleeding, given the higher risk of premature birth. In patients with a history of previous cesarean delivery who have a placenta previa at the site of the previous incision, a color-flow Doppler study should be performed to evaluate for a potential placenta accreta.
Which one of the following classes of diabetes medications acts primarily by stimulating pancreatic insulin secretion? (check one)
A. Biguanides, such as metformin (Glucophage)
B. Thiazolidinediones, such as pioglitazone (Actos)
C. DPP-4 inhibitors, such as sitagliptin (Januvia)
D. Sulfonylureas, such as glipizide (Glucotrol)
E. Amylin analogs, such as pramlintide (Symlin)
Biguanides and thiazolidinediones are insulin sensitizers that decrease hepatic glucose production and increase insulin sensitivity. Sulfonylureas and meglitinides stimulate pancreatic insulin secretion, while DPP-4 inhibitors prevent GLP-1 breakdown and slow the breakdown of some sugars. GLP-1 mimetics stimulate insulin secretion, suppress glucagon secretion, and promote β-cell production. Amylin analogs act with insulin to delay gastric emptying and they also inhibit glucagon release.
A 30-year-old male presents with a 3-week history of severe, burning pain in his right shoulder. He recalls no mechanism of injury. An examination reveals weakness to resistance of the biceps and triceps, and with external rotation of the shoulder. Full range of motion of the neck and shoulder does not worsen the pain.
Which one of the following would be most likely to identify the cause of this patient’s problem? (check one)
A. Electromyography and nerve conduction studies
B. MRI of the neck
C. MR arthrography (MRA) of the shoulder
D. CT of the brain
E. Ultrasonography of the upper extremity
This patient has brachial neuritis, which can be difficult to differentiate from cervical radiculopathy, shoulder pathology, and cerebrovascular accident. The pain preceded the weakness, no trauma was involved, and the weakness is in a nondermatomal distribution, making brachial neuritis the most likely diagnosis. Electromyography is most likely to show this lesion, but only after 3 weeks of symptoms.
A 30-year-old African-American female is being evaluated because of absent menses for the last 6 months. Menarche was at age 12. Her menstrual periods have frequently been irregular, and are accompanied only occasionally by dysmenorrhea. She had her first child 4 years ago, but has not been able to become pregnant since. A physical examination and pelvic examination are unremarkable. A serum pregnancy test is negative, prolactin levels are normal, and LH and FSH levels are both three times normal on two occasions.
The history and physical findings in this patient are consistent with all of the conditions listed. However, the elevated FSH and LH indicate an ovarian problem, and this case is consistent with ovarian failure or premature menopause
Polycystic ovary syndrome usually results in normal to slightly elevated LH levels and tonically low FSH levels
