Quiz 48 Flashcards
A 60-year-old Chinese female asks you about being tested for osteoporosis. She is postmenopausal and has never used hormone therapy. She does not consume dairy products because she has lactose intolerance. She is on no medications, is otherwise healthy, and has no history of falls or fractures. Her mother had osteoporosis and vertebral compression fractures. Her BMI is 20 kg/m2 .
Which one of the following tests would be best to determine whether this patient has osteoporosis?
A central DXA scan of the lumbar spine and hips
This patient has several risk factors for osteoporosis: Asian ethnicity, low body weight, positive family history, postmenopausal status with no history of hormone replacement, and low calcium intake. The best diagnostic test for osteoporosis is a central DXA scan of the hip, femoral neck, and lumbar spine. Quantitative CT is accurate, but cost and radiation exposure are issues. Peripheral DXA and calcaneal sonography results do not correlate well with central DXA. Measurement of biochemical markers is not recommended for the diagnosis of osteoporosis.
A 56-year-old female has a 35-pack-year smoking history. She is concerned that she may have COPD, although she has no history of chronic cough, chest pain, or other pulmonary symptoms. Her family history is remarkable for a mother with COPD who was a smoker, but there is no family history of α1-antitrypsin disease.
Which one of the following would you recommend with regard to screening spirometry?
(check one)
A. Screening, based on her age
B. Screening, based on her family history
C. Screening, based on her smoking history
D. No screening, based on lack of benefit
COPD, The diagnosis is made by documenting airflow obstruction in the presence of symptoms and/or risk factors. Airflow limitation cannot be accurately predicted by the history and examination.
The U.S. Preventive Services Task Force recently concluded that there is “moderate certainty” that screening asymptomatic patients for COPD using spirometry has little or no benefit and is not recommended. This recommendation applies to otherwise healthy individuals without a family history of α1-antitrypsin disease.
An 8-year-old white male presents with a 4-day history of erythematous cheeks, giving him a “slapped-cheek” appearance. Examination of the extremities reveals a mildly pruritic, reticulated, erythematous, maculopapular rash (see Figure 1). He is afebrile and no other constitutional symptoms are present
The most likely etiologic agent is (check one) A. human parvovirus B. adenovirus C. cytomegalovirus D. coxsackievirus
All of these viruses can cause an erythematous exanthem; however, this description is classic for fifth disease, or erythema infectiosum. It was the fifth exanthem to be identified after measles, scarlet fever, rubella, and Filatov-Dukes disease (atypical scarlet fever). Roseola infantum is known as sixth disease.
Erythema infectiosum is caused by parvovirus B19. It presents with the typical viral prodrome, along with mild upper respiratory symptoms. The hallmark rash has three stages. The first is a facial flushing, described as a “slapped cheek” appearance. In the next stage, the exanthem can spread concurrently to the trunk and proximal extremities as a diffuse macular erythematous rash. Finally, central clearing of this rash creates a lacy, reticulated appearance, as seen in Figure 1. This rash tends to be on the extensor surfaces and spares the palms and soles. It resolves in 1–3 weeks but can recur with heat, stress, and exposure to sunlight.
A 35-year-old right-handed softball player injures his left wrist when sliding into second base. When he sees you the next day his description of the injury indicates that he hyperextended his wrist while sliding, and the pain was later accompanied by swelling. Your examination is remarkable only for mild swelling and tenderness of the dorsal wrist, distal to the ulnar styloid. A radiograph of the wrist is shown in Figure 2.
Which one of the following best describes this injury? (check one)
A. Triquetral fracture
B. Scaphoid (navicular) fracture
C. Lunate fracture
D. Lunate dislocation
E. Wrist sprain
Triquetral fractures typically occur with hyperextension of the wrist. Dorsal avulsion fractures are more common than fractures of the body of the bone. Tenderness is characteristically noted on the dorsal wrist on the ulnar side distal to the ulnar styloid. The typical radiologic finding is a small bony avulsion visible on a lateral view of the wrist. Most studies indicate that this carpal bone has the second or third highest fracture rate after the navicular. Avulsion fractures respond well to 4 weeks of splinting and protection.
Clinical and radiologic signs do not match those expected in navicular or scaphoid fractures. Navicular fractures may initially have normal radiologic findings. Immobilization and follow-up radiographs are required. Tenderness in the snuffbox area is expected, but dorsal tenderness and swelling are not characteristic. The radiographs do not show a lunate fracture or dislocation. A wrist sprain is a diagnosis of exclusion and should not be considered too early.
EKG, TAchy with narrow QRS
Adenosine, an expensive intravenous drug, is highly effective in terminating many resultant supraventricular arrhythmias. Although it can cause hypotension or transient atrial fibrillation, adenosine is probably safer than verapamil because it disappears from the circulation within seconds. Because of its safety, many cardiologists now prefer adenosine over verapamil for treatment of hypotensive supraventricular tachycardia. Bretylium tosylate, procainamide, and lidocaine are used to treat ventricular arrhythmias. Atropine is indicated in the treatment of sinus bradycardia.
leg problems in children
The radiograph shows a typical slipped capital femoral epiphysis, with the epiphysis displaced posteriorly and medially. The problem usually occurs in late childhood or adolescence. Osgood-Schlatter disease involves the anterior tibial tubercle. Legg-Calvé-Perthes disease is avascular necrosis of the femoral head. Blount’s disease involves the medial portion of the proximal tibia. All of these conditions cause leg pain in children.
A cement plant worker presents to your office with the recurrent acute skin eruption on his legs.
It extends proximally from the dorsum of the feet to just below the knees. This is the third eruption in 2 years.This patient most likely has: (check one)
Because this dermatitis is recurrent and symmetric, contact dermatitis should be suspected. Rhus dermatitis is a contact dermatitis, but it is more acute and presents with bullae and vesicles that are more linear than those seen in this patient. MRSA usually presents as a unilateral cellulitis, or more commonly as inflammatory nodules or pustules. This dermatitis is not scaling and does not have a distinct border that would suggest tinea.
At a routine annual visit, a 31-year-old inner-city elementary school teacher asks you about a lesion on the nail of her ring finger, shown in Figure 8.
Figure 8
On examination, you note that her other nails all have a slight linear depression or groove. Which one of the following is the most likely cause of this problem? (check one) A. A paronychial fungal infection B. Psoriasis C. Iron deficiency D. Lead exposure E. A traumatic/metabolic event
Fingernails and toenails are often overlooked as clues to systemic illness. Like hair shafts, they document a history of the body during the past several months. The symmetric depression across the nail plate growing toward the distal edge of the nail shown here represents significant trauma to the body some weeks ago. These classic lines are called Beau’s lines. No treatment is required. The other options listed involve the nails, but cause different and characteristic types of nail changes.
