Quiz 56 Flashcards
The most common presenting symptom of obstructive sleep apnea is: (check one) A. excessive daytime sleepiness B. snoring C. morning headache D. gastroesophageal reflux E. enuresis
excessive daytime sleepiness
The most common presenting symptom of obstructive sleep apnea is excessive daytime sleepiness (SOR A). Other symptoms include snoring, unrefreshing or restless sleep, witnessed apneas and nocturnal choking, morning headache, nocturia or enuresis, gastroesophageal reflux, and reduced libido.
Mild cognitive impairment is characterized by which one of the following?
(check one)
A. Localized motor dysfunction
B. Impairment in at least one activity of daily living
C. Impairment in at least one instrumental activity of daily living
D. The presence of the APO E4 allele
E. Objective evidence of memory decline
Mild cognitive impairment is an intermediate stage between normal cognitive function and dementia. Motor function remains normal. The presence of the APO E4 allele is a risk factor, but is not necessary for a diagnosis. Patients have essentially normal functional activities but there is objective evidence of memory impairment, and the patient may express concerns about cognitive decline.
A 50-year-old female complains of a 6-month history of the insidious onset of right shoulder pain and decreased range of motion. She does not respond to consistent use of prescription strength anti-inflammatory medication. Radiographs are negative.
Treatment of this patient’s condition should include:
(check one)
A. physical therapy with home exercises
B. early surgical referral
C. a short course of oral methylprednisolone
D. corticosteroid injection of the acromioclavicular joint
This patient most likely has either adhesive capsulitis or a degenerative rotator cuff tendinopathy. It is important to rule out osteoarthritis with radiographs. Treatment typically includes NSAIDs, subacromial cortisone injections, and physical therapy. These problems take months to treat and should not be referred quickly for surgical evaluation, unless the diagnosis is in question.
the presence of thyroid TSH receptor immunoglobulins
Toxic multinodular goiter B. Toxic adenoma C. Hashimoto’s (lymphadenoid) thyroiditis D. Subacute (giant cell) thyroiditis E. Graves’ disease
Graves’ disease,
in Graves’ disease there is a predominance of TSH receptor antibodies. In Hashimoto’s disease TSH receptor–blocking antibodies are more predominant. These immunoglobulins tend to disappear during therapy.
A 3-year-old male is carried into the office by his mother. Yesterday evening he began complaining of pain around his right hip. Today he has a temperature of 37.6°C (99.7°F), cries when bearing weight on his right leg, and will not allow the leg to be moved in any direction. A radiograph of the hip is normal.
Which one of the following would be most appropriate at this time?
(check one)
A. A CBC and an erythrocyte sedimentation rate
B. A serum antinuclear antibody level
C. Ultrasonography of the hip
D. MRI of the hip
E. In-office aspiration of the hip
A CBC and an erythrocyte sedimentation rate
This presentation is typical of either transient synovitis or septic arthritis of the hip. Because the conditions have very different treatment regimens and outcomes, it is important to differentiate the two. It is recommended that after plain films, the first studies to be performed should be a CBC and an erythrocyte sedimentation rate (ESR). Studies have shown that septic arthritis should be considered highly likely in a child who has a fever over 38.7°C (101.7°F), refuses to bear weight on the leg, has a WBC count >12,000 cells/mm , and has an ESR >40 mm/hr. If several or all of these conditions exist, aspiration 3 of the hip guided by ultrasonography or fluoroscopy should be performed by an experienced practitioner. MRI may be helpful in cases that are unclear based on standard data, or if other etiologies need to be excluded.
The parents of a 7-year-old male ask you to evaluate him because of increasing concerns about his temper tantrums over the past 9 months. He often becomes angry and hostile, argues with them constantly, and refuses to follow rules or directions. A major source of difficulty is his refusal to quit playing with his toys when he is asked to come to the dinner table. After the child ignored repeated attempts to get him to come to the table a few nights ago, the father became frustrated and told him he had lost his television privileges. In response, the child became aggressive and destructive, breaking his toys and sweeping his dinner plate and glass of milk onto the floor. The parents describe many similar scenarios at bedtime, bath time, and when he is getting dressed. They believe that their son is deliberately behaving this way to annoy them. This history is most consistent with: (check one) A. attention-deficit/hyperactivity disorder B. bipolar disorder C. conduct disorder D. oppositional defiant disorder E. normal childhood individualization
This child meets the DSM-V criteria for oppositional defiant disorder, defined as a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months. The child will often lose his or her temper, argue with adults, actively defy or refuse to comply with adults’ requests or rules, deliberately annoy people, blame others for his or her mistakes or misbehavior, be easily annoyed by others, appear angry and resentful, or be spiteful or vindictive. At least four of these behaviors must be present to meet the criteria for diagnosis. The disturbance in behavior must also cause clinically significant impairment in social, academic, or occupational functioning, and the behaviors must not occur exclusively during the course of a psychotic or mood disorder. Meeting the criteria for conduct disorder excludes the diagnosis of oppositional defiant disorder. If the individual is 18 years of age or older and meets the criteria for antisocial personality disorder, then oppositional defiant disorder is excluded.
