Quiz 64

Question 1

A 36-year-old female consults you because of concerns about “fatigue.” After carefully reviewing her history and performing a physical examination, which one of the following would be LEAST valuable in assessing this patient?   (check one)
 A. A baseline serum cortisol level 
 B. An erythrocyte sedimentation rate 
 C. A complete metabolic panel 
 D. A TSH level 
 E. A pregnancy test

Answer 1

A baseline serum cortisol level

In patients with fatigue, family physicians should complete an appropriate history and physical examination. Laboratory studies should be considered, although the results affect management in only 5% of patients. A baseline cortisol level would be valuable only in patients with significant findings of Addison’s disease. In addition to an erythrocyte sedimentation rate, a complete metabolic panel, and a TSH level, many physicians request a CBC and a urinalysis. A pregnancy test should be ordered for women of childbearing age. No other tests have been shown to be useful unless a specific medical condition is suspected.

Question 2

A 45-year-old female presents with a complaint of pain and swelling in her right index finger of 2 days’ duration. She reports that 5 days ago she had artificial nails applied, which she removed yesterday due to the pain. She used hydrogen peroxide on the finger, but it did not help. She denies any systemic symptoms or fever. On examination there is erythema and swelling in the lateral nail fold of the right index finger, with purulent material noted.
Which one of the following would be the most appropriate treatment for this patient?
(check one)
A. Removal of the proximal nail fold
B. Topical corticosteroids
C. Topical antibiotics
D. Topical antifungals

Answer 2

Topical antibiotics

This is a common presentation for acute paronychia, which typically is caused by local trauma to the nail fold or cuticle, with resulting inoculation and infection. Topical antibiotics, with or without topical corticosteroids, is one treatment option. Other options include warm compresses, oral antibiotics, and incision and drainage; however, incision and drainage is not always necessary. Removal of the proximal nail fold is used to treat chronic paronychia that is not responsive to other treatments. Topical corticosteroids can be used alone for chronic paronychia, but if used for acute paronychia, they should be combined with antibiotics since acute paronychia is typically caused by a bacterial infection. Topical antifungals are a treatment option for chronic paronychia, which can be associated with a fungal infection, but not for acute paronychia.

Question 3

A 30-year-old male complains of the gradual onset of anterior right knee pain on climbing the stairs. On examination there is no effusion, but there is tenderness over the medial retinaculum. There is good ligament strength, and range of motion is normal. When the knee is extended from 90° flexion to full extension, the patella deviates laterally.
Which one of the following would be the best initial treatment for this condition?
  (check one)
 A. Bracing 
 B. Taping 
 C. NSAIDs 
 D. Arthroscopic surgery 
 E. Physical therapy

Answer 3

Physical therapy

This patient has patellofemoral stress syndrome. It is often called runner’s knee or anterior knee pain. The patellofemoral joint comprises the patella and femoral trochlea. The best initial treatment is physical therapy.

Question 4

Which one of the following is appropriate at the routine postpartum visit?   (check one)
 A. A CBC 
 B. Screening for depression 
 C. Thyroid function tests 
 D. Glucose tolerance testing 
 E. A urine dipstick

Answer 4

Screening for postpartum depression is recommended as part of the routine postpartum visit.

Question 5

The induction or inhibition of the cytochrome P450 (CYP) enzyme is responsible for many adverse drug reactions. Which one of the following is an inducer of the cytochrome P450 enzyme?   (check one)
 A. Ciprofloxacin (Cipro) 
 B. Fluconazole (Diflucan) 
 C. Phenytoin (Dilantin) 
 D. Clarithromycin (Biaxin) 
 E. Grapefruit juice

Answer 5

All of the drugs listed are inhibitors of the cytochrome P450 enzyme except phenytoin, which is a potent inducer. Grapefruit juice is also a cytochrome P450 enzyme inhibitor.

Question 6

painless postmenopausal

bleeding

Answer 6

Transvaginal ultrasonography
endometrial biopsy is an option if transvaginal ultrasonography is not available.

Transvaginal ultrasonography showing an endometrial thickness <3–4 mm would essentially rule out
endometrial carcinoma

Question 7

A 75-year-old otherwise healthy white female states that she has passed out three times in the last month while walking briskly during her daily walk with the local senior citizens mall walkers’ club. This history would suggest which one of the following as the etiology of her syncope?   (check one)
 A. Vasovagal syncope 
 B. Transient ischemic attack 
 C. Orthostatic hypotension 
 D. Atrial myxoma 
 E. Aortic stenosis

Answer 7

Syncope with exercise is a manifestation of organic heart disease in which cardiac output is fixed and does not rise (or even fall) with exertion. Syncope, commonly on exertion, is reported in up to 42% of patients with severe aortic stenosis.