Test 10

Question 1

Informed consent

Answer 1

In academic institutions, where trainees are involved in patient care to varying degrees, informed consent (eg, for surgery) should include a discussion about all the individuals involved in the patient’s care and their expected roles.

Question 2

Cleft lip and cleft palate

Answer 2

Cleft lip with or without clef palate is typically a multifactorial disorder. It has been associated with the use of teratogenic agents during pregnancy, and the modes of inheritance can be AD, AR, and x-linked. Reconstruction of the cleft lip is general performed at approximately 3 mo of age, according to the rule of ‘10’: 10 Ibs of weight, 10 weeks of age, and 10 g of hemoglobin.

Question 3

Depression

Answer 3

Cognitive impairment is a common sx of late-life depression and is reversible with tx. Older adults with new-onset cognitive impairment should be assessed for depression. Patients with late-life depression (a major depressive episode occurring age > 65) are at higher risk for developing Alzheimer dx and vascular dementia than those with depressive episodes earlier in life. Physicians should remain vigilant for cognitive sx in this patient population.

Question 4

Diabetic neuropathy

Answer 4

The cremasteric reflex is regulated at the L1-L2 level of the spinal cord. This reflex can be diminished or lost secondary to diabetic autonomic neuropathy.

Question 5

Hepatitis B

Answer 5

As patients recover from acute hepatitis B virus (HBV) infection, there is normally a steady drop in both aminotransferase and HBV DNA levels and clearance of hepatitis B surface antigen within 6 months.

Question 6

End of life care

Answer 6

The only requirements for hospice care are a prognosis of less than or equal 6 mo and the patient’s surrogate’s decision to forego life-sustaining tx. Physicians should educate patients and family members that comorbid medical conditions and inability to give full informed consent are not contraindications to hospice care.