Test 13

Question 1

Conflict of interest

Answer 1

Treating family members is generally considered to be ethically problematic. Acute and limited care may be appropriate when no other physician is available.

Question 2

Cryptorchidism

Answer 2

Infants age greater than or equal to 6 months with an undescended testis should be referred for orchiopexy. Although the risk of testicular malignancy is decreased after orchiopexy, it remains higher than in patients without a history of cryptorchidism.

Question 3

Depression

Answer 3

Gastrointestinal and activating side effects are common at the start of therapy with selective serotonin reuptake inhibitors and often improve. Patients should continue the medication for 6 weeks (adequate trial) if the side effects are tolerable. Patients with intolerable side effects and/or an inadequate response following an adequate trial should switch to a different antidepressant.

Question 4

Polycythemia

Answer 4

Neonatal polycythemia is dx when the peripheral venous hematocrit is greater than 65%. High hematocrit levels that are obtained from capillary samples (usually from a heel prick) are unreliable and must be confirmed through venous blood sampling.

Question 5

Giardia

Answer 5

Giardia outbreaks can occur in institutional settings due to poor hand hygiene and fecal incontinence. Affected individuals who are continent poise low risk of transmission and do not require isolation. Symptomatic individuals should be tx and refrain from attending recreational water venues to minimize dx transmission.

Question 6

Hypothyroidism

Answer 6

Patients with hypothyroidism should take levothyroxine on an empty stomach with water 30-60 minutes before breakfast. Common medications, such as calcium and iron supplements, can impair the absorption of levothyroxine and should be separated from it by 3-4 hours.

Question 7

Pulmonary contusion

Answer 7

Pulmonary contusion is a common injury resulting from blunt chest trauma. Patients typically have CP and may develop respiratory distress and hypoxemia that is delayed up to 24 hours from the time of injury. CXR characteristically shows an irregular, localized lung opacification. Pulmonary contusion is best managed with adequate pain control and supportive care to include pulmonary hygiene and supplemental oxygen and ventilatory support as needed.

Question 8

Ocular melanoma

Answer 8

Ocular melanoma is frequently identified on ophthalmologic examination done for other reasons. Asymptomatic patients with small lesions (diameter <10 mm, thickness <3 mm) may be managed with close follow-up.

Question 9

Melanoma

Answer 9

Patients with large or symptomatic choroidal melanomas require definitive treatment with radiotherapy. Enucleation is considered for very large tumors or tumors with extrascleral extension.