Test 16

Question 1

Fat embolism

Answer 1

Always consider the risk of fat embolism in patients with multiple complicated fractures. Fat embolism is a clinical dx that is usually characterized by a triad of respiratory insufficiency, neurological impairment, and a petechial rash. Early immobilization and operative fixation of fractures reduce the chances of fat embolism.

Question 2

Interviewing technique

Answer 2

Once the patient takes initial steps to change behavior, a physician should support the patient’s intrinsic motivation to take further action in that direction.

Question 3

Urinary incontinence

Answer 3

A urethral diverticulum can present with postvoid dribbling, dysuria, dyspareunia, and an anterior vaginal wall mass on pelvic examination.

Question 4

Molluscum contagiosum (MC)

Answer 4

MC causes single or multiple skin-colored, small papules with indented centers and is transmitted via skin-to-skin contact. The lesions can be either asymptomatic or pruritic and can occasionally be accompanied by surrounding dermatitis. Tx is usually conservative. HIV testing should be considered in patients with MC, especially if they have lesions involving the face.

Question 5

Epistaxis

Answer 5

Most epistaxis originate from the Klesselbach plexus in the anterior nasal septum. Nostril pinching is the first step in management, and a topical vasoconstrictor can be applied if direct compression alone is not effective.

Question 6

Myocardial infarction

Answer 6

In men age >40, STEMI is dx by ECG showing >1 mm (0.1 mV) ST elevation (>2 mm in leads V2 and V3) in greater than or equal to 2 anatomically contiguous leads. Primary PCI is recommended within 90 minutes of the first medical contact in patients with STEMI.

Question 7

Metabolic acidosis

Answer 7

Lactic acidosis is a rare but serious complication of metformin. The risk of metformin-induced lactic acidosis increases with hypovolemia, severe liver dx, renal dysfunction, or HF.

Question 8

Orthostatic hypotension

Answer 8

Polypharmacy is frequent in the elderly. Orthostatic hypotension is common in this setting and is usually related to the use of diuretics, alpha blockers, or nitrates.

Question 9

Genu varum

Answer 9

Physiologic genu varum presents in infants age 0-2 years with bilateral, symmetric bow-legs, normal stature, and no lateral thrust. Dx is clinical, and management is reassurance and observation.

Question 10

Hemochromatosis

Answer 10

The arthropathy of hereditary hemochromatosis commonly affects the second and third metacarpophalangeal joints, knees, ankles, and shoulders. Joint aspiration can identify calcium pyrophosphate dihydrate crystals in approximately 50% of patients. Tx of hereditary hemochromatosis with phlebotomy does not equally improve the arthropathy.