Test 20

Question 1

Suicide

Answer 1

Physicians should evaluate both risk and protective factors when performing suicide risk assessments. Connection to family, pregnancy, and responsibility for children are important protective factors. Religious affiliation is often protective but should be carefully assessed to rule out negative religious coping.

Question 2

Professional conduct

Answer 2

Romantic and sexual relationships between physicians and current patients are always considered unethical. Due to the highly personal and emotional nature of the psychiatrist-patient relationship, romantic and sexual relationships between psychiatrists and former psychiatric patients are considered unethical as well.

Question 3

Brain tumors

Answer 3

Pineal tumor classically presents with Parinaud’s syndrome, which is characterized by the loss of pupillary reaction, vertical gaze paralysis, the loss of optokinetic nystagmus, and ataxia. Some pineal tumors are germinomas that can secrete HCG.

Question 4

Otitis media

Answer 4

After appropriate tx of an acute episode of otitis media, serous fluid may persist in the middle ear for up to 3 months, refers to as serous otitis media. The effusion generally resolves spontaneously within 3 months; therefore, watchful waiting is the recommended management, unless there are persistent sx of infection, the effusion is bilateral, or greater than 3 months have elapsed since the initial episode.

Question 5

Clostridioides difficile infection

Answer 5

Clostridioides difficile infection (CDI) is characterized by profuse watery diarrhea and should be suspected when major risk factors (recent abx use, age >65) are present. Severe CDI is characterized by leukocytosis (>15,000/mm^3) and elevated serum creatinine (greater than or equal to 1.5 mg/dL) and can progress to fulminant dx, which may be complicated by colonic dilation, necrosis, and perforation.

Question 6

Lichen planus

Answer 6

Lichen planus is characterized by discrete, intensely pruritic, polygonal-shaped violaceous papules or plaques involving the flexural surfaces of the extremities (most commonly wrists), buccal mucosa, or external genitalia. A skin biopsy may be required to confirm the dx.
Lichen planus often is associated with advanced liver disease due to hepatitis C virus.

Question 7

Mucocutaneous candidiasis

Answer 7

Intertrigo is most commonly due to Candida infection and causes erythematous plaques and erosions in intertriginous regions (inguinal, perineal, genital, intergluteal). Topical antifungals are the preferred initial therapy.

Question 8

Stress fractures

Answer 8

Tibial stress fractures can be managed in most cases with pneumatic splinting, reduced weight bearing, and a graduated exercise program. Most patients may resume full-intensity exercise within 12 weeks, but the program may be delayed if the patient develops recurrent pain.

Question 9

Antepartum bleeding

Answer 9

Rh(D)-negative women are at risk for alloimmunization due to fetomaternal hemorrhage from abruptio placentae after abdominal trauma. A Kleihauer-Betke test determines the presence and quantity of fetomaternal hemorrhage so that the amount of Rho(D) immune globulin to be administered can be calculated.