Test 24

Question 1

Sexual abuse

Answer 1

Sexually active adolescents should be carefully assessed for abusive or coercive sexual encounters. Situations involving sexual partners who occupy positions of power or authority in relation to the teenage patient should raise concerns for coercion. A physician who finds evidence of abuse or exploitation is obligated to notify the state’s child protective services or law enforcement agencies.

Question 2

Child abuse

Answer 2

When child abuse is suspected, the immediate safety of the patient should be secured and child protective services notified. This often involves hospital admission. Situations that provide an opportunity for caregivers to leave with the child should be avoided until child abuse has been excluded.

Question 3

Pagets dx of bone

Answer 3

Indications for tx of Paget dx include bone pain, involvement of weight bearing bones, and neurological compromise. Bisphosphonates are the preferred therapy for the tx of Paget dx. For pt who cannot tolerate Bisphosphonates, calcitonin (a less potent antiresorptive agent) can be considered.

Question 4

Acrochordon

Answer 4

Skin tags are benign outgrowths of normal skin that appear as pedunculated, skin-colored papules in areas of friction. Skin tags are associated with obesity, insulin resistance, overt diabetes, and metabolic syndrome.

Question 5

Asthma

Answer 5

The allergen most frequently associated with asthma is house dust mites.

Question 6

Polycythemia

Answer 6

Serum EPO is a good initial diagnostic test for the evaluation of Polycythemia and helps guide the remainder of the work-up. A low EPO level suggests Polycythemia Vera, whereas a high EPO levels suggests a secondary cause of Polycythemia, such as chronic hypoxia or a hormone-producing neoplasm (commonly renal cell carcinoma).

Question 7

Polycythemia

Answer 7

Chronic hypoxia is the most common cause of secondary Polycythemia. Carboxyhemoglobin levels should be obtained to exclude CO poisoning in certain patients, including those who smoke heavily. Sleep apnea should be considered in patients with a relatively normal oxygen saturation on PE, as the hypoxia may be only intermittently present at night.