Test 34

Question 1

Lyme disease

Answer 1

Lyme arthritis is generally treated with a prolonged course of oral doxycycline or amoxicillin. Doxycycline is typically preferred due to better central nervous system penetration and excellent efficacy against coinfecting, tick-transmitted pathogen. Prognosis is favorable, and most patients recover completely.

Question 2

Power and sample size

Answer 2

Power is the ability to detect a difference in the outcome of interest between 2 groups, if such a difference exists. Increasing sample size increases power of a study and p value will reach statistical significance.

Question 3

Chronic heart failure

Answer 3

Coronary artery disease is the most common cause of secondary dilated cardiomyopathy, and evaluation with stress testing or coronary angiography should be performed in all patients presenting with unexplained heart failure due to left ventricular systolic dysfunction.

Question 4

Venous thromboembolism

Answer 4

In a patient who develops a DVT as a result of a reversible or time-limited risk factor (surgery, pregnancy, oral contraceptive use, or trauma), warfarin anticoagulantion should be continued for a minimum of three months. Treatment for longer than six months, however, is not necessary.

Question 5

Developmental milestones

Answer 5

Walking is a gross motor milestone that normally occurs at age 9-16 months. Evaluation and treatment should be considered if a child is not walking by age 16 months or delays are present in multiple developmental categories.

Question 6

Multiple myeloma

Answer 6

Patients with multiple myeloma require evaluation of the skeletal system to assess for bone involvement. Whole-body cross-sectional evaluation with low-dose CT scan without contrast, MRI, or positron emission tomography scan is preferred. Skeletal survey is less sensitive and is only recommended when whole-body cross sectional imaging is not possible or available.