Test 45

Question 1

Substance use disorders

Answer 1

Physicians must consider the possibilities of misuse, abuse, and diversion when confronted with new patients requesting stimulant prescriptions. They should obtain confirmation of childhood diagnosis and treatment of attention-deficit hyperactivity disorder and carefully assess current functioning before prescribing stimulants.

Question 2

West Nile virus infection

Answer 2

West Nile virus infection can cause meningoencephalitis, inflammation of the meninges and brain parenchyma, following bite from an infected mosquito. Infection typically occurs in the summer and presents with fever, headache, vomiting, nuchal rigidity, and altered mental status.

Question 3

Seizures

Answer 3

Childhood absence epilepsy is characterized by brief lapses in consciousness that last <20 seconds and occur multiple times a day. Electroencephalography shows a pattern of ~3 Hz generalized spike and wave activity. Ethosuximide is the first-line treatment (agranulocytosis).

Question 4

Aging

Answer 4

Photoaging arises from the combination of intrinsic aging and damage caused by ultraviolet light. It results in coarse, deep wrinkles in a rough skin surface and may be accompanied by actinic keratoses, telengiectasias, and brown (liver) spots.

Question 5

Aging

Answer 5

Cigarette smokers have been shown to have more and deeper wrinkles than do nonsmokers.

Question 6

Aging

Answer 6

Tretinoin is an emollient cream approved by the FDA for reduction of fine wrinkles, mottled hyperpigmentation, and roughness of the facial skin. Tretinoin is also successful in reducing actinic keratoses and in improving the appearance of brown spots, regardless of etiology.

Question 7

Systemic sclerosis

Answer 7

Patients with systemic sclerosis are at risk for lung involvement, including pulmonary hypertension or interstitial lung disease. Pulmonary function testing should be performed at the time of diagnosis as it helps to establish a pulmonary diagnosis, guide further work up, and track disease progression.

Question 8

Ankylosing spondylitis

Answer 8

The 3 important clinical criteria for the diagnosis of ankylosing spondylitis are:

1. Presence of low back pain and stiffness for more than a 3 month duration that improves with exercise or activity
2. Limitation of the range of motion of the lumbar spine
3. Limitation of chest expansion relative to the normal values

Question 9

Ankylosing spondylitis

Answer 9

The most common and important extraarticular manifestations of ankylosing spondylitis are acute anterior uveitis, aortic regurgitation, apical pulmonary fibrosis, IgA nephropathy, and restrictive lung disease.

Question 10

Ankylosing spondylitis

Answer 10

Aerobic exercises improve overall functional status of patients with rheumatologic disorders and should be encouraged.

Question 11

Ankylosing spondylitis

Answer 11

Most patients with ankylosing spondylitis do well and have no functional or employment disabilities. There is no increased overall mortality or reduced life expectancy.

Question 12

Cryptococcal infections

Answer 12

Patients with AIDS who develop cryptococcal meningitis may have increased intracranial pressure. Manifestations include headache, vomiting, visual changes, papilledema, and cranial nerve palsies. Patients may require repeated lumbar punctures to reduce the elevated pressure.