Test 49

Question 1

Shoulder dislocation

Answer 1

Patients who experience shoulder dislocation are at increased risk for recurrent dislocation due to residual ligamentous instability/laxity and incomplete healing of prior labral tears.

Question 2

Myocardial infarction

Answer 2

Patients with acute coronary syndrome should be treated with guideline-directed medical therapy, including dual antiplatelet therapy with aspirin and platelet P2Y12 receptor blockers (clopidogrel, prasugrel, or ticagrelor), beta blockers, statins, and anticoagulation therapy to reduce the risk of recurrent nonfatal myocardial infarction and cardiovascular death.

Question 3

Sensitivity, specificity, NPV, PPV

Answer 3

Predictive values change depending on the disease prevalence in a study population. As disease prevalence increases, the positive predictive value increases and the negative predictive value decreases, and vice versa.

Question 4

Serotonin syndrome

Answer 4

Combined use of selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) can lead to serotonin syndrome, a potentially lethal condition characterized by fever, mental status changes, clonus, and hyperreflexia. Switching from fluoxetine (an SSRI) to an MAOI requires a 5-week washout.

Question 5

Systemic sclerosis

Answer 5

Scleroderma renal crisis presents with severe HTN and renal failure in a patient with evidence of underlying scleroderma, such as Raynaud phenomenon and GERD.

Question 6

Systemic sclerosis

Answer 6

ACE inhibitors, particularly captopril, are the drugs of choice for the treatment of HTN in scleroderma renal crisis. The addition of intravenous medications such as nitroprusside is needed if CNS manifestations or papilledema is present.

Question 7

Mucocutaneous candidiasis

Answer 7

The best initial therapy for oral candidiasis (thrush) is a topical antifungal (nystatin suspension or clotrimazole troches), with an oral antifungal such as fluconazole used for resistant cases. In patients where thrush is secondary to inhaled corticosteroids, proper technique should be assessed by watching the patient use the inhaler.

Question 8

Hyponatremia

Answer 8

Moderate to severe hypothyroidism can be associated with mild euvolemic hyponatremia. Treatment of the underlying hypothyroidism with levothyroxine can correct the hyponatremia.

Question 9

Cryoglobulinemia

Answer 9

Mixed cryoglobulinemia syndrome is typically treated with immunosuppressive therapy (corticosteroids and rituximab) followed by target therapy against underlying condition that triggered the disease. Patients with underlying hepatitis C virus (the most common trigger) should receive antiviral treatment.

Question 10

COPD

Answer 10

Ventilation/perfusion (V/Q) mismatch in low V/Q lung regions is the major cause of hypoxemia in patients with COPD, and the mismatch is worsened during exacerbation. Supplemental oxygen improves hypoxemia in these patients primarily by increasing oxygen exchange in lung regions that have a low V/Q ratio.