Test 50

Question 1

Immunizations

Answer 1

Pregnant women should not receive live virus vaccines, but their household members should get all routine immunizations on schedule. Delaying vaccines is not recommended, as vaccines make it less likely that children will contract the disease and expose pregnant women to wild-type infection.

Question 2

AD

Answer 2

Caring for loved ones with dementia can result in burnout, with negative health effects for caregivers and early nursing home placement for those with dementia. Physicians should be alert to signs of caregiver distress and aid in accessing support services (respite care, support groups, comprehensive support programs) as indicated.

Question 3

Bartonella

Answer 3

Oculoglandular syndrome is a specific presentation of cat-scratch disease characterized by conjunctivitis and ipsilateral preauricular and cervical adenopathty. The most common complication of cat scratch disease is lymph node suppuration.

Question 4

Falls

Answer 4

Elderly patients should be asked annually about a history of falls. Patients who report a fall should undergo a comprehensive evaluation including postural stability (“Get Up and Go” test). Patients who perform poorly or have recurrent falls may need a more extensive workup.

Question 5

Thiamine deficiency

Answer 5

Patients with Korsakoff syndrome often have MRI evidence of mammillary body atrophy, a relatively specific finding for this condition.

Question 6

SLE

Answer 6

Achieving optimum calcium and vitamin D levels is the best initial step to prevent bone loss due to prolonged glucocorticoid therapy.

Question 7

Thyroid nodules

Answer 7

Thyroid nodules should be evaluated using TSH level and thyroid ultrasound. Patients with normal or high TSH and a confirmed nodule >1 cm in diameter on ultrasound should undergo fine-needle aspiration with nodule cytology. Patients with low TSH should have a radionuclide thyroid scan.

Question 8

Multiple endocrine neoplasia

Answer 8

Medullary thyroid cancer (MTC) is part of the multiple endocrine neoplasia type 2 syndromes. All patients with new MTC require serum calcitonin and carcinoembryonic antigen, neck US (evaluation for regional metastases), genetic testing for germline RET mutations, and evaluation for coexisting tumors (hyperparathyroidism, pheochromocytomas).

Question 9

Positive skew

Answer 9

Mode < median < mean

Question 10

Celiac disease

Answer 10

In patients on levothyroxine replacement therapy, escalating dose requirements suggest poor absorption due to interaction with other medications (iron, calcium, sucralfate) or an underlying malabsorption disorder. In patients with autoimmune thyroid disorders, celiac disease has an increased prevalence and can lead to impaired absorption of levothyroxine.

Question 11

Tuberculosis

Answer 11

Patients with suspected pulmonary tuberculosis who have abnormal chest imaging should undergo sputum acid-fast bacillus smear, mycobacterial culture, and nucleic acid amplification testing for microbial confirmation. Tuberculin skin testing or interferon-gamma release assay are also typically performed, but these tests cannot be used to distinguish active from latent infection.