Test 59

Question 1

Thyroglossal duct cyst

Answer 1

A thyroglossal duct cyst often presents in children after an upper respiratory tract infection as a fluctuate mass that moves superiorly when swallowing. Imaging of the thyroid should be done to identify ectopic thyroid tissue.

Question 2

ADHD

Answer 2

Stimulant therapy for ADHD does not increase the risk of developing a substance use disorder.

Question 3

Acne vulgaris

Answer 3

Oral doxycycline is used in the treatment of inflammatory acne and is a photosensitizing agent that may cause exaggerated sunburn.

Question 4

Febrile seizure

Answer 4

Febrile seizures typically occur as a complication of viral infection. Diagnosis is clinical and patients have normal development. However, patients with febrile seizures are at an increased risk of recurrence as well as epilepsy.

Question 5

Sarcoidosis

Answer 5

Pulmonary sarcoidosis often manifests with pulmonary (cough, dyspnea, chest pain) and systemic (fatigue, malaise, weight loss) symptoms. Chest imaging usually reveals bilateral hilar lymphadenopathy with or without diffuse interstitial infiltrates. Asymptomatic patients rarely require treatment; those with symptoms or implied pulmonary function usually receive 12-24 months of oral glucocorticoids. Most cases resolve over time and do not recur.

Question 6

Lung cancer

Answer 6

Syndrome of inappropriate antidiuretic hormone (SIADH) is associated with normovolemic hyponatremia and can be caused by small cell carcinoma of the lung.

Question 7

SIADH

Answer 7

Water restriction (with the possible inclusion of salt administration) is the preferred means of correcting mild to moderate hyponatremia associated with SIADH.

Question 8

Confounding, effect modification, bias, errors

Answer 8

Unknown residual confounders may impact the statistical analysis of study result. Randomization removes the effects of known and unknown confounders.

Question 9

Ischemic stroke

Answer 9

Patients with mild but potentially disabling symptoms of acute ischemic stroke should be considered for treatment with thrombolytics. Radiologic findings are not required.

Question 10

Opioids

Answer 10

Severe renal impairment can cause altered mental status due to uremia. Although opioid use can also cause altered mental status in the setting of acute renal failure, it typically occurs with opioids that are dependent on renal clearance and/or have active metabolites (vs fentanyl, which has inactive metabolites).

Question 11

Neonatal evaluation

Answer 11

Neonatal brachial plexus injuries (Erb-Duchenne palsy) are most commonly associated with shoulder dystocia in macrosomic infants. Most infants recover spontaneously with supportive care.

Question 12

Hyperprolactinemia

Answer 12

Prolactinoma is a common cause of amenorrhea and infertility in women. Other endocrine effects include galactorrhea in women, gynecomastia in men, and symptoms of hypogonadism in both sexes. Long-term suppression of sex hormone production by prolactinoma in women can lead to osteoporosis. The primary treatment of prolactinoma is dopamine agonists such as cabergoline, which inhibit prolactin secretion and cause regression of tumor size.

Question 13

Cyanide poisoning

Answer 13

Nitroprusside is frequently used in the management of acute hypertensive emergency. It is metabolized to cyanide, which may accumulate and can be toxic in patients with chronic renal failure or those receiving a high-dose or prolonged infusion. Toxicity should be suspected in all patients on nitroprusside infusion who have unexplained metabolic acidosis and altered mental status.

Question 14

OSA

Answer 14

Patients with OSA are at increased risk of perioperative respiratory failure from procedures involving sedation, neuromuscular blocker, opioids, or anesthesia. When respiratory failure occurs, it results from hypoventilation and typically presents with hypercapnia and hypoxia.