Test 62

Question 1

Parapneumonic effusion & empyema

Answer 1

Empyema in the setting of likely aspiration pneumonia should be empirically treated with abx that target both aerobic and anaerobic organisms. Hospitalized patients who are not critically ill often receive ampicillin-sulbactam; critically ill patients are generally treated with a carbapenem or piperacillin-tazobactam.

Question 2

Assisted suicide and euthanasia

Answer 2

Requests for euthanasia and physician-assisted suicide are most common in patients with terminal cancer. A loss of sense of autonomy and dignity and the fear of future suffering are the factors most consistently associated with these requests.

Question 3

PID

Answer 3

A negative Chlamydia trachomatis nucleic acid amplification test at the initial prenatal visit followed by a positive test in the third trimester most likely indicates a newly acquired infection during pregnancy.

Question 4

PID

Answer 4

Untreated Chlamydia trachomatis infection during pregnancy is associated with obstetric complications (preterm prelabor rupture of membranes, preterm labor, postpartum endometritis) and neonatal complications (neonatal conjunctivitis, pneumonia). First-line treatment for Chalmydia in pregnant women is azithromycin.

Question 5

Kawasaki disease

Answer 5

Kawasaki disease is a febrile vasculitis of childhood, diagnosed based on fever greater than or equal to 5 days with greater than or equal to 4 of the following: conjunctivitis, mucous membrane changes, rash, lymphadenopathy, and extremity edema/erythema. Because symptoms required for diagnosis do not always present simultaneously, patients who have been febrile for greater than or equal to 5 days but who fill less than or equal to 3 diagnostic criteria should have supporting laboratory studies (C-reactive protein or erythrocyte sedimentation rate) ordered and should be reexamined the following day.

Question 6

Kawasaki disease

Answer 6

First-line treatment for Kawasaki disease includes intravenous immunoglobulin (which reduces the risk of cardiac sequelae by an unknown mechanism of action) and aspirin.

Question 7

Kawasaki disease

Answer 7

Children with Kawasaki disease are at risk for the development of coronary artery aneurysms even after appropriate treatment. They should have an echocardiogram performed at the time of diagnosis, and at 2 and 6 weeks after completion of treatment.

Question 8

Kawasaki disease

Answer 8

Intravenous immunoglobulin is composed of pooled antibodies and can alter a person’s normal immune response to live vaccines. Because of this, live vaccines should not be administered for 11 months after treatment of Kawasaki disease.

Question 9

Increased intracranial pressure

Answer 9

Securing and maintaining a patent airway is the first priority in the management of trauma patients with symptomatic intracranial hypertension.

Question 10

Histoplasmosis

Answer 10

Healthy, asymptomatic patients with histoplasmosis do not require treatment because most cases resolve spontaneously. Those with symptoms or underlying HIV should be treated with systemic antifungal therapy.

Question 11

Refeeding syndrome

Answer 11

Patients with alcohol use disorder are frequently phosphate depleted even though serum phosphate levels may initially be normal. Refeeding these patients, particularly if a respiratory alkalosis is also present, may lead to shifts of phosphate intracellularly and a decreased serum phosphate. This may lead to the development of rhabdomyolysis as many of these patients have an underlying myopathy.

Question 12

Cluster headache

Answer 12

Patients with cluster headache should receive preventive treatment at the onset of a cluster period. Verapamil is considered the agent of choice for the prevention of episodic and chronic cluster headaches.

Question 13

Testicular cancer

Answer 13

Scrotal US is the initial test of choice for evaluating a testicular mass. If US shows a solid mass, further workup with serum tumor markers and screening CT scans is required. Patients with suspected testicular cancer usually require radical inguinal orchiectomy for both tissue diagnosis and initial treatment.

Question 14

Meningitis

Answer 14

Patients who received abx prior to obtaining cerebrospinal fluid levels may have negative gram stain and culture and altered cerebrospinal fluid glucose and protein, even with negative gram stain and culture, warrants a full course of abx therapy.