Test 67

Question 1

Suicide

Answer 1

Lithium is an evidence-based treatment for reducing the risk of suicide in mood disorder patients. In suicidal patients already taking lithium, the drug should be maintained rather than discontinued.

Question 2

Renal calculi

Answer 2

Patients with obstructing ureterolithiasis associated with infection, acute kidney injury, or severe pain that has failed initial measures require decompression of the upper urinary text with percutaneous nephrostomy or urethral stent placement. However, percutaneous nephrostomy is generally preferred in patients who are clinically unstable or have very large stones.

Question 3

Vulvovaginitis

Answer 3

Clinical features of vaginitis are common, nonspecific, and can lead to incorrect self-diagnosis. The diagnosis should always be confirmed by wet mount microscopy or nucleic acid amplification testing to avoid inappropriate treatment.

Question 4

Urinary retention

Answer 4

Patients with benign prostatic hyperplasia are at risk for acute urinary retention due to bladder outlet obstruction. Immediate bladder decompression using urethral or suprapubic catheter is required to prevent progression and acute renal failure. For most patients, urethral catheterization is attempted prior to consideration of suprapubic catheterization.

Question 5

Gestational diabetes

Answer 5

Patients with gestational diabetes mellitus can discontinue antiHyperglycemic therapy postpartum. However, they require diabetic screening with a 2-hour glucose tolerance test at 6-12 weeks postpartum due to an increased risk for type 2 diabetes mellitus.

Question 6

Urinary tract infection

Answer 6

Chronic constipation can prevent complete bladder emptying and promote urinary stasis. A risk factor for development of urinary tract infections.

Question 7

Hypopituitarism

Answer 7

Central hypothyroidism is characterized by low thyroid hormone levels with low or low-normal thyroid-stimulating hormone. Central hypothyroidism should prompt assessment of other pituitary hormones as well as pituitary imaging (magnetic resonance imaging).

Question 8

Thyroiditis

Answer 8

Subacute thyroiditis is a self-limited condition. Treatment consists primarily of nonsteroidal anti-inflammatory drugs for pain relief and beta blockers to minimize thyrotoxic symptoms. Severe or refractory cases may require glucocorticoid therapy.

Question 9

Acute diarrhea

Answer 9

Acute diarrhea with blood or mucous (dysentery, inflammatory diarrhea) is most commonly due to bacterial infection (Shiga toxin-producing Escherichia coli, Shigella). Initial evaluation should include stool culture and evaluation for Shiga toxin (multiplex PCR testing, direct immunoassay).

Question 10

Aortic coarctation

Answer 10

Aortic coarctation is a congenital narrowing of the aorta. Patients with mild narrowing may have claudication due to decreased blood flow distal to the aorta. Key findings include upper extremity hypertension, lower extremity hypotension, and weak/delayed distal pulses.

Question 11

Psoriasis

Answer 11

Psoriasis is an inflammatory skin disorder characterized by well-demarcated, erythematous, scaly plaques. The diagnosis is generally made on the basis of characteristic skin lesions. Potential complications include nail and joint involvement. Psoriatic arthritis requires systemic therapy (methotrexate).

Question 12

Warts

Answer 12

Cesarean delivery does not prevent vertical transmission of human papillomavirus. Women with condyloma acuminata can proceed with vaginal delivery unless the condyloma are large and obstruct the birth canal.