Test 69

Question 1

Depression

Answer 1

Depressed patients who deteriorate after initial signs of improvement on an antidepressant should be assessed carefully for substance use. Alcohol, stimulants, and opiates can exacerbate depressive symptoms and contribute to poor antidepressant response.

Question 2

Patient confidentiality

Answer 2

The Health Insurance Portability and Accountability Act (HIPAA) requires a patient to give the physician written authorization before protected health information can be disclosed to an employer. The HIPAA Privacy Rule limits disclosure to the “minimum necessary” information required to complete a request for information.

Question 3

Antepartum bleeding

Answer 3

Patients with vaginal bleeding at >20 weeks gestation and no previous anatomy US require a transvaginal US to exclude placenta previa. Digital cervical examination is contraindicated in patients with placenta previa.

Question 4

Escherichia coli

Answer 4

Patients with infectious diarrhea most commonly have self-limited symptoms and can usually be treated with supportive care. However, with the exception of Shiga toxin-producing Escherichia coli, infectious diarrhea with hemodynamically instability warrants treatment with intravenous antibiotics to reduce the severity of disease and manage potential sepsis.

Question 5

Hand, foot, mouth disease

Answer 5

Nail shedding (onychomadesis) occurs secondary to temporary disruption of nail plate growth. A classic cause of nail shedding in children is infection, specifically hand-foot-and-mouth disease.

Question 6

Discharge process

Answer 6

Elderly patients who are unable to perform the basic daily living activities and take care of themselves can return home only if they are under the care or responsibility of another person, friend, or relative, who will guarantee adherence to the treatment and medical follow-up. If this is not possible, and if the patient has multiple or serious medical conditions, he should be placed in a nursing home.

Question 7

Hyperthyroidism

Answer 7

Thyrotoxicosis in older patients often presents with atypical symptoms, including lethargy, apathy, weight loss, and decreased appetite without characteristic hyperadrenergic features.

Question 8

Gastroparesis

Answer 8

Diabetes mellitus can cause gastroparesis due to autonomic neuropathy, involving impaired parasympathetic control over the stomach and decreased functionality of the intestinal cells of Cajal (gastric pacemaker cells). Gastric smooth muscle cells fail to contract in coordinated fashion, leading to delayed gastric emptying.

Question 9

Enuresis

Answer 9

Primary nocturnal enuresis is the lack of nighttime dryness in children age greater than or equal to 5 and resolves spontaneously over time. A screening urinalysis is recommended to exclude underlying etiologies such as diabetes mellitus or insipidus.

Question 10

Study designs

Answer 10

A control group is an important aspect of experimental research designs. It allows researchers to confirm that study results are due to the treatment rather than other extraneous factors.

Question 11

Mitral valve prolapse

Answer 11

Cardiac auscultation in patients with mitral valve prolapse typically reveals a nonejection click and a systolic murmur of mitral regurgitation. The click and murmur occur later in systole as left ventricular end-diastolic volume increases and in some patients may disappear completely in the setting of large-volume venous return.

Question 12

Gout

Answer 12

The angiotensin receptor blocker losartan has a modest uricosuric effect and is a good choice for treating hypertension in patients with gout. Thiazides, loop diuretics, and low-dose aspirin should be avoided in patients with hyperuricemia when possible.

Question 13

Hypothyroidism

Answer 13

Asymptomatic subclincal hypothyroidism does not require treatment. Treatment is warranted in the presence of:

1. Antithyroid antibodies
2. An abnormal lipid profile
3. Symptoms of hypothyroidism
4. Ovulatory and menstrual dysfunction