Test 75

Question 1

Perioperative medical management

Answer 1

A preoperative ECG is recommended for patients with underlying cardiovascular disease (CAD), except for those undergoing low-risk procedures. The primary reason is to establish a baseline useful for interpreting postoperative changes.

Question 2

Perforated viscus

Answer 2

In preparation for expedited surgical intervention, patients with suspected or confirmed peptic ulcer perforation should receive IVF resuscitation, broad-spectrum IV abx, and IV PPI therapy.

Question 3

Professional conduct

Answer 3

Sexual contact or a romantic relationship between a physician and a current patient is unethical. Many ethicists argue that this also applies to any romantic or sexual relationship with former patients.

Question 4

ADHD

Answer 4

Behavioral therapy is the preferred initial treatment for preschool- age children (3-5) with ADHD.

Question 5

ADHD

Answer 5

Stimulant pharmacotherapy for children with ADHD can be initiated if hx and PE do not suggest cardiac dx. In the absence of positive cardiac hx, further evaluation, including ECG, is unnecessary.

Question 6

ADHD

Answer 6

Patients with ADHD who have an inadequate response or fail to tolerate a stimulant can be tried on another. Other options include switching to a nonstimulant medication such as atomoxetine or an alpha-2 adrenergic agonist.

Question 7

Peritonsillar abscess

Answer 7

A peritonsillar abscess is an acute infection between the tonsil and pharyngeal muscles. Inflammation and spasm of the nearby pterygoid muscles lead to trismus, one of the most specific findings that differentiates tonsillitis from peritonsillar abscess.

Question 8

Acromegaly

Answer 8

Patients with untreated acromegaly have an increased mortality rate mainly due to cardiovascular disease. Early cardiovascular disease in acromegaly is reversible by treatment. Patients with acromegaly also have an increased risk of colon cancer.

Question 9

Osteoporosis

Answer 9

Patients with osteoporosis (T-score less than or equal to -2.5 or osteoporotic fracture) warrant antiresorptive therapy; bisphosphonates (aledronate) are first-line treatment for most patients. For patients with osteopenia (T-score between -1.0 and -2.5), the 10-year fracture risk can be calculated using the Fracture Risk Assessment Tool (FRAX) to determine if antiresorptive therapy is indicated.

Question 10

Infectious mononucleosis

Answer 10

Persistent and localized abnormal LN should be biopsied.

Question 11

Hematuria

Answer 11

Hematuria frequently occurs with extremely strenuous exercise, and can occur in both contact and non-contact sports. The diagnosis should be considered one of exclusion even with appropriate history, and follow up urinalysis is needed in 1 week to ensure that the hematuria has resolved.

Question 12

Interstitial nephritis

Answer 12

Acute interstitial nephritis is characterized by acute kidney injury caused by hypersensitivity to an antigen (antibiotics), which results in tubulointerstitial mononuclear cell infiltration. Pyuria with or without white blood cell casts is a characteristic finding on urinalysis, and peripheral eosinophilia may be present.

Question 13

Hypertrophic cardiomyopathy

Answer 13

Patients with hypertrophic cardiomyopathy are at increased risk for atrial fibrillation and ventricular tachycardia. Periodic ambulatory ECC monitoring is indicated to facilitate prompt recognition and management of these arrhythmias, especially in patients with suggestive symptoms (palpitations).

Question 14

Sarcoidosis

Answer 14

Anterior uveitis typically presents with erythema at the limbus, a constructed pupil, blurred vision, and moderate eye pain. Sarcoidosis is a particularly common cause of anterior uveitis and should be suspected when other characteristic sarcoid findings (bilateral hilar lymphadenopathy, erythema nodosum) are present.

Question 15

Meniere disease

Answer 15

A classic triad of periodic vertigo, UNILATERAL hearing loss and tinnitus is characteristic for Meniere’s dx.

Question 16

Sjogren syndrome

Answer 16

To reveal xerostomia in patients suspected with Sjogren’s/sicca syndrome, some yes/no questions may be asked, such as: “Do you wake up at night feeling dry, and then drink some water?” or “Do you frequently drink water to help you swallow some dry foods?”

Question 17

Paronychia

Answer 17

Acute paronychia is a localized bacterial infection of the nail fold. Most cases are due to gram-positive skin flora. Initial management includes warm soaks; antiseptic agents or topical abx can also be used. Associated abscesses should be drained, but oral abx are not usually needed.

Question 18

Hypothyroidism

Answer 18

Approximately 20% of cases of dementia are due to potentially reversible conditions. In particular, hypothyroidism, vitamin B12 deficiency, and depression should be ruled out in the initial evaluation of dementia. Hypothyroidism in elderly patients may present with impaired cognition and is often associated with hyponatremia and macrocytosis.