Test 53

Question 1

Depression

Answer 1

Major depression is an independent risk factor for increased morbidity and mortality in cardiovascular disease. Treatment with selective serotonin reuptake inhibitors is considered a safe and effective option.

Question 2

Postpartum hemorrhage

Answer 2

The most common cause of postpartum hemorrhage is uterine atony, failure of the uterus to contract after placental separation. First-line management for uterine atony is bimanual massage and oxytocin infusion. Second-line is uterotonic medications. If these fail then uterine balloon tamponade or uterine artery embolization followed by hysterectomy.

Question 3

Preeclampsia

Answer 3

Postpartum preeclampsia, new-onset hypertension with end-organ damage (hyperreflexia), can present up to 12 weeks postpartum and can be complicated by pulmonary edema. Treatment includes magnesium sulfate for seizure prophylaxis, antihypertensives, and fluid restriction, oxygen support, and diuretics for pulmonary edema.

Question 4

Beneficence

Answer 4

If a parent refuses medically necessary care for a child in an emergency situation, treatment should proceed while simultaneously seeking a court order to continue care.

Question 5

Pituitary adenoma

Answer 5

Dopaminergic receptor agonist are first-line treatment for prolactinomas, including large prolactinomas. Treatment with dopaminergic receptor agonists generally leads to a decrease in tumor size within a few days. Visual symptoms usually improve before the tumor’s decrease in size is seen on MRI.

Question 6

Myocardial infarction

Answer 6

Benzodiazepines (lorazepam) should be given early to patients with cocaine-related chest pain to decrease sympathetic outflow and psychomotor agitation and alleviate hypertension and myocardial ischemia. Beta blockers are contraindicated in acute cocaine ingestion due to the risk of excessive alpha-1 receptor-mediated vasoconstriction.

Question 7

Myocardial infarction

Answer 7

The presence of persistent chest pain and neurologic symptoms in a patient with recent cocaine use should raise suspicion for acute dissection of the ascending aorta. Rapid diagnosis is essential and can be made by CT angiography of the chest.

Question 8

Hip fracture

Answer 8

Hip fractures in the elderly are common and should be managed with early surgery (<48 hours) in patients who are ambulatory and stable. Nonoperative management is reserved for those who are nonambulatory, have advanced dementia, or are medically unstable.

Question 9

Clostridioides difficile infection

Answer 9

Recurrence of Clostridioides difficile infection is common, especially in patients on prolonged antibiotics for other conditions. Recurrence is typically due to germination of persistent spores from the initial infection. To reduce the risk of recurrence, treatment for CDI is often extended throughout the course of other antibiotic therapies.

Question 10

Male sexual dysfunction

Answer 10

Priapism is a persistent, painful erection that can lead to irreversible ischemic injury if not corrected promptly. At the onset of symptoms, priapism can be terminated with simple interventions (urination, cold compresses), but symptoms lasting >4 hours requires invasive treatment. Management includes aspiration of the corpora cavernosa and intracavernosal injection of an alpha agonist (phenylephrine).