Test 54

Question 1

Neuroblastoma

Answer 1

Neuroblastomas are the most common extracranial solid tumors in children and typically present with a painless abdominal mass. Patients may have HTN due to the mass compressing the renal artery and activating the renin-angiotensin system, and catecholamine hypersecretion can lead to flushing and sweating.

Question 2

Healthcare quality

Answer 2

Comanagement is a team-based model in which a surgeon and a generalist physician (hospitalist) share responsibility for a surgical patient’s care. In contrast to traditional consultation models, the hospitalist is often automatically involved in the patient’s care and proactively identifies and manages the patient’s medical conditions.

Question 3

Cervical cancer

Answer 3

Cervical cancer can present with vaginal bleeding and a friable, exophytic cervical lesion. Diagnosis is with a biopsy of the lesion. In patients who are HIV positive, invasive cervical cancer is an AIDs-defining illness.

Question 4

OSA

Answer 4

OSA is associated with mild cognitive impairment (irritability, poor concentration, decreased memory) in the elderly. Elderly patients with mild cognitive impairment and signs and symptoms suggestive of OSA (neck circumference >43.2 cm, elevated blood pressure) should be evaluated with polysomnography.

Question 5

Sickle cell

Answer 5

Dactylitis presents in young children with sickle cell disease as symmetric swelling and pain of the hands and feet. Treatment includes pain control (NSAIDs, oral opioids), hydration, and application of heat.

Question 6

Power and sample size

Answer 6

The power of a study is the ability to detect a difference between groups (treated vs nontreated, exposed vs nonexposed) when one exists. Increasing the precision of measurements increases the power of a study.

Question 7

Hypoglycemia

Answer 7

A plasma glucose level of less than 60 mg/dL is suggestive of hypoglycemia. In some normal individuals, the blood glucose level can reach around 45 mg/dL without symptoms. Whipple’s triad is suggestive of true hypoglycemia.

Question 8

Aspergillosis

Answer 8

Treatment for allergic bronchopulmonary aspergillosis is directed at acutely stopping the underlying inflammation and reducing Aspergillus burden. Systemic glucocorticoids are the mainstay therapy with consideration of antifungal therapy (itraconazole or voriconazole) to decrease fungal burden and antigenic stimulus.

Question 9

Tuberculosis

Answer 9

Hepatotoxicity due to isoniazid (INH) can occur within the first 3 months of therapy and range from mild hepatotoxicity to hepatitis. Patients should have baseline and monthly monitoring of aminotransferases. INH should be discontinued in patients who have aminotransferases greater than or equal to 5 times the upper limit of normal (ULN) or develop symptoms with aminotransferases greater than or equal to 3 times the ULN.

Question 10

Diabetes mellitus

Answer 10

Type 1 diabetes is an autoimmune disorder that often occurs with other autoimmune endocrine disorders (primary adrenal insufficiency, autoimmune thyroid disease). Inherited clusters of autoimmune endocrinopathies have been described. Nonendocrine autoimmune conditions, such as pernicious anemia, vitiligo, and celiac disease, may be associated as well.

Question 11

HIT

Answer 11

Patients diagnosed with heparin-induced thrombocytopenia are advised to avoid all forms of heparin (including low-molecular-weight heparin) for life to limit the risk of recurrence.

Question 12

Vestibular schwannoma

Answer 12

Acoustic neuromas result from the proliferation of Schwann cells (schwannomas).

Question 13

Salicylate poisoning

Answer 13

Salicylate toxicity presents with a primary respiratory alkalosis often combined with an anion gap metabolic acidosis. Treatment is alkalinization of blood and urine with sodium bicarbonate drip, supplemental glucose, and, if presentation is early (within 2 hours), activated charcoal. Dialysis may be indicated.

Question 14

SIDS

Answer 14

Nonmodifiable risk factors for sudden infant death syndrome include prematurity, low birth weight, and maternal age <20; the strongest modifiable risk factor is prone-sleep positioning.

Question 15

Warts

Answer 15

Pearly penile papules appear as greater than or equal to 1 rows of small, flesh-colored, dome-topped or filiform papules positioned circumferentially around the corona or sulcus of the glans penis. These lesions are a normal variant and not associated with sexually transmitted infections. Because pearly penile papules are asymptomatic and harbor no malignant potential, no intervention is required other than reassurance.

Question 16

Cushing syndrome

Answer 16

Bitemporal hemianopsia and hyperpigmentation following bilateral adrenalectomy for Cushing’s dx is suggestive of Nelson’s syndrome. A pituitary microadenoma with suprasellar extension on MRI and extremely high plasma ACTH levels are diagnostic.