Test 60

Question 1

Patient confidentiality

Answer 1

Disclosure of HIV-positive status to sexual partners is often complicated by fear of rejection. Physicians should support patients by encouraging them to notify their partners as soon as possible. Physicians are not universally required to disclose the HIV status of patients to involved third parties, although all new cases of HIV must be reported to the local department of public health.

Question 2

Clubfoot

Answer 2

Congenital clubfoot is a deformity of the talus bone, resulting in a fixed, plantar flexed, adducted, and inverted foot. Nonsurgical treatment with serial casting is effective in most infants.

Question 3

Coronary artery disease

Answer 3

Exercise stress testing is useful in the initial diagnosis of coronary artery disease (CAD) and in providing prognostic information in patients with known or highly suspected CAD. Patients with negative stress testing results have a <1% risk of cardiovascular events within the next year.

Question 4

DM

Answer 4

Basal insulin must be continued at all times in type 1 diabetes to prevent diabetic ketoacidosis and severe hyperglycemia. Most hospitalized patients require reduced insulin doses.

Question 5

ILD

Answer 5

Amiodarone: severe or life threatening pulmonary dx can use corticosteroids

Question 6

Hair loss

Answer 6

The classic presentation of Alopecia areata consists of well-demarcated, non-scarred, round patches of hair loss, which may have “exclamation point” hairs. Affected patients are more likely to have a personal or family history of other autoimmune conditions, including autoimmune thyroid disease, pernicious anemia, and vitiligo.

Question 7

Aspiration pneumonia

Answer 7

Bacterial aspiration pneumonia typically presents several days after the aspiration event with fever, cough productive of putrid sputum, and infiltrate in a dependent portion of the lung. When no empyema or lung abscess is present, patients with aspiration pneumonia should be treated for community-acquired pneumonia, anaerobic coverage is not required.

Question 8

Breast cancer

Answer 8

Lobular carcinoma in situ (LCIS) is a nonmalignant lesion, but has a significant association with future development of invasive breast cancer and at minimum close surveillance is required for the duration of the patient’s life. If LCIS is detected on needle biopsy, excisional biopsy is recommended since a significant percentage of cases are upstaged to either invasive cancer or DCIS.