Quiz 14

Question 1

one benefit of treatment of GDM is a decreased risk for

maternal type 2 diabetes mellitus after delivery
B. maternal preeclampsia
C. perinatal death
D. a small-for-gestational-age infant

Answer 1

maternal preeclampsia

Many outcomes for both the mother and infant are improved with
pharmacologic management of GDM. These include a decreased risk for operative delivery,
large-for-gestational-age infants, shoulder dystocia, and maternal preeclampsia. Although a significant
percentage of women with GDM subsequently develop type 2 diabetes mellitus after delivery,
pharmacologic treatment of GDM has not been shown to decrease that risk.

Question 2

haloperidol,

most likely cause of her restlessness is

dystonias,
parkinsonism, akathisia, withdrawal dyskinesias, and tardive dyskinesia.

Answer 2

Motor side effects of the antipsychotic drugs can be separated into five general categories: dystonias,
parkinsonism, akathisia, withdrawal dyskinesias, and tardive dyskinesia. Akathisia is a syndrome marked
by motor restlessness. Affected patients commonly complain of being inexplicably anxious, of being unable
to sit still or concentrate, and of feeling comfortable only when moving. Hysteria is no longer considered
a useful term.

Question 3

A 45-year-old male is seen for a well-demarcated, nonpruritic rash in the right axilla. It is
fine-scaled with a cigarette-paper appearance. The rash has a coral-red fluorescence under a
Wood’s light.

Answer 3

All of the diagnoses listed are intertriginous rashes but only erythrasma fluoresces with Wood’s light.
Erythrasma is a superficial gram-positive bacterial infection caused by Corynebacterium minutissimum.
The fluorescence is caused by porphyrins. Erythrasma is most often seen between the toe web spaces,
followed by the groin and axillae. There are multiple treatments, including topical and oral erythromycins
and clindamycins

Question 4

acute parotitis

Answer 4

Empiric treatment is directed toward gram-positive and anaerobic
organisms, with the most common pathogen being Staphylococcus. These are often penicillin resistant so
a β-lactamase inhibitor is the agent of choice.

Question 5

A 3-week-old infant is brought to your office with a fever.

Answer 5

Any child younger than 29 days old with a fever and any child who appears toxic, regardless of age,
should undergo a complete sepsis workup and be admitted to the hospital for observation until culture
results are known or the source of the fever is found and treated (SOR C).

Observation only, with close follow-up, is recommended for nontoxic infants 3–36 months of age with a
temperature <39.0°C (102.2°F) (SOR C). Children 29–90 days old who appear to be nontoxic and have
negative screening laboratory studies, including a CBC and urinalysis, can be sent home with precautions
and with follow-up in 24 hours

Question 6

asx aortic stenosis

Answer 6

Although aortic stenosis can result in adverse
cardiac events, most of these events occur in patients who are symptomatic

asymptomatic patients with mild
aortic stenosis undergo repeat echocardiography every 3–5 years.

Exercise treadmill testing may be indicated
in patients with severe AS based on echocardiography even if they are asymptomatic.

Use of statin drugs has not been shown to slow or stop progression of AS. Right and left heart
catheterization can be used in an attempt to resolve discrepancies between symptoms and echocardiographic
findings. Because this patient is asymptomatic and her echocardiogram shows only mild AS, left and/or
right heart catheterization is not indicated. An ACE inhibitor would be indicated in patients who have a
reduced ejection fraction.

Question 7

A 79-year-old female had a total knee replacement yesterday.

Last night she became
confused and agitated, striking out at nurses, and could not be consoled

Answer 7

This patient has postoperative delirium, which is associated with an increased mortality rate. Reorientation
and pain management are important management strategies. Benzodiazepines, antipsychotics,
antidepressants, and restraints are not helpful and may make the situation worse. Imaging modalities are
not helpful in the absence of localizing signs.

Question 8

5-year-old daughter

pharyngitis

mass developed over a short span of time, and it is warm, red, and tender.

Answer 8

This child has cervical lymphadenitis, characterized by systemic symptoms, unilateral lymphadenopathy,
skin erythema, node tenderness, and a node that is 2–3 cm in size. The most common organisms associated
with lymphadenitis are Staphylococcus aureus and group A Streptococcus. Empiric antibiotic therapy with
observation for 4 weeks is acceptable for children with presumed reactive lymphadenopathy (SOR C). If
symptoms do not resolve, or if the mass increases in size during antibiotic treatment, further evaluation
is appropriate.

When imaging is indicated, ultrasonography is the preferred initial study for most children with a neck
mass.

Question 9

Which one of the following is the best diagnostic test for vitamin D deficiency?

Answer 9

Undiagnosed vitamin D deficiency is not uncommon, and 25-hydroxyvitamin D is the barometer for
vitamin D status. Although there is no consensus on optimal levels of 25-hydroxyvitamin D as measured
in serum, vitamin D deficiency is defined by most experts as a 25-hydroxyvitamin D level <20 ng/mL
(50 nmol/L).