Quiz 15

Question 1

Which one of the following is most characteristic of hoarding disorder?

Answer 1

Anxiety and emotional distress if collected items are disposed of

It is characterized by excessive, often dangerous, clutter and disorganized
living spaces. The items collected or saved often are worthless, such as old newspapers and paperwork,
but may also be valuable items. Opposed to this is normal collecting, which is organized and pleasurable,
and does not lead to dangerous or chaotic living spaces. Both could involve collecting unusual or seemingly
bizarre items. However, with hoarders, disposing of the items causes extreme anxiety and emotional
distress.

Question 2

Which one of the following is the only medication that has consistent evidence for decreasing
depressive symptoms in children and adolescents?

A. Fluoxetine (Prozac) 
 B. Venlafaxine (Effexor XR) 
 C. Nortriptyline (Pamelor) 
 D. Aripiprazole (Abilify) 
 E. Paroxetine (Paxil)

Answer 2

Fluoxetine is the only medication with consistent evidence showing that it improves depression symptoms
in children and adolescents

Question 3

Which one of the following, especially in homeless people, is a vector for Bartonella quintana,
which causes trench fever, an influenza-like syndrome with relapsing fever? (check one)
A. Fleas
B. Maggots
C. Bedbugs
D. Scabies
E. Lice

Answer 3

Lice, scabies, and secondary bacterial infections are endemic in the homeless. Body lice transmit
Bartonella quintana, which causes trench fever. This disease got its name in World War I, when soldiers
in the trenches were often infested with body lice. This is a serious disease that can be treated with
antibiotics.

Question 4

A 72-year-old previously healthy female comes in for evaluation of recent headaches. She
describes the pain as generalized all over her head and persisting over the past several months.
She reports feeling more achy and fatigued in the past several weeks, with a decreased appetite
and unintentional weight loss of 4 lb in the past 2 months. She denies any other symptoms
including sinus congestion, nausea, vomiting, numbness, tingling, weakness, or vision changes.
Acetaminophen has been minimally helpful for the pain.

On examination you note a temperature of 37.9°C (100.2°F), normal cranial nerves, a normal
eye examination, and no tenderness to palpation of the head. She is mildly tender to palpation
of the shoulders and upper arms. Laboratory testing reveals an erythrocyte sedimentation rate
of 88 mm/hr (N 1–25).

Next step?

Answer 4

Bx

This patient’s clinical picture is most concerning for giant cell arteritis (also known as temporal arteritis).
This condition is a type of vasculitis and in its most serious form can lead to blindness. It is most common
in the elderly and is twice as common in women as in men. Because of its inflammatory nature, patients
commonly have systemic symptoms, including fever. The temporal artery may be thickened, tender, or
lacking pulsation, although a normal artery does not rule out the diagnosis. Jaw claudication is a fairly
specific but nonsensitive finding.

The laboratory finding most classically associated with giant cell arteritis is an elevated erythrocyte
sedimentation rate (ESR).

Question 5

acute otitis media

Answer 5

amoxicillin,

Question 6

exercised-induced bronchospasm.

Answer 6

An inhaled daily low-dose corticosteroid plus occasional use of as-needed inhaled albuterol is the best
regimen for the treatment of exercised-induced bronchospasm

Question 7

right upper quadrant pain that is worse
after fatty meals
Which imaging?

Answer 7

Ultrasonography is the preferred initial imaging modality for suspected acute cholecystitis or cholelithiasis

Question 8

recommended management for patients who have non-severe Salmonella infection

Answer 8

no treatment.

Patients with high-risk conditions that predispose to bacteremia, and those with
severe diarrhea, fever, and systemic toxicity or positive blood cultures should be treated with levofloxacin,
500 mg once daily for 7–10 days (or another fluoroquinolone in an equivalent dosage), or with a slow
intravenous infusion of ceftriaxone, 1–2 g once daily for 7–10 days

Question 9

This normotensive diabetic patient, appropriately screened for microalbuminuria

Answer 9

repeat because could be due to temporary effects. After CKD is confirmed, then do U/S