Quiz 50 Flashcards
A 25-year-old female is concerned about recurrent psychological and physical symptoms that occur during the luteal phase of her menstrual cycle and resolve by the end of menstruation. She wants help managing these symptoms, but does not want to take additional estrogen or progesterone.
Which one of the following management strategies is supported by the best clinical evidence?
Randomized, controlled trials found that luteal-phase spironolactone improved psychological and physical symptoms of premenstrual syndrome over 2–6 months compared with placebo. Based on existing evidence, the effectiveness is unknown for cognitive-behavioral therapy, bright light therapy, evening primrose oil, and black cohosh.
A 55-year-old male is brought to the emergency department with a complaint of pain in the right eye and reduced vision of about 10 minutes’ duration. His eye was injured while he was hitting a metal stake with a sledge hammer. He was not wearing safety goggles. On examination you note a subconjunctival hemorrhage completely surrounding the cornea. The iris is irregular.
Which one of the following is contraindicated prior to emergency transfer to an ophthalmologist? (check one) A. Administering an analgesic B. Attempting tonometry C. A visual acuity test D. Use of an eye shield E. Administering an antiemetic
The injury and findings described raise the possibility of globe rupture due to a fragment of steel penetrating through the cornea and pupil and into the globe. Relief of pain with an analgesic is appropriate before transfer. Because of a risk of extruding intraocular fluid, tonometry should not be attempted if globe rupture is suspected.
Which one of the following would make you suspect retinal vein occlusion as the cause of her
sudden visual loss?
The signs of retinal vein occlusion typically include sudden painless loss of vision or distortion of vision.
Redness is not typical and should cause the clinician to suspect an alternate diagnosis. Tortuous and dilated
retinal veins are the most common finding on funduscopic examination. Patients also often have multiple
cotton-wool spots, although these are not specific to retinal vein occlusion.
Which one of the following injection sites for insulin administration is best for preventing hypoglycemia in a 14-year-old male with diabetes mellitus who wishes to participate in track and field running events? (check one) A. Arm B. Abdomen C. Hip D. Calf E. Thigh
abdomen
The use of a nonexercised injection site for insulin administration, such as the abdomen, may reduce the risk of exercise-induced hypoglycemia.
A 69-year-old male presents with a 2-week history of fever, fatigue, weight loss, and mild diarrhea. He is found to have a mildly tender mass in the left lower quadrant of the abdomen.
The most likely diagnosis is: (check one)
A. Crohn’s disease
B. ulcerative colitis
C. celiac disease
D. diverticulitis
E. lymphoma
diverticulitis
Diverticulitis commonly affects the left lower quadrant in the elderly and may present as an abscess. Crohn’s disease primarily affects the distal small intestine (regional enteritis), most typically in a young person, and usually in the second or third decade of life.
A 2-week history of a palpable mass is not a typical presentation for lymphoma.
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.
Which one of the following is the most likely diagnosis? (check one) A. Candidiasis B. Tinea cruris C. Erythrasma D. Inverse psoriasis
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
