Test 30

Question 1

Macrocephaly

Answer 1

Infants with macrocephaly (head circumference greater than or equal to 98th percentile) who have an open anterior fontanelle and rapidly expanding head circumference should have a head ultrasound to evaluate for pathological intracranial processes.

Question 2

OCD

Answer 2

Patients with OCD experience obsession, compulsions, or both. Obsessions can include intrusive thoughts, violent images, and unwanted urges.

Question 3

Likelihood ratio

Answer 3

The negative likelihood ratio (LR-) represents the value of a negative test result. The smaller the LR, the less likely it is that the disease is actually present. A negative result on a highly sensitive test helps to rule out a disease.

Question 4

Fetal growth restriction

Answer 4

Patients with fetal growth restriction, an ultrasound-estimated fetal weight <10th percentile for gestational age, are followed with weekly umbilical artery Doppler sonography. Absent or reversed umbilical artery end-diastolic flow is a sign of impending fetal hypoxia and an indication for delivery.

Question 5

Compartment syndrome

Answer 5

Compartment syndrome should be suspected in patients with trauma who have early physical signs of extremity tightness, weakness, pain with passive muscle motion, and pain out of proportion to the injury (the most sensitive and early sign). Treatment involves measuring compartment pressures and fasciotomy.

Question 6

Lactose intolerance

Answer 6

Lactose intolerance classically presents with periumbilical abdominal pain, flatulence/bloating, and diarrhea. Suspicion of intolerance can be confirmed with resolution of symptoms on a lactose-restricted diet or by lactase breath hydrogen test.

Question 7

Malignant HTN

Answer 7

Acute decompensated HF results from a critical elevation in intracardiac filling pressures, often due to left ventricular dysfunction, and leads to pulmonary edema. IV diuretics (furosemide) lower intracardiac filling pressures and improve pulmonary edema, and are an important part of initial therapy.

Question 8

Malignant HTN

Answer 8

IV vasodilators (nitroglycerin) reduce intracardiac filling pressures and are recommended in patients with acute decompensated HF who have an inadequate response to initial diuretic therapy. In addition, they are indicated as initial therapy (prior to or instead of IV diuretics) in patients with “flash” pulmonary edema due to severe HTN.

Question 9

Malignant HTN

Answer 9

Transthoracic echocardiogram should be performed in patients with acute decompensated HF of uncertain etiology to evaluate for left ventricular and valvular dysfunction. If significant left ventricular systolic dysfunction is present, evaluation for ischemic cardiomyopathy with stress testing or coronary angiography is indicated.

Question 10

Atopic dermatitis

Answer 10

Initial management of atopic dermatitis (AD) includes topical emollients and avoidance of excessively hot/dry environments and harsh soaps and detergents. Although patients with AD often have evidence of hypersensitivity on antigen patch testing, mitigation of environmental and food allergens does not have a significant benefit for most patients.