Test 43

Question 1

Benign prostatic hyperplasia

Answer 1

Retrograde ejaculation is the most frequent complication of transurethral resection of the prostate, and all patients should be made aware of this.

Question 2

Thalassemia

Answer 2

Screening for anemia is routine at the first prenatal visit. Thalassemia trait is characteristized by a microcytic, hypochromic anemia; mildly elevated ferritin; and normal red cell distribution width. Partners of women with thalassemia minor should undergo hemoglobin analysis to assess fetal risk of inheriting thalassemia.

Question 3

Prostatitis

Answer 3

Patients with acute bacterial prostatitis usually have fever, dysuria, urinary frequency, and cloudy urine. Rectal examination typically reveals a warm, edematous, and very tender prostate (unlike urinary tract infection). Prostatic swelling can lead to bladder outlet obstruction with acute urinary retention; treatment with urgent bladder decompression (suprapubic catheter) and antibiotics is required.

Question 4

Malaria

Answer 4

Malaria should be considered as a differential diagnosis for fever in travelers returning from sub-Saharan Africa, including those who did not complete an appropriate prophylaxis course. Diagnosis is established with a peripheral blood smear.

Question 5

Research ethics

Answer 5

It is appropriate for a conference faculty member presenting a lecture to accept reasonable compensation from a pharmaceutical company (travel reimbursement and/or honoraria). However, it is inappropriate to allow the company to control the lecture’s content or format.

Question 6

Adrenal insufficiency

Answer 6

Chronic adrenal insufficiency should be suspected in patients with fatigue, weight loss, myalgias, increased pigmentation, and decreased axillary and pubic hair. Hyponatremia, hyperkalemia, and hyperchloremic metabolic acidosis are characteristic laboratory findings. The most common etiology of this condition is primary adrenal insufficiency (Addison’s disease). Diagnosis is confirmed with low morning plasma cortisol and elevated adrenocorticotropic hormone [ACTH] (often performed with an ACTH stimulation test).

Question 7

Phencyclidine

Answer 7

PCP intoxication leading to severe agitation and violent behavior should be treated immediately with benzodiazepines to provide sedation. A low-stimulantion environment (with or without benzodiazepines) is more appropriate for patients with milder symptoms of PCP intoxication.