Test 51

Question 1

Bowel obstruction

Answer 1

All patients with partial small bowel obstruction should be admitted and managed initially with conservative therapy (IV hydration, nasogastric suctioning and correction of electrolyte abnormalities).

Question 2

Patient confidentiality

Answer 2

In most states, confidentiality is upheld for adolescents seeking care related to pregnancy, contraception, sexually transmitted disease, substance abuse, and mental health issues. However, physicians must break confidentiality and alert patients when the adolescent is at risk for self-harm.

Question 3

Cryptococcal infections

Answer 3

Cutaneous crytpococcosis can occur in patients with advanced HIV (CD4 count <100/mm^3) and is typically a marker of disseminated disease. Manifestations most commonly include the rapid onset of multiple papular lesions with central umbilication and central hemorrhage/necrosis.

Question 4

Polymyositis and dermatomyositis

Answer 4

Patients with polymyositis can develop pulmonary complications, including interstitial lung disease, infection, drug-induced pneumonias, and respiratory muscle weakness. Interstitial lung disease can be identified on high-resolution CT imaging as ground-glass opacities, reticular changes, honeycombing, or patchy consolidation. Pulmonary function tests show decreased forced viral capacity, total lung capacity, and diffusing capacity.

Question 5

Urticaria

Answer 5

When urticarial lesions exhibit atypical features, a biopsy is needed to assess for urticarial vasculitis. These atypical features include individual lesions lasting >24 hours, systemic/extradermal symptoms, presence of pain, and association with purpura.

Question 6

Gout

Answer 6

Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line therapy and are effective in >90% of patients with acute gout. Oral colchicine is an alternate therapy in patients with contraindications to NSAIDs. Intraarticular steroids can be used in acute gout for patients with one or two inflamed joints and contraindications to NSAIDs or colchicine.

Question 7

Diabetes mellitus

Answer 7

Both NPH and long-acting insulin analogs (detemir, glargine, degludec) are effective in lowering hemoglobin A1C in patients with type 2 diabetes mellitus. However, NPH is associated with a higher risk of hypoglycemia compared with long-acting insulin analogs.

Question 8

Prostate cancer

Answer 8

Transient elevations of prostate-specific antigen (PSA) can occur due to a variety of benign causes (urinary retention) and usually decreases within 4-6 weeks. Further investigation is needed if the PSA level remains elevated or prostate examination shows suspicious findings.