Test 71

Question 1

Infertility

Answer 1

Ovarian hyperstimulation syndrome is a complication of ovulation induction therapy for infertility. Patients have bilateral enlarged ovaries, ascites, hemoconcentration, hypercoagulability, and possible multiorgan failure.

Question 2

Gestational diabetes

Answer 2

Patients with gestational diabetes mellitus may require insulin therapy to optimize maternal glucose control. This intervention can reduce the risk for obstetric complications, including PREECLAMPSIA, fetal macrosomia, neonatal hypoglycemia, and shoulder dystocia.

Question 3

Compartment syndrome

Answer 3

Clinical assessment is an unreliable indicator of disease severity in compartment syndrome. A high index of suspicion and timely fasciotomy are the most important factors predicting complete functional recovery. Complete paralysis is a late finding, usually occurs in patients with a nonviable limb, and is generally not reversible with treatment.

Question 4

Smoking cessation

Answer 4

Although quitting smoking at age greater than or equal to 60 is associated with a smaller absolute decline in mortality rate than for smoking cessation at age <60, cessation at any age has been shown to lower the risk of all-cause mortality and cardiovascular events. The benefits can be seen within 5 years after quitting.

Question 5

Rheumatic fever

Answer 5

Patients with Sydenham chorea should be started on penicillin as soon as possible to eliminate carriage of group A streptococcus. Penicillin should be continued until adulthood with the goal of preventing recurrent rheumatic fever.

Question 6

Gout

Answer 6

Nonsteroidal anti-inflammatory drugs and colchicine are the first line treatments for acute gout flares but are contraindicated in patients with renal failure. Instead, corticosteroids should be used in these patients and can be injected locally in patients with a mono-articular arthritis or given orally in patients with multiple joint involvement.

Question 7

OSA

Answer 7

The next step in evaluation of excessive daytime sleepiness with suspected OSA is polysomnography (PSG). PSG evaluates the quality of sleep, and the recorded tracings of physiologic variables can assist in the diagnosis of obstructive sleep apnea, periodic limb movements, and narcolepsy.

Question 8

Metabolic syndrome

Answer 8

Metformin is especially useful in the management of obese, diabetic patients. This drug, along with pioglitazone (associated weight gain, due to fluid retention, more hepatotoxic), decreases triglycerides, increases HDL and improves non-alcoholic steatohepatitis. Thiazolidinediones, insulin and sulfonylureas cause weight gain. Acarbose’s action is too weak to be used as monotherapy.

Question 9

Cryptorchidism

Answer 9

Spontaneous descent of undescended testes is rare after age 6 months, and an orchiopexy is performed during infancy to optimize fertility and testicular growth.

Question 10

Acute pancreatitis

Answer 10

Pancreatic inflammatory fluid collections (pancreatic pseudocysts) occur in approximately 10% of patients after an episode of acute pancreatitis. Symptoms are largely determined by the mass effects and location of these collections and can include abdominal pain, biliary and pancreatic duct obstruction, fistulization into adjacent organs, and gastrointestinal hemorrhage.

Question 11

Pituitary tumors

Answer 11

Incidentally discovered small lesions in the sellar region are very common. Patients with a small mass or lesion without any hormonal dysfunction can be safely followed by periodic assessment of the pituitary gland with MRI.

Question 12

Adverse drug reaction

Answer 12

Peripheral edema is a common side effect of calcium channel blockers (CCBs). It is most common with dihydropyridine CCBs (amlodipine, nifedipine). The combination of CCBs with ACE inhibitors is associated with a significant reduction in CCB-associated peripheral edema.

Question 13

Complementary and alternative medicine

Answer 13

Compounds in licorice root can inhibit the conversion of cortisol to cortisone. The excess cortisol binds to mineralocorticoid receptors and causes hypertension, hypokalemia, and metabolic alkalosis.

Question 14

Myocardial infarction

Answer 14

Nitrates, diuretics, and opioids can reduce right ventricular (RV) preload and cause hypotension in patients with acute RV myocardial infarction. Such patients with evidence of low cardiac output and hypotension should be treated initially with a bolus of IV fluids to improve RV preload.

Question 15

Breast cancer

Answer 15

Male breast cancer is an uncommon condition. Risk is greatest in those with BRCA mutations and Klinefelter syndrome. Conditions that alter the estrogen-to-androgen ratio (hepatic dysfunction, marijuana use, obesity) confer a mildly elevated risk.