NBME 4 Correct Answer2mo infant is exclusively breastfed. What nutritional supplement? Correct Answer-Oral VitD to prevent rickets What HTN drug causes peripheral edema, flushing, dizziness? Correct Answer-CCB eg nifedipine 15yo girl with recurrent candida infections of skin and mucous membranes since childhood. Dx? Correct Answer-Chronic mucocutaneous candidiasis (T cell dysfunction) 57yoM with impotence for 1 year rand bronze colored skin. Ferritin concentration is 4050 NG/ml. Increased risk for what complication? Correct Answer-1. Liver (primary organ)--hepatocellular carcinoma 2. Others: pancreas (DM), heart (CHF), skin, thyroid (hypo), gonads, joints (arthritis) 87yo's daughter: "we want my mother to receive hospice care at home but no one wants her to die at home. Can she still have hospice services?" Correct Answer-Yes. Hospice can provide home based care and attempt to transfer the pt to another site before death. 32yoF with 4d of fever with lymphatic obstruction. PE: the left lower extremity is diffuse lay red and edematous from just below the knee to the ankle, with a sharp demarcation separating the erythematous area from the normal skin at the knee. The erythematous area is painful and hyperesthetic to touch. The left oral nodes are enlarged and painful. Dx and cause? Correct AnswerErysipelas - usually caused by group A strep - Tx: IM or oral penicillin/erythromycin 16yo girl with painful genital lesions or 2d. Lots of sexual partners. Exam shows two 3x3mm ulcerated lesions on the anterior vaginal vault. How prevent transmission with new partner? Correct AnswerConsistent condom use (NOT pharmacological treatment) 37yo primigravid at 25 weeks' gestation with confusion for 12 hours. Fever and intermittent nausea and vomiting over the past 2 weeks. No contractions, but decreased fetal movement. Family Hx of T1DM, seizure disorder. T 38.8, P 168/min, BP 187/84. Mildly enlarged thyroid gland. Lungs clear. 3/6 systolic ejection murmur. Fetal heart rate 182/min. Labs show: Hb 9.9, platelets 282k, Serum: Na 134, Cl 94, K 2.9, Thyroid-stimulating hormone 0.01, AST 33, LDH 112, Uric acid 5.4. Dx? Correct Answer-Thyroid storm - Precipitants: infection, DKA, stress (childbirth, trauma, surgery, illness) - Sx: fever, tachycardia, agitation, confusion, GI symptoms (n/v/d) - Tx: supportive therapy with IV fluids, cooling blankets, glucose; PTU ever y2h, follow with iodine; beta blockers to control HR; dexamethasone to impair t3 from T4 37yo F with 4-month history of numbness, burning, and tingling of the toes and soles of her feet. 3-year hx of recurrent mouth sores. Numerous oral apthous ulcers, genital ulcers, and several 2.5-cm red lesions over the left anterior tibial region. Photophobia. Ankle reflexes are absent. Proprioception and sensation to pinprick and vibration decreased in lower ext. Dx? Correct Answer-Behcet syndrome - autoimmune vasculititc disease - Sx: recurrent oral and genital ulcerations (usu painful), arthritis (knees, ankles), eye involvement (uveitis, optic neuritis, conjuncitivitis), CNS involvement (intracranial HTN, meningoencephalitis), fever, wt loss; erythema nodosum-like lesions, pseudofolliculitis - Dx: bx Tx: steroids *NOT polyarteritis nodosa - can be associated with hep B, HIV, drug reactions - Sx: fever, wt loss, myalgias, abdominal pain (bowel angina) - Dx: bx; elevated ESR and pANCA - Tx: corticosteroids (if severe, cyclophosphamide) 87yo F with fever for 1 day. Urinary catheter was placed 2 weeks ago. Has dementia, Alzheimer type, and is unable to communicate verbally. T 37.8 C, P 86/min, BP 120/74. Mucous membranes are moist and pink. Urinalysis shows: Color cloudy brown, Ph 8.8, Blood 2+, Glucose negative, Protein 2+, RBC numerous, wbc 20-25, Nitrites 3+, leuk esterase 3+, bacteria many. Gram stain shows gram-negative bacilli. Which would have prevented? Correct Answer-Use of incontinence briefs instead of the catheter (NOT changing catheter daily)