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A 44-year-old male presents for an employment physical and is concerned about testing positive for amphetamines on a drug screen. His current medication list includes metformin, lisinopril, glyburide, and bupropion. The most likely medication cause for a false positive result for amphetamines would be:
- A. Metformin
- B. Lisinopril
- C. Glyburide
- D. Bupropion
Correct Answer: D
Rationale: The correct answer is D, Bupropion. Bupropion is known to potentially cause false-positive results for amphetamines on drug screens due to its structural similarity to amphetamines. Bupropion is a medication commonly used to treat depression and aid in smoking cessation. Metformin (A), Lisinopril (B), and Glyburide (C) are not known to cause false positives for amphetamines. Metformin is used to treat diabetes, Lisinopril is used for hypertension, and Glyburide is used for diabetes. Therefore, the most likely medication cause for a false positive result for amphetamines in this case would be bupropion.
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A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?
- A. Pityriasis rosea
- B. Tinea versicolor
- C. Psoriasis
- D. Atopic eczema
Correct Answer: A
Rationale: The correct answer is A: Pityriasis rosea. The key features that point towards this diagnosis include the sudden eruption of lesions in a Christmas tree pattern on the back and torso, along with itching. Pityriasis rosea commonly presents with a single large patch followed by smaller lesions in a distinct pattern. Other choices can be ruled out based on the description provided. Tinea versicolor typically presents with hypo- or hyperpigmented patches, not the erythematous papules and macules described. Psoriasis usually presents with thick, silvery scales, not erythematous lesions in a Christmas tree pattern. Atopic eczema may present with erythematous papules, but the Christmas tree pattern and acute onset described are not typical.
Symptoms of heartburn and regurgitation are associated with:
- A. Hiatal hernia
- B. Gastroesophageal reflux
- C. Peptic ulcer disease
- D. Esophageal cancer
Correct Answer: B
Rationale: The correct answer is B: Gastroesophageal reflux. Heartburn and regurgitation are classic symptoms of GERD, where stomach acid flows back into the esophagus. This causes a burning sensation in the chest and sour taste in the mouth. Hiatal hernia (A) can contribute to GERD but is not directly associated with these symptoms. Peptic ulcer disease (C) typically presents with stomach pain, not heartburn. Esophageal cancer (D) may present with difficulty swallowing and weight loss, not just heartburn and regurgitation. Therefore, choice B is the most appropriate answer.
When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, boggy, and warm. This finding is consistent with:
- A. A normal prostate gland
- B. Acute bacterial prostatitis
- C. Benign prostatic hyperplasia
- D. Carcinoma of the prostate
Correct Answer: B
Rationale: The correct answer is B: Acute bacterial prostatitis. This is because the symptoms of tenderness, swelling, bogginess, and warmth are indicative of an acute inflammatory process, which is commonly seen in acute bacterial prostatitis. This condition typically presents with localized prostate tenderness and inflammation due to a bacterial infection. Other choices are incorrect because: A) A normal prostate gland should not exhibit these signs of inflammation. C) Benign prostatic hyperplasia is typically asymptomatic or may present with obstructive urinary symptoms, not acute inflammatory signs. D) Carcinoma of the prostate usually does not present with acute inflammatory findings on palpation.
A 45-year-old electrical engineer presents to your clinic, complaining of spots on his scrotum. He first noticed the spots several months ago, and they have gotten bigger. He denies any pain with urination or with sexual intercourse. He has had no fever, night sweats, weight gain, or weight loss. His past medical history consists of a vasectomy 10 years ago and mild obesity. He is on medication for hyperlipidemia. He denies any tobacco or illegal drug use and drinks alcohol socially. His mother has Alzheimer's disease and his father died of leukemia. On examination he appears relaxed and has unremarkable vital signs. On visualization of his penis, he is circumcised and has no lesions on his penis. Visualization of his scrotum shows three yellow nodules 2-3 millimeters in diameter. During palpation they are firm and nontender. What abnormality of the male genitalia is this most likely to be?
- A. Condylomata acuminata
- B. Syphilitic chancre
- C. Peyronie's disease
- D. Epidermoid cysts
Correct Answer: D
Rationale: The correct answer is D: Epidermoid cysts. These cysts typically present as firm, non-tender nodules on the scrotum, consistent with the patient's presentation. The history of gradual growth without associated symptoms supports this diagnosis. Additionally, the lack of pain with urination or sexual intercourse rules out sexually transmitted infections like condylomata acuminata (choice A) and syphilitic chancre (choice B). Peyronie's disease (choice C) involves penile curvature and fibrous plaques, not scrotal nodules. In summary, the patient's presentation, physical examination findings, and absence of specific symptoms point towards epidermoid cysts as the most likely diagnosis.
Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have increased over the past several months. There is no dysuria, hematuria, or sensation of incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild voiding symptoms with low impact on his quality of life. His medical history includes hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized prostate. Which of the following is the best next step?
- A. Urinalysis
- B. Cystoscopy
- C. Lifestyle modifications
- D. Tamsulosin
Correct Answer: C
Rationale: The correct next step is C: Lifestyle modifications. Given the patient's history of mild voiding symptoms and benign prostatic hyperplasia, the first approach should be conservative management. Lifestyle modifications, such as reducing caffeine intake from coffee and diet cola, can help alleviate urinary symptoms. Additionally, optimizing fluid intake and bladder habits can also improve symptoms. Urinalysis (choice A) may be considered later if symptoms persist or worsen. Cystoscopy (choice B) is invasive and not indicated at this stage. Tamsulosin (choice D) is a medication for BPH, but since the patient's symptoms are mild and bother score is low, starting with lifestyle modifications is more appropriate.