Nokea
Which lesion is dark, raised, and asymmetric with an irregular border?
- A. Nevus
- B. Actinic keratosis
- C. Keratoacanthoma
- D. Melanoma
Correct Answer: D
Rationale: The correct answer is D, Melanoma. Melanoma is a type of skin cancer that typically presents as a dark, raised lesion with an irregular border and asymmetry. This is due to the abnormal growth of melanocytes, the pigment-producing cells in the skin. Nevus (A) is a common mole that is usually symmetrical and has a regular border. Actinic keratosis (B) is a precancerous lesion that is typically rough and scaly, not dark or raised. Keratoacanthoma (C) is a low-grade skin cancer that often appears as a dome-shaped lesion with a central crater, not necessarily dark or asymmetric.
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Which of the following is the most common presenting sign of substance abuse in adolescents?
- A. Poor school performance
- B. Change in sleep habits
- C. Increased blood pressure
- D. Changes in behavior
Correct Answer: D
Rationale: The correct answer is D: Changes in behavior. This is the most common presenting sign of substance abuse in adolescents because substance use often leads to noticeable changes in behavior, such as irritability, mood swings, aggression, and withdrawal from family and friends. These behavioral changes are typically the first noticeable signs of substance abuse.
A: Poor school performance may be a consequence of substance abuse, but it is not necessarily the most common presenting sign.
B: Change in sleep habits can be a sign of substance abuse, but changes in behavior are more prominent and common.
C: Increased blood pressure is a physical symptom of substance abuse, but changes in behavior are usually more readily apparent and commonly observed in adolescents with substance abuse issues.
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.
A 29-year-old computer programmer comes to the office for evaluation of a headache. The tightening sensation of moderate intensity is located all over the head. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain, but not taken it away. Based on this description, what is the most likely diagnosis?
- A. Cluster
- B. Analgesic rebound
- C. Tension
- D. Migraine
Correct Answer: C
Rationale: The correct answer is C: Tension headache. The key features in the scenario are the bilateral location of the headache, duration of 5 days, absence of nausea and photophobia, and the patient's occupation as a computer programmer. Tension headaches are typically bilateral, mild to moderate in intensity, and often related to stress, posture, and prolonged screen time. The fact that over-the-counter medication only dulled the pain supports the diagnosis of tension headache.
Summary of other choices:
A: Cluster headaches typically have a unilateral location, severe intensity, and are associated with autonomic symptoms like tearing of the eye.
B: Analgesic rebound headaches occur due to overuse of pain medications, leading to worsening of headaches when the medication wears off.
D: Migraine headaches often present with unilateral throbbing pain, nausea, and sensitivity to light and sound, which are not present in this case.
A patient presents with decreased hearing related to antibiotic use. Which class of antibiotics is this?
- A. Aminoglycosides
- B. Beta-lactams
- C. Cephalosporins
- D. Macrolides
Correct Answer: A
Rationale: The correct answer is A: Aminoglycosides. Aminoglycosides can cause ototoxicity, resulting in decreased hearing. They are known to damage the sensory cells in the inner ear. Beta-lactams (B) and Cephalosporins (C) are not associated with hearing loss. Macrolides (D) can rarely cause hearing loss but are not as commonly linked to ototoxicity as aminoglycosides.
An 82-year-old woman receives oral amoxicillin-clavulanate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management?
- A. Metronidazole is the treatment of choice for C. difficile infection.
- B. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin.
- C. Fecal transplantation is the treatment of choice for C. difficile infection.
- D. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
Correct Answer: D
Rationale: The correct answer is D: Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
1. Choice A is incorrect because metronidazole is no longer recommended as first-line treatment due to increasing resistance.
2. Choice B is incorrect because there is no evidence suggesting older adults require a longer duration of treatment with vancomycin for their first episode.
3. Choice C is incorrect because while fecal transplantation can be used in refractory cases, it is not typically the first-line treatment.
4. The rationale for D being correct is that both vancomycin and fidaxomicin are recommended as first-line treatments for the initial episode of C. difficile infection based on current guidelines. This allows for flexibility in selecting the appropriate antibiotic based on individual patient factors.