Nokea
Which of the following drug classes is not indicated for the treatment of depression?
- A. Buspirone (Buspar)
- B. Selective Serotonin Reuptake Inhibitor (SSRI)
- C. Tricyclic antidepressant (TCA)
- D. Bupropion (Wellbutrin)
Correct Answer: A
Rationale: The correct answer is A: Buspirone (Buspar). Buspirone is not indicated for the treatment of depression; it is primarily used to treat anxiety disorders. SSRIs and TCAs are commonly prescribed for depression due to their ability to increase serotonin levels. Bupropion is an atypical antidepressant that works on norepinephrine and dopamine, making it a suitable option for depression treatment. Buspirone's mechanism of action differs from antidepressants, focusing on serotonin and dopamine receptors rather than directly targeting depression symptoms. Therefore, Buspirone is not a recommended drug class for depression treatment.
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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.
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.
Which is the most effective pattern of palpation for breast cancer?
- A. Beginning at the nipple, make an ever-enlarging spiral.
- B. Divide the breast into quadrants and inspect each systematically.
- C. Examine in lines resembling the back and forth pattern of mowing a lawn.
- D. Beginning at the nipple, palpate outward in a stripe pattern.
Correct Answer: B
Rationale: The correct answer is B. Dividing the breast into quadrants and inspecting each systematically is the most effective pattern of palpation for breast cancer because it ensures thorough coverage of the entire breast, making it easier to detect any abnormalities. This method allows for a structured approach, reducing the likelihood of missing any potential signs of cancer.
A: Beginning at the nipple and making an ever-enlarging spiral may not cover all areas of the breast equally, potentially leading to missed abnormalities.
C: Examining in lines resembling mowing a lawn may also result in uneven coverage and potentially missing crucial areas.
D: Beginning at the nipple and palpating outward in a stripe pattern may not provide comprehensive coverage of the entire breast, increasing the risk of overlooking abnormalities.
A 42-year-old realtor comes to your clinic, complaining of "growths" in her vulvar area. She is currently undergoing a divorce and is convinced she has a sexually transmitted disease. She denies any vaginal discharge or pain with urination. She has had no fever, malaise, or night sweats. Her past medical history consists of depression and hypothyroidism. She has had two spontaneous vaginal deliveries and one cesarean section. She has had no other surgeries. She denies smoking or drug use. She has two to three drinks weekly. Her mother also has hypothyroidism and her father has high blood pressure and hypercholesterolemia. On examination you see a woman who is anxious but appears otherwise healthy. Her blood pressure, pulse, and temperature are unremarkable. On visualization of the perineum you see two 2- to 3- mm, round, yellow nodules on the left labia. On palpation they are nontender and quite firm. What diagnosis best fits this description of her examination?
- A. Genital herpes
- B. Condylomata acuminata
- C. Syphilitic chancre
- D. Epidermoid cyst
Correct Answer: D
Rationale: The correct answer is D: Epidermoid cyst. The key features in the clinical scenario that point towards an epidermoid cyst are the presence of painless, firm, non-tender, round, yellow nodules on the labia. These cysts are common in the vulvar area and often arise from blocked hair follicles. The absence of symptoms suggestive of a sexually transmitted infection (STI) such as vaginal discharge, pain with urination, fever, malaise, or night sweats, along with the patient's history of anxiety and the appearance of the nodules being consistent with an epidermoid cyst support this diagnosis.
Choice A: Genital herpes typically presents with painful vesicles or ulcers, which are not described in this case.
Choice B: Condylomata acuminata (genital warts) would present as soft, pink, or flesh-colored growths and are associated with HPV infection, which is not suggested in this scenario.
Choice C: Sy
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.