[MCQs] The Quizzes about Acute Complaints - Part 2 (20 test)

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Acute Complaints-2

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Question 1

A 20-year-old woman has had menorrhagia leading to Which of the following regimens would lead to the most iron being absorbed?

A	300 mg iron sulfate twice a day
B	300 mg iron sulfate with ascorbic acid twice a day
C	300 mg iron sulfate with calcium carbonate twice a day
D	300 mg iron gluconate twice a day
E	300 mg iron gluconate with calcium carbonate twice a day

Question 1 Explanation:

Oral iron therapy is available as iron salts. One 300 mg tablet of iron sulfate delivers 60 mg of elemental iron. One 300 mg tablet of iron gluconate only delivers 34 mg of elemental iron. Absorption of iron is improved in an acidic environment, thus tablets are often given with ascorbic acid to improve absorption. For the same reason, antacids should be avoided with iron. Other things that inhibit iron absorption are calcium, soy proteins, and tannins (often found in tea and wine).

Question 2

A 60-year-old man is being evaluated for fatigue, weakness, and exercise Laboratory assessment reveals: Hemoglobin 9.1 mg/dL (L) Serum iron 46 mcg/dL (L) Ferritin 9 ng/mL (L) Total iron binding capacity (TIBC) 626 mcg/dL (H) Mean corpuscular volume (MCV) 76 fL (L) What is the most common cause of this condition?

A	Blood loss
B	Poor nutrition
C	Inadequate absorption of iron
D	Chronic disease
E	Folic acid deficiency

Question 2 Explanation:

The laboratory evaluation in this patient clearly indicates iron deficiency anemia. The most common cause is blood loss. Poor nutrition and/or inadequate absorption are less common causes. Chronic disease would lead to a high or normal ferritin and a low TIBC. Folic acid deficiency would lead to an elevated MCV.

Question 3

You are caring for a 64-year-old woman with longstanding type 2 diabetes She comes to you complaining of fatigue. Screening lab- oratory analysis reveals a glycosolated hemoglobin level of 9.8%. Her hemoglobin is 10.4 g/dL, and her mean corpuscular volume is 76 fL (L). Further laboratory analysis reveals a serum iron of 40 mcg/dL (L), a total iron binding capacity of 188 mcg/dL (L), and a ferritin of 333 ng/mL (H). Which of the following treatments are indicated in this patient?

A	Oral iron therapy
B	Parenteral iron therapy
C	Erythropoietin therapy
D	Transfusion
E	Better diabetic control

Question 3 Explanation:

The laboratory results indicate anemia of chronic illness, in this case type 2 diabetes. It is likely a result of trapping of iron stores in the reticuloendothelial system, mildAcute Complaints Answers 147 decrease in erythropoietin production and decreased marrow response to erythropoietin. Although elevated iron and erythropoietin may help slightly, the mainstay of his treatment is treating the underlying condition. Transfusions may be necessary preoperatively if the hemoglobin is less than 10 mg/dL.

Question 4

You are performing a presurgical clearance evaluation on a 44-year- old otherwise healthy African American male who is undergoing a lapro- scopic His complete blood count (CBC) is shown below:

Hemoglobin: 10.6 g/dL Mean corpuscular volume: 54 fL (L) RBC: 6.3 M/uL (H) Red cell distribution width (RDW): 14.1 (NL) What should you do prior to surgery?

A	Oral iron replacement for 4 weeks, then recheck before surgery
B	Parenteral iron replacement for 4 weeks, then recheck before surgery
C	Transfusion
D	Hemoglobin electorphoresis
E	Erythropoietin

Question 4 Explanation:

The patient described has a laboratory profile suspicious for thalassemia minor. These patients have low hemoglobin and MCV, but in contrast to iron deficiency, the patients have an elevated RBC and normal RDW. Additionally, the MCV is low out of proportion to the anemia. Given that the patient is asymptomatic, he should be treated only if necessary. Treatment includes transfusion if blood loss leads to significant anemia. The patient should have genetic counseling if planning a family.

Question 5

You are evaluating a 26-year-old woman with She also com- plains of lightheadedness, some minor weight loss, and paresthesias in her hands and feet. On examination, her vital signs are normal, but you note pallor and glossitis. Laboratory evaluation reveals a hemoglobin of 9.8 g/dL

(L) and a mean corpuscular volume of 102 (H). Which of the following would be most likely to treat her condition?

A	A diet rich in green leafy vegetables
B	A diet rich in iron
C	Vitamin B-12 supplementation
D	Folic acid supplementation
E	Iron supplementation

Question 5 Explanation:

Some clinical features are common to all megaloblastic anemias—anemia, pallor, weight loss, fatigue, and glossitis to name a few. Neurological symptoms are specific to vitamin B-12 deficiency. Usually, treatment is parenteral vitamin B-12 replacement weekly for 1 month, often with concurrent administration of folic acid. Once levels are established, oral therapy may be sufficient.

Question 6

A 68-year-old man complains of He has a history of hyper- tension, well-controlled with hydrochlorothiazide. He’s recently lost 30 lb on a high protein, low carbohydrate diet. He drinks 2–3 beers daily, and smokes half pack of cigarettes daily. Laboratory evaluation reveals a macro- cytic anemia and vitamin B-12 deficiency. What is the most likely cause?

A	Side effects of hydrochlorothiazide
B	High protein diet
C	Low carbohydrate diet
D	Alcohol intake
E	Inadequate vitamin B-12 absorption

Question 6 Explanation:

Most often, vitamin B-12 deficiency is a result of inadequate absorption. Since B-12 is present in all animal products, only strict vegans or people not ingesting animal products would be deficient from a dietary standpoint. Vitamin B-12 deficiency is not a side effect of hydrochlorothiazide. Alcohol can impact intracellular processing of folic acid, but not vitamin B-12.

Question 7

A 3-year-old African American male is brought in by his parents with inconsolable He reports extreme pain in his hands and upper extremities. Laboratory evaluation reveals a hemoglobin of 8.2 mg/dL. His peripheral blood smear is as follows:

(Reproduced, with permission, from McPhee S, Papadakis M, and Tierney L. Current Medical Diagnosis and Treatment 2007, 46th ed. New York: McGraw-Hill, 2007.)

Which of the following measures would be most likely to reduce these events in the future?

A	Chronic use of analgesics
B	Adequate hydration
C	Immunization against streptococcal pneumonia
D	Monthly transfusions
E	Daily penicillin prophylaxis until the age of 5

Question 7 Explanation:

The slide shows sickle cell anemia, an autosomal recessive trait seen in those of African, Mediterranean, or Asian heritage. It is found before age 6 in 90% of patients, with acute pain crises as the most common presentation. Prophylaxis for pain crises involves ensuring adequate oxygenation and hydration. Immunization against streptococcal infection is appropriate, as most patients are functionally asplenic. The patients often have daily prophylaxis with penicillin until the age of 5. Immunization and antibiotic prophylaxis does not, however, prevent pain crises. Chronic analgesics and scheduled transfusions have not been shown to reduce pain crises.

Question 8

You are seeing a 25-year-old male with a It began as pink spots on his extremities, but the lesions have begun to coalesce and become pur- ple in color. He recently returned from a hiking trip in the western moun- tains. Of the following, which is the most likely cause?

A	Lyme disease
B	Rocky Mountain spotted fever
C	Tularemia
D	Brown recluse spider bite
E	Black widow spider bite

Question 8 Explanation:

The skin lesions of Rocky Mountain spotted fever are typically red macules on peripheral extremities that become purpuric and confluent. Lyme disease typically presents as a slowly spreading anular lesion—erythema chronicum migrans. Tularemia is characterized by pain and ulceration at the bite site. Brown recluse spider bites most often present as local pain and itching, then a hemorrhagic bulla with surrounding erythema and induration. The black widow bite is a mild prick followed by pain at the bite site.

Question 9

You are caring for a person who recently visited New England, and returns with symptoms suggestive of a Which of the following arachnid- bourne illnesses is most likely to occur in the Northeastern United States?

A	Lyme disease
B	Rocky Mountain spotted fever
C	Tularemia
D	Brown recluse spider bite
E	Chigger bites

Question 9 Explanation:

Lyme disease occurs in the New England states, New York, and Wisconsin, but can be seen sporadically in the West and Midwest. Rocky Mountain spotted fever occurs in the western mountain states, Tularemia in the west, brown recluse spider bites in the south central United States, and chiggers in the southern and midwestern United States.

Question 10

You are seeing a patient who is complaining of an itching There are erythematous papules on her scalp, and you note small black bulbs at the bases of several hair follicles. Which is the most likely cause of this itch?

A	Flea infestation
B	Bedbugs
C	Head lice
D	Scabies
E	Chigger bites

Question 10 Explanation:

This case describes the typical presentation and physical examination findings of head lice, including the typical erythematous popular rash and “nits” on the hair follicles. Fleas, bedbugs, scabies, and chiggers may all present with erythematous papules, but would have a different distribution and would not have associated nits.

Question 11

A 26-year-old elementary school teacher presents to you with an itchy You note pruritic erythematous papules in between her fingers, on her wrists, and around her waist at the belt line. Which of the following is the most likely cause?

A	Chigger bites
B	Bedbugs
C	Flea infestation
D	Scabies
E	Body lice

Question 11 Explanation:

This case describes the classic distribution of scabies. Sarcoptes scabiei burrow into intertriginous areas, wrists, or areas where clothing is tight next to the skin. The lesions of chigger bites are similar, but bites are typically found in a linear pattern over wrists, ankles, and legs. Bedbugs typically infest unclothed areas—the neck, hands, and face. Fleas typically bite the lower extremities, and lesions from body lice would not follow the pattern described.

Question 12

While you are working in the emergency room, a 17-year-old patient presents with a cat He was helping a neighbor get his cat out of a tree 3 hours ago, and was bitten on the forearm. On examination, you note ery- thema, a puncture wound with a jagged laceration, mild purulent dis- charge, but no tendon involvement. You irrigate the wound thoroughly. What additional therapy is indicated?

A	Hospitalization
B	Human rabies immune globulin
C	Amoxicillin/clavulanic acid
D	Clindamycin
E	Primary closure with subcutaneous sutures

Question 12 Explanation:

After a cat bite, hospitalization is indicated only if the bite involves the tendon, joint capsule, bone, or hand. Bites from a domestic cat carry a small risk of rabies, and immune globulin is not indicated. If rabies is suspected, the cat can be observed or tested. Treatment for the person can begin up to 8 days after exposure. Cat bites can become infected with pasturella multocida, which is sensitive to amoxicillin/clavulanate, but not clindamycin. Subcutaneous sutures are not recommended when closing a bite wound, as they are more likely to become infected.

Question 13

A 20-year-old man presents to you 30 minutes after being stung by a bee on his right He was stung by a bee twice last year. The first sting caused a 3 cm by 3 cm area of erythema, induration and pain around the sting site. The second sting caused a similar 5 cm by 7 cm area. When you examine him, he has an expanding 2 cm by 2 cm area of erythema, indura- tion and pain around the sting site on his thigh. He reports pruritis, fatigue and some nausea, but denies dyspnea. Which of the following is true?

A	This is a typical local reaction, and should spontaneously resolve within hours
B	This is a large local reaction, and the patient has minimal risk for the develop- ment of anaphylaxis upon subsequent exposure
C	This is a large local reaction, and the patient is at significant risk for the devel- opment of anaphylaxis upon subsequent exposure
D	This is considered a toxic systemic reaction, and increases his risk for anaphy- laxis if he is exposed in the future
E	This is considered a mild anaphylactic reaction

Question 13 Explanation:

Typical local reactions to stings include swelling, erythema, and pain at and around the site of the sting. In general, they resolve quickly and minimal analgesia is all that is necessary. Large local reactions include extended areas of swelling that last several days. They are not allergic in origin, and carry a minimal risk of anaphylaxis upon reexposure. Toxic systemic reactions are associated with nausea, vomiting, headache, vertigo, syncope, convulsions, and fever. Pruritis, erythema and urticaria are less common. Persons who have a toxic reaction are at risk for anaphylaxis with subsequent stings. The reaction described in the above question is not anaphylactic in nature.

Question 14

A 15-year-old male comes to your office complaining of bilateral breast enlargement. He is otherwise healthy and on no medications. On examination, there is mildly tender palpable breast tissue The rest of his physical examination, including his testicular examination is normal. Which of the following is true?

A	No further workup is necessary
B	Serum liver studies are needed to elucidate the cause
C	Thyroid function assessment is needed to elucidate the cause
D	Serum estradiol, testosterone, and leutinizing hormone levels are needed to elu- cidate the cause
E	His serum chorionic gonadotropin level is likely to be elevated

Question 14 Explanation:

Gynecomastia is a benign enlargement of the male breast. It may be asymptomatic or painful, bilateral or unilateral. It commonly occurs around the time of puberty, and if so, requires only a history, physical examination, and reassurance if there are no abnormalities found. Most cases resolve within 1 year. Outside of the pubertal period, assessment of hepatic, renal, and thyroid functions may help uncover a cause. Sex hormones are only tested if progressive enlargement is noted.

Question 15

A 22-year-old woman is seeing her physician with complaints of breast pain. It is associated with her menstrual cycle and is described as a bilateral “heaviness” that radiates to the axillae and arms. Examination reveals groups of small breast nodules in the upper outer quadrants of each breast. They are freely mobile and slightly tender. Which of the following statements is most correct?

A	The patient has bilateral fibroadenomas, and reassurance is all that is necessary
B	The patient has bilateral fibroadenomas, and a mammogram is necessary for further evaluation
C	The patient has bilateral fibrocystic changes, and reassurance is all that is necessary
D	The patient has bilateral fibrocystic changes, and a mammogram is necessary for further evaluation
E	The patient has bilateral mastitis, and antibiotic therapy is needed

Question 15 Explanation:

Fibrocystic changes are the most common benign condition of the breast. Cysts may range in size from 1 mm to more than 1 cm in size. Fibroadenomas are usually rubbery, smooth, well-circumscribed, nontender, and freely mobile. Mammograms are not necessary for women under 30, as they are less sensitive in younger women with denser breast tissue. Mastitis generally occurs with nursing, and is characterized by inflammation, edema, and erythema in areas of the breast.

Question 16

A 35-year-old woman presents to you concerned about a breast Examination reveals no skin changes, diffusely nodular breasts bilaterally with a more dominant, firm, nontender fixed nodule on the left side. The nodule is approximately 7 mm in size, in the upper outer quadrant of the left breast. Her mammogram is negative. Which of the following statements is true?

A	The patient should be reassured and resume routine care
B	The mass should be closely followed with repeat mammogram in 3–6 months
C	The patient should undergo testing for breast cancer genetic mutations, and base further workup on the results
D	The patient should be referred for an ultrasound and possible biopsy
E	If clear amber fluid is aspirated from the mass, it is likely benign, and no further workup is necessary

Question 16 Explanation:

Up to 15% of breast cancers are mammographically silent. Therefore, a palpable mass deserves further workup, even if the mammogram is negative. Workup may include an ultrasound to determine if the mass is cystic or solid, and possible biopsy. Aspiration of the mass may be appropriate, but biopsy is still necessary if the mass is palpable after aspiration, if the fluid is bloody, or if the mass reappears within 1 month. The characteristics of the fluid otherwise does not dictate workup. Genetic testing is of no value in the workup of a breast mass, but can be considered based on family history, and under the direction of an experienced genetic counselor.

Question 17

A 28-year-old woman comes to see you for a tender and erythema- tous area on her She is nursing her 6-week-old son. You diagnose mastitis. Which of the following is true regarding this condition?

A	Restricting caffeine and methylxanthines may be efficacious
B	Evening primrose oil has been shown to help with symptoms
C	Applying ice several times a day will help relieve symptoms
D	The patient should discontinue nursing
E	Antibiotic therapy is indicated

Question 17 Explanation:

Patients with mastitis should be encouraged to continue nursing, and should be started on an antibiotic that covers streptococcus and staphylococcal infections. Reducing caffeine and methylxanthines, or using evening primrose oil may decrease symptoms of fibrocystic breast disease, but has no impact on mastitis. Applying heat may help symptoms, but ice will not have the desired effect.

Question 18

You are seeing a 36-year-old woman with a complaint of nipple dis- charge. Which of the following characteristics of the discharge is most sus- picious for breast cancer?

A	Spontaneous discharge
B	Green discharge
C	Bilateral discharge
D	Discharge associated with menses
E	Bloody discharge

Question 18 Explanation:

Spontaneous, unilateral discharge is most suspicious for breast cancer. The characteristics of the discharge cannot be used to distinguish benign versus malignant causes, however, bloody, serous, serosanguineous, or watery discharge deserve a workup.

Question 19

On screening physical examination of a 36-year-old woman, you find a single left breast It is 1 cm in size, firm, smooth, and appar- ently fixed to the underlying tissue. You perform a mammogram which is characterized as BI-RADS 3. What does this indicate?

A	The physician should continue routine screening at the usual intervals
B	The physician should perform additional tests (spot compression mammo- gram, ultrasound) to evaluate the mass as soon as possible
C	The physician should perform diagnostic mammogram of the left breast in 6 months
D	Tissue diagnosis is needed
E	The mass is almost certainly cancerous

Question 19 Explanation:

The degree of abnormality seen on a mammogram is classified using the breast imaging reporting and date system (BI-RADS) system. BI-RADS classification 0 means that the test was incomplete, and additional testing should be conducted as soon as possible. BI-RADS 1 and 2 mean that the mammogram is benign, and routine screening can be conducted at usual intervals. BI-RADS 3 indicates that the lesion is probably benign, but that diagnostic mammogram should be performed in 6 months. BI-RADS 4 and 5 are suspicious for, and highly suggestive of, cancer (respectively) and that tissue diagnosis is needed.

Question 20

You are evaluating a 21-year-old woman with an erythematous, ten- der, and edematous She reports that while playing with her cat 3 days ago, he bit her and punctured the skin. The area around the bite is inflamed, and there is a purulent discharge from the puncture site. What is the most likely infecting organism?

A	Clostridium perfringens
B	Staphylococcus aureus
C	Streptococcus pyogenes
D	Pasteurella multocida
E	Haemophilus influenzae

Question 20 Explanation:

Hand cellulitis often follows puncture wounds, and cat bites may often produce infection with P. multocida. Most skin infections are due to S. aureus or S. pyogenes. C. perfringens may produce gas, and should be considered as a cause for cellulitis that can lead to gangrene, especially if creptius is found on clinical examination. H. influenzae sometimes infects the skin of younger children.

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1.A 20-year-old woman has had menorrhagia leading to Which of the following regimens would lead to the most iron being absorbed?

300 mg iron sulfate twice a day
300 mg iron sulfate with ascorbic acid twice a day
300 mg iron sulfate with calcium carbonate twice a day
300 mg iron gluconate twice a day
300 mg iron gluconate with calcium carbonate twice a day

2. A 60-year-old man is being evaluated for fatigue, weakness, and exercise Laboratory assessment reveals:

Hemoglobin 9.1 mg/dL (L) Serum iron 46 mcg/dL (L) Ferritin 9 ng/mL (L)

Total iron binding capacity (TIBC) 626 mcg/dL (H) Mean corpuscular volume (MCV) 76 fL (L)

What is the most common cause of this condition?

Blood loss
Poor nutrition
Inadequate absorption of iron
Chronic disease
Folic acid deficiency

3. You are caring for a 64-year-old woman with longstanding type 2 diabetes She comes to you complaining of fatigue. Screening lab- oratory analysis reveals a glycosolated hemoglobin level of 9.8%. Her hemoglobin is 10.4 g/dL, and her mean corpuscular volume is 76 fL (L). Further laboratory analysis reveals a serum iron of 40 mcg/dL (L), a total iron binding capacity of 188 mcg/dL (L), and a ferritin of 333 ng/mL (H). Which of the following treatments are indicated in this patient?

Oral iron therapy
Parenteral iron therapy
Erythropoietin therapy
Transfusion
Better diabetic control

4. You are performing a presurgical clearance evaluation on a 44-year- old otherwise healthy African American male who is undergoing a lapro- scopic His complete blood count (CBC) is shown below:

Hemoglobin: 10.6 g/dL

Mean corpuscular volume: 54 fL (L) RBC: 6.3 M/uL (H)

Red cell distribution width (RDW): 14.1 (NL)

What should you do prior to surgery?

Oral iron replacement for 4 weeks, then recheck before surgery
Parenteral iron replacement for 4 weeks, then recheck before surgery
Transfusion
Hemoglobin electorphoresis
Erythropoietin

5. You are evaluating a 26-year-old woman with She also com- plains of lightheadedness, some minor weight loss, and paresthesias in her hands and feet. On examination, her vital signs are normal, but you note pallor and glossitis. Laboratory evaluation reveals a hemoglobin of 9.8 g/dL

(L) and a mean corpuscular volume of 102 (H). Which of the following would be most likely to treat her condition?

A diet rich in green leafy vegetables
A diet rich in iron
Vitamin B-12 supplementation
Folic acid supplementation
Iron supplementation

6. A 68-year-old man complains of He has a history of hyper- tension, well-controlled with hydrochlorothiazide. He’s recently lost 30 lb on a high protein, low carbohydrate diet. He drinks 2–3 beers daily, and smokes half pack of cigarettes daily. Laboratory evaluation reveals a macro- cytic anemia and vitamin B-12 deficiency. What is the most likely cause?

Side effects of hydrochlorothiazide
High protein diet
Low carbohydrate diet
Alcohol intake
Inadequate vitamin B-12 absorption

7. A 3-year-old African American male is brought in by his parents with inconsolable He reports extreme pain in his hands and upper extremities. Laboratory evaluation reveals a hemoglobin of 8.2 mg/dL. His peripheral blood smear is as follows:

Which of the following measures would be most likely to reduce these events in the future?

Chronic use of analgesics
Adequate hydration
Immunization against streptococcal pneumonia
Monthly transfusions
Daily penicillin prophylaxis until the age of 5

8. You are seeing a 25-year-old male with a It began as pink spots on his extremities, but the lesions have begun to coalesce and become pur- ple in color. He recently returned from a hiking trip in the western moun- tains. Of the following, which is the most likely cause?

Lyme disease
Rocky Mountain spotted fever
Tularemia
Brown recluse spider bite
Black widow spider bite

9. You are caring for a person who recently visited New England, and returns with symptoms suggestive of a Which of the following arachnid- bourne illnesses is most likely to occur in the Northeastern United States?

Lyme disease
Rocky Mountain spotted fever
Tularemia
Brown recluse spider bite
Chigger bites

10. You are seeing a patient who is complaining of an itching There are erythematous papules on her scalp, and you note small black bulbs at the bases of several hair follicles. Which is the most likely cause of this itch?

Flea infestation
Bedbugs
Head lice
Scabies
Chigger bites

11. A 26-year-old elementary school teacher presents to you with an itchy You note pruritic erythematous papules in between her fingers, on her wrists, and around her waist at the belt line. Which of the following is the most likely cause?

Chigger bites
Bedbugs
Flea infestation
Scabies
Body lice

12. While you are working in the emergency room, a 17-year-old patient presents with a cat He was helping a neighbor get his cat out of a tree 3 hours ago, and was bitten on the forearm. On examination, you note ery- thema, a puncture wound with a jagged laceration, mild purulent dis- charge, but no tendon involvement. You irrigate the wound thoroughly. What additional therapy is indicated?

Hospitalization
Human rabies immune globulin
Amoxicillin/clavulanic acid
Clindamycin
Primary closure with subcutaneous sutures

13. A 20-year-old man presents to you 30 minutes after being stung by a bee on his right He was stung by a bee twice last year. The first sting caused a 3 cm by 3 cm area of erythema, induration and pain around the sting site. The second sting caused a similar 5 cm by 7 cm area. When you examine him, he has an expanding 2 cm by 2 cm area of erythema, indura- tion and pain around the sting site on his thigh. He reports pruritis, fatigue and some nausea, but denies dyspnea. Which of the following is true?

This is a typical local reaction, and should spontaneously resolve within hours
This is a large local reaction, and the patient has minimal risk for the develop- ment of anaphylaxis upon subsequent exposure
This is a large local reaction, and the patient is at significant risk for the devel- opment of anaphylaxis upon subsequent exposure
This is considered a toxic systemic reaction, and increases his risk for anaphy- laxis if he is exposed in the future
This is considered a mild anaphylactic reaction

14. A 15-year-old male comes to your office complaining of bilateral breast enlargement. He is otherwise healthy and on no medications. On examination, there is mildly tender palpable breast tissue The rest of his physical examination, including his testicular examination is normal. Which of the following is true?

No further workup is necessary
Serum liver studies are needed to elucidate the cause
Thyroid function assessment is needed to elucidate the cause
Serum estradiol, testosterone, and leutinizing hormone levels are needed to elu- cidate the cause
His serum chorionic gonadotropin level is likely to be elevated

15. A 22-year-old woman is seeing her physician with complaints of breast It is associated with her menstrual cycle and is described as a bilateral “heaviness” that radiates to the axillae and arms. Examination reveals groups of small breast nodules in the upper outer quadrants of each breast. They are freely mobile and slightly tender. Which of the following statements is most correct?

The patient has bilateral fibroadenomas, and reassurance is all that is necessary
The patient has bilateral fibroadenomas, and a mammogram is necessary for further evaluation
The patient has bilateral fibrocystic changes, and reassurance is all that is necessary
The patient has bilateral fibrocystic changes, and a mammogram is necessary for further evaluation
The patient has bilateral mastitis, and antibiotic therapy is needed

16. A 35-year-old woman presents to you concerned about a breast Examination reveals no skin changes, diffusely nodular breasts bilaterally with a more dominant, firm, nontender fixed nodule on the left side. The nodule is approximately 7 mm in size, in the upper outer quadrant of the left breast. Her mammogram is negative. Which of the following statements is true?

The patient should be reassured and resume routine care
The mass should be closely followed with repeat mammogram in 3–6 months
The patient should undergo testing for breast cancer genetic mutations, and base further workup on the results
The patient should be referred for an ultrasound and possible biopsy
If clear amber fluid is aspirated from the mass, it is likely benign, and no further workup is necessary

17. A 28-year-old woman comes to see you for a tender and erythema- tous area on her She is nursing her 6-week-old son. You diagnose mastitis. Which of the following is true regarding this condition?

Restricting caffeine and methylxanthines may be efficacious
Evening primrose oil has been shown to help with symptoms
Applying ice several times a day will help relieve symptoms
The patient should discontinue nursing
Antibiotic therapy is indicated

18. You are seeing a 36-year-old woman with a complaint of nipple dis- charge. Which of the following characteristics of the discharge is most sus- picious for breast cancer?

Spontaneous discharge
Green discharge
Bilateral discharge
Discharge associated with menses
Bloody discharge

19. On screening physical examination of a 36-year-old woman, you find a single left breast It is 1 cm in size, firm, smooth, and appar- ently fixed to the underlying tissue. You perform a mammogram which is characterized as BI-RADS 3. What does this indicate?

The physician should continue routine screening at the usual intervals
The physician should perform additional tests (spot compression mammo- gram, ultrasound) to evaluate the mass as soon as possible
The physician should perform diagnostic mammogram of the left breast in 6 months
Tissue diagnosis is needed
The mass is almost certainly cancerous

20. You are evaluating a 21-year-old woman with an erythematous, ten- der, and edematous She reports that while playing with her cat 3 days ago, he bit her and punctured the skin. The area around the bite is inflamed, and there is a purulent discharge from the puncture site. What is the most likely infecting organism?

Clostridium perfringens
Staphylococcus aureus
Streptococcus pyogenes
Pasteurella multocida
Haemophilus influenzae

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[MCQs] The Quizzes about Acute Complaints – Part 2 (20 test)

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