04-17-2008, 09:22 PM
501. For a symptomatic patient with varicose veins without complications, appropriate initial management includes elastic compression stockings (unless there is arterial insufficiency) with leg elevation, avoidance of prolonged standing, and weight loss as appropriate.
502. Based on the Ottawa ankle rules, radiography of the ankle is not indicated in patients with ankle injury who can bear weight and have no bony tenderness over the lateral malleolus or fifth metatarsal bone.
503. Patients with moderate ankle sprains usually are not treated with cast immobilization, which can delay return to normal activities compared with functional therapy.
504. Patients with compensated, asymptomatic heart failure can generally proceed to surgery if the level of other risk factors is acceptable.
505. Effective therapies for reducing the severity of nasal congestion in patients with viral upper respiratory infections include pseudoephedrine, ipratropium nasal inhaler, cromolyn sodium nasal inhaler, and humidified air.
506. Pseudoephedrine is safe in patients with well-controlled hypertension.
507. When the plaques of psoriasis are localized and involve less than 5% of the total body area, treatment with a topical agent is appropriate.
508. Patients with acute coronary syndromes benefit from in-hospital treatment with a statin.
509. In patients who have difficulty complying with the daily use of oral contraceptive pills for symptomatic relief of dysmenorrhea, the contraceptive patch, with similar efficacy, may be an appropriate alternative.
510. The evidence-based standard is selective preoperative testing based on medical history, physical examination, and risk for surgery-specific blood loss.
511. Multiple studies have shown that indiscriminant preoperative testing rarely identifies clinically important abnormalities, delays surgery, or predicts complications.
512. The best treatment for brown recluse spider bites is ice application, wound elevation, and avoidance of strenuous exercise in the muscles surrounding the bite.
513. Blood counts should be monitored in men receiving testosterone-replacement therapy, initially within 1 to 2 months of initiating therapy, then every 3 to 6 months for the first year, and then annually.
514. Higher testosterone levels stimulate erythropoiesis, and injections are more potent stimulants than transdermal preparations.
515. The metabolic syndrome is a secondary target of therapy, after serum low-density lipoprotein level, to reduce a patient's risk for coronary artery disease.
516. Benzodiazepines are one of the most frequently implicated classes of drugs causing delirium and exacerbating pre-existing cognitive impairment in elderly patients.
517. Benzodiazepines are the class of psychotropic agents most often associated with falls and hip fractures in the elderly.
518. The standard of weight loss against which dietary interventions are compared is counseling for exercise and a balanced low-calorie diet.
519. Patients with complex regional pain syndrome respond to bisphosphonate therapy.
520. Arrhythmia should be strongly suspected in patients with syncope and coronary artery disease and bifascicular block.
521. Long-term (more than 30 days) event monitoring with external or implantable continuous-loop recorders is recommended when suspicion of arrhythmia remains after inpatient telemetry and ambulatory electrocardiographic monitoring are nondiagnostic.
522. Corneal abrasion associated with hard or soft contact lenses is especially susceptible to infectious keratitis.
523. Cauda equina syndrome is characterized by urinary retention, saddle anesthesia, and radiculopathy.
524. Cauda equina syndrome is an indication for urgent evaluation and requires definitive imaging to visualize the spinal cord and epidural space.
525. Headaches that are acute in onset, occur after age 50 years, and are associated with a history of malignancy are œred flags prompting immediate neuroradiologic evaluation.
526. The varicella vaccine is recommended for all adults with no evidence of immunity to varicella.
527. Urticaria that does not respond to usual treatment should prompt a workup for urticarial vasculitis, including erythrocyte sedimentation rate, complete blood count, and skin biopsy from the edge of the wheal.
528. In patients with a history of deep venous thrombosis (DVT), the levonorgestrel intrauterine device will not increase the risk for developing embolic disease and also sufficiently decreases the likelihood of pregnancy.
529. Both oral and topical hormonal contraception are contraindicated in patients with a history of DVT.
530. Gabapentin, approved by the Food and Drug Administration for treatment of postherpetic neuralgia, has been shown to reduce pain and improve sleep in randomized controlled trials.
531. Among patients with chronic noncardiac chest pain, randomized, placebo-controlled studies have demonstrated that tricyclic antidepressants, β-blockers, ACE inhibitors, L-arginine, statins, and exercise may relieve symptoms.
532. Causes of unexplained weight loss in the elderly include depression, cancer, benign gastrointestinal conditions, medication toxicities, and socioeconomic concerns.
533. The most common malignancies characterized by weight loss in the elderly are lung and gastrointestinal malignancies.
534. Vestibular rehabilitation is one of the few evidence-based treatments for chronic dizziness, including peripheral vestibular disorders, benign positional vertigo, multifactorial dizziness in the elderly, psychologic factors, and head injury.
535. First-line therapy for panic disorder consists of selective serotonin reuptake inhibitors, such as paroxetine.
536. œAlarm symptoms in patients with abdominal pain include hematochezia, weight loss more than 4.5 kg (10 lb), family history of colon cancer, recurring fever, anemia, or chronic severe diarrhea.
537. Rotator cuff tendonitis is characterized by subacromial tenderness and impingement; pain often occurs with overhead reaching and when lying on the side.
538. Recurrent aphthous ulcers usually begin to occur in the teenaged years and recur intermittently, and their etiology is unknown.
539. If there is no contraindication, patients with coronary artery disease or significant risk factors should take perioperative β-blockers, titrated to a resting heart rate of 60/min.
540. An absence of midline cervical tenderness on direct palpation, focal neurologic deficits, intoxication, or painful distracting injuries; and normal alertness are highly sensitive for ruling out cervical spine injury.
541. Fatigue, hypotension, bradycardia, and exacerbations of reactive airway disease and heart failure are recognized side effects of timolol eye drops.
542. Minor depression consists of the presence of either depressed mood or anhedonia (or both) with other symptoms that total more than two but less than the five total symptoms required to establish a diagnosis of major depression.
543. Although minor depression decreases functional status, several treatment trials of pharmacotherapy and psychotherapy have reported that treatment outcomes for these modalities are no better than those associated with placebo.
544. Selective serotonin reuptake inhibitors may increase the risk for surgical bleeding complications.
545. Estrogen and selective estrogen receptor modulators increase the risk for thromboembolism and should be discontinued perioperatively.
546. When hormone replacement therapy has been prescribed for vasomotor symptoms, the symptoms will recur when therapy is discontinued.
547. Hypothyroidism may be an underlying cause of elevated cholesterol levels, and thyroid replacement therapy can reverse this finding.
548. Obesity is associated with an increased risk for total mortality and chronic conditions, including coronary artery disease, stroke, type 2 diabetes, heart failure, dyslipidemia, and hypertension.
549. Weight loss of approximately 5% at 1 year decreased progression to type 2 diabetes and improved control of lipid levels and hypertension.
550. Except for acute bronchitis in patients with underlying chronic obstructive pulmonary disease, the only bacterial infection requiring antibiotic therapy is Bordetella pertussis.
502. Based on the Ottawa ankle rules, radiography of the ankle is not indicated in patients with ankle injury who can bear weight and have no bony tenderness over the lateral malleolus or fifth metatarsal bone.
503. Patients with moderate ankle sprains usually are not treated with cast immobilization, which can delay return to normal activities compared with functional therapy.
504. Patients with compensated, asymptomatic heart failure can generally proceed to surgery if the level of other risk factors is acceptable.
505. Effective therapies for reducing the severity of nasal congestion in patients with viral upper respiratory infections include pseudoephedrine, ipratropium nasal inhaler, cromolyn sodium nasal inhaler, and humidified air.
506. Pseudoephedrine is safe in patients with well-controlled hypertension.
507. When the plaques of psoriasis are localized and involve less than 5% of the total body area, treatment with a topical agent is appropriate.
508. Patients with acute coronary syndromes benefit from in-hospital treatment with a statin.
509. In patients who have difficulty complying with the daily use of oral contraceptive pills for symptomatic relief of dysmenorrhea, the contraceptive patch, with similar efficacy, may be an appropriate alternative.
510. The evidence-based standard is selective preoperative testing based on medical history, physical examination, and risk for surgery-specific blood loss.
511. Multiple studies have shown that indiscriminant preoperative testing rarely identifies clinically important abnormalities, delays surgery, or predicts complications.
512. The best treatment for brown recluse spider bites is ice application, wound elevation, and avoidance of strenuous exercise in the muscles surrounding the bite.
513. Blood counts should be monitored in men receiving testosterone-replacement therapy, initially within 1 to 2 months of initiating therapy, then every 3 to 6 months for the first year, and then annually.
514. Higher testosterone levels stimulate erythropoiesis, and injections are more potent stimulants than transdermal preparations.
515. The metabolic syndrome is a secondary target of therapy, after serum low-density lipoprotein level, to reduce a patient's risk for coronary artery disease.
516. Benzodiazepines are one of the most frequently implicated classes of drugs causing delirium and exacerbating pre-existing cognitive impairment in elderly patients.
517. Benzodiazepines are the class of psychotropic agents most often associated with falls and hip fractures in the elderly.
518. The standard of weight loss against which dietary interventions are compared is counseling for exercise and a balanced low-calorie diet.
519. Patients with complex regional pain syndrome respond to bisphosphonate therapy.
520. Arrhythmia should be strongly suspected in patients with syncope and coronary artery disease and bifascicular block.
521. Long-term (more than 30 days) event monitoring with external or implantable continuous-loop recorders is recommended when suspicion of arrhythmia remains after inpatient telemetry and ambulatory electrocardiographic monitoring are nondiagnostic.
522. Corneal abrasion associated with hard or soft contact lenses is especially susceptible to infectious keratitis.
523. Cauda equina syndrome is characterized by urinary retention, saddle anesthesia, and radiculopathy.
524. Cauda equina syndrome is an indication for urgent evaluation and requires definitive imaging to visualize the spinal cord and epidural space.
525. Headaches that are acute in onset, occur after age 50 years, and are associated with a history of malignancy are œred flags prompting immediate neuroradiologic evaluation.
526. The varicella vaccine is recommended for all adults with no evidence of immunity to varicella.
527. Urticaria that does not respond to usual treatment should prompt a workup for urticarial vasculitis, including erythrocyte sedimentation rate, complete blood count, and skin biopsy from the edge of the wheal.
528. In patients with a history of deep venous thrombosis (DVT), the levonorgestrel intrauterine device will not increase the risk for developing embolic disease and also sufficiently decreases the likelihood of pregnancy.
529. Both oral and topical hormonal contraception are contraindicated in patients with a history of DVT.
530. Gabapentin, approved by the Food and Drug Administration for treatment of postherpetic neuralgia, has been shown to reduce pain and improve sleep in randomized controlled trials.
531. Among patients with chronic noncardiac chest pain, randomized, placebo-controlled studies have demonstrated that tricyclic antidepressants, β-blockers, ACE inhibitors, L-arginine, statins, and exercise may relieve symptoms.
532. Causes of unexplained weight loss in the elderly include depression, cancer, benign gastrointestinal conditions, medication toxicities, and socioeconomic concerns.
533. The most common malignancies characterized by weight loss in the elderly are lung and gastrointestinal malignancies.
534. Vestibular rehabilitation is one of the few evidence-based treatments for chronic dizziness, including peripheral vestibular disorders, benign positional vertigo, multifactorial dizziness in the elderly, psychologic factors, and head injury.
535. First-line therapy for panic disorder consists of selective serotonin reuptake inhibitors, such as paroxetine.
536. œAlarm symptoms in patients with abdominal pain include hematochezia, weight loss more than 4.5 kg (10 lb), family history of colon cancer, recurring fever, anemia, or chronic severe diarrhea.
537. Rotator cuff tendonitis is characterized by subacromial tenderness and impingement; pain often occurs with overhead reaching and when lying on the side.
538. Recurrent aphthous ulcers usually begin to occur in the teenaged years and recur intermittently, and their etiology is unknown.
539. If there is no contraindication, patients with coronary artery disease or significant risk factors should take perioperative β-blockers, titrated to a resting heart rate of 60/min.
540. An absence of midline cervical tenderness on direct palpation, focal neurologic deficits, intoxication, or painful distracting injuries; and normal alertness are highly sensitive for ruling out cervical spine injury.
541. Fatigue, hypotension, bradycardia, and exacerbations of reactive airway disease and heart failure are recognized side effects of timolol eye drops.
542. Minor depression consists of the presence of either depressed mood or anhedonia (or both) with other symptoms that total more than two but less than the five total symptoms required to establish a diagnosis of major depression.
543. Although minor depression decreases functional status, several treatment trials of pharmacotherapy and psychotherapy have reported that treatment outcomes for these modalities are no better than those associated with placebo.
544. Selective serotonin reuptake inhibitors may increase the risk for surgical bleeding complications.
545. Estrogen and selective estrogen receptor modulators increase the risk for thromboembolism and should be discontinued perioperatively.
546. When hormone replacement therapy has been prescribed for vasomotor symptoms, the symptoms will recur when therapy is discontinued.
547. Hypothyroidism may be an underlying cause of elevated cholesterol levels, and thyroid replacement therapy can reverse this finding.
548. Obesity is associated with an increased risk for total mortality and chronic conditions, including coronary artery disease, stroke, type 2 diabetes, heart failure, dyslipidemia, and hypertension.
549. Weight loss of approximately 5% at 1 year decreased progression to type 2 diabetes and improved control of lipid levels and hypertension.
550. Except for acute bronchitis in patients with underlying chronic obstructive pulmonary disease, the only bacterial infection requiring antibiotic therapy is Bordetella pertussis.