pance rosh UPDATED ACTUAL Questions and CORRECT Answers
1. Papular urticaria Papular urticaria is a hypersensitivity disorder in which
insect bites, most often those of fleas, mosquitoes, or
bedbugs, lead to recurrent and sometimes chronic itchy
papules on exposed areas of skin (like the arms, lower
legs, upper back, and scalp). Papular urticaria is reported
predominantly in young children (typically two to 10 years
of age). The diaper areas, genital, perianal, and axillary
areas are spared. The 0.5 to 1 cm lesions may be urticarial
at the start of the syndrome, but become persistent and
papular or nodular with time. The diagnosis of papular
urticaria is made clinically, although there may be a delay
between the inciting bite and the onset of lesions, or insect
bites may not have been noticed at all. Usually only one
child in a family is affected, a clue that infestation at home
is unlikely. New lesions may appear sporadically, and re-
newed itching may lead to reactivation of older lesions,
leading to a chronic and cycling disorder that may last
from months to years. Management of papular urticaria
includes selective and limited use of non-sedating antihis-
tamines for pruritus, mid-potency topical corticosteroids
applied to individual lesions, and reassurance, as the dis-
order eventually resolves spontaneously.
2. An eight-year-old girl presents C
with her father to the clinic be-
cause of itchy bumps on her
legs. Yesterday, there were a few
bumps on the girl's legs, which
she has been constantly scratch-
ing. She did recall that she had
insect bites on her legs a month
ago when she went hiking with
, her brother and father although
she has not had any insect bite
recently. On skin examination,
there are multiple 0.5 cm to 1 cm
papules with central crusts and
excoriations on both her legs.
Which of the following is the
most likely diagnosis?
AAtopic dermatitis
BLangerhans cell histiocytosis
CPapular urticaria
DScabies
3. Vfib
4. Vtach
5. Changes in preg -- increased CHFCBGPRW
congenital heart failure,
can be GPR woah
6. changes in pregnancy - de- AASHHBUGP
creased
,7. Rust Ring Metallic foreign bodies embedded in the cornea develop
rust rings due to oxidation of the iron. Rust rings can
develop within hours of metallic foreign body contact with
the cornea. Over 24-48 hours, the rust ring will oxidize and
kill surrounding epithelium. At this time, the rust ring will
be soft and easily removed in one solid plug.
8. A 35-year-old woman presents No further follow-up is necessary in a low-risk patient
to her primary care physician for with a solitary pulmonary nodule of < 6 mm. Pulmonary
follow up of an incidental find- nodules can be either benign or malignant. Most nodules
ing on chest CT found during a are benign even among smokers. Benign nodules can be
workup for possible pulmonary caused by infectious granulomas, hamartomas, arteriove-
embolism. She is a non-smoker nous malformations or inflammatory lesions. When decid-
and has a negative family history ing how to best evaluate a nodule, things to consider are
for lung cancer. A solid, solitary the probability of malignancy, the age of the patient, risk
pulmonary nodule of 4 mm was factors for either lung cancer or non-lung cancer nodules,
seen on chest CT. The scan was and the size and features of the nodule. A solid nodule less
otherwise unremarkable. Which than 6 mm does not require follow-up as they are generally
of the following is the next best benign. Nodules between 6-8 mm can be followed with
step? a CT scan. If the patient is at high risk, a second CT scan
ACT scan at 12 months 18 months later can be considered. Serial CT surveillance
BNeedle biopsy would be considered with a low to intermediate risk nod-
CNo further follow-up ule over 8 mm. If there is a high probability of malignancy,
DSerial CT surveillance biopsy and excision should be considered.
9.
, A 30-year-old woman presents Fluorescent treponemal antibody absorption (FTA-ABS), a
to her primary care physician treponemal test, will remain positive after a person's first
with concerns that she has been infection with syphilis leading to a false-positive results
exposed to syphilis by her part- and inaccuracy in diagnosing syphilis. These serologic test
ner. She was treated for syphilis results are based on the reaction of antibodies to specific
in the past. Which of the follow- treponemal antigens. Results are qualitative, they are ei-
ing diagnostic tools would show ther reactive or nonreactive. A reactive result is reactive for
a false-positive result due to her life. Serologic testing to diagnose syphilis should include
prior infection and cannot be the use of both nontreponemal and treponemal tests.
used alone to provide a diagno- Initial screening is performed with a nontreponemal test
sis of syphilis? (eg, RPR). This is a quantitative test (reported as a titer of
antibody) and reflects the activity of the infection. A reactive
nontreponemal test is then confirmed with a treponemal
ADirect fluorescent antibody
test, such as the fluorescent treponemal antibody absorp-
(DFA)
tion (FTA-ABS).
BFluorescent treponemal anti-
body absorption (FTA-ABS)
CPolymerase chain reaction
(PCR)
DRapid plasma reagin (RPR)
10. A 55-year-old man with no his- D
tory of atherosclerotic cardiovas-
cular disease or diabetes mel- The American College of Cardiology and the American
litus presents to your office Heart Association (ACC/AHA) released a new set of guide-
with questions about his cho- lines in 2018 with information about treating blood cho-
lesterol. He was previously tak- lesterol as a means of reducing the risk of atherosclerotic
ing atorvastatin, but stopped cardiovascular disease (ASCVD) in adults. For individuals
because his fasting low-densi- aged 40 to 75 years without a history of ASCVD or diabetes
ty lipoprotein (LDL) cholesterol mellitus, the panel recommends calculating the 10-year
level dropped to 90 mg/dL and event risk for ASCVD as a way of initiating the conversation
he was following the lifestyle about prevention with patients. Those who have a 10-year
1. Papular urticaria Papular urticaria is a hypersensitivity disorder in which
insect bites, most often those of fleas, mosquitoes, or
bedbugs, lead to recurrent and sometimes chronic itchy
papules on exposed areas of skin (like the arms, lower
legs, upper back, and scalp). Papular urticaria is reported
predominantly in young children (typically two to 10 years
of age). The diaper areas, genital, perianal, and axillary
areas are spared. The 0.5 to 1 cm lesions may be urticarial
at the start of the syndrome, but become persistent and
papular or nodular with time. The diagnosis of papular
urticaria is made clinically, although there may be a delay
between the inciting bite and the onset of lesions, or insect
bites may not have been noticed at all. Usually only one
child in a family is affected, a clue that infestation at home
is unlikely. New lesions may appear sporadically, and re-
newed itching may lead to reactivation of older lesions,
leading to a chronic and cycling disorder that may last
from months to years. Management of papular urticaria
includes selective and limited use of non-sedating antihis-
tamines for pruritus, mid-potency topical corticosteroids
applied to individual lesions, and reassurance, as the dis-
order eventually resolves spontaneously.
2. An eight-year-old girl presents C
with her father to the clinic be-
cause of itchy bumps on her
legs. Yesterday, there were a few
bumps on the girl's legs, which
she has been constantly scratch-
ing. She did recall that she had
insect bites on her legs a month
ago when she went hiking with
, her brother and father although
she has not had any insect bite
recently. On skin examination,
there are multiple 0.5 cm to 1 cm
papules with central crusts and
excoriations on both her legs.
Which of the following is the
most likely diagnosis?
AAtopic dermatitis
BLangerhans cell histiocytosis
CPapular urticaria
DScabies
3. Vfib
4. Vtach
5. Changes in preg -- increased CHFCBGPRW
congenital heart failure,
can be GPR woah
6. changes in pregnancy - de- AASHHBUGP
creased
,7. Rust Ring Metallic foreign bodies embedded in the cornea develop
rust rings due to oxidation of the iron. Rust rings can
develop within hours of metallic foreign body contact with
the cornea. Over 24-48 hours, the rust ring will oxidize and
kill surrounding epithelium. At this time, the rust ring will
be soft and easily removed in one solid plug.
8. A 35-year-old woman presents No further follow-up is necessary in a low-risk patient
to her primary care physician for with a solitary pulmonary nodule of < 6 mm. Pulmonary
follow up of an incidental find- nodules can be either benign or malignant. Most nodules
ing on chest CT found during a are benign even among smokers. Benign nodules can be
workup for possible pulmonary caused by infectious granulomas, hamartomas, arteriove-
embolism. She is a non-smoker nous malformations or inflammatory lesions. When decid-
and has a negative family history ing how to best evaluate a nodule, things to consider are
for lung cancer. A solid, solitary the probability of malignancy, the age of the patient, risk
pulmonary nodule of 4 mm was factors for either lung cancer or non-lung cancer nodules,
seen on chest CT. The scan was and the size and features of the nodule. A solid nodule less
otherwise unremarkable. Which than 6 mm does not require follow-up as they are generally
of the following is the next best benign. Nodules between 6-8 mm can be followed with
step? a CT scan. If the patient is at high risk, a second CT scan
ACT scan at 12 months 18 months later can be considered. Serial CT surveillance
BNeedle biopsy would be considered with a low to intermediate risk nod-
CNo further follow-up ule over 8 mm. If there is a high probability of malignancy,
DSerial CT surveillance biopsy and excision should be considered.
9.
, A 30-year-old woman presents Fluorescent treponemal antibody absorption (FTA-ABS), a
to her primary care physician treponemal test, will remain positive after a person's first
with concerns that she has been infection with syphilis leading to a false-positive results
exposed to syphilis by her part- and inaccuracy in diagnosing syphilis. These serologic test
ner. She was treated for syphilis results are based on the reaction of antibodies to specific
in the past. Which of the follow- treponemal antigens. Results are qualitative, they are ei-
ing diagnostic tools would show ther reactive or nonreactive. A reactive result is reactive for
a false-positive result due to her life. Serologic testing to diagnose syphilis should include
prior infection and cannot be the use of both nontreponemal and treponemal tests.
used alone to provide a diagno- Initial screening is performed with a nontreponemal test
sis of syphilis? (eg, RPR). This is a quantitative test (reported as a titer of
antibody) and reflects the activity of the infection. A reactive
nontreponemal test is then confirmed with a treponemal
ADirect fluorescent antibody
test, such as the fluorescent treponemal antibody absorp-
(DFA)
tion (FTA-ABS).
BFluorescent treponemal anti-
body absorption (FTA-ABS)
CPolymerase chain reaction
(PCR)
DRapid plasma reagin (RPR)
10. A 55-year-old man with no his- D
tory of atherosclerotic cardiovas-
cular disease or diabetes mel- The American College of Cardiology and the American
litus presents to your office Heart Association (ACC/AHA) released a new set of guide-
with questions about his cho- lines in 2018 with information about treating blood cho-
lesterol. He was previously tak- lesterol as a means of reducing the risk of atherosclerotic
ing atorvastatin, but stopped cardiovascular disease (ASCVD) in adults. For individuals
because his fasting low-densi- aged 40 to 75 years without a history of ASCVD or diabetes
ty lipoprotein (LDL) cholesterol mellitus, the panel recommends calculating the 10-year
level dropped to 90 mg/dL and event risk for ASCVD as a way of initiating the conversation
he was following the lifestyle about prevention with patients. Those who have a 10-year
