NMS Q&A Family Medicine

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308 NMS Q&A Family Medicineperiorbital edema. Which of the following is the correctdiagnosis?(A) Lupus erythematosus(B) Dermatomyositis(C) Polymyositis(D) Charcot–Marie–Tooth disease(E) Contact dermatitis18 A 55-year-old man complains of stinging pain for3 days in the facial area involving the right foreheadfrom beneath the scalp anteriorly and as low as thelevel of the right eye, seemingly out of proportion toa red rash he notes that is appearing today. The areaof erythema involves a band that matches the areaof pain reported by the patient. Examination reveals1- to 3-mm vesicles on the right cheek against theerythematous background. Which of the followingis the most likely diagnosis?(A) Herpes simplex (HS)(B) Dermatitis herpetiformis(C) Contact dermatitis(D) Herpes zoster(E) Nummular eczema
Dermatology 309Examination Answers1. The answer is C. The incorrect statement regardingscarlatina is that the rash spreads to the palms. Each of theother statements is true. The sandpaper rash has sometimesbeen called pampiniform. The strawberry tongue is classic;as a form of beta-hemolytic streptococcal pharyngitis, itmay manifest symptoms of systemic illness such as nauseaand vomiting. That said, the disease is much less frequentand more benign than it was two generations ago.2. The answer is E. Culture of Pseudomonas from thewater is unreliable is the incorrect statement. In fact, allreports on water exposure folliculitis, P. aeruginosa , hasbeen isolated. Although the infection in healthy people isself-limited, systemic symptoms occur in the majority ofcases as well as external otitis. Each of the other statementsis correct. Successful treatments include polymyxin Bspray and oral cipromycin.3. The answer is B. In RMSF, hepatocellular functionstests may be elevated. Serum sodium, hematocrit, plateletcount, and CSF glucose may each be lower than normal,the latter (hypoglycorrhachia) signaling meningitis in thisdisease, caused by Rickettsia ricketsii , carried by the dogtick in the east and the wood tick in the west. The petechialrash begins on the legs before spreading to the hands.Immunofluorescence titers do not rise until the 2nd weekof symptoms. Treatment in children under 9 years ischloramphenicol, otherwise doxycycline. Untreated caseshave a high risk of dying due to pulmonary hemorrhage.4. The answer is B. Infantile eczema. Psoriasis rarelyoccurs on the face, and the mean age at onset is between20 and 30 years. Compulsive licking followed by chafingthe lips usually occurs during the juvenile years, and thelesions in this case are farther from the mouth than thereach of the tongue. Candidiasis affects the intertriginousareas, opposite from the rash in this case, which involvesthe tops of the folds of skin. Cellulitis is a serious bacterialinfection that occurs in a focal area, not in separate distinctpatches, and it would not manifest chronicity as thepatient’s illness would bring the affair to an early crisis.Finally, statistically, not only the greater prevalence ofinfantile eczema but also the fact that this disorder is amanifestation of the heavily familial-inherited group ofatopic diseases mark this as eczema. The other membersof the group are allergic rhinitis and conjunctivitis (“hayfever”) and asthma.5. The answer is C. Infectious mononucleosis is notedfor an associated morbilliform rash when the patient hasbeen treated with ampicillin, the famous ampicillin rash.The mononucleosis test is not reliable until the illness hasbeen present for 5 to 7 days. Streptococcal pharyngitisnearly always manifests tender adenopathy if the nodesare enlarged. Rubeola causes indeed a morbilliform eruption,but the exudative pharynx is not part of the picture.Urticaria may be mixed with the rash of mononucleosis,which may account for the occasional pruritic aspect ofthe rash on the vignette but that would not account forthe remainder of the presentation.6. The answer is D. Infantile eczema, although geneticallydetermined, is often precipitated by a food allergy inthe first year of life. For a baby on a common formula(e.g., as opposed to breast feeding), the most likely causationis allergy to cow’s milk. Later, after advancement ofthe feeding schedule beyond liquid formula, commonoffenders are egg whites and wheat. Often, a simpleempiric change of formula to one based on soy will resultin total clearing of the eczema within 1 week. Systemicglucocorticoids would be a radical step for an infant whois not critically ill. Although topical glucocorticoids maybe employed for infantile eczema, preparations such astriamcinolone are too potent and carry a high rate ofcomplications of atrophy and scarring striae at the areasof application, particularly on infantile skin. Antibiotics,either systemic or topical, have no place in a noninfectiousinflammatory process such as infantile eczema.7. The answer is D. The patient has what is variouslycalled neuro eczema , nummular eczema , and neurodermatitis.There is a predisposition for atopic diseases in thesepatients. The skin is more sensitive and has a loweredthreshold for itching. In the accessible areas referred to inthe vignette, scratching and rubbing causes a thickening,called, by dermatologists, lichenification. Paradoxically,lichenification causes the threshold for pruritus to be furtherlowered and leads to further rubbing and the viciouscircle of itching and scratching. This cycle is effectivelyinterrupted in the vast majority of cases by topical glucocorticoids.Systemic glucosteroids are not effective, andsystemic antipruritics such as hydroxyzine (e.g., Vistaril)are usually not needed. Although some allergists may tryfood elimination in intractable cases, food allergy is rarelya factor and usually the elimination diet is ineffective.8. The answer is C. The most significant part of the treatmentof a weeping lesion is to apply a drying agent. Themost drying are the wettest upon application, such assaline or Burrow solution, and the most moistening areocclusive agents such as petrolatum (Vaseline). Creamsare positioned toward the moistening end of the spectrum
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NMS Q&AFamily Medicine3rd EDITION
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Acquisitions Editor: Susan RhynerPr
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Foreword to the First EditionFamily
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AcknowledgmentsFor the contribution
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xivContentsChapter 15 Surgical Issu
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SECTION IUrgent Carechapter 1Urgent
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Urgent Care in Family Practice 3(A)
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Urgent Care in Family Practice 5Exa
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Urgent Care in Family Practice 7rem
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10 NMS Q&A Family Medicine(A) To pl
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12 NMS Q&A Family MedicineExaminati
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chapter 3Otolaryngology inPrimary C
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Otolaryngology in Primary Care 17tr
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Otolaryngology in Primary Care 1924
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Otolaryngology in Primary Care 21of
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Otolaryngology in Primary Care 23co
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26 NMS Q&A Family Medicine(A) Migra
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30 NMS Q&A Family MedicineQuestions
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32 NMS Q&A Family Medicine(A) Distu
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36 NMS Q&A Family Medicine80 mm Hg.
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SECTION IIICardiovascular Diseasesi
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Cardiology 41(A) Systolic crescendo
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Cardiology 43Examination Answers1.
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Cardiology 4516. The answer is C. T
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chapter 7Peripheral Vascular Diseas
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Peripheral Vascular Disease 49would
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Peripheral Vascular Disease 51Exami
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Peripheral Vascular Disease 53right
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chap ter 8Cerebrovascular DiseaseEx
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Cerebrovascular Disease 57(A) A non
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Cerebrovascular Disease 59ventricul
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chap ter 9Pediatric CardiologyExami
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Pediatric Cardiology 6315 You hear
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Pediatric Cardiology 65by placing o
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chap ter 10HypertensionExamination
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Hypertension 6915 In hypertensive p
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Hypertension 71systolic hypertensio
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74 NMS Q&A Family Medicine(A) Right
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Neurology 778. The answer is A. The
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SECTION VRespiratory Diseasesin Pri
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Pneumonia and Bronchitides 81(C) Co
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Pneumonia and Bronchitides 836. The
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chapter 13Respiratory Diseasesin Ch
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Respiratory Diseases in Children 87
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SECTION VIThe Gastrointestinal Trac
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Medical Problems of the Gastrointes
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Medical Problems of the Gastrointes
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chap ter 15Surgical Issues of theGa
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Surgical Issues of the Gastrointest
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Surgical Issues of the Gastrointest
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chap ter 16Problems of the LiverExa
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Problems of the Liver 103level, whe
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Problems of the Liver 105been inves
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SECTION VIIUrology and Nephrologyin
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Problems of the Urinary Tract 10913
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Problems of the Urinary Tract 11110
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114 NMS Q&A Family Medicine7 Which
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116 NMS Q&A Family MedicineExaminat
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118 NMS Q&A Family Medicineof malig
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120 NMS Q&A Family Medicine(D) Sulf
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124 NMS Q&A Family MedicineReferenc
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126 NMS Q&A Family Medicinecycle. H
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chapter 21Gynecology in Mature Adul
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Gynecology in Mature Adults 133amen
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Gynecology in Mature Adults 1357. T
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chapter 22Diseases of the Female Br
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Diseases of the Female Breast 139Ex
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Diseases of the Female Breast 141Re
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144 NMS Q&A Family Medicine(B) Long
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146 NMS Q&A Family Medicine(D) PIP
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148 NMS Q&A Family Medicine6. The a
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chapter 24Musculoskeletal Problemso
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Musculoskeletal Problems of the Nec
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Musculoskeletal Problems of the Nec
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chapter 25Musculoskeletal Problemso
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Musculoskeletal Problems of the Low
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Musculoskeletal Problems of the Low
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chapter 26Rheumatology in Primary C
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Rheumatology in Primary Care 165(D)
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Rheumatology in Primary Care 16710.
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170 NMS Q&A Family Medicineof 5 ft,
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172 NMS Q&A Family Medicinepresent.
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174 NMS Q&A Family Medicinenodules.
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178 NMS Q&A Family MedicineReferenc
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180 NMS Q&A Family Medicineperipher
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182 NMS Q&A Family Medicineconditio
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184 NMS Q&A Family Medicine(D) Pneu
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chap ter 31Other Infectious Disease
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Other Infectious Diseases in Primar
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Other Infectious Diseases in Primar
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SECTION XIEndocrinology inPrimary C
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Diabetes Mellitus 197normal saline
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Diabetes Mellitus 199Examination An
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Diabetes Mellitus 20116. The answer
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204 NMS Q&A Family Medicine(A) Seru
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208 NMS Q&A Family Medicine16. The
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210 NMS Q&A Family Medicine(E) Hypo
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214 NMS Q&A Family Medicinelikeliho
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216 NMS Q&A Family Medicine(A) Prad
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SECTION XIIAllergieschapter 36Atopi
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Atopic, Food, and Contact Allergies
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Atopic, Food, and Contact Allergies
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SECTION XIIIPreventive HealthCarech
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Preoperative Clearance 229180 to 22
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Preoperative Clearance 23121 Prophy
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Preoperative Clearance 233example,
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chap ter 38Obesity and Dyslipidemia
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Obesity and Dyslipidemia 23713 A 45
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Obesity and Dyslipidemia 239attriti
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chapter 39Smoking CessationExaminat
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Smoking Cessation 243Examination An
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chapter 40Exercise and HealthExamin
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Exercise and Health 247Examination
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chapter 41Concepts in Epidemiologya
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Concepts in Epidemiology and Resear
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Concepts in Epidemiology and Resear
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Page 333 and 334: Geriatrics 315Examination Answers1.
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NMS Q&A Family Medicine

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