QUESTION: 41

A 42-year-old woman is noted to have a multinodular goiter on examination. She has no symptoms and is clinically euthyroid. Which of the following statements about Hashimoto's thyroiditis is true?

The condition is associated with prior radioactive exposure.
Patients diagnosed with this disorder have an increased incidence of thyroid cancer.
Corticosteroids are helpful in controlling the progression of the disease.
Antinuclear antibodies are pathognomonic for this disease.
Hashimoto's thyroiditis is an autoimmune disease.

Answer(s): E

Explanation:

Hashimoto's thyroiditis, an autoimmune condition, is the leading cause of multinodular goiter in the United States. Although not unique to this condition, antimicrosomal antibodies are found in 7095% of patients.
Antinuclear antibodies are associated with SLE. Although an autoimmune process, steroids are of no benefit in this condition. One-third of patients experience progressive loss of glandular function, and eventually become hypothyroid, but there is no increased incidence of thyroid cancer

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QUESTION: 42

A 55-year-old man complains of severe headaches over the past few weeks. Similar episodes have occurred in past years. Which of the following supports the diagnosis of cluster headaches?

Pain-free intervals can last for days and then recur.
Attacks of daily pain last for 48 weeks.
The most common location of pain is occipital.
Women are affected twice as commonly as men.
Caffeine is the most effective treatment for an acute attack.

Answer(s): B

Explanation:

Men are affected by cluster headaches seven to eight times more often than women. Attacks are typically periorbital and may involve the temporal area. Cluster headaches typically occur daily over a 4- to 8-week period followed by pain-free intervals averaging 1 year. The periodicity of the attacks is often striking, with daily recurrences of pain often at the same hour. Pathogenesis is thought to be due to abnormal serotonergic neurotransmission. One hundred percent oxygen inhalation is most effective acutely. Drugs used to prevent cluster attacks include lithium, ergotamine, sodium valproate, and prednisone.

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QUESTION: 43

A 46-year-old woman presents with a 4-hour history of left flank pain with fever and chills. On examination, her temperature is 103°F, pulse rate is 120/min, re spiratory rate is 40/min, and supine BP is 80/40 mmHg. She has marked tenderness over the left flank and left upper quadrant of the abdomen without rebound. Urinalysis shows multiple red blood cells (RBCs), multiple WBCs, and WBC casts.

Which of the following is the most likely diagnosis?

appendicitis
pyelonephritis
cholelithiasis
diverticulitis
pelvic inflammatory disease

Answer(s): B

Explanation:

Detection of leukocyte casts is pathognomonic for pyelonephritis. Common symptoms include fever, shaking chills, nausea, vomiting, and diarrhea. Flank tenderness over the affected kidney is very common

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QUESTION: 44

A 45-year-old woman presents with fever, anorexia, nausea, and diarrhea. Other patients in the community have presented similarly and have a common exposure at a local restaurant. In the above case of hepatitis, select the most likely type of viral hepatitis.

hepatitis A
hepatitis B
hepatitis C

Answer(s): A

Explanation:

Hepatitis A is transmitted almost exclusively by the fecal-oral route. Large outbreaks have been linked to contaminated food products. Intrafamily and intrainstitutional spread also is common. Clinical severity usually is mild, and hepatitis A does not progress to chronicity. Hepatitis C more commonly progresses to chronicity (5070% develop chronic hepatitis and 8090% of these patients have evidence for chronic infection). Hepatitis C can lead to cirrhosis and hepatocellular carcinoma. Chronicity occurs in only 110% of patients with hepatitis B.

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