Question of the Week # 479

479. A 57 year old female presents for second opinion of a left breast lesion that had been diagnosed as ‘eczema’ by her regular nurse practitioner, which briefly improved after a short course of topical steroids. On physical exam there is an erythematous, scaly lesion involving the left breast. Image is shown below. Her last mammogram was a year ago and it was “fine”. She does not report any family history of breast cancer. What is the next step in the patient’s management?

image br rash

A – Bilateral breast ultrasound

B – Bilateral mammography and punch biopsy of nipple

C – Maintain regular annual mammography appointment

D – Oral corticosteroids

E – Left breast MRI

Question of the Week # 478

478) You are evaluating a 24-year-old female patient who presented with severe abdominal pain two hours prior to admission. She states the pain began in the periumbilical region and has moved to the low abdomen, and she had one episode of emesis with nausea, but no diarrhea. Her last menstrual period was normal and began 27 days ago. On examination, she has a temperature of 98.9, heart rate of 118 beats per minute, and respirations 20/min. Her blood pressure is 100/80. Examination of the abdomen reveals diffuse tenderness to palpation, and she is guarding moderately and has diminished bowel sounds. Complete blood count reveals a hemoglobin of 12 g/dL and a hematocrit of 38%. White blood cell count is 12,500/mm3 with a left shift. Urinalysis reveals 2-5 WBC/hpf. Which of the following is the next best step in management of this patient?

A. Flat and upright abdominal film

B. Pelvic ultrasound

C. Urine b HCG

D. CT abdomen and pelvis

E. Serum beta HCG

Question of the Week # 477

477) A 39-year-old woman presents to clinic with a history of long-standing right leg pain. She complains of “achy” pain at the hip radiating down her femur to the knee, which is exacerbated on exertion, especially with jogging more so than climbing stairs, but also present during rest. She takes acetaminophen for it, which helps her pain. Her past medical history is significant for systemic lupus erythematosus diagnosed at age of 20, for which she has been taking on and off oral prednisone. She does not smoke cigarettes but he drinks alcohol 2 or 3 times per week. She denies any drug use. Physical examination is significant for limited range of motion of the right hip, especially with external rotation. A plain x-ray shows a dulling of the femoral head but no other pathology. What is the next step in diagnosis?
A. Bone scan
B. CT scan
C. MRI scan
D. PET scan
E. Ultrasound

Question of the Week # 476

476. You are evaluating a 12 month old male patient for rhinorrhea and poor appetite. He is friendly and alert. His temperature today is 103.6 degrees Fahrenheit, and his examination is significant for clear nasal discharge and multiple small vesicles on the anterior tonsillar pillars and posterior palate. His examination is otherwise normal. He is accompanied by his mother who seems to be very concerned. The patient has been feeding well and all his developmental milestones have been timely so far. A complete blood count is normal.  Which of the following is his most likely diagnosis?

12 month old male patient for rhinorrhea and poor appetite, temperature 103.6 F.

12 month old male patient for rhinorrhea and poor appetite, temperature 103.6 F.

A. Hand, foot, and mouth disease

B. Apthous stomatitis

C. Herpangina

D. Stevens-Johnson syndrome

E. Kawasaki disease

Question of the Week # 475

A 2-week-old infant is brought to the office for a regular postnatal follow-up. She was born after an uneventful term pregnancy to a 29-year-old G2P2 woman. Mother reports that the infant is feeding well and seems active. No evidence of any fever. The parents are worried about the ‘rash’ that appeared over the infant’s left cheek. On examination, a lesion is noted on the infant’s left cheek as shown below. Vital signs are within normal limits. What is the most appropriate next step in management of this finding?


A Surgical excision of the entire lesion
B Biopsy of the lesion
C Laser removal of the lesion
D Reassurance and observation
E Topical 5-fluoro-uracil

Question of the Week #474

474. A cohort study is done concerning the relationship between exposure to oral contraception and the risk of breast cancer. 1000 women were followed from 2003 to 2007. Results are listed below:

Breast Cancer + Breast Cancer –
Oral contraceptive + 300 (a) 200 (b) a + b = 500

Probability of breast cancer among exposed: 300/500 = 0.6

Oral Contraceptive – 100 © 400 (d) c + d = 500

Probability of breast cancer among those not exposed = 100/500 = 0.2

a + c = 400 b + d = 600

Which of the following represents the absolute risk reduction of breast cancer in women who do not use oral contraceptives?

  1. 75%
  2. 67
  3. 40%
  4. 50%
  5. 30%

Question of the Week # 473

  1. You are reading a study that was conducted to evaluate IQ (intelligence quotient) scores for patients with bipolar disease. Ten patients did not complete the test. Two patients refused to begin the test. Results for the 94 patients who completed the test revealed an average IQ of 130 with a standard deviation of 20. Which of the following best represents the 95% confidence interval for this study?
  1. 4
  2. 2
  3. 1
  4. .05
  5. .1

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