A 20-year-old woman is seen in the clinic because her boyfriend
was found to have gonorrhea. Which of the following is the
treatment of choice for gonorrhea?
a. Ceftriaxone
b. Doxycycline
c. Acyclovir
d. Metronidazole Correct Answer Ceftriaxone
A 22-year-old male is seen in the clinic because he found a hard
lump in his testicle when performing testicular self-examination
(TSE). Which of the following should be included in the list of
differential diagnoses?
Testicular cancer
Inguinal hernia
Varicocele
All of the above Correct Answer All of the above
A 24-year-old man has scrotal pain and marked erythema.
The examiner considers epididymitis. Which
finding is consistent with this problem?
a. The patient's scrotal size and shape are not
symmetric.
b. The patient has anorexia and nausea.
c. The patient reports an acute onset of severe pain.
d. Urinalysis shows elevated WBCs and bacteria. Correct
Answer d. Urinalysis shows elevated WBCs and bacteria.
,A 25-year-old accountant is seen in the clinic complaining of
crampy abdominal pain after meals. She is often constipated and
takes laxatives. Following this, she has diarrhea for a couple of
days. She temporarily feels better after a bowel movement. She
states she is embarrassed by flatulence and has abdominal
distension. She has had no weight loss or blood in her stool. This
problem has gone on for about 6 months. What should the next
step be? Correct Answer Obtain a complete history.
A 27-year-old female presents with a chief complaint of burning
and pain on urination. She has no previous history of urinary
tract infection (UTI). What are some additional symptoms
consistent with a diagnosis of lower UTI?
a. Back and abdominal pain
b. Fever, chills, costovertebral angle (CVA) tenderness
c. Blood in urine and frequency
d. Foul-smelling discharge, perineal itch Correct Answer Blood
in urine ad frequency
A 28-year-old patient is seen in the clinic with colicky
abdominal pain, particularly with meals. She has frequent
constipation, flatulence, and abdominal distension. Which of the
data make a diagnosis of diverticulitis unlikely? Correct
Answer Her age
A 28-year-old patient is seen with complaints of diarrhea. Which
of the following questions would help the clinician establish the
diagnosis of irritable bowel syndrome? Correct Answer Feels
relief after a bowel movement, Sometimes is constipated, Does
not defecate in the middle of the night
,A 29-year-old Englishman is seen in the office with complaints
of pain in his chest and belly for 2 weeks. He gets temporary
relief from Alka Seltzer. The burning pain wakes him at night
and radiates up into his chest. Which factor favors a diagnosis of
gastric ulcer? Correct Answer His use of Alka Seltzer
A 30-year-old patient presents with pain on urination. The urine
microscopy of unspun urine shows greater than 10
leukocytes/mL, and a dipstick is positive for nitrites. What is the
probable diagnosis?
a. Lower urinary tract infection
b. Chlamydia infection
c. Candidiasis
d. Pyelonephritis Correct Answer Lower urinary tract infection
A 34-year-old patient was treated for a UTI and has not
responded to antibiotic therapy. Which of the following actions
should be taken next?
a. Send a urine specimen for microscopy and evaluate for fungal
colonies.
b. Increase the dose of antibiotic.
c. Order a cytoscopy.
d. Order a different antibiotic. Correct Answer Send a urine
specimen for microscopy and evaluate for fungal colonies
A 35-year-old female patient is seen in the clinic complaining of
abdominal pain. Which of the following should be included in
the history and physical exam? Correct Answer igital rectal
exam, Sexual history, Pelvic exam
, A 42-year-old woman is seen in the clinic with fever, chills,
vomiting, and severe dysuria. She is diagnosed with acute
pyelonephritis. How should this patient be managed?
a. 3-day course of oral antibiotics
b. Hospitalization
c. Encourage cranberry juice intake.
d. 6-week course of antibiotics Correct Answer Hospitalization
Oral antibiotics may be prescribed in mild cases of acute
pyelonephritis, characterized by the absence of nausea and
vomiting or signs of sepsis. First-line therapy includes
ciprofloxacin (Cipro) 500 mg two times daily for 7 days, or
ciprofloxacin extended-release (Cipro XR) 1,000 mg daily for 7
days, or levofloxacin (Levaquin) 750 mg daily for 5 days.
Hospitalization may be indicated, depending on the patient's
ability to maintain adequate fluid intake and to tolerate oral
antibiotics, along with the severity of the symptoms and
evidence of bacteremia. Hospitalization of patients who are
pregnant, vomiting, or dehydrated should be strongly
considered. Likewise, the patient's degree of systemic illness
(bacteremia or urosepsis), age, history of chronic disease, or
nonadherence to therapy may lead to the assessment that
hospitalization is necessary. Ninety- five percent of patients
demonstrate a good response within 48 hours to IV antibiotic
treatment and may be discharged on appropriate oral
medication, once urine culture and antibiotic sensitivity results
are available and subsequent antimicrobial therapy may be
narrowed in spectrum.
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