Comprehensive Osteopathic Medical Licensing Examination Level 2-Quiz 09

The clinical presentation of severe headache, blurred vision, epigastric pain, hypertension, and proteinuria is indicative of eclampsia, a serious complication of pregnancy characterized by seizures. Gestational diabetes presents with glucose intolerance. Placental abruption involves premature separation of the placenta. Preterm labor manifests with regular uterine contractions and cervical changes.

The patient’s presentation with severe pain, swelling, and erythema in the knee joint, along with a history of gout and elevated serum uric acid levels, suggests acute gouty arthritis. The most appropriate next step in management is knee joint aspiration to confirm the diagnosis and relieve symptoms. Colchicine may be used but is not the initial step. Increasing allopurinol dose during an acute attack is not recommended. Corticosteroid injection may be considered if aspiration is not feasible or unsuccessful.

The patient’s presentation with recurrent epigastric pain, burning sensation after meals, relief with antacids, and absence of alarming symptoms is highly suggestive of GERD. Peptic ulcer disease may present similarly but often has other associated symptoms or complications. Acute pancreatitis typically presents with severe epigastric pain radiating to the back, often associated with nausea and vomiting. Gallstone pancreatitis presents with epigastric pain and may have jaundice and elevated serum amylase/lipase levels.

According to guidelines, patients suspected of acute coronary syndrome should receive aspirin immediately unless contraindicated. This is based on the principle of antiplatelet therapy to prevent further thrombosis. Oxygen therapy is indicated only if hypoxemia is present. Intravenous nitroglycerin is indicated for ongoing chest pain but not as the initial therapy. Immediate cardioversion is not appropriate for ST-segment elevation myocardial infarction (STEMI).

In cases of partial response or non-response to an antidepressant, adding psychotherapy like cognitive-behavioral therapy (CBT) is recommended. Increasing the SSRI dose may not be effective and can increase side effects. Switching to another SSRI is an option but typically considered if there are intolerable side effects or specific reasons for changing the medication. Initiating a mood stabilizer is not indicated in uncomplicated depression without features of bipolar disorder.

The management of severe preeclampsia includes administering magnesium sulfate for seizure prophylaxis. Immediate induction of labor is considered if there are signs of maternal or fetal distress. Antihypertensive therapy may be indicated but is not the primary treatment for preventing seizures in preeclampsia. Continuous fetal monitoring is important but does not address the immediate risk of seizures in the mother.

In cases of acute ischemic stroke with a large vessel occlusion, endovascular thrombectomy is considered the standard of care if feasible within the time window. Intravenous tPA is generally not recommended for large vessel occlusions. Antiplatelet therapy is indicated after thrombectomy or if thrombolysis is not performed. Statin therapy is part of secondary prevention but is not the immediate priority in acute stroke management.

In patients with hemorrhagic shock due to trauma, the priority is to restore intravascular volume with intravenous crystalloid fluids to stabilize hemodynamics. Direct pressure to the pelvic fracture may help control bleeding but is not the initial management. FAST is important for assessing intra-abdominal bleeding but does not address immediate resuscitation needs. Exploratory laparotomy is indicated if there is evidence of ongoing bleeding despite resuscitation.

Williams syndrome is characterized by distinctive facial features, developmental delay, and failure to thrive. It is associated with cardiovascular abnormalities, hypercalcemia, and a unique cognitive and personality profile. Down syndrome presents with different facial features and characteristics. Prader-Willi syndrome and DiGeorge syndrome have distinct clinical features not described in this scenario.

The presentation with right lower quadrant pain, tenderness, leukocytosis, and a history of Crohn’s disease raises suspicion for appendicitis. Urgent appendectomy is the standard treatment. Acute cholecystitis presents with right upper quadrant pain. Diverticulitis typically presents with left lower quadrant pain. Corticosteroids are used in Crohn’s disease but not as the initial treatment for acute exacerbations with suspected appendicitis.

In outbreaks of vaccine-preventable diseases like measles, mandatory vaccination is a crucial public health intervention to achieve herd immunity and prevent further spread. Quarantine, health education, and contact tracing are important but may not be as effective in rapidly controlling a measles outbreak.

Accepting gifts from pharmaceutical companies can create conflicts of interest and undermine professional integrity. It is ethically appropriate for Dr. Johnson to decline the gift and adhere to ethical guidelines that discourage such practices. Accepting the gift and disclosing it to patients may not fully address the ethical concerns. Reporting the gift to the medical board is not necessary if Dr. Johnson handles the situation appropriately within ethical guidelines.

Randomization in clinical trials is essential to minimize bias and ensure that participants are assigned to treatment groups in an unbiased manner. It helps in achieving comparability between the groups and enhances the validity of study results. Blinding and placebo control are related concepts but not the primary focus of this question. A cross-over design involves participants receiving multiple treatments sequentially, which is different from a parallel-group design with randomization.

ST-segment elevation myocardial infarction (STEMI) requires emergent reperfusion therapy, preferably with PCI if available within a timely manner. Thrombolytic therapy is an alternative if PCI is not immediately available. Aspirin and heparin are part of the initial management but not the definitive treatment. Oxygen therapy and analgesia are supportive measures but do not address the underlying cause of the STEMI.

Edward syndrome (trisomy 18) presents with craniosynostosis, distinctive facial features, cataracts, and growth failure. It is associated with multiple congenital anomalies and has a high mortality rate. Down syndrome presents with different features. Pierre Robin sequence and Rubinstein-Taybi syndrome have distinct clinical presentations not described in this scenario.

Myofascial release is a gentle OMT technique used to address muscle tension and restricted mobility in the soft tissues. It is often beneficial for patients with chronic musculoskeletal pain and restricted range of motion. MET and HVLA thrust techniques may be appropriate in certain cases but can be more forceful and may not be indicated for chronic pain without addressing soft tissue restrictions. Counterstrain is another gentle technique but is typically used for tender points rather than global myofascial release.

Prescribing controlled substances for non-medical purposes is ethically inappropriate and can contribute to substance misuse and harm. Dr. Anderson should refuse the prescription and engage in open communication with the patient to explain the risks and reasons for not providing the prescription. Referring the patient to another physician without addressing the underlying issue is not sufficient. Discussing alternative treatment options is appropriate but should not involve prescribing controlled substances in this context.

The number of previous cesarean sections is a critical factor in assessing the safety of VBAC. Multiple cesarean sections increase the risk of uterine rupture during a trial of labor. Gestational age, maternal preference, and fetal position are important considerations but are secondary to the risk associated with multiple cesarean sections in the context of VBAC.

The presentation of binge eating followed by compensatory purging behaviors, along with feelings of guilt and shame, is consistent with bulimia nervosa. Anorexia nervosa involves restrictive eating behaviors and distorted body image. Binge eating disorder also features binge eating but without compensatory behaviors. Avoidant/restrictive food intake disorder (ARFID) involves limited food intake but is distinct from bulimia nervosa.

In cases of acute ischemic stroke with a large vessel occlusion like a left MCA stroke, endovascular thrombectomy is considered the standard of care if feasible within the time window. Intravenous tPA is generally not recommended for large vessel occlusions. Antiplatelet therapy and anticoagulation are not the primary acute management for ischemic stroke but may be considered in certain cases after thrombectomy or thrombolysis.

The patient’s symptoms of abdominal pain, bloating, diarrhea worsened by dairy consumption, failure to thrive, and signs of malnutrition are indicative of celiac disease, an autoimmune condition triggered by gluten ingestion. Lactose intolerance may cause similar symptoms but is not associated with failure to thrive or malnutrition. Inflammatory bowel disease and irritable bowel syndrome can present with abdominal symptoms but have different clinical features and are less likely in this scenario.

A chest X-ray is the initial diagnostic test of choice for evaluating acute respiratory symptoms and suspected lung pathology, such as pleural effusion or pneumonia. While an echocardiogram is useful for cardiac evaluations, it may not directly visualize lung conditions. Pulmonary function tests assess lung function but are not diagnostic for acute chest pain. CT angiography is more invasive and typically reserved for evaluating vascular issues.

Physician-assisted suicide (PAS) raises ethical and legal considerations. Ethical guidelines emphasize the importance of exploring alternative pain management options, addressing patient concerns, and ensuring adequate palliative care. Referring the patient to another physician without addressing the underlying issues is not sufficient. Agreeing to PAS or denying the request outright without discussion are not aligned with ethical principles.

A postoperative fluid collection with associated symptoms suggests a surgical site infection or abscess. The most appropriate initial management is to drain the fluid collection to relieve symptoms and prevent complications. Antibiotics may be indicated but are not sufficient as the sole treatment. Repeat surgery is reserved for specific situations. Monitoring without intervention is not appropriate when there are signs of infection or complication.

Muscle energy technique (MET) is commonly used to address segmental dysfunctions in the spine by engaging the patient’s muscles in a controlled manner to improve joint mobility and function. HVLA thrust techniques are typically used for joint restrictions but may not be suitable for every segmental dysfunction. Myofascial release is beneficial for soft tissue restrictions but may not directly address segmental dysfunction. Counterstrain technique targets tender points rather than specific segmental dysfunctions.

Cognitive-behavioral therapy (CBT) is the first-line treatment for panic disorder and is effective in addressing the cognitive and behavioral aspects of panic attacks. SSRIs are also commonly used for long-term management but may take several weeks to show benefits. Benzodiazepines are not recommended as initial treatment due to the risk of dependence. Beta-blockers are not indicated for panic attacks.

The sweat chloride test is the gold standard for diagnosing cystic fibrosis (CF) by measuring chloride levels in sweat. It is non-invasive and highly specific for CF diagnosis. Chest X-ray and pulmonary function tests may show abnormalities but are not diagnostic for CF. Genetic testing can identify CFTR gene mutations but is not the initial diagnostic test.

The clinical presentation of hyperglycemia, ketosis, anion gap metabolic acidosis, and symptoms of polyuria, increased thirst, and fatigue are indicative of diabetic ketoacidosis (DKA), a serious complication of uncontrolled diabetes. Hyperosmolar hyperglycemic state (HHS) typically presents with severe hyperglycemia but without significant ketosis or acidosis. Type 1 diabetes may present similarly but is more commonly associated with DKA. Hypoglycemic unawareness refers to a different condition characterized by an impaired ability to detect low blood sugar levels.

The progressive weakness, muscle wasting, fasciculations, and abnormal EMG findings of fibrillation potentials and positive sharp waves are characteristic of amyotrophic lateral sclerosis (ALS), a neurodegenerative disease affecting motor neurons. Guillain-Barré syndrome (GBS) presents with ascending weakness and is typically preceded by an infection. Multiple sclerosis (MS) manifests with demyelinating lesions and variable neurological symptoms. Myasthenia gravis (MG) involves neuromuscular junction dysfunction and presents with fluctuating muscle weakness.

The clinical presentation with ST-segment elevation myocardial infarction (STEMI) requires emergent reperfusion therapy, preferably with percutaneous coronary intervention (PCI) if available within a timely manner. Nitroglycerin may be used for symptomatic relief but is not the primary intervention for STEMI. Thrombolytic therapy is an alternative if PCI is not immediately available. Monitoring vital signs is important but does not address the underlying STEMI.