By J. Sibur-Narad. University of the Incarnate Word. 2018.
Which of the following statements regarding the clinical features of pityriasis rosea is false? Lesions typically occur on the trunk in a symmetrical fashion and form cleavage planes on the skin B buy discount bentyl 10 mg on line. The development of a herald-patch lesion 7 to 10 days before the onset of the diffuse eruption helps establish the diagnosis C order bentyl 10mg free shipping. Pityriasis rosea typically involves the palms and soles D. The disorder is usually self-limited Key Concept/Objective: To understand the distinguishing features of pityriasis rosea Pityriasis rosea is a self-limited, exanthematous disease that manifests as oval papulosqua- mous lesions typically distributed in a symmetrical fashion over the trunk and extremi- ties. The exact etiology is unclear, but viral triggers have been suggested. The eruption is usually preceded by a primary lesion consisting of a slightly raised, salmon-colored oval patch with fine scaling (the “herald patch”). Lesions tend to follow lines of cleavage on the skin and may appear on the back in a typical “fir tree” or “Christmas tree” distribution. The differential diagnosis of pityriasis rosea lesions includes secondary syphilis, tinea cor- poris, and tinea versicolor. The appearance of lesions on the palms and soles is more typi- cal of secondary syphilis and may help distinguish this rash from pityriasis rosea. If there is high suspicion of syphilis or if the diagnosis is unclear, a serologic test for syphilis is war- ranted. The lesions of pityriasis rosea typically resolve spontaneously in 6 to 8 weeks. For an otherwise healthy individual with typical pityriasis rosea, which of the following would NOT be an appropriate option for treating symptoms? Low-potency topical steroids for lesions on the trunk B. Use of ultraviolet B (UVB) or exposure to sunlight early in the course of the eruption E. Retinoic acid Key Concept/Objective: To understand the treatment options for pityriasis rosea Pityriasis rosea is typically self-limited, but several treatment options exist.
In South Africa there is some suggestion that black Africans have a low rate of RA in rural areas but have the same rate as whites when they migrate to the city generic bentyl 10 mg without a prescription. There is some evidence that the incidence of RA amongst women has fallen in recent years in Europe11 and the USA order bentyl 10mg otc. There is direct evidence from Finland14 and indirect evidence from review of publications on early RA that the median age of onset of RA is increasing. It is possible that there may be an increase in the frequency of late onset RA over the next couple of decades in the more developed countries as a consequence of widespread use of the oral contraceptive pill. It is difficult to predict what the impact of increased use of the oral contraceptive pill might be in developing countries where the incidence of RA is already low. Whatever happens with regards to RA incidence, the prevalence is likely to rise quite steeply because of the demographic changes referred to above. In developing countries the median age of onset of RA is currently around 55 years. Changes in disease course There has been increasing emphasis in recent years on early aggressive treatment of RA. There is a considerable body of evidence that this improves the outcome of the disease in terms of disability16 and probably mortality, certainly in the short term. Most of the excess mortality in RA is related to comorbidity, in particular to coronary heart disease18, and it is not clear whether improved disease control will influence this long-term outcome. The last year has seen the advent 25 BONE AND JOINT FUTURES of a new second line agent19 and the introduction of a new class of therapy – the biological agents. However, even before the introduction of these new treatments, outcome had been improved with the use of methotrexate. Methotrexate is inexpensive and so may improve the outcome of patients in less affluent regions. Overall, therefore, it seems likely that the burden of disability, if not the burden of mortality, due to RA for the individual will fall. In conclusion it is likely that the absolute number of RA cases worldwide will rise over the next few decades reflecting world population growth. The proportion of the world’s population with RA will also rise, reflecting demographic changes in the age structure of the population.
A 14-year-old boy with a history of juvenile myoclonic epilepsy is seen for recurrent seizures cheap 10 mg bentyl fast delivery. His disease was very well controlled in the past with valproate buy 10 mg bentyl mastercard, and he was seizure-free for 18 months. During the past 2 months, the patient has had eight seizures, which the patient’s father describes as being different from his usual myoclonic jerks and generalized tonic-clonic seizures. These seizures are different each time; they last from 20 to 45 minutes. On the basis of this patient’s clinical picture, what would be the most likely cause of these seizures? Nonepileptic seizure Key Concept/Objective: To recognize the clinical picture of nonepileptic seizures Approximately 20% of patients admitted to epilepsy monitoring units for diagnostic eval- uation have episodic behavioral alterations that are not caused by physiologic dysfunction of the brain. In the past, these alterations were called pseudoseizures; currently, the pre- ferred term for such seizures is nonepileptic seizures. Use of this term tends to help the patients understand their problem and facilitates referral for behavioral therapy. An important clue to the diagnosis of nonepileptic seizures is that they are periodic events that tend not to be stereotyped. Both patients and observers report varied behaviors with each event. Nonepileptic seizures may last 30 min- utes to several hours—longer than typical seizures. Patients with both nonepileptic seizures and epilepsy pose a challenging problem; this combination is occasionally found in patients undergoing assessment in epilepsy monitoring units. Treatment of nonepileptic seizures requires behavioral intervention. If both disorders are found, treatment of epilep- sy needs to be continued in parallel with behavioral therapy. A 44-year-old woman is admitted to the hospital with pneumonia.
The resurgence of new cases of syphilis in the late 1980s has been linked to the epidemic use of crack cocaine and the exchange of sex for drugs D cheap 10mg bentyl fast delivery. White and minority populations are affected with equal frequency E 10mg bentyl otc. Incidence rates are higher in inner-city populations than in rural ones Key Concept/Objective: To understand the epidemiology of syphilis Disease caused by the spirochete Treponema pallidum has been recognized for centuries. With advances in drug therapy and diagnostic methods, the control and, possibly, the eradication of syphilis in the United States have become realistic goals. Syphilis is transmitted through sexual contact primarily, with few cases associated with nonsexual exposure. The highest rates of infection occur in inner-city populations with lower socioeconomic status and are largely confined in the 22 BOARD REVIEW southeastern United States. Minorities are affected to a much higher degree than whites (25:1 in some studies). The high rates of new syphilis cases among inner-city popula- tions in the late 1980s and early 1990s has been linked strongly to the epidemic use of crack cocaine. Which of the following findings would NOT be consistent with the secondary stage of syphilis? Diffuse, painless lymphadenopathy and patchy alopecia B. A hyperpigmented maculopapular rash involving the trunk, extrem- ities, palms, and soles C. Signs and symptoms of meningitis (fever, stiff neck, photophobia) accompanied by abnormalities of the cerebrospinal fluid D. A single indurated and nontender ulcerative genital lesion accompa- nied by nonsuppurative regional lymphadenopathy E. Raised, moist, nontender plaques in intertriginous areas and on mucosal surfaces, the swabbing of which reveals spirochetes on darkfield microscopy Key Concept/Objective: To know the distinguishing features of secondary syphilis Once T. The characteristic lesion of primary syphilis is the chancre, an indurated, painless ulcer that can be up to 1 to 2 cm in size. Without treatment, the chancre typically resolves in 2 to 8 weeks; in a majority of cases, the chancre is not present by the time signs and symptoms of dissemination (secondary syphilis) develop. The clinical findings of secondary syphilis are varied but often include fever, malaise, diffuse lymphadenopathy, patchy alopecia, and a charac- teristic maculopapular rash, which involves the palms and soles.
