Which one of the following is true concerning scabies?
Correct Answer B:
The mite burrow confirms the diagnosis of scabies, but can be missed if the skin is excoriated. Scabies spreads by direct skin contact, and is seldom spread by transfer from bedding. Children frequently have scabies lesions on the face or neck, while this rarely happens in adults. Scabies infections usually cause itching among several family members, but they may not admit it. Scabies can recur after treatment, usually because of incorrect or insufficient application of the treatment.
The disappearance of a ventricular septal defect (VSD) murmur in a patient known to have a large left-to-right shunt is most likely due to:
Correct Answer E:
A ventricular septal defect is one or more openings in the interventricular septum, producing a shunt between ventricles. Large defects result in a significant left-to-right shunt and produce dyspnea with feeding and poor growth. A loud, harsh, holosystolic murmur at the lower left sternal border is common. Recurrent respiratory infections and heart failure may develop. Diagnosis is by echocardiography. Defects may close spontaneously during infancy or require surgical repair.
Eisenmenger's syndrome or Eisenmenger's reaction is defined as the process in which a left to-right shunt in the heart causes increased flow through the pulmonary vasculature, causing pulmonary hypertension, which in turn, causes increased pressures in the right side of the heart and reversal of the shunt into a right-to-left shunt.
Which of the following is true regarding prophylactic antibiotic therapy use for tooth extraction in a patient with a prosthetic heart valve?
Antimicrobial prophylaxis is recommended for patients at high to moderate risk of infective endocarditis before procedures associated with bacteremias and subsequent infective endocarditis. For most patients and procedures, a single dose shortly before (1h) the procedure is effective.
Procedures requiring antimicrobial endocarditis prophylaxis include oral-dental procedures, dental extraction, dental implant placement and reimplantation of avulsed teeth and periodontal procedures, including surgery, scaling, root planing, and probing.
Antimicrobial prophylaxis is recommended for patients at high risk of an adverse outcome from infective endocarditis. Such patients include those with:
Drug treatment in patients allergic to penicillin is with clindamycin or a macrolide such as erythromycin, clarithromycin or azithromycin.
A newborn is noted to have a loud holosystolic murmur at the lower left sternal border. He also has episodes of difficulty breathing and has not been feeding well.
Which of the following congenital heart defects does he most likely have?
A previously well 13-year-old boy experiences a sudden onset of pain in the right testicle with accompanying nausea and vomiting. On examination 8 hours after the onset of pain, the testicle is located high in the scrotum and is swollen and exquisitely tender. The overlying epididymis cannot be separately palpated.
The most likely diagnosis is:
Testicular torsion is an emergency condition due to rotation of the testis and consequent strangulation of its blood supply. Symptoms are acute scrotal pain and swelling, nausea, and vomiting. Diagnosis is based on physical examination and confirmed by color Doppler. Treatment is immediate manual detorsion followed by surgical intervention.
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