PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps

このデッキのカード

1. カード 1

   質問

   What core mechanism explains acute coronary syndrome?

   回答

   Plaque disruption with superimposed coronary thrombosis causes most acute coronary syndromes.

   2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

2. カード 2

   質問

   When an adult patient with decision-making capacity refuses a recommended treatment, what is the clinician’s next step?

   回答

   Confirm that the choice is informed and voluntary, explain material risks and alternatives, document the discussion, and respect the refusal.

   Informed Consent · reviewed 2026-08-26

3. カード 3

   質問

   In a child or adolescent, what core mechanism explains asthma?

   回答

   Airway inflammation and hyperresponsiveness create variable, usually reversible airflow obstruction.

   2026 GINA Strategy Report · reviewed 2026-08-26

4. カード 4

   質問

   What core mechanism explains upper gastrointestinal bleeding?

   回答

   Bleeding proximal to the ligament of Treitz is altered by gastric acid and intestinal transit, producing hematemesis or melena.

   ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

5. カード 5

   質問

   In a child or adolescent, what core mechanism explains septic arthritis?

   回答

   Bacterial invasion of synovium triggers destructive inflammation that can rapidly damage cartilage.

   Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

6. カード 6

   質問

   What core mechanism explains acute ischemic stroke?

   回答

   Arterial occlusion deprives brain tissue of oxygen, leaving a salvageable penumbra around the infarct core.

   2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

7. カード 7

   質問

   What core mechanism explains community-acquired pneumonia?

   回答

   Alveolar infection fills air spaces with inflammatory exudate and impairs gas exchange.

   Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

8. カード 8

   質問

   What core mechanism explains ectopic pregnancy?

   回答

   Implantation outside the endometrial cavity, usually in the tube, can erode vessels and rupture.

   Ectopic Pregnancy · reviewed 2026-08-26

9. カード 9

   質問

   In a child or adolescent, what core mechanism explains major depressive disorder?

   回答

   Mood-network and stress-system dysregulation interacts with genetic and environmental vulnerability; no single neurotransmitter explains the disorder.

   Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

10. カード 10

    質問

    What core mechanism explains type 2 diabetes mellitus?

    回答

    Insulin resistance plus progressive beta-cell dysfunction produces chronic hyperglycemia.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

11. カード 11

    質問

    What core mechanism explains acute angle-closure glaucoma?

    回答

    Closure of the anterior-chamber angle blocks aqueous outflow and abruptly raises intraocular pressure.

    Management of Angle-Closure Glaucoma · reviewed 2026-08-26

12. カード 12

    質問

    What clinical clue should raise suspicion for aortic dissection?

    回答

    Abrupt severe chest or back pain, pulse or blood-pressure asymmetry, and a new aortic regurgitation murmur are high-risk clues.

    2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

13. カード 13

    質問

    What core mechanism explains chronic kidney disease?

    回答

    Progressive nephron loss causes hyperfiltration in remaining nephrons, fibrosis, and multisystem toxin accumulation.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

14. カード 14

    質問

    What core mechanism explains iron-deficiency anemia?

    回答

    Iron depletion limits heme synthesis, producing hypochromic microcytes and eventually tissue iron symptoms.

    British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

15. カード 15

    質問

    In an infant aged 1–23 months with a viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty, what is the most likely diagnosis?

    回答

    Bronchiolitis. An infant with viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty likely has bronchiolitis.

    Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26

16. カード 16

    質問

    In a child or adolescent, what core mechanism explains atopic dermatitis?

    回答

    Skin-barrier dysfunction and type 2 inflammation increase transepidermal water loss and itch.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

17. カード 17

    質問

    What clinical clue should raise suspicion for acute pancreatitis?

    回答

    Severe persistent epigastric pain radiating to the back with nausea and vomiting is typical.

    ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

18. カード 18

    質問

    What core mechanism explains uncomplicated cystitis?

    回答

    Ascending periurethral bacteria inflame the bladder mucosa without renal-parenchymal involvement.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

19. カード 19

    質問

    Which diagnosis causes symmetric synovitis of the MCP, PIP, or wrist joints with prolonged morning stiffness?

    回答

    Rheumatoid arthritis. Symmetric inflammatory pain and prolonged morning stiffness in MCP, PIP, or wrist joints with synovitis suggest rheumatoid arthritis.

    Rheumatoid Arthritis · reviewed 2026-08-26

20. カード 20

    質問

    What abilities are assessed when determining decision-making capacity for a specific choice?

    回答

    The patient must communicate a choice, understand relevant information, appreciate how it applies personally, and reason about the options.

    Informed Consent · reviewed 2026-08-26

21. カード 21

    質問

    Which diagnosis causes fluctuating, fatigable ptosis, diplopia, dysarthria, dysphagia, or proximal weakness that worsens with use?

    回答

    Myasthenia gravis. Fluctuating fatigable ptosis, diplopia, dysarthria, dysphagia, or proximal weakness that worsens with use suggests myasthenia.

    International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26

22. カード 22

    質問

    Which diagnosis best fits new clinically significant diarrhea after antibiotics or healthcare exposure, especially with abdominal pain or leukocytosis?

    回答

    Clostridioides difficile infection. New clinically significant diarrhea after antibiotics or healthcare exposure, with abdominal pain or leukocytosis, suggests C. difficile.

    2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults · reviewed 2026-08-26

23. カード 23

    質問

    For surgical decision-making, after delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicate which obstetric emergency?

    回答

    Shoulder dystocia. After delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicates dystocia.

    Shoulder Dystocia · reviewed 2026-08-26

24. カード 24

    質問

    In a child or adolescent, which diagnosis causes persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment?

    回答

    Attention-deficit/hyperactivity disorder. Persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment suggests ADHD.

    ADHD in Children and Youth: Part 1—Etiology, Diagnosis, and Comorbidity · reviewed 2026-08-26

25. カード 25

    質問

    Which diagnosis best fits sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation?

    回答

    Acute pericarditis. Sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation support pericarditis.

    2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

26. カード 26

    質問

    Which next action matters most in acute respiratory distress syndrome?

    回答

    Treat the cause, ventilate with low tidal volumes and limited pressures, and use prone positioning for severe hypoxemia.

    An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26

27. カード 27

    質問

    For surgical decision-making, identify the condition from this pattern: Proximal weakness, easy bruising, facial plethora, wide violaceous striae, osteoporosis, or difficult diabetes and hypertension are discriminating clues.

    回答

    Cushing syndrome. Proximal weakness, easy bruising, facial plethora, wide violaceous striae, osteoporosis, or difficult diabetes and hypertension are discriminating clues.

    Diagnosis of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

28. カード 28

    質問

    For surgical decision-making, identify the condition from this pattern: Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

    回答

    Peritonsillar abscess. Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

29. カード 29

    質問

    What clinical clue should raise suspicion for anterior cruciate ligament tear?

    回答

    A noncontact pivot, audible pop, immediate swelling, and instability with a positive Lachman test suggest an ACL tear.

    Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

30. カード 30

    質問

    Which diagnosis may be silent until edema, pruritus, anemia, hypertension, or abnormal urine testing appears?

    回答

    Chronic kidney disease. CKD may be silent; edema, pruritus, anemia, hypertension, or abnormal urine testing often appears later.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

31. カード 31

    質問

    For surgical decision-making, which next action matters most in aortic dissection?

    回答

    Start rapid heart-rate and blood-pressure control and obtain emergency surgical evaluation for ascending dissection.

    2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

32. カード 32

    質問

    Identify the condition from this pattern: Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia.

    回答

    Iron-deficiency anemia. Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia.

    British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

33. カード 33

    質問

    What clinical clue should raise suspicion for bacterial brain abscess?

    回答

    Headache, fever, focal deficit, seizure, or signs of raised intracranial pressure after sinus, ear, dental, or bloodstream infection raise suspicion.

    ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

34. カード 34

    質問

    Which diagnosis best fits chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions?

    回答

    Crohn disease. Chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions support Crohn disease.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

35. カード 35

    質問

    What clinical clue should raise suspicion for pulmonary tuberculosis?

    回答

    Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

    Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

36. カード 36

    質問

    Which diagnosis causes well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting?

    回答

    Plaque psoriasis. Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

37. カード 37

    質問

    What clinical clue should raise suspicion for endometriosis?

    回答

    Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis.

    Endometriosis · reviewed 2026-08-26

38. カード 38

    質問

    Identify the condition from this pattern: Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

    回答

    Acute pyelonephritis. Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

39. カード 39

    質問

    What clinical clue should raise suspicion for panic disorder?

    回答

    Recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least a month suggests panic disorder.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

40. カード 40

    質問

    What drug class or regimen fits acute pericarditis?

    回答

    Use an NSAID plus colchicine for uncomplicated acute pericarditis when not contraindicated.

    2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

41. カード 41

    質問

    What clinical clue should raise suspicion for tension pneumothorax?

    回答

    Severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock suggest tension physiology.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

42. カード 42

    質問

    In a child or adolescent, which next action matters most in diabetic ketoacidosis?

    回答

    Begin isotonic fluids, replace potassium according to the measured level, and start IV insulin once potassium is safe.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

43. カード 43

    質問

    Who makes decisions when an adult patient lacks capacity and has no applicable advance directive?

    回答

    Use the legally authorized surrogate and guide decisions by the patient’s known wishes or, if unknown, best interests.

    Decisions for Adult Patients Who Lack Capacity · reviewed 2026-08-26

44. カード 44

    質問

    For surgical decision-making, which next action matters most in retinal detachment?

    回答

    Send the patient to an eye doctor or emergency department immediately for retinal evaluation and treatment. Early treatment helps prevent permanent vision loss.

    Retinal Detachment · reviewed 2026-08-26

45. カード 45

    質問

    What clinical clue should raise suspicion for acute deep-vein thrombosis?

    回答

    Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

    ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

46. カード 46

    質問

    Which next action matters most in Crohn disease?

    回答

    Drain abscesses and involve surgery for obstruction, fistula complications, perforation, or refractory disease.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

47. カード 47

    質問

    Which next action matters most in rheumatoid arthritis?

    回答

    Refer early and start disease-modifying therapy rather than relying on symptomatic treatment.

    2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis · reviewed 2026-08-26

48. カード 48

    質問

    What antimicrobial approach is appropriate for suspected or confirmed pleural infection?

    回答

    Start empiric antibiotics before culture results, covering likely organisms including anaerobes, then narrow therapy to microbiology and clinical context.

    British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

49. カード 49

    質問

    In a child or adolescent, which next action matters most in nephritic syndrome?

    回答

    Control pressure and volume, treat the cause, and obtain urgent nephrology input for rapidly progressive loss.

    KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

50. カード 50

    質問

    Which prevention or risk-reduction step is important for acute coronary syndrome?

    回答

    Treat tobacco use, hypertension, diabetes, and dyslipidemia to reduce atherosclerotic risk.

    2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

51. カード 51

    質問

    Which next action matters most in multiple sclerosis relapse?

    回答

    Exclude infection or pseudo-relapse, then treat functionally significant relapse and reassess disease-modifying therapy.

    Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

52. カード 52

    質問

    Which next action matters most in HIV infection?

    回答

    Link a newly diagnosed patient rapidly to HIV care and begin antiretroviral therapy as soon as feasible.

    Initiation of Antiretroviral Therapy · reviewed 2026-08-26

53. カード 53

    質問

    For surgical decision-making, which next action matters most in postpartum hemorrhage?

    回答

    Call the hemorrhage team, massage an atonic uterus, give uterotonics, replace blood products, and control the cause procedurally if needed.

    Postpartum Hemorrhage · reviewed 2026-08-26

54. カード 54

    質問

    Which next action matters most in delirium?

    回答

    Treat the cause, protect the patient, and use nonpharmacologic measures first.

    Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

55. カード 55

    質問

    After successful endoscopic hemostasis of a high-risk bleeding peptic ulcer, what medication strategy is recommended?

    回答

    Give high-dose proton-pump inhibitor therapy continuously or intermittently for 3 days.

    ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

56. カード 56

    質問

    What clinical clue should raise suspicion for thyroid storm?

    回答

    Fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in thyrotoxicosis suggest storm.

    2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26

57. カード 57

    質問

    In a child or adolescent, what drug class or regimen fits septic arthritis?

    回答

    Cover likely gram-positive organisms initially, adding gram-negative coverage for relevant risk.

    Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

58. カード 58

    質問

    What clinical clue should raise suspicion for acute bacterial rhinosinusitis?

    回答

    Persistent symptoms beyond 10 days, severe fever with purulent drainage, or worsening after initial improvement are patterns that support bacterial disease.

    Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

59. カード 59

    質問

    How should a clinician respond when a patient asks not to hear serious diagnostic information?

    回答

    Explore the request and preferences, confirm it is voluntary, and identify whether the patient wants information shared with a chosen surrogate.

    Withholding Information from Patients · reviewed 2026-08-26

60. カード 60

    質問

    What is the key first diagnostic step for cardiac tamponade?

    回答

    Bedside echocardiography can show effusion with chamber collapse and respiratory flow variation.

    2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

61. カード 61

    質問

    In a child or adolescent, which next action matters most in atopic dermatitis?

    回答

    Treat active inflammation and address infection, sleep disruption, and trigger exposure.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

62. カード 62

    質問

    What is the key first diagnostic step for idiopathic pulmonary fibrosis?

    回答

    High-resolution CT showing a usual interstitial pneumonia pattern can establish diagnosis in the right context; multidisciplinary review is key.

    Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26

63. カード 63

    質問

    What drug class or regimen fits benign prostatic hyperplasia?

    回答

    Alpha-1 blockers improve symptoms quickly; 5-alpha-reductase inhibitors reduce progression in appropriately enlarged prostates.

    EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26

64. カード 64

    質問

    In a child or adolescent, what clinical clue should raise suspicion for nephritic syndrome?

    回答

    Hematuria with dysmorphic red cells or casts, hypertension, edema, and reduced kidney function suggests glomerular inflammation.

    KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

65. カード 65

    質問

    In a child or adolescent, which initial medication regimen is indicated for a convulsive seizure lasting at least five minutes or recurring without recovery?

    回答

    A benzodiazepine is first-line for convulsive status epilepticus, followed by an appropriate longer-acting antiseizure medicine.

    Treatment of Prolonged Seizures in Children and Adults · reviewed 2026-08-26

66. カード 66

    質問

    Which next action matters most in acute deep-vein thrombosis?

    回答

    Start anticoagulation promptly after acute deep-vein thrombosis is confirmed, unless a contraindication changes the plan.

    ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

67. カード 67

    質問

    What drug class or regimen fits sepsis?

    回答

    Use broad therapy matched to source, host, and local resistance, then de-escalate from cultures and response.

    2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

68. カード 68

    質問

    Which bedside pattern best points to infective endocarditis?

    回答

    Fever plus a new or changing murmur, embolic findings, injection-drug use, or prosthetic material raises suspicion.

    2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

69. カード 69

    質問

    What drug class or regimen fits pelvic inflammatory disease?

    回答

    Outpatient therapy commonly uses ceftriaxone plus doxycycline and metronidazole.

    Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

70. カード 70

    質問

    Which prevention or risk-reduction step is important for acute pancreatitis?

    回答

    Treat gallstones, avoid alcohol excess, and control severe hypertriglyceridemia to reduce recurrence.

    ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

71. カード 71

    質問

    What drug class or regimen fits schizophrenia?

    回答

    Use an antipsychotic through shared decision-making; clozapine is indicated for treatment resistance or persistent suicide risk under monitoring.

    Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

72. カード 72

    質問

    Which prevention or risk-reduction step is important for anterior cruciate ligament tear?

    回答

    Neuromuscular warm-up and landing programs reduce noncontact ACL injuries in high-risk athletes.

    Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

73. カード 73

    質問

    What is the key first diagnostic step for primary hypothyroidism?

    回答

    Measure TSH first in most patients and free T4 to characterize overt disease.

    Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

74. カード 74

    質問

    In an acutely ill hospitalized medical patient, what VTE prevention strategy is appropriate?

    回答

    Assess VTE and bleeding risk, then use pharmacologic prophylaxis when indicated or mechanical prophylaxis when anticoagulation is unsuitable.

    ASH VTE Guidelines: Prophylaxis for Medical Patients · reviewed 2026-08-26

75. カード 75

    質問

    In a child aged 6 months or older, what drug class or regimen fits acute otitis media?

    回答

    Amoxicillin is first-line for most children who need an antibiotic, with alternatives guided by allergy and prior treatment.

    Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

76. カード 76

    質問

    What makes informed consent more than a signed form?

    回答

    It is a communication process covering the nature, expected benefits, material risks, alternatives, and the option to decline, followed by a voluntary decision.

    Informed Consent · reviewed 2026-08-26

77. カード 77

    質問

    What condition should be suspected from this finding: Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

    回答

    Hypertensive emergency. Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

78. カード 78

    質問

    Which prevention or risk-reduction step is important for migraine with aura?

    回答

    Regular sleep, meals, hydration, activity, trigger management, and limiting acute-medicine overuse reduce attacks.

    AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26

79. カード 79

    質問

    What is the key first diagnostic step for upper gastrointestinal bleeding?

    回答

    Check hemodynamics, CBC, metabolic and coagulation studies, type and screen, then perform timely upper endoscopy after stabilization.

    ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

80. カード 80

    質問

    Which prevention or risk-reduction step is important for early syphilis?

    回答

    Condom use, partner services, repeat testing for ongoing risk, and prenatal screening reduce transmission and congenital disease.

    Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

81. カード 81

    質問

    In a child or adolescent, what is the key first diagnostic step for septic arthritis?

    回答

    Perform urgent arthrocentesis for cell count, crystals, Gram stain, and culture; obtain blood cultures.

    Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

82. カード 82

    質問

    Which prevention or risk-reduction step is important for abnormal uterine bleeding from anovulation?

    回答

    Address reversible causes of ovulatory dysfunction, review medicines that worsen bleeding, and monitor for anemia.

    Abnormal Uterine Bleeding · reviewed 2026-08-26

83. カード 83

    質問

    In a young child, which diagnosis best fits a barking cough, hoarseness, and inspiratory stridor after a viral prodrome?

    回答

    Croup. Barking cough, hoarseness, and inspiratory stridor after a viral prodrome in a young child suggests croup.

    Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

84. カード 84

    質問

    Which intervention is recommended to reduce later PTSD in an adult diagnosed with acute stress disorder?

    回答

    Offer individual trauma-focused cognitive behavioral psychotherapy with exposure and/or cognitive restructuring.

    Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

85. カード 85

    質問

    What clinical clue should raise suspicion for cellulitis?

    回答

    Unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border favor cellulitis.

    Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26

86. カード 86

    質問

    How should a clinician initially manage infective endocarditis?

    回答

    Start targeted IV antibiotics after cultures; seek early valve-team input for heart failure, uncontrolled infection, or major embolic risk.

    2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

87. カード 87

    質問

    What clinical clue should raise suspicion for benign prostatic hyperplasia?

    回答

    Progressive weak stream, hesitancy, incomplete emptying, nocturia, and frequency suggest bladder-outlet symptoms.

    EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26

88. カード 88

    質問

    What drug class or regimen fits chronic kidney disease?

    回答

    Use an ACE inhibitor or ARB for appropriate albuminuric CKD and an SGLT2 inhibitor for eligible patients.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

89. カード 89

    質問

    Which microbiologic test is essential when gonococcal conjunctivitis is suspected?

    回答

    Obtain a conjunctival specimen for culture; add a locally validated nucleic-acid amplification test when available, and perform susceptibility testing on cultured isolates when indicated.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

90. カード 90

    質問

    What drug class or regimen fits iron-deficiency anemia?

    回答

    Oral iron is first-line for many patients; IV iron is useful when absorption, tolerance, severity, or speed makes oral therapy unsuitable.

    British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

91. カード 91

    質問

    When may treatment proceed without prior consent in an emergency?

    回答

    When urgent treatment is needed, the patient cannot participate, no surrogate is available, and delay threatens life or serious health; document the circumstances.

    Informed Consent · reviewed 2026-08-26

92. カード 92

    質問

    What drug class or regimen fits primary adrenal insufficiency?

    回答

    Replace glucocorticoid and usually mineralocorticoid in chronic primary disease.

    Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

93. カード 93

    質問

    What is the key first diagnostic step for subarachnoid hemorrhage?

    回答

    Use immediate noncontrast CT; if negative but suspicion remains, follow the time-appropriate pathway with lumbar puncture or vascular imaging.

    2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

94. カード 94

    質問

    Which bedside pattern best points to celiac disease?

    回答

    Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.

    ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26

95. カード 95

    質問

    In a child or adolescent, what is the key first diagnostic step for bacterial meningitis?

    回答

    Obtain blood cultures and lumbar puncture when safe; perform head imaging first only for defined risk features.

    WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

96. カード 96

    質問

    In a postmenopausal woman or man aged 50 or older, which diagnosis is established by a hip or vertebral fragility fracture?

    回答

    Osteoporosis. A hip or vertebral fracture from low trauma establishes osteoporosis regardless of T-score.

    The clinician’s guide to prevention and treatment of osteoporosis · reviewed 2026-08-26

97. カード 97

    質問

    What is the key first diagnostic step for preeclampsia with severe features?

    回答

    Confirm pressure correctly and assess urine protein, CBC, creatinine, liver tests, fetal status, and symptoms.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

98. カード 98

    質問

    In an infant aged 1–23 months, how should a clinician initially manage bronchiolitis?

    回答

    Support oxygenation and hydration; use suction selectively and assess apnea or exhaustion.

    Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26

99. カード 99

    質問

    What is the key first diagnostic step for bipolar I mania?

    回答

    Diagnosis is clinical; assess substances, thyroid disease, medicines, psychosis, and safety.

    Management of Bipolar Disorder in Adults · reviewed 2026-08-26

100. カード 100

     質問

     How should medication be used in hypertensive emergency?

     回答

     Choose a titratable IV agent suited to the clinical syndrome; do not rapidly normalize pressure in most presentations.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

101. カード 101

     質問

     Which bedside pattern best points to obstructive sleep apnea?

     回答

     Loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension suggests OSA.

     Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea · reviewed 2026-08-26

102. カード 102

     質問

     What counseling point helps reduce harm from heart failure with reduced ejection fraction?

     回答

     Control blood pressure and coronary risk, and avoid medicines that worsen fluid retention.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

103. カード 103

     質問

     What condition should be suspected from this finding: Increasing abdominal girth, shifting dullness, edema, jaundice, or stigmata of portal hypertension suggest decompensation.

     回答

     Cirrhosis with ascites. Increasing abdominal girth, shifting dullness, edema, jaundice, or stigmata of portal hypertension suggest decompensation.

     Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26

104. カード 104

     質問

     Which bedside pattern best points to carpal tunnel syndrome?

     回答

     Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.

     Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

105. カード 105

     質問

     In a patient with prior demyelinating events, which diagnosis fits a new focal neurologic deficit evolving over hours to days and lasting more than 24 hours?

     回答

     Multiple sclerosis relapse. A focal neurologic deficit evolving over hours to days and lasting over 24 hours, separated in time and space from prior events, suggests relapse.

     Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

106. カード 106

     質問

     Which prevention or risk-reduction step is important for primary hyperparathyroidism?

     回答

     Maintain hydration and avoid unnecessary calcium-raising medicines while monitoring patients who do not have surgery.

     Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

107. カード 107

     質問

     What condition should be suspected from this finding: Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

     回答

     HIV infection. Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

     About HIV · reviewed 2026-08-26

108. カード 108

     質問

     Which prevention or risk-reduction step is important for sudden sensorineural hearing loss?

     回答

     Counsel patients to seek same-day care for sudden hearing change rather than waiting for spontaneous recovery.

     Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

109. カード 109

     質問

     For surgical decision-making, what condition should be suspected from this finding: Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

     回答

     Postpartum hemorrhage. Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

     Postpartum Hemorrhage · reviewed 2026-08-26

110. カード 110

     質問

     What is the clinician’s duty after recognizing a significant medical error that harmed a patient?

     回答

     Disclose the known facts honestly, explain the clinical impact and next care steps, express appropriate concern, and follow reporting processes.

     Promoting Patient Safety · reviewed 2026-08-26

111. カード 111

     質問

     Which diagnosis causes an acute, fluctuating disturbance of attention and awareness with disorganized thinking?

     回答

     Delirium. An acute fluctuating disturbance of attention and awareness with disorganized thinking suggests delirium.

     Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

112. カード 112

     質問

     In a child or adolescent, what is the key first diagnostic step for nephritic syndrome?

     回答

     Use urine microscopy, protein quantification, complement and serologic testing, and biopsy for severe or unclear disease.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

113. カード 113

     質問

     Which next action matters most in uncomplicated cystitis?

     回答

     Assess for pyelonephritis, pregnancy, obstruction, or sepsis before treating as uncomplicated disease.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

114. カード 114

     質問

     What is the key first diagnostic step for acute deep-vein thrombosis?

     回答

     Use pretest probability with D-dimer or compression ultrasonography rather than symptoms alone.

     ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

115. カード 115

     質問

     How should medication be used in idiopathic pulmonary fibrosis?

     回答

     Nintedanib or pirfenidone can slow functional decline; neither reverses established fibrosis.

     Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26

116. カード 116

     質問

     What diagnostic approach is most appropriate when stable chronic hypertension is suspected?

     回答

     Confirm persistent elevation with standardized office technique and out-of-office monitoring when appropriate.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

117. カード 117

     質問

     How should a clinician initially manage cirrhosis with ascites?

     回答

     Restrict sodium, assess for infection, and perform large-volume paracentesis with albumin when tense ascites causes symptoms.

     Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26

118. カード 118

     質問

     What is the key first diagnostic step for herpes zoster?

     回答

     Clinical diagnosis is typical; PCR from a lesion is most useful when confirmation matters.

     Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

119. カード 119

     質問

     How should a clinician initially manage osteoporosis in a postmenopausal woman at high fracture risk?

     回答

     Offer pharmacologic therapy after shared decision-making, then reassess adherence and fracture risk.

     Pharmacological Management of Osteoporosis in Postmenopausal Women · reviewed 2026-08-26

120. カード 120

     質問

     Which bedside pattern best points to migraine with aura?

     回答

     Recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms, suggests migraine with aura.

     ICHD-3: Migraine with Aura · reviewed 2026-08-26

121. カード 121

     質問

     What condition should be suspected from this finding: Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.

     回答

     Type 2 diabetes mellitus. Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

122. カード 122

     質問

     Which bedside pattern best points to early syphilis?

     回答

     A painless chancre or a diffuse rash involving palms and soles with generalized lymphadenopathy suggests syphilis by stage.

     Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

123. カード 123

     質問

     For surgical decision-making, what condition should be suspected from this finding: Sudden painful red eye, blurred vision with halos, headache, nausea, a fixed mid-dilated pupil, and a firm globe are classic.

     回答

     Acute angle-closure glaucoma. Sudden painful red eye, blurred vision with halos, headache, nausea, a fixed mid-dilated pupil, and a firm globe are classic.

     Management of Angle-Closure Glaucoma · reviewed 2026-08-26

124. カード 124

     質問

     Which bedside pattern best points to abnormal uterine bleeding from anovulation?

     回答

     Irregular unpredictable bleeding without cyclic ovulation is common at reproductive extremes or with endocrine disruption.

     Abnormal Uterine Bleeding · reviewed 2026-08-26

125. カード 125

     質問

     How should a clinician manage a boundary-crossing gift from a patient?

     回答

     Assess its meaning, value, timing, and effect on care; decline gifts that exploit, obligate, or distort the professional relationship.

     Gifts from Patients · reviewed 2026-08-26

126. カード 126

     質問

     A clinician is considering symptomatic aortic stenosis. Which finding adds the most support?

     回答

     Exertional dyspnea, angina, or syncope with a harsh crescendo-decrescendo systolic murmur radiating to the carotids is typical.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

127. カード 127

     質問

     Which bedside pattern best points to post-traumatic stress disorder?

     回答

     Intrusion, avoidance, negative mood or cognition, and hyperarousal lasting over a month after trauma suggest PTSD.

     Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

128. カード 128

     質問

     In a child aged 6–11 years or an adolescent, what diagnostic approach is most appropriate when asthma is suspected?

     回答

     Demonstrate variable expiratory airflow limitation with spirometry and bronchodilator response or an accepted alternative.

     2026 GINA Strategy Report · reviewed 2026-08-26

129. カード 129

     質問

     Which prevention or risk-reduction step is important for chronic kidney disease?

     回答

     Control blood pressure, diabetes, tobacco use, and nephrotoxin exposure; vaccinate and reduce cardiovascular risk.

     2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

130. カード 130

     質問

     In a child or adolescent, how should medication be used in acute appendicitis?

     回答

     Preoperative antibiotics should cover enteric gram-negative organisms and anaerobes.

     Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

131. カード 131

     質問

     Which prevention or risk-reduction step is important for iron-deficiency anemia?

     回答

     Adequate dietary iron and evaluation of menstrual or gastrointestinal blood loss prevent recurrence.

     British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

132. カード 132

     質問

     Which drug class is preferred before oral therapy for knee osteoarthritis pain when topical treatment is feasible?

     回答

     Use a topical NSAID first; it provides local pain relief with less systemic exposure than an oral NSAID.

     2019 ACR/Arthritis Foundation Guideline for Osteoarthritis · reviewed 2026-08-26

133. カード 133

     質問

     A patient has this pattern: Exertional calf discomfort relieved by rest, diminished pulses, and nonhealing foot wounds suggest lower-extremity arterial disease. What is the most likely diagnosis?

     回答

     Peripheral artery disease. Exertional calf discomfort relieved by rest, diminished pulses, and nonhealing foot wounds suggest lower-extremity arterial disease.

     2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26

134. カード 134

     質問

     For surgical decision-making, how should a clinician initially manage acute ischemic stroke?

     回答

     Activate a stroke pathway and evaluate immediately for IV thrombolysis and mechanical thrombectomy eligibility.

     2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

135. カード 135

     質問

     Which prevention or risk-reduction step is important for melanoma?

     回答

     Use sun protection and teach patients to report changing lesions rather than relying on routine self-treatment.

     Melanoma Clinical Guidelines · reviewed 2026-08-26

136. カード 136

     質問

     How should a clinician initially manage community-acquired pneumonia?

     回答

     Stabilize oxygenation and sepsis, then choose outpatient or inpatient care using clinical judgment and a validated severity tool.

     Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

137. カード 137

     質問

     Which prevention or risk-reduction step is important for ureteral stone?

     回答

     High fluid intake and stone-specific dietary changes based on metabolic evaluation reduce recurrence.

     EAU Guidelines on Urolithiasis · reviewed 2026-08-26

138. カード 138

     質問

     For surgical decision-making, how should a clinician initially manage ectopic pregnancy?

     回答

     Hemodynamic instability or suspected rupture requires emergency surgery; stable management depends on imaging, hCG, size, and follow-up reliability.

     Ectopic Pregnancy · reviewed 2026-08-26

139. カード 139

     質問

     What counseling point helps reduce harm from tension pneumothorax?

     回答

     After chest trauma or an invasive thoracic procedure, urgently reassess new dyspnea, hypotension, or unilateral breath-sound loss so tension physiology is decompressed without delay.

     Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

140. カード 140

     質問

     In a child or adolescent, how should a clinician initially manage major depressive disorder?

     回答

     Assess safety first, create an urgent plan for imminent risk, and use psychotherapy, medication, or both by severity and preference.

     Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

141. カード 141

     質問

     What should happen when a clinician’s personal belief conflicts with a requested legal service?

     回答

     Disclose the limitation without judgment, protect urgent care, provide timely information or referral, and avoid abandoning the patient.

     Physician Exercise of Conscience · reviewed 2026-08-26

142. カード 142

     質問

     For surgical decision-making, what immediate plan is appropriate for symptomatic aortic stenosis?

     回答

     Severe symptomatic aortic stenosis requires valve-replacement evaluation rather than medical therapy alone.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

143. カード 143

     質問

     What counseling point helps reduce harm from celiac disease?

     回答

     Screen appropriate first-degree relatives and correct micronutrient deficits.

     ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26

144. カード 144

     質問

     How should a clinician initially manage primary hypothyroidism?

     回答

     Start replacement when indicated and recheck TSH after dose changes rather than adjusting from symptoms alone.

     Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

145. カード 145

     質問

     Which activity counseling can reduce carpal tunnel symptoms or slow progression?

     回答

     Modify job or recreational activities that aggravate symptoms, especially prolonged wrist flexion or extension.

     Carpal Tunnel Syndrome · reviewed 2026-08-26

146. カード 146

     質問

     How should a clinician initially manage bacterial conjunctivitis?

     回答

     Remove contact lenses and urgently assess pain, photophobia, vision loss, corneal opacity, or hyperacute discharge.

     Clinical Overview of Pink Eye (Conjunctivitis) · reviewed 2026-08-26

147. カード 147

     質問

     Which diagnosis is marked by a rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis?

     回答

     Acute kidney injury. A rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis indicates AKI.

     KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

148. カード 148

     質問

     How should medication be used in bacterial brain abscess?

     回答

     Empiric therapy should cover likely streptococci, anaerobes, and staphylococci according to source, then narrow to cultures.

     ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

149. カード 149

     質問

     In a child or adolescent, what condition should be suspected from this finding: Isolated petechiae, bruising, or mucosal bleeding with thrombocytopenia and otherwise preserved cell lines suggests ITP.

     回答

     Immune thrombocytopenia. Isolated petechiae, bruising, or mucosal bleeding with thrombocytopenia and otherwise preserved cell lines suggests ITP.

     American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

150. カード 150

     質問

     What medication strategy is appropriate for peripheral artery disease?

     回答

     Antiplatelet and high-intensity statin therapy reduce cardiovascular risk in symptomatic disease.

     2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26

151. カード 151

     質問

     A patient has this pattern: Dyspnea with reduced breath sounds, dullness to percussion, and decreased tactile fremitus suggests pleural fluid. What is the most likely diagnosis?

     回答

     Pleural effusion. Dyspnea with reduced breath sounds, dullness to percussion, and decreased tactile fremitus suggests pleural fluid.

     British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

152. カード 152

     質問

     How should medication be used in pulmonary tuberculosis?

     回答

     Treat drug-susceptible disease with a multidrug regimen and adherence support; tailor to susceptibility and patient factors.

     Treatment for Drug-Susceptible Tuberculosis Disease · reviewed 2026-08-26

153. カード 153

     質問

     How should medication be used in endometriosis?

     回答

     Combined hormonal contraceptives or progestins are common first-line suppressive therapies when pregnancy is not desired.

     Endometriosis · reviewed 2026-08-26

154. カード 154

     質問

     How should medication be used in panic disorder?

     回答

     SSRIs or SNRIs are preferred long-term medicines; benzodiazepines carry dependence and safety risks.

     Panic Disorder: What You Need to Know · reviewed 2026-08-26

155. カード 155

     質問

     A clinician is considering ulcerative colitis. Which finding adds the most support?

     回答

     Bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation suggest ulcerative colitis.

     Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26

156. カード 156

     質問

     In a patient younger than 16, which diagnosis fits persistent joint swelling, limited motion, or morning stiffness after other causes are excluded?

     回答

     Juvenile idiopathic arthritis. Persistent joint swelling, limited motion, or morning stiffness beginning before age 16, after excluding other causes, suggests JIA.

     2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

157. カード 157

     質問

     Which bedside pattern best points to primary adrenal insufficiency?

     回答

     Weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia suggest primary adrenal failure.

     Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

158. カード 158

     質問

     When can confidential information be shared with another treating clinician without a separate HIPAA authorization?

     回答

     HIPAA generally permits disclosure for treatment, using reasonable safeguards and only information relevant to care.

     Uses and Disclosures for Treatment, Payment, and Health Care Operations · reviewed 2026-08-26

159. カード 159

     質問

     In a child aged 6 months or older, which bedside pattern best points to acute otitis media?

     回答

     A bulging tympanic membrane with acute ear pain or new otorrhea is more specific than redness alone.

     Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

160. カード 160

     質問

     Which pathophysiologic process drives heart failure with reduced ejection fraction?

     回答

     Reduced contractility activates sympathetic and renin-angiotensin-aldosterone pathways that drive maladaptive remodeling.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

161. カード 161

     質問

     In a child, typically 6 months to 3 years, what immediate plan is appropriate for croup?

     回答

     Keep the child calm, give dexamethasone, and add nebulized epinephrine for moderate or severe stridor.

     Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

162. カード 162

     質問

     What drug class or regimen fits cellulitis?

     回答

     Use an agent active against streptococci for nonpurulent disease; add MRSA coverage when risk or purulence warrants it.

     Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26

163. カード 163

     質問

     What is the key first diagnostic step for testicular torsion?

     回答

     Make a clinical diagnosis and obtain urgent urologic assessment; use Doppler ultrasound only if the diagnosis is uncertain and imaging will not delay exploration.

     Testicular Torsion · reviewed 2026-08-26

164. カード 164

     質問

     What counseling point helps reduce harm from Parkinson disease?

     回答

     Exercise, fall-risk reduction, medication review, and driving and swallowing assessment reduce complications.

     Parkinson’s Disease in Adults · reviewed 2026-08-26

165. カード 165

     質問

     How should a clinician initially manage hyperkalemia?

     回答

     With ECG changes or severe elevation, stabilize the myocardium, shift potassium intracellularly, and remove it from the body.

     Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26

166. カード 166

     質問

     What counseling point helps reduce harm from gonococcal urethritis or cervicitis?

     回答

     Condom use, routine screening by risk, and partner treatment reduce reinfection and complications.

     Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

167. カード 167

     質問

     Which history or examination finding most strongly supports acute pericarditis?

     回答

     Sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation support pericarditis.

     2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

168. カード 168

     質問

     What counseling point helps reduce harm from menopause vasomotor symptoms?

     回答

     Cooling strategies and avoiding individual triggers can reduce symptom burden; assess bone and cardiovascular risk separately.

     The Menopause Years · reviewed 2026-08-26

169. カード 169

     質問

     A patient has this pattern: Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease. What is the most likely diagnosis?

     回答

     Chronic hepatitis C. Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease.

     Viral Hepatitis Clinical Care · reviewed 2026-08-26

170. カード 170

     質問

     What counseling point helps reduce harm from alcohol withdrawal?

     回答

     Treat alcohol-use disorder, plan medically supported withdrawal for high-risk patients, and provide thiamine when nutrition is poor.

     The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26

171. カード 171

     質問

     What diagnostic approach is most appropriate when acute compartment syndrome is suspected?

     回答

     Diagnosis is clinical; compartment-pressure measurement helps when the examination is unreliable or equivocal.

     Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

172. カード 172

     質問

     In a child or adolescent with sickle cell disease, which pain pattern supports an acute vaso-occlusive episode?

     回答

     Acute severe extremity, back, or bone pain that matches the patient’s typical vaso-occlusive pattern and has no alternative cause supports an acute vaso-occlusive pain episode.

     ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26

173. カード 173

     質問

     What diagnostic approach is most appropriate when thyroid storm is suspected?

     回答

     Diagnosis is clinical; obtain thyroid tests and evaluate the trigger without delaying treatment.

     2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26

174. カード 174

     質問

     A clinician is considering acute respiratory distress syndrome. Which finding adds the most support?

     回答

     Acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult suggests ARDS.

     An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26

175. カード 175

     質問

     How should medication be used in sudden sensorineural hearing loss?

     回答

     Offer corticosteroids within the treatment window when appropriate; intratympanic therapy is an option in selected cases.

     Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

176. カード 176

     質問

     What is the HIPAA minimum-necessary rule?

     回答

     For many uses and disclosures, limit protected information to what is reasonably needed for the purpose; the rule does not apply in the same way to disclosures for treatment.

     Minimum Necessary Requirement · reviewed 2026-08-26

177. カード 177

     質問

     For surgical decision-making, hypotension, elevated jugular venous pressure, tachycardia, muffled heart sounds, and pulsus paradoxus indicate which diagnosis?

     回答

     Cardiac tamponade. Hypotension, elevated jugular venous pressure, tachycardia, muffled heart sounds, and pulsus paradoxus suggest tamponade physiology.

     2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

178. カード 178

     質問

     In a child or adolescent, what diagnostic approach is most appropriate when acute appendicitis is suspected?

     回答

     Use ultrasound as the initial imaging study in many children; use CT or MRI when ultrasound is nondiagnostic and suspicion persists, according to local expertise.

     Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

179. カード 179

     質問

     For surgical decision-making, sudden focal weakness, facial droop, speech change, gaze deviation, neglect, or ataxia indicate which time-critical diagnosis?

     回答

     Acute ischemic stroke. Sudden focal weakness, facial droop, speech change, gaze deviation, neglect, or ataxia is stroke until proved otherwise.

     2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

180. カード 180

     質問

     A clinician is considering gout flare. Which finding adds the most support?

     回答

     Abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint, suggests gout.

     Gout · reviewed 2026-08-26

181. カード 181

     質問

     Which diagnosis best fits new cough, fever, dyspnea, pleuritic pain, and focal crackles when an infiltrate is confirmed?

     回答

     Community-acquired pneumonia. New cough, fever, dyspnea, pleuritic pain, and focal crackles suggest pneumonia, but clinical findings alone are imperfect.

     Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

182. カード 182

     質問

     In a child aged 6–11 years or an adolescent, what medication strategy is appropriate for asthma?

     回答

     For children 6–11 years and adolescents, use an age-appropriate inhaled corticosteroid-containing strategy rather than short-acting beta agonist-only treatment.

     2026 GINA Strategy Report · reviewed 2026-08-26

183. カード 183

     質問

     For surgical decision-making, a patient has this pattern: Unilateral pelvic pain or bleeding in early pregnancy, especially with syncope or shoulder pain, raises concern for ectopic implantation. What is the most likely diagnosis?

     回答

     Ectopic pregnancy. Unilateral pelvic pain or bleeding in early pregnancy, especially with syncope or shoulder pain, raises concern for ectopic implantation.

     Ectopic Pregnancy · reviewed 2026-08-26

184. カード 184

     質問

     In a child or adolescent, which diagnosis requires at least two weeks of depressed mood or loss of interest with functional change and associated neurovegetative or cognitive symptoms?

     回答

     Major depressive disorder. At least two weeks of depressed mood or loss of interest with functional change and associated neurovegetative or cognitive symptoms suggests major depression.

     Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

185. カード 185

     質問

     Which preventive measure belongs in care for atrial fibrillation?

     回答

     Address hypertension, obesity, sleep apnea, alcohol excess, and other modifiable drivers.

     2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

186. カード 186

     質問

     For surgical decision-making, what condition should be suspected from this finding: An evolving asymmetric pigmented lesion with border irregularity, color variation, or a concerning outlier pattern requires evaluation.

     回答

     Melanoma. An evolving asymmetric pigmented lesion with border irregularity, color variation, or a concerning outlier pattern requires evaluation.

     Melanoma Clinical Guidelines · reviewed 2026-08-26

187. カード 187

     質問

     Which bedside pattern best points to hyperkalemia?

     回答

     Weakness, paresthesias, bradycardia, or ECG changes can occur, but dangerous hyperkalemia may be asymptomatic.

     Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26

188. カード 188

     質問

     For surgical decision-making, what condition should be suspected from this finding: Sudden colicky flank pain radiating to the groin with hematuria and restlessness is typical.

     回答

     Ureteral stone. Sudden colicky flank pain radiating to the groin with hematuria and restlessness is typical.

     EAU Guidelines on Urolithiasis · reviewed 2026-08-26

189. カード 189

     質問

     In a child or adolescent, how should a clinician initially manage sickle cell vaso-occlusive crisis?

     回答

     Provide rapid individualized analgesia, assess oxygenation and hydration, and evaluate acute chest syndrome or infection.

     ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26

190. カード 190

     質問

     How should medication be used in primary hyperparathyroidism?

     回答

     Cinacalcet can lower calcium when surgery is not possible; antiresorptive therapy targets low bone density.

     Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

191. カード 191

     質問

     What diagnostic approach is most appropriate when acute bacterial rhinosinusitis is suspected?

     回答

     Diagnosis is clinical; routine imaging is not needed unless a complication or alternative diagnosis is suspected.

     Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

192. カード 192

     質問

     What should a clinician do before discussing a patient in a public or semipublic area?

     回答

     Move to a private setting when practical and use reasonable safeguards so others do not overhear identifiable information.

     Incidental Uses and Disclosures · reviewed 2026-08-26

193. カード 193

     質問

     A clinician is considering Parkinson disease. Which finding adds the most support?

     回答

     Bradykinesia plus rest tremor or rigidity, with reduced arm swing and shuffling gait, supports parkinsonism.

     Parkinson’s Disease in Adults · reviewed 2026-08-26

194. カード 194

     質問

     What immediate plan is appropriate for chronic hepatitis C?

     回答

     Stage liver disease, review interactions, test for coinfections, and link every patient with active infection to curative treatment.

     Viral Hepatitis Clinical Care · reviewed 2026-08-26

195. カード 195

     質問

     A clinician is considering gonococcal urethritis or cervicitis. Which finding adds the most support?

     回答

     Purulent urethral discharge, dysuria, cervicitis, pelvic pain, or exposure may indicate gonorrhea, but infection can be asymptomatic.

     Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

196. カード 196

     質問

     In a child or adolescent, what immediate plan is appropriate for juvenile idiopathic arthritis?

     回答

     Refer to pediatric rheumatology early and treat to control inflammation and preserve function.

     2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

197. カード 197

     質問

     A clinician is considering menopause vasomotor symptoms. Which finding adds the most support?

     回答

     Hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age usually identify menopausal vasomotor symptoms.

     The Menopause Years · reviewed 2026-08-26

198. カード 198

     質問

     Which diagnosis best fits this presentation: Progressive exertional dyspnea, dry cough, bibasilar fine crackles, and clubbing in an older adult suggest fibrotic interstitial disease.

     回答

     Idiopathic pulmonary fibrosis. Progressive exertional dyspnea, dry cough, bibasilar fine crackles, and clubbing in an older adult suggest fibrotic interstitial disease.

     Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26

199. カード 199

     質問

     A clinician is considering alcohol withdrawal. Which finding adds the most support?

     回答

     Tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use suggests withdrawal.

     The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26

200. カード 200

     質問

     What is the priority management step for acute pericarditis?

     回答

     Assess immediately for tamponade or high-risk features that require admission.

     2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

201. カード 201

     質問

     In complicated acute calculous cholecystitis, how should empiric antibiotics be selected?

     回答

     Base the regimen on likely biliary pathogens and local resistance patterns, with enteric gram-negative aerobes and anaerobes among the common targets.

     2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26

202. カード 202

     質問

     For surgical decision-making, what is the priority management step for pleural effusion?

     回答

     Drain a large symptomatic effusion or complicated parapneumonic collection and treat the underlying disease.

     British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

203. カード 203

     質問

     In acute decompensated heart failure with fluid overload, which drug class is used first to relieve congestion?

     回答

     Give an intravenous loop diuretic and adjust it to urine output, symptoms, renal function, and electrolytes.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

204. カード 204

     質問

     For surgical decision-making, what immediate plan is appropriate for subarachnoid hemorrhage?

     回答

     Stabilize, control pressure carefully, give nimodipine, and obtain urgent neurovascular treatment of the aneurysm.

     2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

205. カード 205

     質問

     What medication strategy is appropriate for hip fracture?

     回答

     Use multimodal analgesia and guideline-based VTE prophylaxis around surgery.

     Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

206. カード 206

     質問

     In a child or adolescent, what immediate plan is appropriate for bacterial meningitis?

     回答

     Give empiric antibiotics immediately; do not delay for imaging or lumbar puncture when delay is likely.

     WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

207. カード 207

     質問

     In a child or adolescent, which diagnosis fits hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status?

     回答

     Diabetic ketoacidosis. Hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status suggests ketoacidosis.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

208. カード 208

     質問

     For surgical decision-making, what immediate plan is appropriate for preeclampsia with severe features?

     回答

     Stabilize the mother, prevent seizure, control persistent severe pressure, and plan delivery by gestational age and status.

     Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

209. カード 209

     質問

     For surgical decision-making, new flashes, floaters, and a curtain or shadow across the visual field indicate which diagnosis?

     回答

     Retinal detachment. New flashes, floaters, and a curtain or shadow across the visual field suggest detachment.

     Retinal Detachment · reviewed 2026-08-26

210. カード 210

     質問

     What immediate plan is appropriate for bipolar I mania?

     回答

     Hospitalize when danger, grave disability, or severe psychosis requires containment; stop antidepressant monotherapy.

     Management of Bipolar Disorder in Adults · reviewed 2026-08-26

211. カード 211

     質問

     May a clinician leave appointment information in a voicemail?

     回答

     Yes, with reasonable safeguards: keep the message limited and follow any confidential communication request the patient has made.

     Incidental Uses and Disclosures · reviewed 2026-08-26

212. カード 212

     質問

     When is a loop diuretic appropriate in acute kidney injury?

     回答

     Use a loop diuretic only to manage volume overload; it does not reverse intrinsic kidney injury or improve renal recovery.

     KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

213. カード 213

     質問

     How should a clinician initially manage plaque psoriasis?

     回答

     Assess body-surface area, special-site involvement, symptoms, and joint disease before selecting therapy.

     Psoriasis Clinical Guidelines · reviewed 2026-08-26

214. カード 214

     質問

     In a child or adolescent, how should medication be used in immune thrombocytopenia?

     回答

     Corticosteroids or IVIG are common initial treatments when therapy is needed; longer-term choices depend on response and duration.

     American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

215. カード 215

     質問

     Which test or testing sequence best evaluates suspected ventricular fibrillation cardiac arrest?

     回答

     Use rhythm analysis during high-quality CPR without delaying compressions.

     2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26

216. カード 216

     質問

     Which drug class is first-line for erectile dysfunction when no contraindication such as nitrate use exists?

     回答

     Use a phosphodiesterase-5 inhibitor after reviewing cardiovascular fitness, interactions, and correct use; never combine it with nitrates.

     Erectile Dysfunction Guideline · reviewed 2026-08-26

217. カード 217

     質問

     Which pathophysiologic process drives COPD?

     回答

     Small-airway disease and emphysematous parenchymal destruction cause persistent expiratory flow limitation.

     2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

218. カード 218

     質問

     Which history or examination finding most strongly supports Crohn disease?

     回答

     Chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions support Crohn disease.

     Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

219. カード 219

     質問

     Which pathophysiologic process drives acute compartment syndrome?

     回答

     Rising pressure within a closed fascial space compromises capillary perfusion and causes muscle and nerve ischemia.

     Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

220. カード 220

     質問

     What medication strategy is appropriate for migraine with aura?

     回答

     Use an NSAID or triptan for many acute attacks; select preventive therapy around comorbidities and patient preference.

     AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26

221. カード 221

     質問

     What clinical clue should raise suspicion for hypertensive emergency?

     回答

     Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

222. カード 222

     質問

     What medication strategy is appropriate for early syphilis?

     回答

     Benzathine penicillin G is preferred for early syphilis; penicillin is required in pregnancy.

     Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

223. カード 223

     質問

     What counseling point helps reduce harm from Cushing syndrome?

     回答

     Limit avoidable exogenous glucocorticoid exposure and taper chronic therapy safely when appropriate.

     Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

224. カード 224

     質問

     What medication strategy is appropriate for abnormal uterine bleeding from anovulation?

     回答

     Progestin or combined hormonal therapy can regulate bleeding; tranexamic acid reduces heavy bleeding in eligible patients.

     Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women · reviewed 2026-08-26

225. カード 225

     質問

     What counseling point helps reduce harm from peritonsillar abscess?

     回答

     Seek prompt care for worsening unilateral throat pain, drooling, muffled voice, trismus, or breathing difficulty so an abscess and airway risk are not missed.

     Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

226. カード 226

     質問

     What medication strategy is appropriate for post-traumatic stress disorder?

     回答

     Sertraline, paroxetine, or venlafaxine can help; benzodiazepines are not recommended for PTSD treatment.

     Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

227. カード 227

     質問

     When may protected health information be disclosed to prevent a serious threat?

     回答

     HIPAA permits a good-faith disclosure consistent with law and ethical standards to someone reasonably able to prevent or lessen a serious and imminent threat.

     HIPAA Disclosure to Prevent or Lessen a Serious and Imminent Threat · reviewed 2026-08-26

228. カード 228

     質問

     In an infant aged 1–23 months, which history or examination finding most strongly supports bronchiolitis?

     回答

     An infant with viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty likely has bronchiolitis.

     Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26

229. カード 229

     質問

     Which diagnosis causes marked edema, heavy proteinuria, hypoalbuminemia, and hyperlipidemia?

     回答

     Nephrotic syndrome. Marked edema, heavy proteinuria, hypoalbuminemia, and hyperlipidemia define a nephrotic pattern.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

230. カード 230

     質問

     Which bedside pattern best points to herpes zoster?

     回答

     A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

     Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

231. カード 231

     質問

     A patient has this pattern: Thrombocytopenia plus microangiopathic hemolytic anemia, often with neurologic, renal, or fever findings, is an emergency. What is the most likely diagnosis?

     回答

     Thrombotic thrombocytopenic purpura. Thrombocytopenia plus microangiopathic hemolytic anemia, often with neurologic, renal, or fever findings, is an emergency.

     ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26

232. カード 232

     質問

     Which bedside pattern best points to testicular torsion?

     回答

     Sudden severe unilateral testicular pain with nausea or vomiting, a high-riding transverse testis, and loss of the cremasteric reflex strongly suggests torsion.

     Testicular Torsion · reviewed 2026-08-26

233. カード 233

     質問

     For surgical decision-making, which diagnosis best fits hematemesis, coffee-ground emesis, or melena with orthostasis?

     回答

     Upper gastrointestinal bleeding. Hematemesis, coffee-ground emesis, or melena with orthostasis indicates an upper gastrointestinal source until shown otherwise.

     ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

234. カード 234

     質問

     In a child or adolescent, what diagnostic approach is most appropriate when generalized tonic-clonic seizure is suspected?

     回答

     Check glucose and reversible causes; use EEG and brain imaging based on whether this is a first unprovoked event or known epilepsy.

     Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

235. カード 235

     質問

     Identify the condition from this pattern: Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

     回答

     Stable chronic hypertension. Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

236. カード 236

     質問

     What diagnostic approach is most appropriate when sepsis is suspected?

     回答

     Measure lactate, obtain cultures before antibiotics when this causes no meaningful delay, and evaluate the source.

     2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

237. カード 237

     質問

     For surgical decision-making, in a child with acute severe monoarticular pain, restricted passive motion, fever, or bacteremia risk, which diagnosis must be excluded urgently?

     回答

     Septic arthritis. Acute severe monoarticular pain, restricted passive motion, fever, or bacteremia risk is septic arthritis until excluded.

     Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

238. カード 238

     質問

     What diagnostic approach is most appropriate when pelvic inflammatory disease is suspected?

     回答

     Test for gonorrhea, chlamydia, HIV, and syphilis; use ultrasound when abscess or another diagnosis is possible.

     Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

239. カード 239

     質問

     Which pharmacologic approach is preferred for COPD?

     回答

     Long-acting bronchodilators are maintenance therapy; add inhaled corticosteroid for selected exacerbation-prone patients based on phenotype and eosinophils.

     2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

240. カード 240

     質問

     What diagnostic approach is most appropriate when schizophrenia is suspected?

     回答

     Diagnosis is clinical with medical, neurologic, and substance evaluation for first-episode psychosis.

     Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

241. カード 241

     質問

     Which next action matters most in hypertensive emergency?

     回答

     Lower pressure with monitored IV therapy at a controlled rate tailored to the injured organ.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

242. カード 242

     質問

     How should an interpreter be used for a patient with limited English proficiency?

     回答

     Use a qualified medical interpreter, speak to the patient directly, pause in short segments, and avoid relying on children or untrained family for consequential decisions.

     Limited English Proficiency Guidance · reviewed 2026-08-26

243. カード 243

     質問

     What immediate plan is appropriate for thyroid storm?

     回答

     Give a beta-blocker, block hormone synthesis, then block hormone release, add glucocorticoid, cool supportively, and treat the trigger.

     2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26

244. カード 244

     質問

     Which preventive measure belongs in care for ulcerative colitis?

     回答

     Use effective maintenance therapy and monitor symptoms together with objective inflammatory activity to reduce relapse and complications.

     Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26

245. カード 245

     質問

     What immediate plan is appropriate for acute bacterial rhinosinusitis?

     回答

     Assess orbital or intracranial red flags and arrange urgent evaluation when present.

     Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

246. カード 246

     質問

     Which preventive measure belongs in care for gout flare?

     回答

     Weight management, limiting excess alcohol, reviewing urate-raising medicines, and long-term urate control reduce flares.

     Gout · reviewed 2026-08-26

247. カード 247

     質問

     What immediate plan is appropriate for hyponatremia due to SIADH?

     回答

     Treat severe neurologic symptoms with carefully dosed hypertonic saline and avoid overly rapid correction.

     Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia · reviewed 2026-08-26

248. カード 248

     質問

     In a child or adolescent, which pathophysiologic process drives immune thrombocytopenia?

     回答

     Autoantibodies accelerate platelet clearance and can impair platelet production.

     American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

249. カード 249

     質問

     Which test or testing sequence best evaluates suspected COPD?

     回答

     Post-bronchodilator spirometry confirms persistent airflow obstruction.

     2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

250. カード 250

     質問

     Why does atrial fibrillation produce its defining clinical pattern?

     回答

     Chaotic atrial activation eliminates coordinated atrial contraction and creates irregular AV nodal conduction.

     2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

251. カード 251

     質問

     Which pathophysiologic process drives subarachnoid hemorrhage?

     回答

     Arterial blood entering the subarachnoid space raises intracranial pressure and can trigger vasospasm.

     2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

252. カード 252

     質問

     In a child or adolescent, which pathophysiologic process drives bacterial meningitis?

     回答

     Bacterial invasion of the subarachnoid space triggers intense inflammation, edema, and raised intracranial pressure.

     WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

253. カード 253

     質問

     Which pathophysiologic process drives preeclampsia with severe features?

     回答

     Abnormal placentation and systemic endothelial dysfunction produce vasoconstriction and multisystem injury.

     Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

254. カード 254

     質問

     Which clinical feature defines bipolar I disorder?

     回答

     At least one manic episode defines bipolar I disorder; a major depressive episode is common but is not required for the diagnosis.

     Management of Bipolar Disorder in Adults · reviewed 2026-08-26

255. カード 255

     質問

     For surgical decision-making, what is the priority management step for upper gastrointestinal bleeding?

     回答

     Establish IV access, resuscitate, use a restrictive transfusion strategy for most patients, and arrange endoscopic hemostasis.

     ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

256. カード 256

     質問

     Which history or examination finding most strongly supports rheumatoid arthritis?

     回答

     Symmetric inflammatory pain and prolonged morning stiffness in MCP, PIP, or wrist joints with synovitis suggest rheumatoid arthritis.

     Rheumatoid Arthritis · reviewed 2026-08-26

257. カード 257

     質問

     What is teach-back?

     回答

     Ask the patient to explain the plan in their own words so the clinician can find and correct communication gaps without testing or blaming the patient.

     Use the Teach-Back Method · reviewed 2026-08-26

258. カード 258

     質問

     A clinician is considering primary hyperparathyroidism. Which finding adds the most support?

     回答

     Often asymptomatic hypercalcemia, nephrolithiasis, bone loss, constipation, or neurocognitive symptoms can be the clue.

     Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

259. カード 259

     質問

     How can a clinician reduce avoidable harm related to aortic dissection?

     回答

     Long-term blood-pressure control and surveillance imaging reduce later aortic complications.

     2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

260. カード 260

     質問

     A clinician is considering sudden sensorineural hearing loss. Which finding adds the most support?

     回答

     A rapid unilateral hearing decrease, often noticed on waking and sometimes with tinnitus, is an otologic emergency.

     Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

261. カード 261

     質問

     Which preventive measure belongs in care for obstructive sleep apnea?

     回答

     Weight management, alcohol and sedative avoidance near bedtime, and treatment of nasal obstruction reduce severity.

     Sleep Apnea Treatment · reviewed 2026-08-26

262. カード 262

     質問

     In a child or adolescent, what diagnostic approach is most appropriate when atopic dermatitis is suspected?

     回答

     Diagnosis is clinical; testing is reserved for an alternative diagnosis or a specific suspected trigger.

     Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

263. カード 263

     質問

     How should a clinician initially manage acute pyelonephritis?

     回答

     Give fluids and antibiotics, and admit patients with sepsis, inability to take oral therapy, pregnancy concerns, or obstruction.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

264. カード 264

     質問

     For surgical decision-making, which diagnosis best fits this presentation: A sudden maximal-at-onset thunderclap headache, neck stiffness, vomiting, or brief loss of consciousness is concerning.

     回答

     Subarachnoid hemorrhage. A sudden maximal-at-onset thunderclap headache, neck stiffness, vomiting, or brief loss of consciousness is concerning.

     2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

265. カード 265

     質問

     What diagnostic approach is most appropriate when hyperkalemia is suspected?

     回答

     Repeat a possibly hemolyzed sample while obtaining an ECG; assess kidney function, acid-base status, and contributing medicines.

     Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26

266. カード 266

     質問

     In a child or adolescent, which diagnosis best fits this presentation: Fever, headache, neck stiffness, altered mental status, or a nonblanching rash should trigger urgent evaluation.

     回答

     Bacterial meningitis. Fever, headache, neck stiffness, altered mental status, or a nonblanching rash should trigger urgent evaluation.

     WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

267. カード 267

     質問

     What drug class or regimen fits stable chronic hypertension?

     回答

     First-line classes include thiazide-type diuretics, ACE inhibitors or ARBs, and long-acting dihydropyridine calcium-channel blockers.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

268. カード 268

     質問

     For surgical decision-making, which diagnosis best fits this presentation: New hypertension after 20 weeks with end-organ findings such as severe pressure, thrombocytopenia, liver injury, kidney injury, pulmonary edema, or neurologic symptoms suggests severe disease.

     回答

     Preeclampsia with severe features. New hypertension after 20 weeks with end-organ findings such as severe pressure, thrombocytopenia, liver injury, kidney injury, pulmonary edema, or neurologic symptoms suggests severe disease.

     Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

269. カード 269

     質問

     Which pharmacologic approach is preferred for acute pancreatitis?

     回答

     Routine prophylactic antibiotics do not treat sterile pancreatitis; reserve antimicrobials for proven or strongly suspected infection.

     ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

270. カード 270

     質問

     Which diagnosis best fits this presentation: At least one week of elevated or irritable mood with increased energy, decreased sleep, pressured speech, grandiosity, and risky behavior suggests mania.

     回答

     Bipolar I mania. At least one week of elevated or irritable mood with increased energy, decreased sleep, pressured speech, grandiosity, and risky behavior suggests mania.

     Management of Bipolar Disorder in Adults · reviewed 2026-08-26

271. カード 271

     質問

     For surgical decision-making, in a child or adolescent, what is the priority management step for septic arthritis?

     回答

     Drain the joint promptly and start empiric antibiotics after cultures unless the patient is unstable.

     Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

272. カード 272

     質問

     In a child or adolescent, what diagnostic approach is most appropriate when sickle cell vaso-occlusive crisis is suspected?

     回答

     Use focused labs and imaging for the suspected complication; do not require a changed hemoglobin to validate pain.

     ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26

273. カード 273

     質問

     In a child or adolescent, which diagnosis causes variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers?

     回答

     Asthma. Variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers suggests asthma.

     2026 GINA Strategy Report · reviewed 2026-08-26

274. カード 274

     質問

     In a child or adolescent, which pathophysiologic process drives diabetic ketoacidosis?

     回答

     Absolute or marked insulin deficiency drives lipolysis, ketogenesis, osmotic diuresis, and total-body potassium loss.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

275. カード 275

     質問

     How should a clinician respond to a patient requesting an unnecessary antibiotic?

     回答

     Acknowledge the concern, explain why the antibiotic will not help and may harm, offer a clear alternative plan, and define return precautions.

     Core Elements of Outpatient Antibiotic Stewardship · reviewed 2026-08-26

276. カード 276

     質問

     Which pathophysiologic process drives retinal detachment?

     回答

     Fluid passing through a retinal break separates neurosensory retina from the pigment epithelium.

     Retinal Detachment · reviewed 2026-08-26

277. カード 277

     質問

     Which bedside pattern best points to peripheral artery disease?

     回答

     Exertional calf discomfort relieved by rest, diminished pulses, and nonhealing foot wounds suggest lower-extremity arterial disease.

     2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26

278. カード 278

     質問

     Which preventive measure belongs in care for myasthenia gravis?

     回答

     Avoid medicines that worsen neuromuscular transmission and plan carefully for infection, surgery, and pregnancy.

     International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26

279. カード 279

     質問

     In a child or adolescent, which pathophysiologic process drives acute appendicitis?

     回答

     Luminal obstruction causes distention, ischemia, bacterial overgrowth, and eventual perforation.

     Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

280. カード 280

     質問

     Which preventive measure belongs in care for Clostridioides difficile infection?

     回答

     Isolate suspected or confirmed CDI with contact precautions, use C. difficile sporicidal agents for daily and terminal cleaning, and engage antibiotic stewardship.

     Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities · reviewed 2026-08-26

281. カード 281

     質問

     After an acute ACL tear, which nonprescription medicines may be used for symptom relief when safe?

     回答

     Ibuprofen or naproxen can reduce pain and swelling; acetaminophen can reduce pain. Check comorbidities and contraindications before NSAID use.

     Anterior cruciate ligament (ACL) injury - aftercare · reviewed 2026-08-26

282. カード 282

     質問

     Which preventive measure belongs in care for shoulder dystocia?

     回答

     Team drills, clear communication, and avoiding fundal pressure reduce preventable harm.

     Shoulder Dystocia · reviewed 2026-08-26

283. カード 283

     質問

     Which next action matters most in idiopathic pulmonary fibrosis?

     回答

     Assess oxygen need, comorbidity, transplant eligibility, and goals while monitoring progression.

     Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26

284. カード 284

     質問

     In a child or adolescent, which preventive measure belongs in care for attention-deficit/hyperactivity disorder?

     回答

     Use an individualized multimodal plan with psychoeducation, parent and school interventions, and clear functional goals.

     ADHD in Children and Youth: Part 2—Treatment · reviewed 2026-08-26

285. カード 285

     質問

     Which diagnosis best fits unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border?

     回答

     Cellulitis. Unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border favor cellulitis.

     Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26

286. カード 286

     質問

     A clinician is considering hyponatremia due to SIADH. Which finding adds the most support?

     回答

     Nausea, confusion, gait change, seizure, or subtle cognitive symptoms with hypotonic euvolemic hyponatremia may reflect SIADH.

     Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia · reviewed 2026-08-26

287. カード 287

     質問

     During a pulseless arrest, the monitor shows chaotic ventricular activity without organized QRS complexes. Which arrest rhythm is present?

     回答

     Ventricular fibrillation cardiac arrest. Sudden unresponsiveness with absent normal breathing and no pulse is cardiac arrest; the monitor may show chaotic ventricular activity.

     2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26

288. カード 288

     質問

     A clinician is considering neutropenic fever. Which finding adds the most support?

     回答

     A single fever in a patient with severe chemotherapy-related neutropenia is an emergency even when examination is unrevealing.

     Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26

289. カード 289

     質問

     A patient has this pattern: Progressive weak stream, hesitancy, incomplete emptying, nocturia, and frequency suggest bladder-outlet symptoms. What is the most likely diagnosis?

     回答

     Benign prostatic hyperplasia. Progressive weak stream, hesitancy, incomplete emptying, nocturia, and frequency suggest bladder-outlet symptoms.

     EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26

290. カード 290

     質問

     Which test or testing sequence best evaluates suspected primary adrenal insufficiency?

     回答

     Measure morning cortisol and ACTH, then confirm with cosyntropin testing when the patient is stable.

     Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

291. カード 291

     質問

     What medication strategy is appropriate for peritonsillar abscess?

     回答

     Use antibiotics covering group A streptococci and oral anaerobes after drainage.

     Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

292. カード 292

     質問

     What belongs in a safe handoff?

     回答

     State illness severity, active problems, recent changes, pending results, contingency plans, and who owns each next action, then allow questions.

     TeamSTEPPS Communication Module · reviewed 2026-08-26

293. カード 293

     質問

     Which history or examination finding most strongly supports myasthenia gravis?

     回答

     Fluctuating fatigable ptosis, diplopia, dysarthria, dysphagia, or proximal weakness that worsens with use suggests myasthenia.

     International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26

294. カード 294

     質問

     For surgical decision-making, identify the condition from this pattern: Pain out of proportion, pain with passive stretch, tense swelling, and progressive neurologic deficits after injury are warning signs.

     回答

     Acute compartment syndrome. Pain out of proportion, pain with passive stretch, tense swelling, and progressive neurologic deficits after injury are warning signs.

     Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

295. カード 295

     質問

     Which history or examination finding most strongly supports Clostridioides difficile infection?

     回答

     New clinically significant diarrhea after antibiotics or healthcare exposure, with abdominal pain or leukocytosis, suggests C. difficile.

     2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults · reviewed 2026-08-26

296. カード 296

     質問

     How should a clinician confirm or characterize acute coronary syndrome?

     回答

     Obtain a 12-lead ECG within 10 minutes and measure serial high-sensitivity troponin.

     2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

297. カード 297

     質問

     Which history or examination finding most strongly supports shoulder dystocia?

     回答

     After delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicates dystocia.

     Shoulder Dystocia · reviewed 2026-08-26

298. カード 298

     質問

     In a child or adolescent, which history or examination finding most strongly supports attention-deficit/hyperactivity disorder?

     回答

     Persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment suggests ADHD.

     ADHD in Children and Youth: Part 1—Etiology, Diagnosis, and Comorbidity · reviewed 2026-08-26

299. カード 299

     質問

     What clinical clue should raise suspicion for cirrhosis with ascites?

     回答

     Increasing abdominal girth, shifting dullness, edema, jaundice, or stigmata of portal hypertension suggest decompensation.

     Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26

300. カード 300

     質問

     In a child, typically 6 months to 3 years, what clinical clue should raise suspicion for croup?

     回答

     Barking cough, hoarseness, and inspiratory stridor after a viral prodrome in a young child suggests croup.

     Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

     

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     PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps

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301. カード 301

     質問

     How should a clinician initially manage peripheral artery disease?

     回答

     Use supervised or structured exercise; evaluate revascularization for lifestyle-limiting symptoms despite therapy or limb threat.

     2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26

302. カード 302

     質問

     What drug class or regimen fits pulmonary embolism?

     回答

     Direct oral anticoagulants are preferred for many stable eligible patients; choose differently for pregnancy, severe renal disease, or specific cancer contexts.

     ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

303. カード 303

     質問

     For surgical decision-making, in a child or adolescent, identify the condition from this pattern: Periumbilical pain migrating to the right lower quadrant with anorexia, nausea, fever, and focal tenderness is typical.

     回答

     Acute appendicitis. Periumbilical pain migrating to the right lower quadrant with anorexia, nausea, fever, and focal tenderness is typical.

     Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

304. カード 304

     質問

     Which test or testing sequence best evaluates suspected hip fracture?

     回答

     Obtain hip and pelvis radiographs; MRI detects an occult fracture when suspicion remains high.

     Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

305. カード 305

     質問

     In a child or adolescent, what is the priority management step for generalized tonic-clonic seizure?

     回答

     Protect from injury, position for airway safety, time the event, and treat as status epilepticus when it persists.

     Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

306. カード 306

     質問

     Which diagnosis causes fatigue, cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation?

     回答

     Primary hypothyroidism. Fatigue, cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation support hypothyroidism.

     Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

307. カード 307

     質問

     What is the priority management step for sepsis?

     回答

     Start rapid resuscitation, broad empiric antimicrobials, and urgent source control.

     2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

308. カード 308

     質問

     Which diagnosis best fits diffuse conjunctival injection with mucopurulent discharge and eyelids stuck on waking?

     回答

     Bacterial conjunctivitis. Diffuse conjunctival injection with mucopurulent discharge and eyelids stuck on waking supports bacterial conjunctivitis.

     Clinical Overview of Pink Eye (Conjunctivitis) · reviewed 2026-08-26

309. カード 309

     質問

     What is the priority management step for pelvic inflammatory disease?

     回答

     Start empiric treatment promptly; admit for pregnancy, severe illness, abscess, surgical emergency uncertainty, or failed outpatient care.

     Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

310. カード 310

     質問

     What is closed-loop communication during an emergency?

     回答

     The receiver repeats the instruction, the sender confirms or corrects it, and completion is announced so the team shares the same state.

     TeamSTEPPS Check-Back Tool · reviewed 2026-08-26

311. カード 311

     質問

     What is the priority management step for schizophrenia?

     回答

     Assess danger, catatonia, and ability to care for self, then combine antipsychotic treatment with psychosocial support.

     Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

312. カード 312

     質問

     What medication strategy is appropriate for nephrotic syndrome?

     回答

     Use renin-angiotensin system blockade to reduce proteinuria when appropriate; disease-specific immunotherapy depends on pathology.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

313. カード 313

     質問

     What immediate plan is appropriate for neutropenic fever?

     回答

     Give empiric antipseudomonal antibiotics rapidly and stratify for inpatient versus carefully selected outpatient care.

     Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26

314. カード 314

     質問

     What counseling point helps reduce harm from cellulitis?

     回答

     Treat tinea pedis, edema, skin breaks, and other portals of entry to reduce recurrence.

     Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26

315. カード 315

     質問

     A clinician is considering cardiac tamponade. Which finding adds the most support?

     回答

     Hypotension, elevated jugular venous pressure, tachycardia, muffled heart sounds, and pulsus paradoxus suggest tamponade physiology.

     2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

316. カード 316

     質問

     What counseling point helps reduce harm from benign prostatic hyperplasia?

     回答

     Review fluid timing and medicines that worsen retention, and monitor complications.

     EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26

317. カード 317

     質問

     Which diagnosis best fits progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants?

     回答

     COPD. Progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants suggest COPD.

     2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

318. カード 318

     質問

     Which test or testing sequence best evaluates suspected acute cholecystitis?

     回答

     Right-upper-quadrant ultrasound is first-line; a gallbladder nuclear-medicine scan (HIDA) is an appropriate next study when ultrasound is negative or equivocal and suspicion remains high.

     ACR Appropriateness Criteria® Right Upper Quadrant Pain · reviewed 2026-08-26

319. カード 319

     質問

     In a postmenopausal woman or man aged 50 or older, what clinical clue should raise suspicion for osteoporosis?

     回答

     A fragility fracture, height loss, or kyphosis should prompt assessment for osteoporosis and vertebral fracture.

     The clinician’s guide to prevention and treatment of osteoporosis · reviewed 2026-08-26

320. カード 320

     質問

     Which pharmacologic approach is preferred for Parkinson disease?

     回答

     Levodopa provides the strongest motor benefit for many patients; dopamine agonists carry impulse-control and sleep risks.

     Parkinson’s Disease in Adults · reviewed 2026-08-26

321. カード 321

     質問

     A patient has this pattern: Pressure-like substernal pain with diaphoresis, nausea, or radiation to the arm or jaw is a classic ischemic pattern. What is the most likely diagnosis?

     回答

     Acute coronary syndrome. Pressure-like substernal pain with diaphoresis, nausea, or radiation to the arm or jaw is a classic ischemic pattern.

     2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

322. カード 322

     質問

     Which pharmacologic approach is preferred for gonococcal urethritis or cervicitis?

     回答

     Ceftriaxone is first-line for uncomplicated infection; add chlamydia treatment if it has not been excluded.

     Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

323. カード 323

     質問

     In a child aged 6 months or older, which examination best evaluates suspected acute otitis media?

     回答

     Use pneumatic otoscopy to confirm middle-ear effusion and assess for a bulging tympanic membrane; tympanometry is less reliable in young infants.

     Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

324. カード 324

     質問

     Which pharmacologic approach is preferred for menopause vasomotor symptoms?

     回答

     Systemic menopausal hormone therapy is most effective for eligible patients; nonhormonal options include selected SSRIs, SNRIs, gabapentin, or fezolinetant.

     Hormone Therapy for Menopause · reviewed 2026-08-26

325. カード 325

     質問

     How should a clinician handle an ambiguous verbal medication order?

     回答

     Stop and clarify the drug, dose, route, timing, and patient; read it back and do not guess.

     TeamSTEPPS Communication Module · reviewed 2026-08-26

326. カード 326

     質問

     Which pharmacologic approach is preferred for alcohol withdrawal?

     回答

     Benzodiazepines are first-line for clinically significant withdrawal; phenobarbital requires experienced protocols and monitoring.

     The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26

327. カード 327

     質問

     In a child or adolescent, how should a clinician initially manage asthma?

     回答

     Assess severity during exacerbation, give repeated bronchodilator, systemic corticosteroid when indicated, oxygen, and escalate for fatigue or silent chest.

     2026 GINA Strategy Report · reviewed 2026-08-26

328. カード 328

     質問

     What medication strategy is appropriate for Cushing syndrome?

     回答

     Medical cortisol-lowering therapy can bridge or treat selected patients when definitive source control is delayed or unavailable.

     Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

329. カード 329

     質問

     What counseling point helps reduce harm from acute kidney injury?

     回答

     Avoid unnecessary nephrotoxins, adjust medicine doses, maintain perfusion, and monitor high-risk patients.

     KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

330. カード 330

     質問

     What medication strategy is appropriate for thrombotic thrombocytopenic purpura?

     回答

     Caplacizumab is added in many acute immune TTP protocols under specialist care.

     ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26

331. カード 331

     質問

     For surgical decision-making, in a child or adolescent, which next action matters most in acute appendicitis?

     回答

     Give fluids, analgesia, antibiotics, and obtain prompt surgical consultation.

     Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

332. カード 332

     質問

     How should medication be used in ventricular fibrillation cardiac arrest?

     回答

     Give epinephrine during the arrest algorithm and consider amiodarone or lidocaine for refractory shockable rhythms.

     2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26

333. カード 333

     質問

     For surgical decision-making, which next action matters most in acute compartment syndrome?

     回答

     Remove constrictive material and obtain immediate surgical fasciotomy evaluation.

     Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

334. カード 334

     質問

     In a child or adolescent, which diagnosis fits sudden loss of consciousness with bilateral tonic then clonic movements followed by confusion?

     回答

     Generalized tonic-clonic seizure. Sudden loss of consciousness with bilateral tonic then clonic movements followed by confusion supports a generalized convulsion.

     Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

335. カード 335

     質問

     How should medication be used in herpes zoster?

     回答

     Start an oral antiviral early for eligible patients, especially with severe pain, older age, or high-risk sites.

     Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

336. カード 336

     質問

     Which diagnosis is defined by suspected infection with acute organ dysfunction and may include altered mentation, hypotension, tachypnea, or poor perfusion?

     回答

     Sepsis. Suspected infection with acute organ dysfunction, altered mentation, hypotension, tachypnea, or poor perfusion suggests sepsis.

     2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

337. カード 337

     質問

     What medication strategy is appropriate for uncomplicated cystitis?

     回答

     Nitrofurantoin, trimethoprim-sulfamethoxazole where appropriate, or fosfomycin are common first-line options guided by patient factors and resistance.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

338. カード 338

     質問

     Which diagnosis warrants empiric treatment when lower abdominal pain occurs with cervical-motion, uterine, or adnexal tenderness in a patient at STI risk?

     回答

     Pelvic inflammatory disease. Lower abdominal pain with cervical motion, uterine, or adnexal tenderness in a patient at STI risk supports empiric PID treatment.

     Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

339. カード 339

     質問

     How should a clinician confirm or characterize pulmonary embolism?

     回答

     Use pretest probability with PERC or D-dimer when appropriate and CT pulmonary angiography for indicated stable patients.

     ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

340. カード 340

     質問

     Which diagnosis requires at least six months of illness with psychosis and functional decline, including at least one month of active symptoms, after exclusions?

     回答

     Schizophrenia. At least six months of illness with psychosis and functional decline, including at least one month of active symptoms, supports schizophrenia after exclusions.

     Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

341. カード 341

     質問

     Which prevention or risk-reduction step is important for infective endocarditis?

     回答

     Reserve antibiotic prophylaxis for defined high-risk cardiac conditions undergoing relevant dental procedures.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

342. カード 342

     質問

     What is the priority management step for primary adrenal insufficiency?

     回答

     Suspected adrenal crisis requires immediate glucocorticoid and isotonic fluid treatment before confirmatory results.

     Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

343. カード 343

     質問

     What is the safest response to a critical test result that arrives after a patient leaves?

     回答

     Acknowledge it promptly, contact the patient or responsible team, document attempts and advice, and escalate until ownership is clear.

     Quick Safety 52: Advancing Safety with Closed-loop Communication of Test Results · reviewed 2026-08-26

344. カード 344

     質問

     In a child aged 6 months or older, what is the priority management step for acute otitis media?

     回答

     Provide analgesia; treat severe illness promptly with antibiotics and use 24–48 hours of watchful waiting only for selected mildly ill children with reliable follow-up.

     Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

345. カード 345

     質問

     When antibiotic susceptibility is unknown, which empiric regimen is preferred for most treatment-naive Helicobacter pylori infection?

     回答

     Use 14-day optimized bismuth quadruple therapy: a proton-pump inhibitor, bismuth, tetracycline, and metronidazole.

     ACG Clinical Guideline: Treatment of Helicobacter pylori Infection · reviewed 2026-08-26

346. カード 346

     質問

     In a child or adolescent, which diagnosis best fits this presentation: Hematuria with dysmorphic red cells or casts, hypertension, edema, and reduced kidney function suggests glomerular inflammation.

     回答

     Nephritic syndrome. Hematuria with dysmorphic red cells or casts, hypertension, edema, and reduced kidney function suggests glomerular inflammation.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

347. カード 347

     質問

     What drug class or regimen fits carpal tunnel syndrome?

     回答

     A local corticosteroid injection can provide relief; oral medicines do not correct the compression.

     Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

348. カード 348

     質問

     In a child or adolescent, what counseling point helps reduce harm from immune thrombocytopenia?

     回答

     Avoid platelet-impairing medicines and counsel on bleeding precautions when counts are low.

     American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

349. カード 349

     質問

     Which test or testing sequence best evaluates suspected bacterial brain abscess?

     回答

     Contrast-enhanced MRI is preferred; obtain blood cultures and avoid lumbar puncture when mass effect is possible.

     ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

350. カード 350

     質問

     What physiologic disturbance underlies aortic dissection?

     回答

     An intimal tear lets blood split the aortic media, creating a false lumen.

     2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

351. カード 351

     質問

     How can a clinician reduce avoidable harm related to acute respiratory distress syndrome?

     回答

     Use lung-protective ventilation in mechanically ventilated patients at risk for ARDS to reduce ventilator-induced injury.

     An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26

352. カード 352

     質問

     Which test or testing sequence best evaluates suspected pulmonary tuberculosis?

     回答

     Obtain chest imaging and multiple respiratory specimens for nucleic-acid testing, smear, and culture with susceptibility testing.

     Clinical and Laboratory Diagnosis for Tuberculosis · reviewed 2026-08-26

353. カード 353

     質問

     Which test or testing sequence best evaluates suspected endometriosis?

     回答

     Diagnosis can be clinical with imaging for endometrioma or deep disease; laparoscopy is not mandatory before initial treatment.

     Endometriosis · reviewed 2026-08-26

354. カード 354

     質問

     Which test or testing sequence best evaluates suspected panic disorder?

     回答

     Diagnosis is clinical after considering cardiac, pulmonary, endocrine, neurologic, medication, and substance causes.

     Panic Disorder: What You Need to Know · reviewed 2026-08-26

355. カード 355

     質問

     How can a clinician reduce avoidable harm related to Crohn disease?

     回答

     Support smoking cessation and use effective maintenance therapy with objective monitoring to reduce relapse and complications.

     Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

356. カード 356

     質問

     Which history or examination finding most strongly supports Cushing syndrome?

     回答

     Proximal weakness, easy bruising, facial plethora, wide violaceous striae, osteoporosis, or difficult diabetes and hypertension are discriminating clues.

     Diagnosis of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

357. カード 357

     質問

     How can a clinician reduce avoidable harm related to rheumatoid arthritis?

     回答

     Keep indicated vaccines current and coordinate timing with immunosuppressive therapy to reduce preventable infection risk.

     2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases · reviewed 2026-08-26

358. カード 358

     質問

     Which history or examination finding most strongly supports peritonsillar abscess?

     回答

     Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

     Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

359. カード 359

     質問

     When should a safety event or near miss be reported?

     回答

     Report it through the local safety system promptly, including near misses, so hazards can be corrected without waiting for patient harm.

     Reporting Patient Safety Events · reviewed 2026-08-26

360. カード 360

     質問

     For surgical decision-making, what immediate plan is appropriate for cardiac tamponade?

     回答

     Urgent pericardial drainage is the definitive step when tamponade causes hemodynamic compromise.

     2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

361. カード 361

     質問

     Which bedside pattern best points to pleural effusion?

     回答

     Dyspnea with reduced breath sounds, dullness to percussion, and decreased tactile fremitus suggests pleural fluid.

     British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

362. カード 362

     質問

     For surgical decision-making, what immediate plan is appropriate for melanoma?

     回答

     Prompt complete diagnostic excision and staging guide definitive surgical management.

     Melanoma Clinical Guidelines · reviewed 2026-08-26

363. カード 363

     質問

     A clinician is considering uncomplicated cystitis. Which finding adds the most support?

     回答

     Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

364. カード 364

     質問

     In a child or adolescent, which clinical sequence defines a generalized tonic-clonic seizure?

     回答

     Loss of consciousness with bilateral tonic stiffening followed by clonic jerking and a postictal period defines the typical sequence.

     Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

365. カード 365

     質問

     What is the priority management step for chronic kidney disease?

     回答

     Identify cause, quantify progression risk, treat complications, and refer for high-risk features or advanced disease.

     2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

366. カード 366

     質問

     Why does sepsis produce its defining clinical pattern?

     回答

     A dysregulated host response causes endothelial injury, vasodilation, capillary leak, and organ dysfunction.

     2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

367. カード 367

     質問

     Which history or examination finding most strongly supports stable chronic hypertension?

     回答

     Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

368. カード 368

     質問

     Why does pelvic inflammatory disease produce its defining clinical pattern?

     回答

     Ascending polymicrobial infection inflames endometrium and tubes, causing scarring and future ectopic or infertility risk.

     Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

369. カード 369

     質問

     Which bedside pattern best points to chronic hepatitis C?

     回答

     Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease.

     Viral Hepatitis Clinical Care · reviewed 2026-08-26

370. カード 370

     質問

     Which symptom domains should a clinician assess in schizophrenia?

     回答

     Assess positive, negative, cognitive, and mood symptoms together with substance use, functioning, and safety.

     Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

371. カード 371

     質問

     For surgical decision-making, an older adult after a fall has groin pain, cannot bear weight, and holds a shortened, externally rotated leg. Which diagnosis is most likely?

     回答

     Hip fracture. An older adult after a fall with groin pain, inability to bear weight, and a shortened externally rotated leg likely has a hip fracture.

     Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

372. カード 372

     質問

     In pulmonary embolism with hemodynamic compromise and no prohibitive bleeding risk, which drug class should be considered for reperfusion?

     回答

     Use systemic thrombolytic therapy followed by anticoagulation; weigh the immediate bleeding risk and activate an advanced-reperfusion pathway.

     ASH 2020 Guidelines for Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

373. カード 373

     質問

     Which diagnosis best fits this presentation: Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

     回答

     Acute deep-vein thrombosis. Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

     ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

374. カード 374

     質問

     Which preventive measure belongs in care for type 2 diabetes mellitus?

     回答

     Weight-supportive nutrition, physical activity, tobacco avoidance, and cardiometabolic risk control prevent complications.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

375. カード 375

     質問

     What is the first response when a colleague appears impaired while providing care?

     回答

     Protect patients immediately, remove the colleague from unsafe duties through the proper chain, and activate confidential professional-assistance procedures.

     Physician Responsibilities to Colleagues with Illness, Disability or Impairment · reviewed 2026-08-26

376. カード 376

     質問

     Which preventive measure belongs in care for acute angle-closure glaucoma?

     回答

     Definitive treatment of the fellow narrow-angle eye helps prevent a second attack.

     Management of Angle-Closure Glaucoma · reviewed 2026-08-26

377. カード 377

     質問

     Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, an S3, and an echocardiographic LVEF of 35% indicate which heart-failure phenotype?

     回答

     Heart failure with reduced ejection fraction (HFrEF). The congestion findings establish heart failure, and an LVEF of 40% or less identifies the reduced-EF phenotype.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

378. カード 378

     質問

     What clinical clue should raise suspicion for multiple sclerosis relapse?

     回答

     A focal neurologic deficit evolving over hours to days and lasting over 24 hours, separated in time and space from prior events, suggests relapse.

     Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

379. カード 379

     質問

     For surgical decision-making, which diagnosis best fits persistent right-upper-quadrant pain or tenderness, fever, leukocytosis, and a positive Murphy sign?

     回答

     Acute calculous cholecystitis. The combined clinical and inflammatory findings support the diagnosis; confirm it with imaging.

     2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26

380. カード 380

     質問

     What clinical clue should raise suspicion for HIV infection?

     回答

     Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

     About HIV · reviewed 2026-08-26

381. カード 381

     質問

     Why does hip fracture produce its defining clinical pattern?

     回答

     Osteoporotic bone can fail under low-energy load, and immobility rapidly adds medical risk.

     Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

382. カード 382

     質問

     What clinical clue should raise suspicion for postpartum hemorrhage?

     回答

     Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

     Postpartum Hemorrhage · reviewed 2026-08-26

383. カード 383

     質問

     Why does pulmonary embolism produce its defining clinical pattern?

     回答

     Pulmonary embolism is venous thromboembolism obstructing the pulmonary arteries, which increases right-ventricular afterload.

     ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

384. カード 384

     質問

     What clinical clue should raise suspicion for delirium?

     回答

     An acute fluctuating disturbance of attention and awareness with disorganized thinking suggests delirium.

     Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

385. カード 385

     質問

     For surgical decision-making, what immediate plan is appropriate for ureteral stone?

     回答

     Provide analgesia, check for infection and kidney injury, and decompress urgently when obstruction is infected.

     EAU Guidelines on Urolithiasis · reviewed 2026-08-26

386. カード 386

     質問

     What is the key first diagnostic step for heart failure with reduced ejection fraction?

     回答

     Transthoracic echocardiography defines ejection fraction and structural disease.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

387. カード 387

     質問

     In a child or adolescent, a clinician is considering atopic dermatitis. Which finding adds the most support?

     回答

     Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

     Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

388. カード 388

     質問

     Which diagnosis causes fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in a patient with thyrotoxicosis?

     回答

     Thyroid storm. Fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in thyrotoxicosis suggest storm.

     2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26

389. カード 389

     質問

     Which history or examination finding most strongly supports chronic kidney disease?

     回答

     CKD may be silent; edema, pruritus, anemia, hypertension, or abnormal urine testing often appears later.

     2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

390. カード 390

     質問

     Identify the condition from this pattern: Persistent symptoms beyond 10 days, severe fever with purulent drainage, or worsening after initial improvement are patterns that support bacterial disease.

     回答

     Acute bacterial rhinosinusitis. Persistent symptoms beyond 10 days, severe fever with purulent drainage, or worsening after initial improvement are patterns that support bacterial disease.

     Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

391. カード 391

     質問

     Which history or examination finding most strongly supports iron-deficiency anemia?

     回答

     Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia.

     British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

392. カード 392

     質問

     How should a clinician respond to a patient’s prejudiced request or discriminatory behavior?

     回答

     Address the behavior directly, explore its reasons, set limits that protect staff and other patients, and do not accommodate invidious discrimination; urgent care still takes priority.

     Discrimination and Disruptive Behavior by Patients · reviewed 2026-08-26

393. カード 393

     質問

     For surgical decision-making, which next action matters most in bacterial brain abscess?

     回答

     Start IV antibiotics and obtain urgent neurosurgical consultation for aspiration or drainage when indicated.

     ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

394. カード 394

     質問

     How should a clinician confirm or characterize acute pancreatitis?

     回答

     Diagnosis requires two of three: characteristic pain, lipase or amylase at least three times normal, or compatible imaging.

     ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

395. カード 395

     質問

     Which next action matters most in pulmonary tuberculosis?

     回答

     Isolate suspected contagious disease and coordinate promptly with public health.

     Tuberculosis Infection Control · reviewed 2026-08-26

396. カード 396

     質問

     How should a clinician confirm or characterize anterior cruciate ligament tear?

     回答

     MRI confirms associated soft-tissue injury when it will guide management; radiographs assess fracture.

     Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

397. カード 397

     質問

     For surgical decision-making, which next action matters most in endometriosis?

     回答

     Offer empiric symptom treatment or surgery based on severity, fertility goals, masses, and response.

     Endometriosis · reviewed 2026-08-26

398. カード 398

     質問

     A patient has this pattern: Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, hemoptysis, or syncope with VTE risk raises suspicion. What is the most likely diagnosis?

     回答

     Pulmonary embolism. Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, hemoptysis, or syncope with VTE risk raises suspicion.

     ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

399. カード 399

     質問

     Which next action matters most in panic disorder?

     回答

     During an attack, ensure safety and exclude an emergency; for ongoing disorder, offer cognitive behavioral therapy and/or medication.

     Panic Disorder: What You Need to Know · reviewed 2026-08-26

400. カード 400

     質問

     What medication strategy is appropriate for acute coronary syndrome?

     回答

     Use dual antiplatelet therapy after ACS when indicated, balancing ischemic benefit against bleeding risk.

     2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

401. カード 401

     質問

     What immediate plan is appropriate for COPD?

     回答

     For an exacerbation, increase short-acting bronchodilation, use systemic steroids, add antibiotics when indicated, and support ventilation.

     2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

402. カード 402

     質問

     In a child or adolescent, which bedside pattern best points to juvenile idiopathic arthritis?

     回答

     Persistent joint swelling, limited motion, or morning stiffness beginning before age 16, after excluding other causes, suggests JIA.

     2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

403. カード 403

     質問

     What is the priority management step for stable chronic hypertension?

     回答

     Estimate cardiovascular risk, assess target-organ damage, and set an individualized treatment plan.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

404. カード 404

     質問

     What drug class or regimen fits myasthenia gravis?

     回答

     Pyridostigmine treats symptoms; corticosteroid or other immunotherapy controls autoimmune activity.

     International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26

405. カード 405

     質問

     For surgical decision-making, how should a fit patient with acute calculous cholecystitis be managed initially?

     回答

     Give fluids and analgesia, prescribe antibiotics when indicated, and arrange early laparoscopic cholecystectomy as soon as possible.

     2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26

406. カード 406

     質問

     What drug class or regimen fits Clostridioides difficile infection?

     回答

     Oral fidaxomicin is preferred for many initial episodes; oral vancomycin remains an accepted alternative.

     2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults · reviewed 2026-08-26

407. カード 407

     質問

     How should a clinician confirm or characterize primary hyperparathyroidism?

     回答

     Confirm elevated albumin-corrected or ionized calcium with an inappropriately high PTH; assess kidneys and bone.

     Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

408. カード 408

     質問

     Which medication prevents seizures in preeclampsia with severe features?

     回答

     Use magnesium sulfate for seizure prophylaxis while controlling severe hypertension and planning delivery according to maternal and fetal status.

     Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

409. カード 409

     質問

     What is shared decision-making?

     回答

     The clinician presents reasonable options and evidence, elicits the patient’s goals and tradeoffs, and reaches a choice together when more than one path is reasonable.

     The SHARE Approach · reviewed 2026-08-26

410. カード 410

     質問

     In a child aged 6 years or older or an adolescent, what drug class or regimen fits attention-deficit/hyperactivity disorder?

     回答

     Extended-release stimulants are first-line medication for most children and adolescents when combined with nonpharmacologic care and monitored for benefit and adverse effects.

     ADHD in Children and Youth: Part 2—Treatment · reviewed 2026-08-26

411. カード 411

     質問

     What is the priority management step for iron-deficiency anemia?

     回答

     Identify and control bleeding, then replace iron; investigate occult gastrointestinal loss when appropriate.

     British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

412. カード 412

     質問

     Which pharmacologic approach is preferred for acute angle-closure glaucoma?

     回答

     Use pressure-lowering topical agents plus systemic acetazolamide when appropriate; pilocarpine is added after pressure begins to fall.

     Management of Angle-Closure Glaucoma · reviewed 2026-08-26

413. カード 413

     質問

     Which diagnosis best fits this presentation: A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

     回答

     Herpes zoster. A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

     Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

414. カード 414

     質問

     In a child or adolescent, which pharmacologic approach is preferred for nephritic syndrome?

     回答

     Immunosuppression is disease-specific and should follow a supported diagnosis rather than empiric routine use.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

415. カード 415

     質問

     What counseling point helps reduce harm from symptomatic aortic stenosis?

     回答

     Teach patients to report exertional dyspnea, angina, presyncope, or syncope promptly; new symptoms require timely reassessment, and severe symptomatic AS warrants valve-team evaluation rather than surveillance alone.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

416. カード 416

     質問

     For surgical decision-making, which diagnosis best fits this presentation: Abrupt severe unilateral scrotal pain, a high-riding transverse testis, nausea, and an absent cremasteric reflex are concerning.

     回答

     Testicular torsion. Sudden severe unilateral pain with nausea or vomiting, a high-riding transverse testis, and loss of the cremasteric reflex is the classic pattern.

     Testicular Torsion · reviewed 2026-08-26

417. カード 417

     質問

     A clinician is considering idiopathic pulmonary fibrosis. Which finding adds the most support?

     回答

     Progressive exertional dyspnea, dry cough, bibasilar fine crackles, and clubbing in an older adult suggest fibrotic interstitial disease.

     Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26

418. カード 418

     質問

     How should medication be used in ulcerative colitis?

     回答

     Use 5-aminosalicylates for many mild-to-moderate cases; advanced therapy is selected by severity and prior response.

     Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26

419. カード 419

     質問

     For surgical decision-making, how should a clinician initially manage hip fracture?

     回答

     Provide analgesia, optimize medical issues, and arrange timely operative management for most displaced fractures.

     Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

420. カード 420

     質問

     For surgical decision-making, what condition should be suspected from this finding: Headache, fever, focal deficit, seizure, or signs of raised intracranial pressure after sinus, ear, dental, or bloodstream infection raise suspicion.

     回答

     Bacterial brain abscess. Headache, fever, focal deficit, seizure, or signs of raised intracranial pressure after sinus, ear, dental, or bloodstream infection raise suspicion.

     ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

421. カード 421

     質問

     What clinical clue should raise suspicion for ventricular fibrillation cardiac arrest?

     回答

     Sudden unresponsiveness with absent normal breathing and no pulse is cardiac arrest; the monitor may show chaotic ventricular activity.

     2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26

422. カード 422

     質問

     What condition should be suspected from this finding: Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

     回答

     Pulmonary tuberculosis. Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

     Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

423. カード 423

     質問

     Which pharmacologic approach is preferred for type 2 diabetes mellitus?

     回答

     Choose glucose-lowering therapy around comorbid ASCVD, heart failure, CKD, weight goals, hypoglycemia risk, and patient priorities; metformin remains appropriate for many.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

424. カード 424

     質問

     For surgical decision-making, which diagnosis best fits cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility?

     回答

     Endometriosis. Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis.

     Endometriosis · reviewed 2026-08-26

425. カード 425

     質問

     How should a clinician confirm or characterize sudden sensorineural hearing loss?

     回答

     Differentiate sensorineural from conductive loss with bedside testing and urgent audiometry.

     Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

426. カード 426

     質問

     Which diagnosis requires recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least one month?

     回答

     Panic disorder. Recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least a month suggests panic disorder.

     Panic Disorder: What You Need to Know · reviewed 2026-08-26

427. カード 427

     質問

     How should uncertainty be communicated?

     回答

     Name what is known and unknown, explain the leading possibilities and why, state the plan to reduce uncertainty, and give specific follow-up or return precautions.

     Why Does Clinical Uncertainty Matter? · reviewed 2026-08-26

428. カード 428

     質問

     Which medication is FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity?

     回答

     Tirzepatide is approved for adults with obesity and moderate-to-severe obstructive sleep apnea, used with a reduced-calorie diet and increased physical activity.

     FDA Approves First Medication for Obstructive Sleep Apnea · reviewed 2026-08-26

429. カード 429

     質問

     Which pathophysiologic process drives acute kidney injury?

     回答

     Abrupt loss of filtration disturbs volume, electrolytes, acid-base balance, and toxin clearance.

     KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

430. カード 430

     質問

     Which pharmacologic approach is preferred for acute deep-vein thrombosis?

     回答

     A direct oral anticoagulant is preferred for many eligible patients; selection changes with pregnancy, cancer, renal function, and antiphospholipid syndrome.

     ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

431. カード 431

     質問

     A clinician is considering upper gastrointestinal bleeding. Which finding adds the most support?

     回答

     Hematemesis, coffee-ground emesis, or melena with orthostasis indicates an upper gastrointestinal source until shown otherwise.

     ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

432. カード 432

     質問

     How should medication be used in gout flare?

     回答

     Use an NSAID, colchicine, or glucocorticoid based on comorbidity and timing; allopurinol is preferred long-term urate lowering for most.

     2020 American College of Rheumatology Guideline for the Management of Gout · reviewed 2026-08-26

433. カード 433

     質問

     Which diagnosis best fits an irregularly irregular pulse with palpitations, fatigue, or dyspnea?

     回答

     Atrial fibrillation. An irregularly irregular pulse with palpitations, fatigue, or dyspnea suggests atrial fibrillation.

     2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

434. カード 434

     質問

     Which treatment should not be offered solely to treat multiple sclerosis?

     回答

     Do not offer vitamin D solely to treat multiple sclerosis.

     Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

435. カード 435

     質問

     Which pathophysiologic process drives plaque psoriasis?

     回答

     IL-23 and Th17 pathway activation drives accelerated keratinocyte turnover.

     Psoriasis Clinical Guidelines · reviewed 2026-08-26

436. カード 436

     質問

     How can a clinician reduce avoidable harm related to HIV infection?

     回答

     PrEP, condoms, sterile injection equipment, perinatal treatment, and sustained viral suppression prevent transmission.

     Preventing HIV · reviewed 2026-08-26

437. カード 437

     質問

     Which pathophysiologic process drives acute pyelonephritis?

     回答

     Ascending infection reaches the renal pelvis and parenchyma, producing systemic illness.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

438. カード 438

     質問

     How can a clinician reduce avoidable harm related to postpartum hemorrhage?

     回答

     Antenatal anemia treatment, active management of the third stage, and hemorrhage protocols reduce morbidity.

     Postpartum Hemorrhage · reviewed 2026-08-26

439. カード 439

     質問

     What is the key first diagnostic step for tension pneumothorax?

     回答

     Diagnosis is clinical in an unstable patient; bedside ultrasound can support it but imaging must not delay decompression.

     Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

440. カード 440

     質問

     How can a clinician reduce avoidable harm related to delirium?

     回答

     Orientation, mobility, sleep protection, hearing and vision aids, hydration, and medication review reduce hospital delirium.

     Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

441. カード 441

     質問

     What core mechanism explains infective endocarditis?

     回答

     Microbial adherence to damaged endocardium or prosthetic material produces infected vegetations.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

442. カード 442

     質問

     For surgical decision-making, which next action matters most in primary hyperparathyroidism?

     回答

     Refer for parathyroidectomy when symptomatic or when guideline thresholds for calcium, kidney, bone, or age are met.

     Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

443. カード 443

     質問

     What makes a useful return precaution?

     回答

     It names concrete symptoms or changes, states how urgently to act, and tells the patient where to seek help.

     IDEAL Discharge Planning Overview, Process, and Checklist · reviewed 2026-08-26

444. カード 444

     質問

     Which next action matters most in sudden sensorineural hearing loss?

     回答

     Arrange urgent otolaryngology evaluation and assess for retrocochlear pathology.

     Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

445. カード 445

     質問

     A patient has this pattern: Severe persistent epigastric pain radiating to the back with nausea and vomiting is typical. What is the most likely diagnosis?

     回答

     Acute pancreatitis. Severe persistent epigastric pain radiating to the back with nausea and vomiting is typical.

     ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

446. カード 446

     質問

     For surgical decision-making, a noncontact pivot causes an audible pop, immediate swelling, instability, and a positive Lachman test. What is the most likely diagnosis?

     回答

     Anterior cruciate ligament tear. A noncontact pivot, audible pop, immediate swelling, and instability with a positive Lachman test suggest an ACL tear.

     Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

447. カード 447

     質問

     Which bedside pattern best points to acute ischemic stroke?

     回答

     Sudden focal weakness, facial droop, speech change, gaze deviation, neglect, or ataxia is stroke until proved otherwise.

     2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

448. カード 448

     質問

     Which electrolyte disorder may cause weakness, paresthesias, bradycardia, or ECG changes but can be dangerous even without symptoms?

     回答

     Hyperkalemia. Weakness, paresthesias, bradycardia, or ECG changes can occur, but dangerous hyperkalemia may be asymptomatic.

     Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26

449. カード 449

     質問

     Which bedside pattern best points to community-acquired pneumonia?

     回答

     New cough, fever, dyspnea, pleuritic pain, and focal crackles suggest pneumonia, but clinical findings alone are imperfect.

     Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

450. カード 450

     質問

     Which pharmacologic approach is preferred for heart failure with reduced ejection fraction?

     回答

     Foundational chronic therapy includes an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, an MRA, and an SGLT2 inhibitor when tolerated.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

451. カード 451

     質問

     For surgical decision-making, severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock indicate which diagnosis?

     回答

     Tension pneumothorax. Severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock suggest tension physiology.

     Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

452. カード 452

     質問

     Which bedside pattern best points to ectopic pregnancy?

     回答

     Unilateral pelvic pain or bleeding in early pregnancy, especially with syncope or shoulder pain, raises concern for ectopic implantation.

     Ectopic Pregnancy · reviewed 2026-08-26

453. カード 453

     質問

     In a child with sickle cell disease, sudden severe limb or back pain matches prior vaso-occlusive episodes and no alternative cause is found. Which diagnosis best fits?

     回答

     Acute sickle cell vaso-occlusive pain episode.

     ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26

454. カード 454

     質問

     In a child or adolescent, which bedside pattern best points to major depressive disorder?

     回答

     At least two weeks of depressed mood or loss of interest with functional change and associated neurovegetative or cognitive symptoms suggests major depression.

     Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

455. カード 455

     質問

     Which prevention or risk-reduction step is important for cirrhosis with ascites?

     回答

     Use sodium restriction, review medicines that can worsen kidney perfusion, and monitor weight, kidney function, and electrolytes.

     Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26

456. カード 456

     質問

     What clinical clue should raise suspicion for type 2 diabetes mellitus?

     回答

     Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

457. カード 457

     質問

     In a postmenopausal woman or man aged 50 or older, which steps support bone health and reduce fracture risk?

     回答

     Adequate calcium and vitamin D, weight-bearing and muscle-strengthening exercise, fall-risk reduction, tobacco cessation, and avoiding excess alcohol support bone health.

     The clinician’s guide to prevention and treatment of osteoporosis · reviewed 2026-08-26

458. カード 458

     質問

     What clinical clue should raise suspicion for acute angle-closure glaucoma?

     回答

     Sudden painful red eye, blurred vision with halos, headache, nausea, a fixed mid-dilated pupil, and a firm globe are classic.

     Management of Angle-Closure Glaucoma · reviewed 2026-08-26

459. カード 459

     質問

     How should a clinician respond to an incidental finding outside the visit’s main problem?

     回答

     Explain the finding and its uncertainty, recommend proportionate follow-up, assign ownership, and document the plan.

     Catching Those Who Fall Through the Cracks: Follow-up for Incidental Radiologic Findings · reviewed 2026-08-26

460. カード 460

     質問

     Which next action matters most in ventricular fibrillation cardiac arrest?

     回答

     Start high-quality CPR and defibrillate ventricular fibrillation or pulseless ventricular tachycardia as soon as possible.

     2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26

461. カード 461

     質問

     Which test or testing sequence best evaluates suspected plaque psoriasis?

     回答

     Diagnosis is usually clinical; biopsy is reserved for uncertain morphology.

     Psoriasis Clinical Guidelines · reviewed 2026-08-26

462. カード 462

     質問

     What is the priority management step for pulmonary embolism?

     回答

     Start anticoagulation for confirmed pulmonary embolism; consider thrombolysis for selected patients with hemodynamic compromise and acceptable bleeding risk.

     ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

463. カード 463

     質問

     What diagnostic approach is most appropriate when uncomplicated cystitis is suspected?

     回答

     Urinalysis supports the diagnosis; culture is important for complicated, recurrent, resistant, pregnant, or atypical cases.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

464. カード 464

     質問

     How should a clinician initially manage migraine with aura?

     回答

     Treat early with an effective acute medicine and choose prevention when frequency or disability justifies it.

     AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26

465. カード 465

     質問

     Why does thrombotic thrombocytopenic purpura produce its defining clinical pattern?

     回答

     Severe ADAMTS13 deficiency permits ultra-large von Willebrand factor multimers to form platelet-rich microthrombi.

     ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26

466. カード 466

     質問

     How should a clinician initially manage early syphilis?

     回答

     Treat the patient and ensure partner evaluation; urgent specialist evaluation is needed for ocular, otic, or neurologic disease.

     Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

467. カード 467

     質問

     What diagnostic approach is most appropriate when atrial fibrillation is suspected?

     回答

     Confirm the rhythm with a 12-lead ECG and assess for structural disease and reversible triggers.

     2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

468. カード 468

     質問

     How should a clinician initially manage abnormal uterine bleeding from anovulation?

     回答

     Stabilize acute heavy bleeding first, then protect the endometrium and control ongoing blood loss.

     Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women · reviewed 2026-08-26

469. カード 469

     質問

     Why does acute cholecystitis produce its defining clinical pattern?

     回答

     A gallstone can block bile flow, causing gallbladder pain and swelling (inflammation).

     Cholecystectomy · reviewed 2026-08-26

470. カード 470

     質問

     How should a clinician initially manage post-traumatic stress disorder?

     回答

     Offer individual trauma-focused psychotherapy as first-line treatment when available and acceptable.

     Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

471. カード 471

     質問

     In a child or adolescent, a clinician is considering septic arthritis. Which finding adds the most support?

     回答

     Acute severe monoarticular pain, restricted passive motion, fever, or bacteremia risk is septic arthritis until excluded.

     Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

472. カード 472

     質問

     Which next action matters most in acute kidney injury?

     回答

     Treat the cause, restore perfusion without overload, stop nephrotoxins, and relieve obstruction.

     KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

473. カード 473

     質問

     For an eligible infant or selected high-risk child aged 8–19 months, which immunization strategy reduces severe RSV disease?

     回答

     Use either maternal RSV vaccination or a recommended long-acting RSV antibody to protect infants; give nirsevimab to eligible high-risk children aged 8–19 months entering a second RSV season.

     RSV Immunization Guidance for Infants and Young Children · reviewed 2026-08-26

474. カード 474

     質問

     Which diagnosis causes weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia?

     回答

     Primary adrenal insufficiency. Weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia suggest primary adrenal failure.

     Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

475. カード 475

     質問

     What is the ethical approach to a learner performing a procedure?

     回答

     Tell the patient who will participate, describe supervision, obtain voluntary agreement, and ensure refusal does not compromise care.

     Residents and Fellows: Patient Involvement in Self-Education · reviewed 2026-08-26

476. カード 476

     質問

     In a child aged 6 months or older, what condition should be suspected from a bulging tympanic membrane with acute ear pain or new otorrhea?

     回答

     Acute otitis media. A bulging tympanic membrane with acute ear pain or new otorrhea is more specific than redness alone.

     Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

477. カード 477

     質問

     Which bedside pattern best points to acute coronary syndrome?

     回答

     Pressure-like substernal pain with diaphoresis, nausea, or radiation to the arm or jaw is a classic ischemic pattern.

     2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

478. カード 478

     質問

     How should medication be used in multiple sclerosis relapse?

     回答

     High-dose corticosteroids shorten a disabling relapse; they do not alter long-term progression by themselves.

     Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

479. カード 479

     質問

     What immediate plan is appropriate for acute pancreatitis?

     回答

     Use early isotonic fluids guided by response, analgesia, and early oral feeding as tolerated; address the cause.

     ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

480. カード 480

     質問

     How should medication be used in HIV infection?

     回答

     Use a recommended combination antiretroviral regimen selected for resistance, interactions, comorbidity, pregnancy potential, and patient preference.

     What to Start: Initial Combination Antiretroviral Regimens · reviewed 2026-08-26

481. カード 481

     質問

     For surgical decision-making, what immediate plan is appropriate for anterior cruciate ligament tear?

     回答

     Control swelling, restore motion, begin rehabilitation, and individualize reconstruction by instability and activity goals.

     Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

482. カード 482

     質問

     How should medication be used in postpartum hemorrhage?

     回答

     Oxytocin is first-line for uterine atony; add other uterotonics according to contraindications and give tranexamic acid early when indicated.

     Postpartum Hemorrhage · reviewed 2026-08-26

483. カード 483

     質問

     In a child or adolescent, which history or examination finding most strongly supports asthma?

     回答

     Variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers suggests asthma.

     2026 GINA Strategy Report · reviewed 2026-08-26

484. カード 484

     質問

     How should medication be used in delirium?

     回答

     Reserve short-term antipsychotic use for severe dangerous agitation after reversible causes and contraindications are addressed.

     Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

485. カード 485

     質問

     Which preventive measure belongs in care for herpes zoster?

     回答

     Age-appropriate recombinant zoster vaccination lowers zoster and postherpetic-neuralgia risk.

     Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

486. カード 486

     質問

     For surgical decision-making, what condition should be suspected from this finding: Abrupt severe chest or back pain, pulse or blood-pressure asymmetry, and a new aortic regurgitation murmur are high-risk clues.

     回答

     Aortic dissection. Abrupt severe chest or back pain, pulse or blood-pressure asymmetry, and a new aortic regurgitation murmur are high-risk clues.

     2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

487. カード 487

     質問

     Which preventive step is required during surgery for viable testicular torsion?

     回答

     Perform bilateral orchiopexy, fixing the affected and contralateral testes to reduce future torsion risk.

     Testicular Torsion · reviewed 2026-08-26

488. カード 488

     質問

     Which test or testing sequence best evaluates suspected hyponatremia due to SIADH?

     回答

     Confirm low serum osmolality with inappropriately concentrated urine and urine sodium after excluding thyroid, adrenal, renal, and diuretic causes.

     Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia · reviewed 2026-08-26

489. カード 489

     質問

     Why does primary hypothyroidism produce its defining clinical pattern?

     回答

     Low thyroid hormone removes feedback inhibition, so TSH rises in primary gland failure.

     Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

490. カード 490

     質問

     Which test or testing sequence best evaluates suspected neutropenic fever?

     回答

     Obtain blood cultures and targeted cultures or imaging, but do not delay empiric antibiotics.

     Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26

491. カード 491

     質問

     Why does bacterial conjunctivitis produce its defining clinical pattern?

     回答

     Bacterial infection of the conjunctiva commonly produces red eye with purulent discharge that mats the eyelids.

     Clinical Overview of Pink Eye (Conjunctivitis) · reviewed 2026-08-26

492. カード 492

     質問

     When is a chaperone appropriate for an intimate examination?

     回答

     Offer a trained chaperone, respect patient preferences when safety permits, explain the examination, obtain consent, and document who was present.

     Use of Chaperones · reviewed 2026-08-26

493. カード 493

     質問

     Which diagnosis causes recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms?

     回答

     Migraine with aura. Recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms, suggests migraine with aura.

     ICHD-3: Migraine with Aura · reviewed 2026-08-26

494. カード 494

     質問

     What medication strategy is appropriate for Crohn disease?

     回答

     Corticosteroids can induce remission but are not maintenance therapy; immunomodulator or biologic selection depends on risk and phenotype.

     Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

495. カード 495

     質問

     Which diagnosis best fits a painless chancre or a diffuse rash involving the palms and soles with generalized lymphadenopathy?

     回答

     Early syphilis. A painless chancre or a diffuse rash involving palms and soles with generalized lymphadenopathy suggests syphilis by stage.

     Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

496. カード 496

     質問

     What medication strategy is appropriate for rheumatoid arthritis?

     回答

     Methotrexate is a preferred anchor drug for many patients with moderate-to-high activity, with folate and safety monitoring.

     2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis · reviewed 2026-08-26

497. カード 497

     質問

     Which diagnosis best fits irregular, unpredictable uterine bleeding at reproductive extremes or with endocrine disruption?

     回答

     Abnormal uterine bleeding from anovulation. Irregular unpredictable bleeding without cyclic ovulation is common at reproductive extremes or with endocrine disruption.

     Abnormal Uterine Bleeding · reviewed 2026-08-26

498. カード 498

     質問

     Which medication class does the 2024 SCCM focused update suggest for an adult with acute respiratory distress syndrome?

     回答

     Use systemic corticosteroids in selected adults with ARDS; the guideline does not specify one best molecule, dose, or duration.

     2024 Focused Update: Corticosteroids in Sepsis, ARDS, and Community-Acquired Pneumonia · reviewed 2026-08-26

499. カード 499

     質問

     Which diagnosis requires intrusion, avoidance, negative mood or cognition, and hyperarousal lasting more than one month after trauma?

     回答

     Post-traumatic stress disorder. Intrusion, avoidance, negative mood or cognition, and hyperarousal lasting over a month after trauma suggest PTSD.

     Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

500. カード 500

     質問

     Which preventive measure belongs in care for acute pericarditis?

     回答

     Restrict strenuous activity until symptoms and inflammatory findings resolve.

     2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

501. カード 501

     質問

     Which diagnosis best fits loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension?

     回答

     Obstructive sleep apnea. Loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension suggests OSA.

     Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea · reviewed 2026-08-26

502. カード 502

     質問

     What drug class or regimen fits atrial fibrillation?

     回答

     Choose anticoagulation from validated thromboembolic-risk assessment; direct oral anticoagulants are preferred for most eligible patients without mechanical valves or moderate-to-severe rheumatic mitral stenosis.

     2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

503. カード 503

     質問

     In a child or adolescent, which history or examination finding most strongly supports acute appendicitis?

     回答

     Periumbilical pain migrating to the right lower quadrant with anorexia, nausea, fever, and focal tenderness is typical.

     Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

504. カード 504

     質問

     Which diagnosis best fits this presentation: Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.

     回答

     Carpal tunnel syndrome. Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.

     Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

505. カード 505

     質問

     In an adult with headaches consistent with migraine with aura and a normal neurologic examination, when is neuroimaging needed?

     回答

     Routine neuroimaging is unnecessary; consider it when the aura is unusual, prolonged, or persistent or when other atypical or red-flag features are present.

     Neuroimaging for Migraine: The American Headache Society Systematic Review and Evidence-Based Guideline · reviewed 2026-08-26

506. カード 506

     質問

     In a child or adolescent, how can a clinician reduce avoidable harm related to diabetic ketoacidosis?

     回答

     Sick-day planning, continued basal insulin, ketone checks, and early contact for illness reduce recurrence.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

507. カード 507

     質問

     How should a clinician confirm or characterize early syphilis?

     回答

     Use a nontreponemal test with a treponemal confirmatory test, or the reverse sequence; evaluate neurologic or ocular symptoms separately.

     Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

508. カード 508

     質問

     How can a clinician reduce avoidable harm related to retinal detachment?

     回答

     Assess sudden new floaters, flashes, or a curtain immediately; early treatment can prevent permanent vision loss. Dilated examination can find a small tear or detachment before vision is affected.

     Retinal Detachment · reviewed 2026-08-26

509. カード 509

     質問

     How should a clinician confirm or characterize abnormal uterine bleeding from anovulation?

     回答

     Exclude pregnancy, assess anemia, review medicines and systemic causes, and sample endometrium when age or risk warrants.

     Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women · reviewed 2026-08-26

510. カード 510

     質問

     How should social media be handled when a clinical story seems de-identified?

     回答

     Do not post patient material without proper authorization; combinations of details can identify a person even when names are removed.

     Professionalism in the Use of Social Media · reviewed 2026-08-26

511. カード 511

     質問

     How should a clinician confirm or characterize post-traumatic stress disorder?

     回答

     Use a trauma-informed clinical assessment and a validated symptom measure while checking safety and comorbidity.

     Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

512. カード 512

     質問

     Which preventive measure belongs in care for nephrotic syndrome?

     回答

     Vaccination, thrombosis-risk assessment, infection prevention, and cardiovascular-risk control reduce complications.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

513. カード 513

     質問

     In a child or adolescent, what medication strategy is appropriate for atopic dermatitis?

     回答

     Topical corticosteroids are first-line for most flares; steroid-sparing topical agents help at sensitive sites or with maintenance.

     Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

514. カード 514

     質問

     Which preventive measure belongs in care for thrombotic thrombocytopenic purpura?

     回答

     Recognize relapse symptoms early and maintain specialist follow-up after recovery.

     ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26

515. カード 515

     質問

     How should a clinician initially manage acute coronary syndrome?

     回答

     Give aspirin promptly when acute coronary syndrome is suspected and no contraindication exists; activate reperfusion pathways for STEMI.

     2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

516. カード 516

     質問

     Which history or examination finding most strongly supports acute pyelonephritis?

     回答

     Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

517. カード 517

     質問

     For surgical decision-making, which next action matters most in tension pneumothorax?

     回答

     Perform immediate decompression followed by tube thoracostomy.

     Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

518. カード 518

     質問

     Which diagnosis best fits this presentation: Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.

     回答

     Celiac disease. Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.

     ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26

519. カード 519

     質問

     What physiologic disturbance underlies anterior cruciate ligament tear?

     回答

     An ACL tear removes a primary restraint to anterior tibial translation and rotation, producing anterior and rotational instability.

     The Management of Anterior Cruciate Ligament Injuries · reviewed 2026-08-26

520. カード 520

     質問

     A clinician is considering heart failure with reduced ejection fraction. Which finding adds the most support?

     回答

     Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, and an S3 support volume-overloaded heart failure.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

521. カード 521

     質問

     What physiologic disturbance underlies bacterial brain abscess?

     回答

     Localized infection produces cerebritis and a capsule with surrounding edema and mass effect.

     ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

522. カード 522

     質問

     What is the key first diagnostic step for Cushing syndrome?

     回答

     Use an accepted first-line screen such as late-night salivary cortisol, 24-hour urinary free cortisol, or overnight dexamethasone suppression.

     Diagnosis of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

523. カード 523

     質問

     What physiologic disturbance underlies pulmonary tuberculosis?

     回答

     Mycobacteria survive in macrophages and drive granulomatous inflammation with latent or active disease.

     Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

524. カード 524

     質問

     Which antibiotic is required for gonococcal conjunctivitis in an adult?

     回答

     Give systemic ceftriaxone; consider one-time saline lavage and evaluate for chlamydial coinfection when it has not been excluded.

     Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

525. カード 525

     質問

     What physiologic disturbance underlies endometriosis?

     回答

     Estrogen-responsive ectopic endometrial-like tissue drives inflammation, fibrosis, and pain.

     Endometriosis · reviewed 2026-08-26

526. カード 526

     質問

     What should a clinician do after sending protected information to the wrong recipient?

     回答

     Act immediately to limit further disclosure, notify the organization’s privacy or security process, document facts, and follow breach assessment requirements.

     Breach Notification Rule · reviewed 2026-08-26

527. カード 527

     質問

     Which clinical pattern defines a panic attack?

     回答

     An abrupt surge of intense fear or discomfort with physical and cognitive symptoms that peaks within minutes defines a panic attack.

     Panic Disorder: What You Need to Know · reviewed 2026-08-26

528. カード 528

     質問

     What clinical clue should raise suspicion for acute kidney injury?

     回答

     A rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis indicates AKI.

     KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

529. カード 529

     質問

     What physiologic disturbance underlies tension pneumothorax?

     回答

     A one-way pleural air leak raises intrathoracic pressure, collapses the lung, and impairs venous return.

     Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

530. カード 530

     質問

     In a child or adolescent, what clinical clue should raise suspicion for immune thrombocytopenia?

     回答

     Isolated petechiae, bruising, or mucosal bleeding with thrombocytopenia and otherwise preserved cell lines suggests ITP.

     American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

531. カード 531

     質問

     What is the key first diagnostic step for celiac disease?

     回答

     Order tissue-transglutaminase IgA with total IgA while the patient is eating gluten; confirm as guideline-directed.

     ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26

532. カード 532

     質問

     A patient has this pattern: Fever plus a new or changing murmur, embolic findings, injection-drug use, or prosthetic material raises suspicion. What is the most likely diagnosis?

     回答

     Infective endocarditis. Fever plus a new or changing murmur, embolic findings, injection-drug use, or prosthetic material raises suspicion.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

533. カード 533

     質問

     What is the key first diagnostic step for carpal tunnel syndrome?

     回答

     Diagnosis is often clinical; electrodiagnostic testing helps when severe, atypical, or before selected surgery.

     Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

534. カード 534

     質問

     Which prevention step is essential before oral intake in acute ischemic stroke?

     回答

     Screen swallowing before food, fluids, or oral medication to reduce aspiration risk.

     2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

535. カード 535

     質問

     What is the priority management step for cellulitis?

     回答

     Mark the margin, assess for abscess or necrotizing infection, and escalate care for systemic toxicity.

     Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26

536. カード 536

     質問

     Which prevention or risk-reduction step is important for community-acquired pneumonia?

     回答

     Keep age- and risk-appropriate pneumococcal vaccination current to reduce preventable pneumococcal pneumonia.

     Pneumococcal Vaccine Recommendations · reviewed 2026-08-26

537. カード 537

     質問

     For surgical decision-making, what is the priority management step for benign prostatic hyperplasia?

     回答

     Urgently catheterize acute urinary retention and evaluate infection, kidney injury, or severe hematuria.

     EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26

538. カード 538

     質問

     Which prevention or risk-reduction step is important for ectopic pregnancy?

     回答

     Early testing after a missed period and prompt evaluation of pain or bleeding reduce rupture morbidity.

     Ectopic Pregnancy · reviewed 2026-08-26

539. カード 539

     質問

     What diagnostic approach is most appropriate when obstructive sleep apnea is suspected?

     回答

     Confirm with polysomnography or an appropriate home sleep-apnea test in selected uncomplicated adults.

     Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea · reviewed 2026-08-26

540. カード 540

     質問

     In a child or adolescent, which prevention or risk-reduction step is important for major depressive disorder?

     回答

     Monitor symptoms, suicidality, functioning, treatment adherence, and recurrence with a clear follow-up and safety plan.

     Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

541. カード 541

     質問

     Which pathophysiologic process drives symptomatic aortic stenosis?

     回答

     Calcific leaflet narrowing creates a fixed left-ventricular outflow obstruction and pressure overload.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

542. カード 542

     質問

     In a child or adolescent, what drug class or regimen fits diabetic ketoacidosis?

     回答

     Use continuous IV regular insulin; add dextrose as glucose falls so ketone clearance can continue.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

543. カード 543

     質問

     What is the key first diagnostic step for peritonsillar abscess?

     回答

     Diagnosis is usually clinical; ultrasound or CT helps when the diagnosis or deep-space extension is uncertain.

     Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

544. カード 544

     質問

     What does continuity require before ending a clinician-patient relationship?

     回答

     Give reasonable notice, provide urgent coverage during the transition, offer transfer resources, and make records available as permitted.

     Terminating a Patient-Physician Relationship · reviewed 2026-08-26

545. カード 545

     質問

     What counseling point helps reduce harm from chronic hepatitis C?

     回答

     Avoid blood exposure, do not share injection equipment, and screen all adults and each pregnancy as recommended.

     Viral Hepatitis Clinical Care · reviewed 2026-08-26

546. カード 546

     質問

     What drug class or regimen fits hyperkalemia?

     回答

     IV calcium protects the heart; insulin with glucose shifts potassium, while diuresis, binders, or dialysis remove it.

     Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26

547. カード 547

     質問

     In a child or adolescent, what counseling point helps reduce harm from juvenile idiopathic arthritis?

     回答

     Vaccination, eye screening, activity, and growth monitoring reduce preventable morbidity.

     2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

548. カード 548

     質問

     In a child or adolescent, which next action matters most in immune thrombocytopenia?

     回答

     Treat clinically important bleeding urgently; observation is appropriate for selected patients with minor symptoms.

     American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

549. カード 549

     質問

     A clinician is considering subarachnoid hemorrhage. Which finding adds the most support?

     回答

     A sudden maximal-at-onset thunderclap headache, neck stiffness, vomiting, or brief loss of consciousness is concerning.

     2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

550. カード 550

     質問

     Which test or testing sequence best evaluates suspected aortic dissection?

     回答

     CT angiography is the usual rapid definitive study in a stable patient; transesophageal echocardiography is useful when unstable.

     2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

551. カード 551

     質問

     In a child, typically 6 months to 3 years, what counseling point helps reduce harm from croup?

     回答

     Caregivers should seek urgent assessment for stridor at rest, marked chest retractions, cyanosis, lethargy, or poor air entry.

     Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

552. カード 552

     質問

     In a child or adolescent, a clinician is considering bacterial meningitis. Which finding adds the most support?

     回答

     Fever, headache, neck stiffness, altered mental status, or a nonblanching rash should trigger urgent evaluation.

     WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

553. カード 553

     質問

     A clinician is considering preeclampsia with severe features. Which finding adds the most support?

     回答

     New hypertension after 20 weeks with end-organ findings such as severe pressure, thrombocytopenia, liver injury, kidney injury, pulmonary edema, or neurologic symptoms suggests severe disease.

     Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

554. カード 554

     質問

     A clinician is considering bipolar I mania. Which finding adds the most support?

     回答

     At least one week of elevated or irritable mood with increased energy, decreased sleep, pressured speech, grandiosity, and risky behavior suggests mania.

     Management of Bipolar Disorder in Adults · reviewed 2026-08-26

555. カード 555

     質問

     What is the priority management step for celiac disease?

     回答

     Do not start a gluten-free diet before completing diagnostic testing unless immediate clinical needs demand it.

     ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26

556. カード 556

     質問

     Which history or examination finding most strongly supports acute compartment syndrome?

     回答

     Pain out of proportion, pain with passive stretch, tense swelling, and progressive neurologic deficits after injury are warning signs.

     Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

557. カード 557

     質問

     For surgical decision-making, how should a clinician initially manage Cushing syndrome?

     回答

     Confirm hypercortisolism, identify whether it is ACTH dependent, and localize the source before definitive treatment.

     Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

558. カード 558

     質問

     Which bedside pattern best points to retinal detachment?

     回答

     New flashes, floaters, and a curtain or shadow across the visual field suggest detachment.

     Retinal Detachment · reviewed 2026-08-26

559. カード 559

     質問

     How should a clinician respond when requested to falsify a work note or record?

     回答

     Decline, document objective facts accurately, explain what can truthfully be certified, and preserve the integrity of the record.

     Management of Medical Records · reviewed 2026-08-26

560. カード 560

     質問

     How can a clinician reduce avoidable harm related to hypertensive emergency?

     回答

     Accurate home monitoring and sustained treatment adherence reduce progression to crisis.

     2025 High Blood Pressure Guideline · reviewed 2026-08-26

561. カード 561

     質問

     What clinical clue should raise suspicion for COPD?

     回答

     Progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants suggest COPD.

     2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

562. カード 562

     質問

     Which pharmacologic approach is preferred for acute pyelonephritis?

     回答

     Select empiric therapy from local resistance and severity, then narrow to the culture.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

563. カード 563

     質問

     Which history or examination finding most strongly supports plaque psoriasis?

     回答

     Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis.

     Psoriasis Clinical Guidelines · reviewed 2026-08-26

564. カード 564

     質問

     What immediate plan is appropriate for Parkinson disease?

     回答

     Start multidisciplinary care and choose symptomatic treatment by functional impact, age, cognition, and adverse-effect risk.

     Parkinson’s Disease in Adults · reviewed 2026-08-26

565. カード 565

     質問

     Which diagnosis best fits hypotonic euvolemic hyponatremia with inappropriately concentrated urine after thyroid, adrenal, renal, and diuretic causes are excluded?

     回答

     Hyponatremia due to SIADH. Nausea, confusion, gait change, seizure, or subtle cognitive symptoms with hypotonic euvolemic hyponatremia may reflect SIADH.

     Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia · reviewed 2026-08-26

566. カード 566

     質問

     What immediate plan is appropriate for gonococcal urethritis or cervicitis?

     回答

     Treat promptly, test for other STIs, abstain until treatment criteria are met, and arrange partner services.

     Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

567. カード 567

     質問

     How should medication be used in aortic dissection?

     回答

     Use an IV beta-blocker first to reduce shear stress, then add a vasodilator if pressure remains high.

     2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

568. カード 568

     質問

     What immediate plan is appropriate for menopause vasomotor symptoms?

     回答

     Match treatment to symptom burden, uterus status, contraindications, and patient preference.

     Hormone Therapy for Menopause · reviewed 2026-08-26

569. カード 569

     質問

     Which pharmacologic approach is preferred for cirrhosis with ascites?

     回答

     Spironolactone with furosemide is a common diuretic combination when renal function and electrolytes allow.

     Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26

570. カード 570

     質問

     What immediate plan is appropriate for alcohol withdrawal?

     回答

     Stabilize, give thiamine, use symptom- or risk-guided withdrawal treatment, and admit high-risk patients.

     The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26

571. カード 571

     質問

     In a child or adolescent, what drug class or regimen fits sickle cell vaso-occlusive crisis?

     回答

     Use rapid individualized analgesia, with nonsteroidal anti-inflammatory drugs for selected mild pain and opioids for severe pain, followed by frequent reassessment.

     ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26

572. カード 572

     質問

     For surgical decision-making, what is the priority management step for carpal tunnel syndrome?

     回答

     Use neutral-position night splinting initially; refer for decompression with severe weakness, denervation, or persistent symptoms.

     Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

573. カード 573

     質問

     In an infant aged 1–23 months, what drug class or regimen fits bronchiolitis?

     回答

     Routine salbutamol, corticosteroids, and antibiotics are not recommended; use antibiotics only when bacterial infection is evident or strongly suspected.

     Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26

574. カード 574

     質問

     In a child or adolescent, which bedside pattern best points to diabetic ketoacidosis?

     回答

     Hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status suggests ketoacidosis.

     Standards of Care in Diabetes—2026 · reviewed 2026-08-26

575. カード 575

     質問

     For surgical decision-making, how should a clinician initially manage peritonsillar abscess?

     回答

     Assess the airway, drain the abscess, hydrate, and treat infection.

     Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

576. カード 576

     質問

     Which factors determine a PA’s scope of practice?

     回答

     A PA’s education and experience, state law, practice-setting policy and credentialing, and the care team’s arrangements together define the services the PA may provide.

     PA Scope of Practice · reviewed 2026-08-26

577. カード 577

     質問

     What immediate plan is appropriate for heart failure with reduced ejection fraction?

     回答

     For acute pulmonary edema, support oxygenation and relieve congestion while identifying the trigger.

     2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

578. カード 578

     質問

     What medication strategy is appropriate for acute ischemic stroke?

     回答

     Antiplatelet therapy is used after hemorrhage is excluded when thrombolysis timing and stroke mechanism allow.

     2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

579. カード 579

     質問

     What combination of findings should raise suspicion for acute calculous cholecystitis?

     回答

     Right-upper-quadrant pain or tenderness, fever, leukocytosis, and a positive Murphy sign support the diagnosis when considered together.

     2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26

580. カード 580

     質問

     What medication strategy is appropriate for community-acquired pneumonia?

     回答

     Use guideline-concordant empiric antibiotics based on setting, comorbidity, and local resistance; narrow when microbiology permits.

     Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

581. カード 581

     質問

     Which diagnosis is defined by acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult?

     回答

     Acute respiratory distress syndrome. Acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult suggests ARDS.

     An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26

582. カード 582

     質問

     What medication strategy is appropriate for ectopic pregnancy?

     回答

     Methotrexate is an option for selected stable unruptured ectopic pregnancy without contraindications.

     Ectopic Pregnancy · reviewed 2026-08-26

583. カード 583

     質問

     In a child or adolescent, what medication strategy is appropriate for major depressive disorder?

     回答

     When medication is indicated for an adolescent, use an evidence-supported SSRI with close monitoring; combine it with psychotherapy according to severity and preference.

     Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

584. カード 584

     質問

     In a child or adolescent, identify the condition from this pattern: Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

     回答

     Atopic dermatitis. Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

     Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

585. カード 585

     質問

     Which pharmacologic approach is preferred for a postmenopausal woman with osteoporosis at high fracture risk?

     回答

     Bisphosphonates are first-line for many postmenopausal women at high fracture risk; consider anabolic therapy for very high risk.

     Pharmacological Management of Osteoporosis in Postmenopausal Women · reviewed 2026-08-26

586. カード 586

     質問

     Which history or examination finding most strongly supports atrial fibrillation?

     回答

     An irregularly irregular pulse with palpitations, fatigue, or dyspnea suggests atrial fibrillation.

     2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

587. カード 587

     質問

     Which diagnosis best fits dysuria and frequency without vaginal symptoms in an otherwise appropriate patient?

     回答

     Uncomplicated cystitis. Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

     EAU Guidelines on Urological Infections · reviewed 2026-08-26

588. カード 588

     質問

     How should a clinician initially manage nephrotic syndrome?

     回答

     Manage edema and cause, and urgently evaluate thrombosis, infection, or severe volume compromise.

     KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

589. カード 589

     質問

     What condition should be suspected from this finding: A single fever in a patient with severe chemotherapy-related neutropenia is an emergency even when examination is unrevealing.

     回答

     Neutropenic fever. A single fever in a patient with severe chemotherapy-related neutropenia is an emergency even when examination is unrevealing.

     Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26

590. カード 590

     質問

     What is the purpose of root cause analysis after a serious patient-safety event?

     回答

     Identify active and latent system contributors, then design and track corrective actions that reduce recurrence rather than stopping at individual blame.

     Root Cause Analysis · reviewed 2026-08-26

591. カード 591

     質問

     For surgical decision-making, a patient has this pattern: Often asymptomatic hypercalcemia, nephrolithiasis, bone loss, constipation, or neurocognitive symptoms can be the clue. What is the most likely diagnosis?

     回答

     Primary hyperparathyroidism. Often asymptomatic hypercalcemia, nephrolithiasis, bone loss, constipation, or neurocognitive symptoms can be the clue.

     Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

592. カード 592

     質問

     How should a clinician initially manage obstructive sleep apnea?

     回答

     Offer positive airway pressure for obstructive sleep apnea with excessive sleepiness and consider it for impaired sleep-related quality of life or comorbid hypertension.

     Clinical Practice Guideline for Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure · reviewed 2026-08-26

593. カード 593

     質問

     A patient has this pattern: A rapid unilateral hearing decrease, often noticed on waking and sometimes with tinnitus, is an otologic emergency. What is the most likely diagnosis?

     回答

     Sudden sensorineural hearing loss. A rapid unilateral hearing decrease, often noticed on waking and sometimes with tinnitus, is an otologic emergency.

     Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

594. カード 594

     質問

     Which diagnosis requires bradykinesia plus rest tremor or rigidity and often includes reduced arm swing or a shuffling gait?

     回答

     Parkinson disease. Bradykinesia plus rest tremor or rigidity, with reduced arm swing and shuffling gait, supports parkinsonism.

     Parkinson’s Disease in Adults · reviewed 2026-08-26

595. カード 595

     質問

     Which diagnosis best fits purulent urethral discharge, dysuria, cervicitis, pelvic pain, or a relevant sexual exposure, although infection may be asymptomatic?

     回答

     Gonococcal urethritis or cervicitis. Purulent urethral discharge, dysuria, cervicitis, pelvic pain, or exposure may indicate gonorrhea, but infection can be asymptomatic.

     Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

596. カード 596

     質問

     Which diagnosis best fits hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age?

     回答

     Menopause vasomotor symptoms. Hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age usually identify menopausal vasomotor symptoms.

     The Menopause Years · reviewed 2026-08-26

597. カード 597

     質問

     Which diagnosis causes tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use?

     回答

     Alcohol withdrawal. Tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use suggests withdrawal.

     The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26

598. カード 598

     質問

     Which diagnosis causes bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation?

     回答

     Ulcerative colitis. Bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation suggest ulcerative colitis.

     Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26

599. カード 599

     質問

     Which diagnosis best fits abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint?

     回答

     Gout flare. Abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint, suggests gout.

     Gout · reviewed 2026-08-26

600. カード 600

     質問

     For surgical decision-making, which diagnosis best fits this presentation: Exertional dyspnea, angina, or syncope with a harsh crescendo-decrescendo systolic murmur radiating to the carotids is typical.

     回答

     Symptomatic aortic stenosis. Exertional dyspnea, angina, or syncope with a harsh crescendo-decrescendo systolic murmur radiating to the carotids is typical.

     2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26