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

Study diagnoses, tests, next steps and management with a source-linked PANCE deck organized by the January 2025 NCCPA blueprint.

作者 Flashcards Open Source App

关于这套卡组

Reviewed for 2026, this 600-card English deck follows the January 2025 NCCPA PANCE blueprint. Its two public tag axes let you switch between medical-content systems and exam-task retrievals: discriminating history and examination cues, diagnosis, diagnostic-study choice, prevention, next-step intervention, pharmacotherapy, and selected foundations. Every answer links to a current first-party clinical guideline or authoritative public-health or professional body and records the 2026-08-26 review date. Official PANCE eligibility and certification requirements remain with NCCPA. No recalled or leaked exam questions, exam items, mark schemes, curriculum prose, commercial deck wording, logos, figures, or trade dress were copied. Educational review only. This deck isn't medical advice and isn't a substitute for current clinical guidance, supervision, local protocols, or patient-specific judgment. This independently written resource is unofficial and is not affiliated with or endorsed by NCCPA.

这套卡组中的卡片

  2. 卡片 2

    问题

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

    答案

    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. 卡片 3

    问题

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

    答案

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  8. 卡片 8

    问题

    What core mechanism explains ectopic pregnancy?

    答案

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

    Ectopic Pregnancy · reviewed 2026-08-26

  10. 卡片 10

    问题

    What core mechanism explains type 2 diabetes mellitus?

    答案

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

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

  11. 卡片 11

    问题

    What core mechanism explains acute angle-closure glaucoma?

    答案

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

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

  13. 卡片 13

    问题

    What core mechanism explains chronic kidney disease?

    答案

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

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

  16. 卡片 16

    问题

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

    答案

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  18. 卡片 18

    问题

    What core mechanism explains uncomplicated cystitis?

    答案

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

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

  19. 卡片 19

    问题

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

    答案

    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. 卡片 20

    问题

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

    答案

    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

  22. 卡片 22

    问题

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

    答案

    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. 卡片 23

    问题

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

    答案

    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. 卡片 24

    问题

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

    答案

    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. 卡片 25

    问题

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

    答案

    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

  27. 卡片 27

    问题

    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.

    答案

    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. 卡片 28

    问题

    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.

    答案

    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

  30. 卡片 30

    问题

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

    答案

    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

  34. 卡片 34

    问题

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

    答案

    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. 卡片 35

    问题

    What clinical clue should raise suspicion for pulmonary tuberculosis?

    答案

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

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

  36. 卡片 36

    问题

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

    答案

    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. 卡片 37

    问题

    What clinical clue should raise suspicion for endometriosis?

    答案

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

    Endometriosis · reviewed 2026-08-26

  38. 卡片 38

    问题

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

    答案

    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. 卡片 39

    问题

    What clinical clue should raise suspicion for panic disorder?

    答案

    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

  41. 卡片 41

    问题

    What clinical clue should raise suspicion for tension pneumothorax?

    答案

    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. 卡片 42

    问题

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

    答案

    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. 卡片 43

    问题

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

    答案

    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. 卡片 44

    问题

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

    答案

    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. 卡片 45

    问题

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

    答案

    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. 卡片 46

    问题

    Which next action matters most in Crohn disease?

    答案

    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

  48. 卡片 48

    问题

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

    答案

    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

  51. 卡片 51

    问题

    Which next action matters most in multiple sclerosis relapse?

    答案

    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. 卡片 52

    问题

    Which next action matters most in HIV infection?

    答案

    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. 卡片 53

    问题

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

    答案

    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

  58. 卡片 58

    问题

    What clinical clue should raise suspicion for acute bacterial rhinosinusitis?

    答案

    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. 卡片 59

    问题

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

    答案

    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

  61. 卡片 61

    问题

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

    答案

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  65. 卡片 65

    问题

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

    答案

    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

  67. 卡片 67

    问题

    What drug class or regimen fits sepsis?

    答案

    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

  71. 卡片 71

    问题

    What drug class or regimen fits schizophrenia?

    答案

    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

  73. 卡片 73

    问题

    What is the key first diagnostic step for primary hypothyroidism?

    答案

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

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

  74. 卡片 74

    问题

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

    答案

    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

  76. 卡片 76

    问题

    What makes informed consent more than a signed form?

    答案

    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. 卡片 77

    问题

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

    答案

    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

  80. 卡片 80

    问题

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

    答案

    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

  82. 卡片 82

    问题

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

    答案

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  83. 卡片 83

    问题

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

    答案

    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

  88. 卡片 88

    问题

    What drug class or regimen fits chronic kidney disease?

    答案

    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. 卡片 89

    问题

    Which microbiologic test is essential when gonococcal conjunctivitis is suspected?

    答案

    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

  91. 卡片 91

    问题

    When may treatment proceed without prior consent in an emergency?

    答案

    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

  93. 卡片 93

    问题

    What is the key first diagnostic step for subarachnoid hemorrhage?

    答案

    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

  95. 卡片 95

    问题

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

    答案

    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. 卡片 96

    问题

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

    答案

    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. 卡片 97

    问题

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

    答案

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  99. 卡片 99

    问题

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

    答案

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

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

  100. 卡片 100

    问题

    How should medication be used in hypertensive emergency?

    答案

    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

  105. 卡片 105

    问题

    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?

    答案

    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

  107. 卡片 107

    问题

    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.

    答案

    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. 卡片 108

    问题

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

    答案

    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. 卡片 109

    问题

    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.

    答案

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  110. 卡片 110

    问题

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

    答案

    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. 卡片 111

    问题

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

    答案

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

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

  113. 卡片 113

    问题

    Which next action matters most in uncomplicated cystitis?

    答案

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

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

  116. 卡片 116

    问题

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

    答案

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

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

  118. 卡片 118

    问题

    What is the key first diagnostic step for herpes zoster?

    答案

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

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

  120. 卡片 120

    问题

    Which bedside pattern best points to migraine with aura?

    答案

    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. 卡片 121

    问题

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

    答案

    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

  123. 卡片 123

    问题

    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.

    答案

    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. 卡片 124

    问题

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

    答案

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  125. 卡片 125

    问题

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

    答案

    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

  128. 卡片 128

    问题

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

    答案

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  129. 卡片 129

    问题

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

    答案

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

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

  132. 卡片 132

    问题

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

    答案

    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. 卡片 133

    问题

    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?

    答案

    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

  135. 卡片 135

    问题

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

    答案

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

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  137. 卡片 137

    问题

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

    答案

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  138. 卡片 138

    问题

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

    答案

    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. 卡片 139

    问题

    What counseling point helps reduce harm from tension pneumothorax?

    答案

    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

  141. 卡片 141

    问题

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

    答案

    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

  144. 卡片 144

    问题

    How should a clinician initially manage primary hypothyroidism?

    答案

    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. 卡片 145

    问题

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

    答案

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

    Carpal Tunnel Syndrome · reviewed 2026-08-26

  146. 卡片 146

    问题

    How should a clinician initially manage bacterial conjunctivitis?

    答案

    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. 卡片 147

    问题

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

    答案

    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

  149. 卡片 149

    问题

    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.

    答案

    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

  151. 卡片 151

    问题

    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?

    答案

    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. 卡片 152

    问题

    How should medication be used in pulmonary tuberculosis?

    答案

    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. 卡片 153

    问题

    How should medication be used in endometriosis?

    答案

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

    Endometriosis · reviewed 2026-08-26

  154. 卡片 154

    问题

    How should medication be used in panic disorder?

    答案

    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

  156. 卡片 156

    问题

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

    答案

    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. 卡片 157

    问题

    Which bedside pattern best points to primary adrenal insufficiency?

    答案

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

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

  161. 卡片 161

    问题

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

    答案

    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

  163. 卡片 163

    问题

    What is the key first diagnostic step for testicular torsion?

    答案

    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. 卡片 164

    问题

    What counseling point helps reduce harm from Parkinson disease?

    答案

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

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

  166. 卡片 166

    问题

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

    答案

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

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

  168. 卡片 168

    问题

    What counseling point helps reduce harm from menopause vasomotor symptoms?

    答案

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

    The Menopause Years · reviewed 2026-08-26

  169. 卡片 169

    问题

    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?

    答案

    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

  172. 卡片 172

    问题

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

    答案

    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

  175. 卡片 175

    问题

    How should medication be used in sudden sensorineural hearing loss?

    答案

    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. 卡片 176

    问题

    What is the HIPAA minimum-necessary rule?

    答案

    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. 卡片 177

    问题

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

    答案

    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. 卡片 178

    问题

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

    答案

    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. 卡片 179

    问题

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

    答案

    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. 卡片 180

    问题

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

    答案

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

    Gout · reviewed 2026-08-26

  181. 卡片 181

    问题

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

    答案

    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. 卡片 182

    问题

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

    答案

    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. 卡片 183

    问题

    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?

    答案

    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. 卡片 184

    问题

    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?

    答案

    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

  186. 卡片 186

    问题

    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.

    答案

    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

  188. 卡片 188

    问题

    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.

    答案

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  191. 卡片 191

    问题

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

    答案

    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. 卡片 192

    问题

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

    答案

    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. 卡片 193

    问题

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

    答案

    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. 卡片 194

    问题

    What immediate plan is appropriate for chronic hepatitis C?

    答案

    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. 卡片 195

    问题

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

    答案

    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. 卡片 196

    问题

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

    答案

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

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

  197. 卡片 197

    问题

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

    答案

    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. 卡片 198

    问题

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

    答案

    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

  202. 卡片 202

    问题

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

    答案

    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. 卡片 203

    问题

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

    答案

    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. 卡片 204

    问题

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

    答案

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

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

  206. 卡片 206

    问题

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

    答案

    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. 卡片 207

    问题

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

    答案

    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. 卡片 208

    问题

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

    答案

    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. 卡片 209

    问题

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

    答案

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

    Retinal Detachment · reviewed 2026-08-26

  210. 卡片 210

    问题

    What immediate plan is appropriate for bipolar I mania?

    答案

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

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

  211. 卡片 211

    问题

    May a clinician leave appointment information in a voicemail?

    答案

    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

  213. 卡片 213

    问题

    How should a clinician initially manage plaque psoriasis?

    答案

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  216. 卡片 216

    问题

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

    答案

    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. 卡片 217

    问题

    Which pathophysiologic process drives COPD?

    答案

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

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

  218. 卡片 218

    问题

    Which history or examination finding most strongly supports Crohn disease?

    答案

    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

  221. 卡片 221

    问题

    What clinical clue should raise suspicion for hypertensive emergency?

    答案

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

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

  225. 卡片 225

    问题

    What counseling point helps reduce harm from peritonsillar abscess?

    答案

    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

  227. 卡片 227

    问题

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

    答案

    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

  230. 卡片 230

    问题

    Which bedside pattern best points to herpes zoster?

    答案

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

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

  231. 卡片 231

    问题

    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?

    答案

    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. 卡片 232

    问题

    Which bedside pattern best points to testicular torsion?

    答案

    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. 卡片 233

    问题

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

    答案

    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. 卡片 234

    问题

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

    答案

    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. 卡片 235

    问题

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

    答案

    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. 卡片 236

    问题

    What diagnostic approach is most appropriate when sepsis is suspected?

    答案

    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. 卡片 237

    问题

    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?

    答案

    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. 卡片 238

    问题

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

    答案

    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. 卡片 239

    问题

    Which pharmacologic approach is preferred for COPD?

    答案

    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. 卡片 240

    问题

    What diagnostic approach is most appropriate when schizophrenia is suspected?

    答案

    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. 卡片 241

    问题

    Which next action matters most in hypertensive emergency?

    答案

    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. 卡片 242

    问题

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

    答案

    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

  246. 卡片 246

    问题

    Which preventive measure belongs in care for gout flare?

    答案

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

    Gout · reviewed 2026-08-26

  249. 卡片 249

    问题

    Which test or testing sequence best evaluates suspected COPD?

    答案

    Post-bronchodilator spirometry confirms persistent airflow obstruction.

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

  252. 卡片 252

    问题

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

    答案

    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. 卡片 253

    问题

    Which pathophysiologic process drives preeclampsia with severe features?

    答案

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  254. 卡片 254

    问题

    Which clinical feature defines bipolar I disorder?

    答案

    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. 卡片 255

    问题

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

    答案

    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. 卡片 256

    问题

    Which history or examination finding most strongly supports rheumatoid arthritis?

    答案

    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. 卡片 257

    问题

    What is teach-back?

    答案

    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

  260. 卡片 260

    问题

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

    答案

    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. 卡片 261

    问题

    Which preventive measure belongs in care for obstructive sleep apnea?

    答案

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

    Sleep Apnea Treatment · reviewed 2026-08-26

  262. 卡片 262

    问题

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

    答案

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  263. 卡片 263

    问题

    How should a clinician initially manage acute pyelonephritis?

    答案

    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. 卡片 264

    问题

    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.

    答案

    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

  266. 卡片 266

    问题

    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.

    答案

    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. 卡片 267

    问题

    What drug class or regimen fits stable chronic hypertension?

    答案

    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. 卡片 268

    问题

    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.

    答案

    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. 卡片 269

    问题

    Which pharmacologic approach is preferred for acute pancreatitis?

    答案

    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. 卡片 270

    问题

    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.

    答案

    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. 卡片 271

    问题

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

    答案

    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

  273. 卡片 273

    问题

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

    答案

    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. 卡片 274

    问题

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

    答案

    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. 卡片 275

    问题

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

    答案

    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. 卡片 276

    问题

    Which pathophysiologic process drives retinal detachment?

    答案

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

    Retinal Detachment · reviewed 2026-08-26

  281. 卡片 281

    问题

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

    答案

    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. 卡片 282

    问题

    Which preventive measure belongs in care for shoulder dystocia?

    答案

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

    Shoulder Dystocia · reviewed 2026-08-26

  284. 卡片 284

    问题

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

    答案

    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

  287. 卡片 287

    问题

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

    答案

    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

  289. 卡片 289

    问题

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

    答案

    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. 卡片 290

    问题

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

    答案

    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. 卡片 291

    问题

    What medication strategy is appropriate for peritonsillar abscess?

    答案

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  292. 卡片 292

    问题

    What belongs in a safe handoff?

    答案

    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

  294. 卡片 294

    问题

    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.

    答案

    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

  297. 卡片 297

    问题

    Which history or examination finding most strongly supports shoulder dystocia?

    答案

    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. 卡片 298

    问题

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

    答案

    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

  300. 卡片 300

    问题

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

    答案

    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

    Illustrated clinical review desk with a stethoscope, ECG trace, lungs, brain, and study cards arranged around a clear central title-safe area.

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

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  303. 卡片 303

    问题

    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.

    答案

    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

  305. 卡片 305

    问题

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

    答案

    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. 卡片 306

    问题

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

    答案

    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

  308. 卡片 308

    问题

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

    答案

    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. 卡片 309

    问题

    What is the priority management step for pelvic inflammatory disease?

    答案

    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. 卡片 310

    问题

    What is closed-loop communication during an emergency?

    答案

    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. 卡片 311

    问题

    What is the priority management step for schizophrenia?

    答案

    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

  317. 卡片 317

    问题

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

    答案

    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. 卡片 318

    问题

    Which test or testing sequence best evaluates suspected acute cholecystitis?

    答案

    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. 卡片 319

    问题

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

    答案

    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. 卡片 320

    问题

    Which pharmacologic approach is preferred for Parkinson disease?

    答案

    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. 卡片 321

    问题

    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?

    答案

    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. 卡片 322

    问题

    Which pharmacologic approach is preferred for gonococcal urethritis or cervicitis?

    答案

    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. 卡片 323

    问题

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

    答案

    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. 卡片 324

    问题

    Which pharmacologic approach is preferred for menopause vasomotor symptoms?

    答案

    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. 卡片 325

    问题

    How should a clinician handle an ambiguous verbal medication order?

    答案

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

    TeamSTEPPS Communication Module · reviewed 2026-08-26

  327. 卡片 327

    问题

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

    答案

    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

  331. 卡片 331

    问题

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

    答案

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

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

  334. 卡片 334

    问题

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

    答案

    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. 卡片 335

    问题

    How should medication be used in herpes zoster?

    答案

    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. 卡片 336

    问题

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

    答案

    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. 卡片 337

    问题

    What medication strategy is appropriate for uncomplicated cystitis?

    答案

    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. 卡片 338

    问题

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

    答案

    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. 卡片 339

    问题

    How should a clinician confirm or characterize pulmonary embolism?

    答案

    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. 卡片 340

    问题

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

    答案

    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

  342. 卡片 342

    问题

    What is the priority management step for primary adrenal insufficiency?

    答案

    Suspected adrenal crisis requires immediate glucocorticoid and isotonic fluid treatment before confirmatory results.

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

  344. 卡片 344

    问题

    In a child aged 6 months or older, what is the priority management step for acute otitis media?

    答案

    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. 卡片 345

    问题

    When antibiotic susceptibility is unknown, which empiric regimen is preferred for most treatment-naive Helicobacter pylori infection?

    答案

    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

  352. 卡片 352

    问题

    Which test or testing sequence best evaluates suspected pulmonary tuberculosis?

    答案

    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. 卡片 353

    问题

    Which test or testing sequence best evaluates suspected endometriosis?

    答案

    Diagnosis can be clinical with imaging for endometrioma or deep disease; laparoscopy is not mandatory before initial treatment.

    Endometriosis · reviewed 2026-08-26

  354. 卡片 354

    问题

    Which test or testing sequence best evaluates suspected panic disorder?

    答案

    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. 卡片 355

    问题

    How can a clinician reduce avoidable harm related to Crohn disease?

    答案

    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

  358. 卡片 358

    问题

    Which history or examination finding most strongly supports peritonsillar abscess?

    答案

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  359. 卡片 359

    问题

    When should a safety event or near miss be reported?

    答案

    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

  362. 卡片 362

    问题

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

    答案

    Prompt complete diagnostic excision and staging guide definitive surgical management.

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  363. 卡片 363

    问题

    A clinician is considering uncomplicated cystitis. Which finding adds the most support?

    答案

    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. 卡片 364

    问题

    In a child or adolescent, which clinical sequence defines a generalized tonic-clonic seizure?

    答案

    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. 卡片 365

    问题

    What is the priority management step for chronic kidney disease?

    答案

    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. 卡片 366

    问题

    Why does sepsis produce its defining clinical pattern?

    答案

    A dysregulated host response causes endothelial injury, vasodilation, capillary leak, and organ dysfunction.

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

  367. 卡片 367

    问题

    Which history or examination finding most strongly supports stable chronic hypertension?

    答案

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

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

  368. 卡片 368

    问题

    Why does pelvic inflammatory disease produce its defining clinical pattern?

    答案

    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. 卡片 369

    问题

    Which bedside pattern best points to chronic hepatitis C?

    答案

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

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  370. 卡片 370

    问题

    Which symptom domains should a clinician assess in schizophrenia?

    答案

    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. 卡片 371

    问题

    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?

    答案

    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. 卡片 372

    问题

    In pulmonary embolism with hemodynamic compromise and no prohibitive bleeding risk, which drug class should be considered for reperfusion?

    答案

    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. 卡片 373

    问题

    Which diagnosis best fits this presentation: Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

    答案

    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. 卡片 374

    问题

    Which preventive measure belongs in care for type 2 diabetes mellitus?

    答案

    Weight-supportive nutrition, physical activity, tobacco avoidance, and cardiometabolic risk control prevent complications.

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

  376. 卡片 376

    问题

    Which preventive measure belongs in care for acute angle-closure glaucoma?

    答案

    Definitive treatment of the fellow narrow-angle eye helps prevent a second attack.

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

  377. 卡片 377

    问题

    Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, an S3, and an echocardiographic LVEF of 35% indicate which heart-failure phenotype?

    答案

    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. 卡片 378

    问题

    What clinical clue should raise suspicion for multiple sclerosis relapse?

    答案

    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

  380. 卡片 380

    问题

    What clinical clue should raise suspicion for HIV infection?

    答案

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

    About HIV · reviewed 2026-08-26

  382. 卡片 382

    问题

    What clinical clue should raise suspicion for postpartum hemorrhage?

    答案

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  384. 卡片 384

    问题

    What clinical clue should raise suspicion for delirium?

    答案

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

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

  385. 卡片 385

    问题

    For surgical decision-making, what immediate plan is appropriate for ureteral stone?

    答案

    Provide analgesia, check for infection and kidney injury, and decompress urgently when obstruction is infected.

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  387. 卡片 387

    问题

    In a child or adolescent, a clinician is considering atopic dermatitis. Which finding adds the most support?

    答案

    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

  389. 卡片 389

    问题

    Which history or examination finding most strongly supports chronic kidney disease?

    答案

    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. 卡片 390

    问题

    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.

    答案

    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

  392. 卡片 392

    问题

    How should a clinician respond to a patient’s prejudiced request or discriminatory behavior?

    答案

    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

  394. 卡片 394

    问题

    How should a clinician confirm or characterize acute pancreatitis?

    答案

    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. 卡片 395

    问题

    Which next action matters most in pulmonary tuberculosis?

    答案

    Isolate suspected contagious disease and coordinate promptly with public health.

    Tuberculosis Infection Control · reviewed 2026-08-26

  397. 卡片 397

    问题

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

    答案

    Offer empiric symptom treatment or surgery based on severity, fertility goals, masses, and response.

    Endometriosis · reviewed 2026-08-26

  398. 卡片 398

    问题

    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?

    答案

    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. 卡片 399

    问题

    Which next action matters most in panic disorder?

    答案

    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

  401. 卡片 401

    问题

    What immediate plan is appropriate for COPD?

    答案

    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. 卡片 402

    问题

    In a child or adolescent, which bedside pattern best points to juvenile idiopathic arthritis?

    答案

    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. 卡片 403

    问题

    What is the priority management step for stable chronic hypertension?

    答案

    Estimate cardiovascular risk, assess target-organ damage, and set an individualized treatment plan.

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

  408. 卡片 408

    问题

    Which medication prevents seizures in preeclampsia with severe features?

    答案

    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. 卡片 409

    问题

    What is shared decision-making?

    答案

    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. 卡片 410

    问题

    In a child aged 6 years or older or an adolescent, what drug class or regimen fits attention-deficit/hyperactivity disorder?

    答案

    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

  412. 卡片 412

    问题

    Which pharmacologic approach is preferred for acute angle-closure glaucoma?

    答案

    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. 卡片 413

    问题

    Which diagnosis best fits this presentation: A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

    答案

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

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

  415. 卡片 415

    问题

    What counseling point helps reduce harm from symptomatic aortic stenosis?

    答案

    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. 卡片 416

    问题

    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.

    答案

    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

  420. 卡片 420

    问题

    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.

    答案

    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

  422. 卡片 422

    问题

    What condition should be suspected from this finding: Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

    答案

    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. 卡片 423

    问题

    Which pharmacologic approach is preferred for type 2 diabetes mellitus?

    答案

    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. 卡片 424

    问题

    For surgical decision-making, which diagnosis best fits cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility?

    答案

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

    Endometriosis · reviewed 2026-08-26

  426. 卡片 426

    问题

    Which diagnosis requires recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least one month?

    答案

    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. 卡片 427

    问题

    How should uncertainty be communicated?

    答案

    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. 卡片 428

    问题

    Which medication is FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity?

    答案

    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

  431. 卡片 431

    问题

    A clinician is considering upper gastrointestinal bleeding. Which finding adds the most support?

    答案

    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

  434. 卡片 434

    问题

    Which treatment should not be offered solely to treat multiple sclerosis?

    答案

    Do not offer vitamin D solely to treat multiple sclerosis.

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

  435. 卡片 435

    问题

    Which pathophysiologic process drives plaque psoriasis?

    答案

    IL-23 and Th17 pathway activation drives accelerated keratinocyte turnover.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  436. 卡片 436

    问题

    How can a clinician reduce avoidable harm related to HIV infection?

    答案

    PrEP, condoms, sterile injection equipment, perinatal treatment, and sustained viral suppression prevent transmission.

    Preventing HIV · reviewed 2026-08-26

  437. 卡片 437

    问题

    Which pathophysiologic process drives acute pyelonephritis?

    答案

    Ascending infection reaches the renal pelvis and parenchyma, producing systemic illness.

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

  438. 卡片 438

    问题

    How can a clinician reduce avoidable harm related to postpartum hemorrhage?

    答案

    Antenatal anemia treatment, active management of the third stage, and hemorrhage protocols reduce morbidity.

    Postpartum Hemorrhage · reviewed 2026-08-26

  439. 卡片 439

    问题

    What is the key first diagnostic step for tension pneumothorax?

    答案

    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. 卡片 440

    问题

    How can a clinician reduce avoidable harm related to delirium?

    答案

    Orientation, mobility, sleep protection, hearing and vision aids, hydration, and medication review reduce hospital delirium.

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

  445. 卡片 445

    问题

    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?

    答案

    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

  448. 卡片 448

    问题

    Which electrolyte disorder may cause weakness, paresthesias, bradycardia, or ECG changes but can be dangerous even without symptoms?

    答案

    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

  450. 卡片 450

    问题

    Which pharmacologic approach is preferred for heart failure with reduced ejection fraction?

    答案

    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. 卡片 451

    问题

    For surgical decision-making, severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock indicate which diagnosis?

    答案

    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. 卡片 452

    问题

    Which bedside pattern best points to ectopic pregnancy?

    答案

    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

  456. 卡片 456

    问题

    What clinical clue should raise suspicion for type 2 diabetes mellitus?

    答案

    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. 卡片 457

    问题

    In a postmenopausal woman or man aged 50 or older, which steps support bone health and reduce fracture risk?

    答案

    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. 卡片 458

    问题

    What clinical clue should raise suspicion for acute angle-closure glaucoma?

    答案

    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

  461. 卡片 461

    问题

    Which test or testing sequence best evaluates suspected plaque psoriasis?

    答案

    Diagnosis is usually clinical; biopsy is reserved for uncertain morphology.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  463. 卡片 463

    问题

    What diagnostic approach is most appropriate when uncomplicated cystitis is suspected?

    答案

    Urinalysis supports the diagnosis; culture is important for complicated, recurrent, resistant, pregnant, or atypical cases.

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

  466. 卡片 466

    问题

    How should a clinician initially manage early syphilis?

    答案

    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

  469. 卡片 469

    问题

    Why does acute cholecystitis produce its defining clinical pattern?

    答案

    A gallstone can block bile flow, causing gallbladder pain and swelling (inflammation).

    Cholecystectomy · reviewed 2026-08-26

  471. 卡片 471

    问题

    In a child or adolescent, a clinician is considering septic arthritis. Which finding adds the most support?

    答案

    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

  473. 卡片 473

    问题

    For an eligible infant or selected high-risk child aged 8–19 months, which immunization strategy reduces severe RSV disease?

    答案

    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. 卡片 474

    问题

    Which diagnosis causes weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia?

    答案

    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. 卡片 475

    问题

    What is the ethical approach to a learner performing a procedure?

    答案

    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. 卡片 476

    问题

    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?

    答案

    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

  478. 卡片 478

    问题

    How should medication be used in multiple sclerosis relapse?

    答案

    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

  480. 卡片 480

    问题

    How should medication be used in HIV infection?

    答案

    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

  482. 卡片 482

    问题

    How should medication be used in postpartum hemorrhage?

    答案

    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. 卡片 483

    问题

    In a child or adolescent, which history or examination finding most strongly supports asthma?

    答案

    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. 卡片 484

    问题

    How should medication be used in delirium?

    答案

    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. 卡片 485

    问题

    Which preventive measure belongs in care for herpes zoster?

    答案

    Age-appropriate recombinant zoster vaccination lowers zoster and postherpetic-neuralgia risk.

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

  486. 卡片 486

    问题

    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.

    答案

    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. 卡片 487

    问题

    Which preventive step is required during surgery for viable testicular torsion?

    答案

    Perform bilateral orchiopexy, fixing the affected and contralateral testes to reduce future torsion risk.

    Testicular Torsion · reviewed 2026-08-26

  489. 卡片 489

    问题

    Why does primary hypothyroidism produce its defining clinical pattern?

    答案

    Low thyroid hormone removes feedback inhibition, so TSH rises in primary gland failure.

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

  491. 卡片 491

    问题

    Why does bacterial conjunctivitis produce its defining clinical pattern?

    答案

    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. 卡片 492

    问题

    When is a chaperone appropriate for an intimate examination?

    答案

    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. 卡片 493

    问题

    Which diagnosis causes recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms?

    答案

    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. 卡片 494

    问题

    What medication strategy is appropriate for Crohn disease?

    答案

    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. 卡片 495

    问题

    Which diagnosis best fits a painless chancre or a diffuse rash involving the palms and soles with generalized lymphadenopathy?

    答案

    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

  497. 卡片 497

    问题

    Which diagnosis best fits irregular, unpredictable uterine bleeding at reproductive extremes or with endocrine disruption?

    答案

    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

  499. 卡片 499

    问题

    Which diagnosis requires intrusion, avoidance, negative mood or cognition, and hyperarousal lasting more than one month after trauma?

    答案

    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

  502. 卡片 502

    问题

    What drug class or regimen fits atrial fibrillation?

    答案

    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. 卡片 503

    问题

    In a child or adolescent, which history or examination finding most strongly supports acute appendicitis?

    答案

    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. 卡片 504

    问题

    Which diagnosis best fits this presentation: Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.

    答案

    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

  506. 卡片 506

    问题

    In a child or adolescent, how can a clinician reduce avoidable harm related to diabetic ketoacidosis?

    答案

    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. 卡片 507

    问题

    How should a clinician confirm or characterize early syphilis?

    答案

    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. 卡片 508

    问题

    How can a clinician reduce avoidable harm related to retinal detachment?

    答案

    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

  510. 卡片 510

    问题

    How should social media be handled when a clinical story seems de-identified?

    答案

    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

  513. 卡片 513

    问题

    In a child or adolescent, what medication strategy is appropriate for atopic dermatitis?

    答案

    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

  516. 卡片 516

    问题

    Which history or examination finding most strongly supports acute pyelonephritis?

    答案

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

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

  517. 卡片 517

    问题

    For surgical decision-making, which next action matters most in tension pneumothorax?

    答案

    Perform immediate decompression followed by tube thoracostomy.

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

  518. 卡片 518

    问题

    Which diagnosis best fits this presentation: Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.

    答案

    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. 卡片 519

    问题

    What physiologic disturbance underlies anterior cruciate ligament tear?

    答案

    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. 卡片 520

    问题

    A clinician is considering heart failure with reduced ejection fraction. Which finding adds the most support?

    答案

    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

  523. 卡片 523

    问题

    What physiologic disturbance underlies pulmonary tuberculosis?

    答案

    Mycobacteria survive in macrophages and drive granulomatous inflammation with latent or active disease.

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

  524. 卡片 524

    问题

    Which antibiotic is required for gonococcal conjunctivitis in an adult?

    答案

    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. 卡片 525

    问题

    What physiologic disturbance underlies endometriosis?

    答案

    Estrogen-responsive ectopic endometrial-like tissue drives inflammation, fibrosis, and pain.

    Endometriosis · reviewed 2026-08-26

  526. 卡片 526

    问题

    What should a clinician do after sending protected information to the wrong recipient?

    答案

    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. 卡片 527

    问题

    Which clinical pattern defines a panic attack?

    答案

    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. 卡片 528

    问题

    What clinical clue should raise suspicion for acute kidney injury?

    答案

    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. 卡片 529

    问题

    What physiologic disturbance underlies tension pneumothorax?

    答案

    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

  532. 卡片 532

    问题

    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?

    答案

    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

  536. 卡片 536

    问题

    Which prevention or risk-reduction step is important for community-acquired pneumonia?

    答案

    Keep age- and risk-appropriate pneumococcal vaccination current to reduce preventable pneumococcal pneumonia.

    Pneumococcal Vaccine Recommendations · reviewed 2026-08-26

  538. 卡片 538

    问题

    Which prevention or risk-reduction step is important for ectopic pregnancy?

    答案

    Early testing after a missed period and prompt evaluation of pain or bleeding reduce rupture morbidity.

    Ectopic Pregnancy · reviewed 2026-08-26

  542. 卡片 542

    问题

    In a child or adolescent, what drug class or regimen fits diabetic ketoacidosis?

    答案

    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. 卡片 543

    问题

    What is the key first diagnostic step for peritonsillar abscess?

    答案

    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. 卡片 544

    问题

    What does continuity require before ending a clinician-patient relationship?

    答案

    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. 卡片 545

    问题

    What counseling point helps reduce harm from chronic hepatitis C?

    答案

    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

  547. 卡片 547

    问题

    In a child or adolescent, what counseling point helps reduce harm from juvenile idiopathic arthritis?

    答案

    Vaccination, eye screening, activity, and growth monitoring reduce preventable morbidity.

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

  549. 卡片 549

    问题

    A clinician is considering subarachnoid hemorrhage. Which finding adds the most support?

    答案

    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

  551. 卡片 551

    问题

    In a child, typically 6 months to 3 years, what counseling point helps reduce harm from croup?

    答案

    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. 卡片 552

    问题

    In a child or adolescent, a clinician is considering bacterial meningitis. Which finding adds the most support?

    答案

    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. 卡片 553

    问题

    A clinician is considering preeclampsia with severe features. Which finding adds the most support?

    答案

    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. 卡片 554

    问题

    A clinician is considering bipolar I mania. Which finding adds the most support?

    答案

    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

  558. 卡片 558

    问题

    Which bedside pattern best points to retinal detachment?

    答案

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

    Retinal Detachment · reviewed 2026-08-26

  559. 卡片 559

    问题

    How should a clinician respond when requested to falsify a work note or record?

    答案

    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. 卡片 560

    问题

    How can a clinician reduce avoidable harm related to hypertensive emergency?

    答案

    Accurate home monitoring and sustained treatment adherence reduce progression to crisis.

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

  561. 卡片 561

    问题

    What clinical clue should raise suspicion for COPD?

    答案

    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. 卡片 562

    问题

    Which pharmacologic approach is preferred for acute pyelonephritis?

    答案

    Select empiric therapy from local resistance and severity, then narrow to the culture.

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

  563. 卡片 563

    问题

    Which history or examination finding most strongly supports plaque psoriasis?

    答案

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  564. 卡片 564

    问题

    What immediate plan is appropriate for Parkinson disease?

    答案

    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. 卡片 565

    问题

    Which diagnosis best fits hypotonic euvolemic hyponatremia with inappropriately concentrated urine after thyroid, adrenal, renal, and diuretic causes are excluded?

    答案

    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. 卡片 566

    问题

    What immediate plan is appropriate for gonococcal urethritis or cervicitis?

    答案

    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

  568. 卡片 568

    问题

    What immediate plan is appropriate for menopause vasomotor symptoms?

    答案

    Match treatment to symptom burden, uterus status, contraindications, and patient preference.

    Hormone Therapy for Menopause · reviewed 2026-08-26

  574. 卡片 574

    问题

    In a child or adolescent, which bedside pattern best points to diabetic ketoacidosis?

    答案

    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. 卡片 575

    问题

    For surgical decision-making, how should a clinician initially manage peritonsillar abscess?

    答案

    Assess the airway, drain the abscess, hydrate, and treat infection.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  576. 卡片 576

    问题

    Which factors determine a PA’s scope of practice?

    答案

    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

  581. 卡片 581

    问题

    Which diagnosis is defined by acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult?

    答案

    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. 卡片 582

    问题

    What medication strategy is appropriate for ectopic pregnancy?

    答案

    Methotrexate is an option for selected stable unruptured ectopic pregnancy without contraindications.

    Ectopic Pregnancy · reviewed 2026-08-26

  584. 卡片 584

    问题

    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.

    答案

    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. 卡片 585

    问题

    Which pharmacologic approach is preferred for a postmenopausal woman with osteoporosis at high fracture risk?

    答案

    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

  587. 卡片 587

    问题

    Which diagnosis best fits dysuria and frequency without vaginal symptoms in an otherwise appropriate patient?

    答案

    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

  589. 卡片 589

    问题

    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.

    答案

    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. 卡片 590

    问题

    What is the purpose of root cause analysis after a serious patient-safety event?

    答案

    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. 卡片 591

    问题

    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?

    答案

    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

  593. 卡片 593

    问题

    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?

    答案

    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. 卡片 594

    问题

    Which diagnosis requires bradykinesia plus rest tremor or rigidity and often includes reduced arm swing or a shuffling gait?

    答案

    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. 卡片 595

    问题

    Which diagnosis best fits purulent urethral discharge, dysuria, cervicitis, pelvic pain, or a relevant sexual exposure, although infection may be asymptomatic?

    答案

    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. 卡片 596

    问题

    Which diagnosis best fits hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age?

    答案

    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. 卡片 597

    问题

    Which diagnosis causes tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use?

    答案

    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. 卡片 598

    问题

    Which diagnosis causes bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation?

    答案

    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. 卡片 599

    问题

    Which diagnosis best fits abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint?

    答案

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

    Gout · reviewed 2026-08-26

  600. 卡片 600

    问题

    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.

    答案

    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

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