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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.

Автор Flashcards Open Source App

За това тесте

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.

Карти в това тесте

  2. Карта 2

    Въпрос

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

    Отговор

    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. Карта 3

    Въпрос

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

    Отговор

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  8. Карта 8

    Въпрос

    What core mechanism explains ectopic pregnancy?

    Отговор

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

    Ectopic Pregnancy · reviewed 2026-08-26

  10. Карта 10

    Въпрос

    What core mechanism explains type 2 diabetes mellitus?

    Отговор

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

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

  11. Карта 11

    Въпрос

    What core mechanism explains acute angle-closure glaucoma?

    Отговор

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

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

  13. Карта 13

    Въпрос

    What core mechanism explains chronic kidney disease?

    Отговор

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

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

  16. Карта 16

    Въпрос

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

    Отговор

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  18. Карта 18

    Въпрос

    What core mechanism explains uncomplicated cystitis?

    Отговор

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

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

  19. Карта 19

    Въпрос

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

    Отговор

    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. Карта 20

    Въпрос

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

    Отговор

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

    Informed Consent · reviewed 2026-08-26

  21. Карта 21

    Въпрос

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

    Отговор

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

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

  22. Карта 22

    Въпрос

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

    Отговор

    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. Карта 23

    Въпрос

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

    Отговор

    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. Карта 24

    Въпрос

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

    Отговор

    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. Карта 25

    Въпрос

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

    Отговор

    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. Карта 27

    Въпрос

    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.

    Отговор

    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. Карта 28

    Въпрос

    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.

    Отговор

    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. Карта 30

    Въпрос

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

    Отговор

    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. Карта 34

    Въпрос

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

    Отговор

    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. Карта 35

    Въпрос

    What clinical clue should raise suspicion for pulmonary tuberculosis?

    Отговор

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

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

  36. Карта 36

    Въпрос

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

    Отговор

    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. Карта 37

    Въпрос

    What clinical clue should raise suspicion for endometriosis?

    Отговор

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

    Endometriosis · reviewed 2026-08-26

  38. Карта 38

    Въпрос

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

    Отговор

    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. Карта 39

    Въпрос

    What clinical clue should raise suspicion for panic disorder?

    Отговор

    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. Карта 41

    Въпрос

    What clinical clue should raise suspicion for tension pneumothorax?

    Отговор

    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. Карта 42

    Въпрос

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

    Отговор

    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. Карта 43

    Въпрос

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

    Отговор

    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. Карта 44

    Въпрос

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

    Отговор

    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. Карта 45

    Въпрос

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

    Отговор

    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. Карта 46

    Въпрос

    Which next action matters most in Crohn disease?

    Отговор

    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. Карта 48

    Въпрос

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

    Отговор

    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. Карта 51

    Въпрос

    Which next action matters most in multiple sclerosis relapse?

    Отговор

    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. Карта 52

    Въпрос

    Which next action matters most in HIV infection?

    Отговор

    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. Карта 53

    Въпрос

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

    Отговор

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  54. Карта 54

    Въпрос

    Which next action matters most in delirium?

    Отговор

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

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

  55. Карта 55

    Въпрос

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

    Отговор

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

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

  58. Карта 58

    Въпрос

    What clinical clue should raise suspicion for acute bacterial rhinosinusitis?

    Отговор

    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. Карта 59

    Въпрос

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

    Отговор

    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. Карта 61

    Въпрос

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

    Отговор

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  65. Карта 65

    Въпрос

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

    Отговор

    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. Карта 67

    Въпрос

    What drug class or regimen fits sepsis?

    Отговор

    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

  70. Карта 70

    Въпрос

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

    Отговор

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

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

  71. Карта 71

    Въпрос

    What drug class or regimen fits schizophrenia?

    Отговор

    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. Карта 73

    Въпрос

    What is the key first diagnostic step for primary hypothyroidism?

    Отговор

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

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

  74. Карта 74

    Въпрос

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

    Отговор

    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. Карта 76

    Въпрос

    What makes informed consent more than a signed form?

    Отговор

    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. Карта 77

    Въпрос

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

    Отговор

    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

  79. Карта 79

    Въпрос

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

    Отговор

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

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

  80. Карта 80

    Въпрос

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

    Отговор

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

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

  81. Карта 81

    Въпрос

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

    Отговор

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

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

  82. Карта 82

    Въпрос

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

    Отговор

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  83. Карта 83

    Въпрос

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

    Отговор

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

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

  84. Карта 84

    Въпрос

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

    Отговор

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

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

  88. Карта 88

    Въпрос

    What drug class or regimen fits chronic kidney disease?

    Отговор

    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. Карта 89

    Въпрос

    Which microbiologic test is essential when gonococcal conjunctivitis is suspected?

    Отговор

    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. Карта 91

    Въпрос

    When may treatment proceed without prior consent in an emergency?

    Отговор

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

    Informed Consent · reviewed 2026-08-26

  92. Карта 92

    Въпрос

    What drug class or regimen fits primary adrenal insufficiency?

    Отговор

    Replace glucocorticoid and usually mineralocorticoid in chronic primary disease.

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

  93. Карта 93

    Въпрос

    What is the key first diagnostic step for subarachnoid hemorrhage?

    Отговор

    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. Карта 95

    Въпрос

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

    Отговор

    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. Карта 96

    Въпрос

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

    Отговор

    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. Карта 97

    Въпрос

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

    Отговор

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  99. Карта 99

    Въпрос

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

    Отговор

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

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

  100. Карта 100

    Въпрос

    How should medication be used in hypertensive emergency?

    Отговор

    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. Карта 105

    Въпрос

    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?

    Отговор

    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. Карта 107

    Въпрос

    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.

    Отговор

    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. Карта 108

    Въпрос

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

    Отговор

    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. Карта 109

    Въпрос

    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.

    Отговор

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  110. Карта 110

    Въпрос

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

    Отговор

    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. Карта 111

    Въпрос

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

    Отговор

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

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

  113. Карта 113

    Въпрос

    Which next action matters most in uncomplicated cystitis?

    Отговор

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

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

  114. Карта 114

    Въпрос

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

    Отговор

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

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

  116. Карта 116

    Въпрос

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

    Отговор

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

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

  118. Карта 118

    Въпрос

    What is the key first diagnostic step for herpes zoster?

    Отговор

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

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

  119. Карта 119

    Въпрос

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

    Отговор

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

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

  120. Карта 120

    Въпрос

    Which bedside pattern best points to migraine with aura?

    Отговор

    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. Карта 121

    Въпрос

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

    Отговор

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

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

  122. Карта 122

    Въпрос

    Which bedside pattern best points to early syphilis?

    Отговор

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

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

  123. Карта 123

    Въпрос

    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.

    Отговор

    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. Карта 124

    Въпрос

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

    Отговор

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  125. Карта 125

    Въпрос

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

    Отговор

    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. Карта 128

    Въпрос

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

    Отговор

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  129. Карта 129

    Въпрос

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

    Отговор

    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. Карта 132

    Въпрос

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

    Отговор

    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. Карта 133

    Въпрос

    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?

    Отговор

    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. Карта 135

    Въпрос

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

    Отговор

    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. Карта 137

    Въпрос

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

    Отговор

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  138. Карта 138

    Въпрос

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

    Отговор

    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. Карта 139

    Въпрос

    What counseling point helps reduce harm from tension pneumothorax?

    Отговор

    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. Карта 141

    Въпрос

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

    Отговор

    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. Карта 144

    Въпрос

    How should a clinician initially manage primary hypothyroidism?

    Отговор

    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. Карта 145

    Въпрос

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

    Отговор

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

    Carpal Tunnel Syndrome · reviewed 2026-08-26

  146. Карта 146

    Въпрос

    How should a clinician initially manage bacterial conjunctivitis?

    Отговор

    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. Карта 147

    Въпрос

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

    Отговор

    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. Карта 149

    Въпрос

    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.

    Отговор

    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. Карта 151

    Въпрос

    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?

    Отговор

    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. Карта 152

    Въпрос

    How should medication be used in pulmonary tuberculosis?

    Отговор

    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. Карта 153

    Въпрос

    How should medication be used in endometriosis?

    Отговор

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

    Endometriosis · reviewed 2026-08-26

  154. Карта 154

    Въпрос

    How should medication be used in panic disorder?

    Отговор

    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. Карта 156

    Въпрос

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

    Отговор

    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. Карта 157

    Въпрос

    Which bedside pattern best points to primary adrenal insufficiency?

    Отговор

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

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

  158. Карта 158

    Въпрос

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

    Отговор

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

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

  160. Карта 160

    Въпрос

    Which pathophysiologic process drives heart failure with reduced ejection fraction?

    Отговор

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

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

  161. Карта 161

    Въпрос

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

    Отговор

    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. Карта 163

    Въпрос

    What is the key first diagnostic step for testicular torsion?

    Отговор

    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. Карта 164

    Въпрос

    What counseling point helps reduce harm from Parkinson disease?

    Отговор

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

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

  166. Карта 166

    Въпрос

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

    Отговор

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

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

  168. Карта 168

    Въпрос

    What counseling point helps reduce harm from menopause vasomotor symptoms?

    Отговор

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

    The Menopause Years · reviewed 2026-08-26

  169. Карта 169

    Въпрос

    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?

    Отговор

    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. Карта 172

    Въпрос

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

    Отговор

    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. Карта 175

    Въпрос

    How should medication be used in sudden sensorineural hearing loss?

    Отговор

    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. Карта 176

    Въпрос

    What is the HIPAA minimum-necessary rule?

    Отговор

    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. Карта 177

    Въпрос

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

    Отговор

    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. Карта 178

    Въпрос

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

    Отговор

    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. Карта 179

    Въпрос

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

    Отговор

    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. Карта 180

    Въпрос

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

    Отговор

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

    Gout · reviewed 2026-08-26

  181. Карта 181

    Въпрос

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

    Отговор

    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. Карта 182

    Въпрос

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

    Отговор

    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. Карта 183

    Въпрос

    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?

    Отговор

    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. Карта 184

    Въпрос

    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?

    Отговор

    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. Карта 186

    Въпрос

    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.

    Отговор

    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. Карта 188

    Въпрос

    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.

    Отговор

    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. Карта 191

    Въпрос

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

    Отговор

    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. Карта 192

    Въпрос

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

    Отговор

    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. Карта 193

    Въпрос

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

    Отговор

    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. Карта 194

    Въпрос

    What immediate plan is appropriate for chronic hepatitis C?

    Отговор

    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. Карта 195

    Въпрос

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

    Отговор

    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. Карта 196

    Въпрос

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

    Отговор

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

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

  197. Карта 197

    Въпрос

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

    Отговор

    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. Карта 198

    Въпрос

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

    Отговор

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

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

  199. Карта 199

    Въпрос

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

    Отговор

    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

  202. Карта 202

    Въпрос

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

    Отговор

    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. Карта 203

    Въпрос

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

    Отговор

    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. Карта 204

    Въпрос

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

    Отговор

    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. Карта 206

    Въпрос

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

    Отговор

    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. Карта 207

    Въпрос

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

    Отговор

    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. Карта 208

    Въпрос

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

    Отговор

    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. Карта 209

    Въпрос

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

    Отговор

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

    Retinal Detachment · reviewed 2026-08-26

  210. Карта 210

    Въпрос

    What immediate plan is appropriate for bipolar I mania?

    Отговор

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

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

  211. Карта 211

    Въпрос

    May a clinician leave appointment information in a voicemail?

    Отговор

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

    Incidental Uses and Disclosures · reviewed 2026-08-26

  212. Карта 212

    Въпрос

    When is a loop diuretic appropriate in acute kidney injury?

    Отговор

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

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

  213. Карта 213

    Въпрос

    How should a clinician initially manage plaque psoriasis?

    Отговор

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  216. Карта 216

    Въпрос

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

    Отговор

    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. Карта 217

    Въпрос

    Which pathophysiologic process drives COPD?

    Отговор

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

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

  218. Карта 218

    Въпрос

    Which history or examination finding most strongly supports Crohn disease?

    Отговор

    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. Карта 221

    Въпрос

    What clinical clue should raise suspicion for hypertensive emergency?

    Отговор

    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. Карта 225

    Въпрос

    What counseling point helps reduce harm from peritonsillar abscess?

    Отговор

    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. Карта 227

    Въпрос

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

    Отговор

    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. Карта 230

    Въпрос

    Which bedside pattern best points to herpes zoster?

    Отговор

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

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

  231. Карта 231

    Въпрос

    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?

    Отговор

    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. Карта 232

    Въпрос

    Which bedside pattern best points to testicular torsion?

    Отговор

    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. Карта 233

    Въпрос

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

    Отговор

    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. Карта 234

    Въпрос

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

    Отговор

    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. Карта 235

    Въпрос

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

    Отговор

    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. Карта 236

    Въпрос

    What diagnostic approach is most appropriate when sepsis is suspected?

    Отговор

    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. Карта 237

    Въпрос

    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?

    Отговор

    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. Карта 238

    Въпрос

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

    Отговор

    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. Карта 239

    Въпрос

    Which pharmacologic approach is preferred for COPD?

    Отговор

    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. Карта 240

    Въпрос

    What diagnostic approach is most appropriate when schizophrenia is suspected?

    Отговор

    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. Карта 241

    Въпрос

    Which next action matters most in hypertensive emergency?

    Отговор

    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. Карта 242

    Въпрос

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

    Отговор

    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

  245. Карта 245

    Въпрос

    What immediate plan is appropriate for acute bacterial rhinosinusitis?

    Отговор

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

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

  246. Карта 246

    Въпрос

    Which preventive measure belongs in care for gout flare?

    Отговор

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

    Gout · reviewed 2026-08-26

  249. Карта 249

    Въпрос

    Which test or testing sequence best evaluates suspected COPD?

    Отговор

    Post-bronchodilator spirometry confirms persistent airflow obstruction.

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

  251. Карта 251

    Въпрос

    Which pathophysiologic process drives subarachnoid hemorrhage?

    Отговор

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

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

  252. Карта 252

    Въпрос

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

    Отговор

    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. Карта 253

    Въпрос

    Which pathophysiologic process drives preeclampsia with severe features?

    Отговор

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  254. Карта 254

    Въпрос

    Which clinical feature defines bipolar I disorder?

    Отговор

    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. Карта 255

    Въпрос

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

    Отговор

    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. Карта 256

    Въпрос

    Which history or examination finding most strongly supports rheumatoid arthritis?

    Отговор

    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. Карта 257

    Въпрос

    What is teach-back?

    Отговор

    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. Карта 260

    Въпрос

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

    Отговор

    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. Карта 261

    Въпрос

    Which preventive measure belongs in care for obstructive sleep apnea?

    Отговор

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

    Sleep Apnea Treatment · reviewed 2026-08-26

  262. Карта 262

    Въпрос

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

    Отговор

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  263. Карта 263

    Въпрос

    How should a clinician initially manage acute pyelonephritis?

    Отговор

    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. Карта 264

    Въпрос

    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.

    Отговор

    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. Карта 266

    Въпрос

    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.

    Отговор

    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. Карта 267

    Въпрос

    What drug class or regimen fits stable chronic hypertension?

    Отговор

    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. Карта 268

    Въпрос

    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.

    Отговор

    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. Карта 269

    Въпрос

    Which pharmacologic approach is preferred for acute pancreatitis?

    Отговор

    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. Карта 270

    Въпрос

    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.

    Отговор

    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. Карта 271

    Въпрос

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

    Отговор

    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. Карта 273

    Въпрос

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

    Отговор

    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. Карта 274

    Въпрос

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

    Отговор

    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. Карта 275

    Въпрос

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

    Отговор

    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. Карта 276

    Въпрос

    Which pathophysiologic process drives retinal detachment?

    Отговор

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

    Retinal Detachment · reviewed 2026-08-26

  279. Карта 279

    Въпрос

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

    Отговор

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

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

  280. Карта 280

    Въпрос

    Which preventive measure belongs in care for Clostridioides difficile infection?

    Отговор

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

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

  281. Карта 281

    Въпрос

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

    Отговор

    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. Карта 282

    Въпрос

    Which preventive measure belongs in care for shoulder dystocia?

    Отговор

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

    Shoulder Dystocia · reviewed 2026-08-26

  284. Карта 284

    Въпрос

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

    Отговор

    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. Карта 287

    Въпрос

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

    Отговор

    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. Карта 289

    Въпрос

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

    Отговор

    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. Карта 290

    Въпрос

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

    Отговор

    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. Карта 291

    Въпрос

    What medication strategy is appropriate for peritonsillar abscess?

    Отговор

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  292. Карта 292

    Въпрос

    What belongs in a safe handoff?

    Отговор

    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. Карта 294

    Въпрос

    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.

    Отговор

    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. Карта 297

    Въпрос

    Which history or examination finding most strongly supports shoulder dystocia?

    Отговор

    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. Карта 298

    Въпрос

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

    Отговор

    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. Карта 300

    Въпрос

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

    Отговор

    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.

    600 карти

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

    Учете с това тесте безплатно

    Nibomo се отваря, за да започнете да учите.

  303. Карта 303

    Въпрос

    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.

    Отговор

    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. Карта 305

    Въпрос

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

    Отговор

    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. Карта 306

    Въпрос

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

    Отговор

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

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

  307. Карта 307

    Въпрос

    What is the priority management step for sepsis?

    Отговор

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

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

  308. Карта 308

    Въпрос

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

    Отговор

    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. Карта 309

    Въпрос

    What is the priority management step for pelvic inflammatory disease?

    Отговор

    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. Карта 310

    Въпрос

    What is closed-loop communication during an emergency?

    Отговор

    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. Карта 311

    Въпрос

    What is the priority management step for schizophrenia?

    Отговор

    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. Карта 317

    Въпрос

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

    Отговор

    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. Карта 318

    Въпрос

    Which test or testing sequence best evaluates suspected acute cholecystitis?

    Отговор

    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. Карта 319

    Въпрос

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

    Отговор

    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. Карта 320

    Въпрос

    Which pharmacologic approach is preferred for Parkinson disease?

    Отговор

    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. Карта 321

    Въпрос

    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?

    Отговор

    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. Карта 322

    Въпрос

    Which pharmacologic approach is preferred for gonococcal urethritis or cervicitis?

    Отговор

    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. Карта 323

    Въпрос

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

    Отговор

    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. Карта 324

    Въпрос

    Which pharmacologic approach is preferred for menopause vasomotor symptoms?

    Отговор

    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. Карта 325

    Въпрос

    How should a clinician handle an ambiguous verbal medication order?

    Отговор

    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. Карта 327

    Въпрос

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

    Отговор

    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

  329. Карта 329

    Въпрос

    What counseling point helps reduce harm from acute kidney injury?

    Отговор

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

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

  331. Карта 331

    Въпрос

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

    Отговор

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

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

  334. Карта 334

    Въпрос

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

    Отговор

    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. Карта 335

    Въпрос

    How should medication be used in herpes zoster?

    Отговор

    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. Карта 336

    Въпрос

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

    Отговор

    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. Карта 337

    Въпрос

    What medication strategy is appropriate for uncomplicated cystitis?

    Отговор

    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. Карта 338

    Въпрос

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

    Отговор

    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. Карта 339

    Въпрос

    How should a clinician confirm or characterize pulmonary embolism?

    Отговор

    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. Карта 340

    Въпрос

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

    Отговор

    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. Карта 342

    Въпрос

    What is the priority management step for primary adrenal insufficiency?

    Отговор

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

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

  344. Карта 344

    Въпрос

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

    Отговор

    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. Карта 345

    Въпрос

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

    Отговор

    Use 14-day optimized bismuth quadruple therapy: a proton-pump inhibitor, bismuth, tetracycline, and metronidazole.

    ACG Clinical Guideline: Treatment of Helicobacter pylori Infection · reviewed 2026-08-26

  346. Карта 346

    Въпрос

    In a child or adolescent, which diagnosis best fits this presentation: Hematuria with dysmorphic red cells or casts, hypertension, edema, and reduced kidney function suggests glomerular inflammation.

    Отговор

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

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

  352. Карта 352

    Въпрос

    Which test or testing sequence best evaluates suspected pulmonary tuberculosis?

    Отговор

    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. Карта 353

    Въпрос

    Which test or testing sequence best evaluates suspected endometriosis?

    Отговор

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

    Endometriosis · reviewed 2026-08-26

  354. Карта 354

    Въпрос

    Which test or testing sequence best evaluates suspected panic disorder?

    Отговор

    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. Карта 355

    Въпрос

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

    Отговор

    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. Карта 358

    Въпрос

    Which history or examination finding most strongly supports peritonsillar abscess?

    Отговор

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  359. Карта 359

    Въпрос

    When should a safety event or near miss be reported?

    Отговор

    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

  361. Карта 361

    Въпрос

    Which bedside pattern best points to pleural effusion?

    Отговор

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

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

  362. Карта 362

    Въпрос

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

    Отговор

    Prompt complete diagnostic excision and staging guide definitive surgical management.

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  363. Карта 363

    Въпрос

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

    Отговор

    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. Карта 364

    Въпрос

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

    Отговор

    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. Карта 365

    Въпрос

    What is the priority management step for chronic kidney disease?

    Отговор

    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. Карта 366

    Въпрос

    Why does sepsis produce its defining clinical pattern?

    Отговор

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

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

  367. Карта 367

    Въпрос

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

    Отговор

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

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

  368. Карта 368

    Въпрос

    Why does pelvic inflammatory disease produce its defining clinical pattern?

    Отговор

    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. Карта 369

    Въпрос

    Which bedside pattern best points to chronic hepatitis C?

    Отговор

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

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  370. Карта 370

    Въпрос

    Which symptom domains should a clinician assess in schizophrenia?

    Отговор

    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. Карта 371

    Въпрос

    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?

    Отговор

    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. Карта 372

    Въпрос

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

    Отговор

    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. Карта 373

    Въпрос

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

    Отговор

    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. Карта 374

    Въпрос

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

    Отговор

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

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

  376. Карта 376

    Въпрос

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

    Отговор

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

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

  377. Карта 377

    Въпрос

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

    Отговор

    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. Карта 378

    Въпрос

    What clinical clue should raise suspicion for multiple sclerosis relapse?

    Отговор

    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. Карта 380

    Въпрос

    What clinical clue should raise suspicion for HIV infection?

    Отговор

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

    About HIV · reviewed 2026-08-26

  382. Карта 382

    Въпрос

    What clinical clue should raise suspicion for postpartum hemorrhage?

    Отговор

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  384. Карта 384

    Въпрос

    What clinical clue should raise suspicion for delirium?

    Отговор

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

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

  385. Карта 385

    Въпрос

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

    Отговор

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  387. Карта 387

    Въпрос

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

    Отговор

    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. Карта 389

    Въпрос

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

    Отговор

    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. Карта 390

    Въпрос

    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.

    Отговор

    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. Карта 392

    Въпрос

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

    Отговор

    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. Карта 394

    Въпрос

    How should a clinician confirm or characterize acute pancreatitis?

    Отговор

    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. Карта 395

    Въпрос

    Which next action matters most in pulmonary tuberculosis?

    Отговор

    Isolate suspected contagious disease and coordinate promptly with public health.

    Tuberculosis Infection Control · reviewed 2026-08-26

  397. Карта 397

    Въпрос

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

    Отговор

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

    Endometriosis · reviewed 2026-08-26

  398. Карта 398

    Въпрос

    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?

    Отговор

    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. Карта 399

    Въпрос

    Which next action matters most in panic disorder?

    Отговор

    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. Карта 401

    Въпрос

    What immediate plan is appropriate for COPD?

    Отговор

    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. Карта 402

    Въпрос

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

    Отговор

    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. Карта 403

    Въпрос

    What is the priority management step for stable chronic hypertension?

    Отговор

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

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

  408. Карта 408

    Въпрос

    Which medication prevents seizures in preeclampsia with severe features?

    Отговор

    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. Карта 409

    Въпрос

    What is shared decision-making?

    Отговор

    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. Карта 410

    Въпрос

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

    Отговор

    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. Карта 412

    Въпрос

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

    Отговор

    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. Карта 413

    Въпрос

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

    Отговор

    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. Карта 415

    Въпрос

    What counseling point helps reduce harm from symptomatic aortic stenosis?

    Отговор

    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. Карта 416

    Въпрос

    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.

    Отговор

    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. Карта 420

    Въпрос

    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.

    Отговор

    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. Карта 422

    Въпрос

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

    Отговор

    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. Карта 423

    Въпрос

    Which pharmacologic approach is preferred for type 2 diabetes mellitus?

    Отговор

    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. Карта 424

    Въпрос

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

    Отговор

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

    Endometriosis · reviewed 2026-08-26

  425. Карта 425

    Въпрос

    How should a clinician confirm or characterize sudden sensorineural hearing loss?

    Отговор

    Differentiate sensorineural from conductive loss with bedside testing and urgent audiometry.

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

  426. Карта 426

    Въпрос

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

    Отговор

    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. Карта 427

    Въпрос

    How should uncertainty be communicated?

    Отговор

    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. Карта 428

    Въпрос

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

    Отговор

    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. Карта 431

    Въпрос

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

    Отговор

    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. Карта 434

    Въпрос

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

    Отговор

    Do not offer vitamin D solely to treat multiple sclerosis.

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

  435. Карта 435

    Въпрос

    Which pathophysiologic process drives plaque psoriasis?

    Отговор

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  436. Карта 436

    Въпрос

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

    Отговор

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

    Preventing HIV · reviewed 2026-08-26

  437. Карта 437

    Въпрос

    Which pathophysiologic process drives acute pyelonephritis?

    Отговор

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

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

  438. Карта 438

    Въпрос

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

    Отговор

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  439. Карта 439

    Въпрос

    What is the key first diagnostic step for tension pneumothorax?

    Отговор

    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. Карта 440

    Въпрос

    How can a clinician reduce avoidable harm related to delirium?

    Отговор

    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. Карта 445

    Въпрос

    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?

    Отговор

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

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

  446. Карта 446

    Въпрос

    For surgical decision-making, a noncontact pivot causes an audible pop, immediate swelling, instability, and a positive Lachman test. What is the most likely diagnosis?

    Отговор

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

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

  448. Карта 448

    Въпрос

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

    Отговор

    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. Карта 450

    Въпрос

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

    Отговор

    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. Карта 451

    Въпрос

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

    Отговор

    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. Карта 452

    Въпрос

    Which bedside pattern best points to ectopic pregnancy?

    Отговор

    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. Карта 456

    Въпрос

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

    Отговор

    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. Карта 457

    Въпрос

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

    Отговор

    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. Карта 458

    Въпрос

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

    Отговор

    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. Карта 461

    Въпрос

    Which test or testing sequence best evaluates suspected plaque psoriasis?

    Отговор

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  463. Карта 463

    Въпрос

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

    Отговор

    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. Карта 466

    Въпрос

    How should a clinician initially manage early syphilis?

    Отговор

    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. Карта 469

    Въпрос

    Why does acute cholecystitis produce its defining clinical pattern?

    Отговор

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

    Cholecystectomy · reviewed 2026-08-26

  471. Карта 471

    Въпрос

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

    Отговор

    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. Карта 473

    Въпрос

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

    Отговор

    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. Карта 474

    Въпрос

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

    Отговор

    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. Карта 475

    Въпрос

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

    Отговор

    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. Карта 476

    Въпрос

    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?

    Отговор

    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. Карта 478

    Въпрос

    How should medication be used in multiple sclerosis relapse?

    Отговор

    High-dose corticosteroids shorten a disabling relapse; they do not alter long-term progression by themselves.

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

  479. Карта 479

    Въпрос

    What immediate plan is appropriate for acute pancreatitis?

    Отговор

    Use early isotonic fluids guided by response, analgesia, and early oral feeding as tolerated; address the cause.

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

  480. Карта 480

    Въпрос

    How should medication be used in HIV infection?

    Отговор

    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. Карта 482

    Въпрос

    How should medication be used in postpartum hemorrhage?

    Отговор

    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. Карта 483

    Въпрос

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

    Отговор

    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. Карта 484

    Въпрос

    How should medication be used in delirium?

    Отговор

    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. Карта 485

    Въпрос

    Which preventive measure belongs in care for herpes zoster?

    Отговор

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

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

  486. Карта 486

    Въпрос

    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.

    Отговор

    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. Карта 487

    Въпрос

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

    Отговор

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

    Testicular Torsion · reviewed 2026-08-26

  488. Карта 488

    Въпрос

    Which test or testing sequence best evaluates suspected hyponatremia due to SIADH?

    Отговор

    Confirm low serum osmolality with inappropriately concentrated urine and urine sodium after excluding thyroid, adrenal, renal, and diuretic causes.

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

  489. Карта 489

    Въпрос

    Why does primary hypothyroidism produce its defining clinical pattern?

    Отговор

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

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

  491. Карта 491

    Въпрос

    Why does bacterial conjunctivitis produce its defining clinical pattern?

    Отговор

    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. Карта 492

    Въпрос

    When is a chaperone appropriate for an intimate examination?

    Отговор

    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. Карта 493

    Въпрос

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

    Отговор

    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. Карта 494

    Въпрос

    What medication strategy is appropriate for Crohn disease?

    Отговор

    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. Карта 495

    Въпрос

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

    Отговор

    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. Карта 497

    Въпрос

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

    Отговор

    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. Карта 499

    Въпрос

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

    Отговор

    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

  501. Карта 501

    Въпрос

    Which diagnosis best fits loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension?

    Отговор

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

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

  502. Карта 502

    Въпрос

    What drug class or regimen fits atrial fibrillation?

    Отговор

    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. Карта 503

    Въпрос

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

    Отговор

    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. Карта 504

    Въпрос

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

    Отговор

    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. Карта 506

    Въпрос

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

    Отговор

    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. Карта 507

    Въпрос

    How should a clinician confirm or characterize early syphilis?

    Отговор

    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. Карта 508

    Въпрос

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

    Отговор

    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. Карта 510

    Въпрос

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

    Отговор

    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. Карта 513

    Въпрос

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

    Отговор

    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. Карта 516

    Въпрос

    Which history or examination finding most strongly supports acute pyelonephritis?

    Отговор

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

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

  517. Карта 517

    Въпрос

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

    Отговор

    Perform immediate decompression followed by tube thoracostomy.

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

  518. Карта 518

    Въпрос

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

    Отговор

    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. Карта 519

    Въпрос

    What physiologic disturbance underlies anterior cruciate ligament tear?

    Отговор

    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. Карта 520

    Въпрос

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

    Отговор

    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. Карта 523

    Въпрос

    What physiologic disturbance underlies pulmonary tuberculosis?

    Отговор

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

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

  524. Карта 524

    Въпрос

    Which antibiotic is required for gonococcal conjunctivitis in an adult?

    Отговор

    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. Карта 525

    Въпрос

    What physiologic disturbance underlies endometriosis?

    Отговор

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

    Endometriosis · reviewed 2026-08-26

  526. Карта 526

    Въпрос

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

    Отговор

    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. Карта 527

    Въпрос

    Which clinical pattern defines a panic attack?

    Отговор

    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. Карта 528

    Въпрос

    What clinical clue should raise suspicion for acute kidney injury?

    Отговор

    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. Карта 529

    Въпрос

    What physiologic disturbance underlies tension pneumothorax?

    Отговор

    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. Карта 532

    Въпрос

    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?

    Отговор

    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. Карта 536

    Въпрос

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

    Отговор

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

    Pneumococcal Vaccine Recommendations · reviewed 2026-08-26

  538. Карта 538

    Въпрос

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

    Отговор

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

    Ectopic Pregnancy · reviewed 2026-08-26

  542. Карта 542

    Въпрос

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

    Отговор

    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. Карта 543

    Въпрос

    What is the key first diagnostic step for peritonsillar abscess?

    Отговор

    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. Карта 544

    Въпрос

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

    Отговор

    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. Карта 545

    Въпрос

    What counseling point helps reduce harm from chronic hepatitis C?

    Отговор

    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. Карта 547

    Въпрос

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

    Отговор

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

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

  549. Карта 549

    Въпрос

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

    Отговор

    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. Карта 551

    Въпрос

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

    Отговор

    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. Карта 552

    Въпрос

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

    Отговор

    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. Карта 553

    Въпрос

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

    Отговор

    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. Карта 554

    Въпрос

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

    Отговор

    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. Карта 558

    Въпрос

    Which bedside pattern best points to retinal detachment?

    Отговор

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

    Retinal Detachment · reviewed 2026-08-26

  559. Карта 559

    Въпрос

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

    Отговор

    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. Карта 560

    Въпрос

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

    Отговор

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

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

  561. Карта 561

    Въпрос

    What clinical clue should raise suspicion for COPD?

    Отговор

    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. Карта 562

    Въпрос

    Which pharmacologic approach is preferred for acute pyelonephritis?

    Отговор

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

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

  563. Карта 563

    Въпрос

    Which history or examination finding most strongly supports plaque psoriasis?

    Отговор

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  564. Карта 564

    Въпрос

    What immediate plan is appropriate for Parkinson disease?

    Отговор

    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. Карта 565

    Въпрос

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

    Отговор

    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. Карта 566

    Въпрос

    What immediate plan is appropriate for gonococcal urethritis or cervicitis?

    Отговор

    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. Карта 568

    Въпрос

    What immediate plan is appropriate for menopause vasomotor symptoms?

    Отговор

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

    Hormone Therapy for Menopause · reviewed 2026-08-26

  574. Карта 574

    Въпрос

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

    Отговор

    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. Карта 575

    Въпрос

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

    Отговор

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  576. Карта 576

    Въпрос

    Which factors determine a PA’s scope of practice?

    Отговор

    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

  580. Карта 580

    Въпрос

    What medication strategy is appropriate for community-acquired pneumonia?

    Отговор

    Use guideline-concordant empiric antibiotics based on setting, comorbidity, and local resistance; narrow when microbiology permits.

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

  581. Карта 581

    Въпрос

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

    Отговор

    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. Карта 582

    Въпрос

    What medication strategy is appropriate for ectopic pregnancy?

    Отговор

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

    Ectopic Pregnancy · reviewed 2026-08-26

  584. Карта 584

    Въпрос

    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.

    Отговор

    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. Карта 585

    Въпрос

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

    Отговор

    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. Карта 587

    Въпрос

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

    Отговор

    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. Карта 589

    Въпрос

    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.

    Отговор

    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. Карта 590

    Въпрос

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

    Отговор

    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. Карта 591

    Въпрос

    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?

    Отговор

    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. Карта 593

    Въпрос

    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?

    Отговор

    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. Карта 594

    Въпрос

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

    Отговор

    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. Карта 595

    Въпрос

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

    Отговор

    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. Карта 596

    Въпрос

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

    Отговор

    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. Карта 597

    Въпрос

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

    Отговор

    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. Карта 598

    Въпрос

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

    Отговор

    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. Карта 599

    Въпрос

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

    Отговор

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

    Gout · reviewed 2026-08-26

  600. Карта 600

    Въпрос

    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.

    Отговор

    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

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

600 карти

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

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