What core mechanism explains acute coronary syndrome?

Plaque disruption with superimposed coronary thrombosis causes most acute coronary syndromes. 2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

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

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

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

Airway inflammation and hyperresponsiveness create variable, usually reversible airflow obstruction. 2026 GINA Strategy Report · reviewed 2026-08-26

What core mechanism explains upper gastrointestinal bleeding?

Bleeding proximal to the ligament of Treitz is altered by gastric acid and intestinal transit, producing hematemesis or melena. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

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

Bacterial invasion of synovium triggers destructive inflammation that can rapidly damage cartilage. Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

What core mechanism explains acute ischemic stroke?

Arterial occlusion deprives brain tissue of oxygen, leaving a salvageable penumbra around the infarct core. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

What core mechanism explains community-acquired pneumonia?

Alveolar infection fills air spaces with inflammatory exudate and impairs gas exchange. Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

What core mechanism explains ectopic pregnancy?

Implantation outside the endometrial cavity, usually in the tube, can erode vessels and rupture. Ectopic Pregnancy · reviewed 2026-08-26

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

Mood-network and stress-system dysregulation interacts with genetic and environmental vulnerability; no single neurotransmitter explains the disorder. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

What core mechanism explains type 2 diabetes mellitus?

Insulin resistance plus progressive beta-cell dysfunction produces chronic hyperglycemia. Standards of Care in Diabetes—2026 · reviewed 2026-08-26

What core mechanism explains acute angle-closure glaucoma?

Closure of the anterior-chamber angle blocks aqueous outflow and abruptly raises intraocular pressure. Management of Angle-Closure Glaucoma · reviewed 2026-08-26

What clinical clue should raise suspicion for 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

What core mechanism explains chronic kidney disease?

Progressive nephron loss causes hyperfiltration in remaining nephrons, fibrosis, and multisystem toxin accumulation. 2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

What core mechanism explains iron-deficiency anemia?

Iron depletion limits heme synthesis, producing hypochromic microcytes and eventually tissue iron symptoms. British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

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

Bronchiolitis. An infant with viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty likely has bronchiolitis. Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26

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

Skin-barrier dysfunction and type 2 inflammation increase transepidermal water loss and itch. Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

What clinical clue should raise suspicion for 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

What core mechanism explains uncomplicated cystitis?

Ascending periurethral bacteria inflame the bladder mucosa without renal-parenchymal involvement. EAU Guidelines on Urological Infections · reviewed 2026-08-26

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which next action matters most in acute respiratory distress syndrome?

Treat the cause, ventilate with low tidal volumes and limited pressures, and use prone positioning for severe hypoxemia. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26

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.

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

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.

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

What clinical clue should raise suspicion for 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

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

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

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

Start rapid heart-rate and blood-pressure control and obtain emergency surgical evaluation for ascending dissection. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

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

Iron-deficiency anemia. Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia. British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26

What clinical clue should raise suspicion for 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

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

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

What clinical clue should raise suspicion for pulmonary tuberculosis?

Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern. Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

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

Plaque psoriasis. Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis. Psoriasis Clinical Guidelines · reviewed 2026-08-26

What clinical clue should raise suspicion for endometriosis?

Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis. Endometriosis · reviewed 2026-08-26

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

Acute pyelonephritis. Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection. EAU Guidelines on Urological Infections · reviewed 2026-08-26

What clinical clue should raise suspicion for 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

What drug class or regimen fits acute pericarditis?

Use an NSAID plus colchicine for uncomplicated acute pericarditis when not contraindicated. 2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

What clinical clue should raise suspicion for 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

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

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

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

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

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

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

What clinical clue should raise suspicion for 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

Which next action matters most in Crohn disease?

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

Which next action matters most in rheumatoid arthritis?

Refer early and start disease-modifying therapy rather than relying on symptomatic treatment. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis · reviewed 2026-08-26

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

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

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

Control pressure and volume, treat the cause, and obtain urgent nephrology input for rapidly progressive loss. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26

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

Treat tobacco use, hypertension, diabetes, and dyslipidemia to reduce atherosclerotic risk. 2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

Which next action matters most in multiple sclerosis relapse?

Exclude infection or pseudo-relapse, then treat functionally significant relapse and reassess disease-modifying therapy. Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

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.

Per Flashcards Open Source App

Estudia aquesta baralla de franc

Nibomo s'obre perquè puguis començar a estudiar.

Detalls de la baralla

Targetes: 600 targetes
Versió: 1
Publicada: 26 d’agost del 2026
Última actualització: 10 de setembre del 2026
Llicència: Common knowledge · CC0 1.0
Idiomes del públic: en
Matèria: Medicine
Nivell: PANCE
Etiquetes: pance-cardiovascular, task-foundations, pance-professional, task-professional, pance-pulmonary, pance-gi-nutrition, pance-musculoskeletal, pance-neurology, pance-infectious, pance-reproductive, pance-psychiatry, pance-endocrine, pance-eent, task-history-exam, pance-renal, pance-hematology, task-diagnosis, pance-dermatology, pance-genitourinary, task-intervention, task-pharmacotherapy, task-prevention, task-diagnostics

Baralles similars

Sobre aquesta baralla

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.

Targetes d'aquesta baralla

Targeta 1
Pregunta
What core mechanism explains acute coronary syndrome?
Resposta
Plaque disruption with superimposed coronary thrombosis causes most acute coronary syndromes.

2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26
Targeta 2
Pregunta
When an adult patient with decision-making capacity refuses a recommended treatment, what is the clinician’s next step?
Resposta
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
Targeta 3
Pregunta
In a child or adolescent, what core mechanism explains asthma?
Resposta
Airway inflammation and hyperresponsiveness create variable, usually reversible airflow obstruction.

2026 GINA Strategy Report · reviewed 2026-08-26
Targeta 4
Pregunta
What core mechanism explains upper gastrointestinal bleeding?
Resposta
Bleeding proximal to the ligament of Treitz is altered by gastric acid and intestinal transit, producing hematemesis or melena.

ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26
Targeta 5
Pregunta
In a child or adolescent, what core mechanism explains septic arthritis?
Resposta
Bacterial invasion of synovium triggers destructive inflammation that can rapidly damage cartilage.

Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26
Targeta 6
Pregunta
What core mechanism explains acute ischemic stroke?
Resposta
Arterial occlusion deprives brain tissue of oxygen, leaving a salvageable penumbra around the infarct core.

2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26
Targeta 7
Pregunta
What core mechanism explains community-acquired pneumonia?
Resposta
Alveolar infection fills air spaces with inflammatory exudate and impairs gas exchange.

Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26
Targeta 8
Pregunta
What core mechanism explains ectopic pregnancy?
Resposta
Implantation outside the endometrial cavity, usually in the tube, can erode vessels and rupture.

Ectopic Pregnancy · reviewed 2026-08-26
Targeta 9
Pregunta
In a child or adolescent, what core mechanism explains major depressive disorder?
Resposta
Mood-network and stress-system dysregulation interacts with genetic and environmental vulnerability; no single neurotransmitter explains the disorder.

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26
Targeta 10
Pregunta
What core mechanism explains type 2 diabetes mellitus?
Resposta
Insulin resistance plus progressive beta-cell dysfunction produces chronic hyperglycemia.

Standards of Care in Diabetes—2026 · reviewed 2026-08-26
Targeta 11
Pregunta
What core mechanism explains acute angle-closure glaucoma?
Resposta
Closure of the anterior-chamber angle blocks aqueous outflow and abruptly raises intraocular pressure.

Management of Angle-Closure Glaucoma · reviewed 2026-08-26
Targeta 12
Pregunta
What clinical clue should raise suspicion for aortic dissection?
Resposta
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
Targeta 13
Pregunta
What core mechanism explains chronic kidney disease?
Resposta
Progressive nephron loss causes hyperfiltration in remaining nephrons, fibrosis, and multisystem toxin accumulation.

2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26
Targeta 14
Pregunta
What core mechanism explains iron-deficiency anemia?
Resposta
Iron depletion limits heme synthesis, producing hypochromic microcytes and eventually tissue iron symptoms.

British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26
Targeta 15
Pregunta
In an infant aged 1–23 months with a viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty, what is the most likely diagnosis?
Resposta
Bronchiolitis. An infant with viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty likely has bronchiolitis.

Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26
Targeta 16
Pregunta
In a child or adolescent, what core mechanism explains atopic dermatitis?
Resposta
Skin-barrier dysfunction and type 2 inflammation increase transepidermal water loss and itch.

Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26
Targeta 17
Pregunta
What clinical clue should raise suspicion for acute pancreatitis?
Resposta
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
Targeta 18
Pregunta
What core mechanism explains uncomplicated cystitis?
Resposta
Ascending periurethral bacteria inflame the bladder mucosa without renal-parenchymal involvement.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 19
Pregunta
Which diagnosis causes symmetric synovitis of the MCP, PIP, or wrist joints with prolonged morning stiffness?
Resposta
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
Targeta 20
Pregunta
What abilities are assessed when determining decision-making capacity for a specific choice?
Resposta
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
Targeta 21
Pregunta
Which diagnosis causes fluctuating, fatigable ptosis, diplopia, dysarthria, dysphagia, or proximal weakness that worsens with use?
Resposta
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
Targeta 22
Pregunta
Which diagnosis best fits new clinically significant diarrhea after antibiotics or healthcare exposure, especially with abdominal pain or leukocytosis?
Resposta
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
Targeta 23
Pregunta
For surgical decision-making, after delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicate which obstetric emergency?
Resposta
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
Targeta 24
Pregunta
In a child or adolescent, which diagnosis causes persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment?
Resposta
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
Targeta 25
Pregunta
Which diagnosis best fits sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation?
Resposta
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
Targeta 26
Pregunta
Which next action matters most in acute respiratory distress syndrome?
Resposta
Treat the cause, ventilate with low tidal volumes and limited pressures, and use prone positioning for severe hypoxemia.

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26
Targeta 27
Pregunta
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.
Resposta
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
Targeta 28
Pregunta
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.
Resposta
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
Targeta 29
Pregunta
What clinical clue should raise suspicion for anterior cruciate ligament tear?
Resposta
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
Targeta 30
Pregunta
Which diagnosis may be silent until edema, pruritus, anemia, hypertension, or abnormal urine testing appears?
Resposta
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
Targeta 31
Pregunta
For surgical decision-making, which next action matters most in aortic dissection?
Resposta
Start rapid heart-rate and blood-pressure control and obtain emergency surgical evaluation for ascending dissection.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26
Targeta 32
Pregunta
Identify the condition from this pattern: Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia.
Resposta
Iron-deficiency anemia. Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia.

British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26
Targeta 33
Pregunta
What clinical clue should raise suspicion for bacterial brain abscess?
Resposta
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
Targeta 34
Pregunta
Which diagnosis best fits chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions?
Resposta
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
Targeta 35
Pregunta
What clinical clue should raise suspicion for pulmonary tuberculosis?
Resposta
Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26
Targeta 36
Pregunta
Which diagnosis causes well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting?
Resposta
Plaque psoriasis. Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis.

Psoriasis Clinical Guidelines · reviewed 2026-08-26
Targeta 37
Pregunta
What clinical clue should raise suspicion for endometriosis?
Resposta
Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis.

Endometriosis · reviewed 2026-08-26
Targeta 38
Pregunta
Identify the condition from this pattern: Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.
Resposta
Acute pyelonephritis. Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 39
Pregunta
What clinical clue should raise suspicion for panic disorder?
Resposta
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
Targeta 40
Pregunta
What drug class or regimen fits acute pericarditis?
Resposta
Use an NSAID plus colchicine for uncomplicated acute pericarditis when not contraindicated.

2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26
Targeta 41
Pregunta
What clinical clue should raise suspicion for tension pneumothorax?
Resposta
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
Targeta 42
Pregunta
In a child or adolescent, which next action matters most in diabetic ketoacidosis?
Resposta
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
Targeta 43
Pregunta
Who makes decisions when an adult patient lacks capacity and has no applicable advance directive?
Resposta
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
Targeta 44
Pregunta
For surgical decision-making, which next action matters most in retinal detachment?
Resposta
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
Targeta 45
Pregunta
What clinical clue should raise suspicion for acute deep-vein thrombosis?
Resposta
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
Targeta 46
Pregunta
Which next action matters most in Crohn disease?
Resposta
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
Targeta 47
Pregunta
Which next action matters most in rheumatoid arthritis?
Resposta
Refer early and start disease-modifying therapy rather than relying on symptomatic treatment.

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis · reviewed 2026-08-26
Targeta 48
Pregunta
What antimicrobial approach is appropriate for suspected or confirmed pleural infection?
Resposta
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
Targeta 49
Pregunta
In a child or adolescent, which next action matters most in nephritic syndrome?
Resposta
Control pressure and volume, treat the cause, and obtain urgent nephrology input for rapidly progressive loss.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 50
Pregunta
Which prevention or risk-reduction step is important for acute coronary syndrome?
Resposta
Treat tobacco use, hypertension, diabetes, and dyslipidemia to reduce atherosclerotic risk.

2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26
Targeta 51
Pregunta
Which next action matters most in multiple sclerosis relapse?
Resposta
Exclude infection or pseudo-relapse, then treat functionally significant relapse and reassess disease-modifying therapy.

Multiple Sclerosis in Adults: Management · reviewed 2026-08-26
Targeta 52
Pregunta
Which next action matters most in HIV infection?
Resposta
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
Targeta 53
Pregunta
For surgical decision-making, which next action matters most in postpartum hemorrhage?
Resposta
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
Targeta 54
Pregunta
Which next action matters most in delirium?
Resposta
Treat the cause, protect the patient, and use nonpharmacologic measures first.

Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26
Targeta 55
Pregunta
After successful endoscopic hemostasis of a high-risk bleeding peptic ulcer, what medication strategy is recommended?
Resposta
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
Targeta 56
Pregunta
What clinical clue should raise suspicion for thyroid storm?
Resposta
Fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in thyrotoxicosis suggest storm.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26
Targeta 57
Pregunta
In a child or adolescent, what drug class or regimen fits septic arthritis?
Resposta
Cover likely gram-positive organisms initially, adding gram-negative coverage for relevant risk.

Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26
Targeta 58
Pregunta
What clinical clue should raise suspicion for acute bacterial rhinosinusitis?
Resposta
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
Targeta 59
Pregunta
How should a clinician respond when a patient asks not to hear serious diagnostic information?
Resposta
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
Targeta 60
Pregunta
What is the key first diagnostic step for cardiac tamponade?
Resposta
Bedside echocardiography can show effusion with chamber collapse and respiratory flow variation.

2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26
Targeta 61
Pregunta
In a child or adolescent, which next action matters most in atopic dermatitis?
Resposta
Treat active inflammation and address infection, sleep disruption, and trigger exposure.

Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26
Targeta 62
Pregunta
What is the key first diagnostic step for idiopathic pulmonary fibrosis?
Resposta
High-resolution CT showing a usual interstitial pneumonia pattern can establish diagnosis in the right context; multidisciplinary review is key.

Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26
Targeta 63
Pregunta
What drug class or regimen fits benign prostatic hyperplasia?
Resposta
Alpha-1 blockers improve symptoms quickly; 5-alpha-reductase inhibitors reduce progression in appropriately enlarged prostates.

EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26
Targeta 64
Pregunta
In a child or adolescent, what clinical clue should raise suspicion for nephritic syndrome?
Resposta
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
Targeta 65
Pregunta
In a child or adolescent, which initial medication regimen is indicated for a convulsive seizure lasting at least five minutes or recurring without recovery?
Resposta
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
Targeta 66
Pregunta
Which next action matters most in acute deep-vein thrombosis?
Resposta
Start anticoagulation promptly after acute deep-vein thrombosis is confirmed, unless a contraindication changes the plan.

ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26
Targeta 67
Pregunta
What drug class or regimen fits sepsis?
Resposta
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
Targeta 68
Pregunta
Which bedside pattern best points to infective endocarditis?
Resposta
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
Targeta 69
Pregunta
What drug class or regimen fits pelvic inflammatory disease?
Resposta
Outpatient therapy commonly uses ceftriaxone plus doxycycline and metronidazole.

Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26
Targeta 70
Pregunta
Which prevention or risk-reduction step is important for acute pancreatitis?
Resposta
Treat gallstones, avoid alcohol excess, and control severe hypertriglyceridemia to reduce recurrence.

ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26
Targeta 71
Pregunta
What drug class or regimen fits schizophrenia?
Resposta
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
Targeta 72
Pregunta
Which prevention or risk-reduction step is important for anterior cruciate ligament tear?
Resposta
Neuromuscular warm-up and landing programs reduce noncontact ACL injuries in high-risk athletes.

Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 73
Pregunta
What is the key first diagnostic step for primary hypothyroidism?
Resposta
Measure TSH first in most patients and free T4 to characterize overt disease.

Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26
Targeta 74
Pregunta
In an acutely ill hospitalized medical patient, what VTE prevention strategy is appropriate?
Resposta
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
Targeta 75
Pregunta
In a child aged 6 months or older, what drug class or regimen fits acute otitis media?
Resposta
Amoxicillin is first-line for most children who need an antibiotic, with alternatives guided by allergy and prior treatment.

Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26
Targeta 76
Pregunta
What makes informed consent more than a signed form?
Resposta
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
Targeta 77
Pregunta
What condition should be suspected from this finding: Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.
Resposta
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
Targeta 78
Pregunta
Which prevention or risk-reduction step is important for migraine with aura?
Resposta
Regular sleep, meals, hydration, activity, trigger management, and limiting acute-medicine overuse reduce attacks.

AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26
Targeta 79
Pregunta
What is the key first diagnostic step for upper gastrointestinal bleeding?
Resposta
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
Targeta 80
Pregunta
Which prevention or risk-reduction step is important for early syphilis?
Resposta
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
Targeta 81
Pregunta
In a child or adolescent, what is the key first diagnostic step for septic arthritis?
Resposta
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
Targeta 82
Pregunta
Which prevention or risk-reduction step is important for abnormal uterine bleeding from anovulation?
Resposta
Address reversible causes of ovulatory dysfunction, review medicines that worsen bleeding, and monitor for anemia.

Abnormal Uterine Bleeding · reviewed 2026-08-26
Targeta 83
Pregunta
In a young child, which diagnosis best fits a barking cough, hoarseness, and inspiratory stridor after a viral prodrome?
Resposta
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
Targeta 84
Pregunta
Which intervention is recommended to reduce later PTSD in an adult diagnosed with acute stress disorder?
Resposta
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
Targeta 85
Pregunta
What clinical clue should raise suspicion for cellulitis?
Resposta
Unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border favor cellulitis.

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26
Targeta 86
Pregunta
How should a clinician initially manage infective endocarditis?
Resposta
Start targeted IV antibiotics after cultures; seek early valve-team input for heart failure, uncontrolled infection, or major embolic risk.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26
Targeta 87
Pregunta
What clinical clue should raise suspicion for benign prostatic hyperplasia?
Resposta
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
Targeta 88
Pregunta
What drug class or regimen fits chronic kidney disease?
Resposta
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
Targeta 89
Pregunta
Which microbiologic test is essential when gonococcal conjunctivitis is suspected?
Resposta
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
Targeta 90
Pregunta
What drug class or regimen fits iron-deficiency anemia?
Resposta
Oral iron is first-line for many patients; IV iron is useful when absorption, tolerance, severity, or speed makes oral therapy unsuitable.

British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26
Targeta 91
Pregunta
When may treatment proceed without prior consent in an emergency?
Resposta
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
Targeta 92
Pregunta
What drug class or regimen fits primary adrenal insufficiency?
Resposta
Replace glucocorticoid and usually mineralocorticoid in chronic primary disease.

Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26
Targeta 93
Pregunta
What is the key first diagnostic step for subarachnoid hemorrhage?
Resposta
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
Targeta 94
Pregunta
Which bedside pattern best points to celiac disease?
Resposta
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
Targeta 95
Pregunta
In a child or adolescent, what is the key first diagnostic step for bacterial meningitis?
Resposta
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
Targeta 96
Pregunta
In a postmenopausal woman or man aged 50 or older, which diagnosis is established by a hip or vertebral fragility fracture?
Resposta
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
Targeta 97
Pregunta
What is the key first diagnostic step for preeclampsia with severe features?
Resposta
Confirm pressure correctly and assess urine protein, CBC, creatinine, liver tests, fetal status, and symptoms.

Gestational Hypertension and Preeclampsia · reviewed 2026-08-26
Targeta 98
Pregunta
In an infant aged 1–23 months, how should a clinician initially manage bronchiolitis?
Resposta
Support oxygenation and hydration; use suction selectively and assess apnea or exhaustion.

Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26
Targeta 99
Pregunta
What is the key first diagnostic step for bipolar I mania?
Resposta
Diagnosis is clinical; assess substances, thyroid disease, medicines, psychosis, and safety.

Management of Bipolar Disorder in Adults · reviewed 2026-08-26
Targeta 100
Pregunta
How should medication be used in hypertensive emergency?
Resposta
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
Targeta 101
Pregunta
Which bedside pattern best points to obstructive sleep apnea?
Resposta
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
Targeta 102
Pregunta
What counseling point helps reduce harm from heart failure with reduced ejection fraction?
Resposta
Control blood pressure and coronary risk, and avoid medicines that worsen fluid retention.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26
Targeta 103
Pregunta
What condition should be suspected from this finding: Increasing abdominal girth, shifting dullness, edema, jaundice, or stigmata of portal hypertension suggest decompensation.
Resposta
Cirrhosis with ascites. Increasing abdominal girth, shifting dullness, edema, jaundice, or stigmata of portal hypertension suggest decompensation.

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26
Targeta 104
Pregunta
Which bedside pattern best points to carpal tunnel syndrome?
Resposta
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
Targeta 105
Pregunta
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?
Resposta
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
Targeta 106
Pregunta
Which prevention or risk-reduction step is important for primary hyperparathyroidism?
Resposta
Maintain hydration and avoid unnecessary calcium-raising medicines while monitoring patients who do not have surgery.

Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26
Targeta 107
Pregunta
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.
Resposta
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
Targeta 108
Pregunta
Which prevention or risk-reduction step is important for sudden sensorineural hearing loss?
Resposta
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
Targeta 109
Pregunta
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.
Resposta
Postpartum hemorrhage. Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

Postpartum Hemorrhage · reviewed 2026-08-26
Targeta 110
Pregunta
What is the clinician’s duty after recognizing a significant medical error that harmed a patient?
Resposta
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
Targeta 111
Pregunta
Which diagnosis causes an acute, fluctuating disturbance of attention and awareness with disorganized thinking?
Resposta
Delirium. An acute fluctuating disturbance of attention and awareness with disorganized thinking suggests delirium.

Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26
Targeta 112
Pregunta
In a child or adolescent, what is the key first diagnostic step for nephritic syndrome?
Resposta
Use urine microscopy, protein quantification, complement and serologic testing, and biopsy for severe or unclear disease.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 113
Pregunta
Which next action matters most in uncomplicated cystitis?
Resposta
Assess for pyelonephritis, pregnancy, obstruction, or sepsis before treating as uncomplicated disease.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 114
Pregunta
What is the key first diagnostic step for acute deep-vein thrombosis?
Resposta
Use pretest probability with D-dimer or compression ultrasonography rather than symptoms alone.

ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26
Targeta 115
Pregunta
How should medication be used in idiopathic pulmonary fibrosis?
Resposta
Nintedanib or pirfenidone can slow functional decline; neither reverses established fibrosis.

Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26
Targeta 116
Pregunta
What diagnostic approach is most appropriate when stable chronic hypertension is suspected?
Resposta
Confirm persistent elevation with standardized office technique and out-of-office monitoring when appropriate.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 117
Pregunta
How should a clinician initially manage cirrhosis with ascites?
Resposta
Restrict sodium, assess for infection, and perform large-volume paracentesis with albumin when tense ascites causes symptoms.

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26
Targeta 118
Pregunta
What is the key first diagnostic step for herpes zoster?
Resposta
Clinical diagnosis is typical; PCR from a lesion is most useful when confirmation matters.

Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26
Targeta 119
Pregunta
How should a clinician initially manage osteoporosis in a postmenopausal woman at high fracture risk?
Resposta
Offer pharmacologic therapy after shared decision-making, then reassess adherence and fracture risk.

Pharmacological Management of Osteoporosis in Postmenopausal Women · reviewed 2026-08-26
Targeta 120
Pregunta
Which bedside pattern best points to migraine with aura?
Resposta
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
Targeta 121
Pregunta
What condition should be suspected from this finding: Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.
Resposta
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
Targeta 122
Pregunta
Which bedside pattern best points to early syphilis?
Resposta
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
Targeta 123
Pregunta
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.
Resposta
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
Targeta 124
Pregunta
Which bedside pattern best points to abnormal uterine bleeding from anovulation?
Resposta
Irregular unpredictable bleeding without cyclic ovulation is common at reproductive extremes or with endocrine disruption.

Abnormal Uterine Bleeding · reviewed 2026-08-26
Targeta 125
Pregunta
How should a clinician manage a boundary-crossing gift from a patient?
Resposta
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
Targeta 126
Pregunta
A clinician is considering symptomatic aortic stenosis. Which finding adds the most support?
Resposta
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
Targeta 127
Pregunta
Which bedside pattern best points to post-traumatic stress disorder?
Resposta
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
Targeta 128
Pregunta
In a child aged 6–11 years or an adolescent, what diagnostic approach is most appropriate when asthma is suspected?
Resposta
Demonstrate variable expiratory airflow limitation with spirometry and bronchodilator response or an accepted alternative.

2026 GINA Strategy Report · reviewed 2026-08-26
Targeta 129
Pregunta
Which prevention or risk-reduction step is important for chronic kidney disease?
Resposta
Control blood pressure, diabetes, tobacco use, and nephrotoxin exposure; vaccinate and reduce cardiovascular risk.

2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26
Targeta 130
Pregunta
In a child or adolescent, how should medication be used in acute appendicitis?
Resposta
Preoperative antibiotics should cover enteric gram-negative organisms and anaerobes.

Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26
Targeta 131
Pregunta
Which prevention or risk-reduction step is important for iron-deficiency anemia?
Resposta
Adequate dietary iron and evaluation of menstrual or gastrointestinal blood loss prevent recurrence.

British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26
Targeta 132
Pregunta
Which drug class is preferred before oral therapy for knee osteoarthritis pain when topical treatment is feasible?
Resposta
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
Targeta 133
Pregunta
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?
Resposta
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
Targeta 134
Pregunta
For surgical decision-making, how should a clinician initially manage acute ischemic stroke?
Resposta
Activate a stroke pathway and evaluate immediately for IV thrombolysis and mechanical thrombectomy eligibility.

2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26
Targeta 135
Pregunta
Which prevention or risk-reduction step is important for melanoma?
Resposta
Use sun protection and teach patients to report changing lesions rather than relying on routine self-treatment.

Melanoma Clinical Guidelines · reviewed 2026-08-26
Targeta 136
Pregunta
How should a clinician initially manage community-acquired pneumonia?
Resposta
Stabilize oxygenation and sepsis, then choose outpatient or inpatient care using clinical judgment and a validated severity tool.

Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26
Targeta 137
Pregunta
Which prevention or risk-reduction step is important for ureteral stone?
Resposta
High fluid intake and stone-specific dietary changes based on metabolic evaluation reduce recurrence.

EAU Guidelines on Urolithiasis · reviewed 2026-08-26
Targeta 138
Pregunta
For surgical decision-making, how should a clinician initially manage ectopic pregnancy?
Resposta
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
Targeta 139
Pregunta
What counseling point helps reduce harm from tension pneumothorax?
Resposta
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
Targeta 140
Pregunta
In a child or adolescent, how should a clinician initially manage major depressive disorder?
Resposta
Assess safety first, create an urgent plan for imminent risk, and use psychotherapy, medication, or both by severity and preference.

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26
Targeta 141
Pregunta
What should happen when a clinician’s personal belief conflicts with a requested legal service?
Resposta
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
Targeta 142
Pregunta
For surgical decision-making, what immediate plan is appropriate for symptomatic aortic stenosis?
Resposta
Severe symptomatic aortic stenosis requires valve-replacement evaluation rather than medical therapy alone.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26
Targeta 143
Pregunta
What counseling point helps reduce harm from celiac disease?
Resposta
Screen appropriate first-degree relatives and correct micronutrient deficits.

ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26
Targeta 144
Pregunta
How should a clinician initially manage primary hypothyroidism?
Resposta
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
Targeta 145
Pregunta
Which activity counseling can reduce carpal tunnel symptoms or slow progression?
Resposta
Modify job or recreational activities that aggravate symptoms, especially prolonged wrist flexion or extension.

Carpal Tunnel Syndrome · reviewed 2026-08-26
Targeta 146
Pregunta
How should a clinician initially manage bacterial conjunctivitis?
Resposta
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
Targeta 147
Pregunta
Which diagnosis is marked by a rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis?
Resposta
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
Targeta 148
Pregunta
How should medication be used in bacterial brain abscess?
Resposta
Empiric therapy should cover likely streptococci, anaerobes, and staphylococci according to source, then narrow to cultures.

ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26
Targeta 149
Pregunta
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.
Resposta
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
Targeta 150
Pregunta
What medication strategy is appropriate for peripheral artery disease?
Resposta
Antiplatelet and high-intensity statin therapy reduce cardiovascular risk in symptomatic disease.

2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26
Targeta 151
Pregunta
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?
Resposta
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
Targeta 152
Pregunta
How should medication be used in pulmonary tuberculosis?
Resposta
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
Targeta 153
Pregunta
How should medication be used in endometriosis?
Resposta
Combined hormonal contraceptives or progestins are common first-line suppressive therapies when pregnancy is not desired.

Endometriosis · reviewed 2026-08-26
Targeta 154
Pregunta
How should medication be used in panic disorder?
Resposta
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
Targeta 155
Pregunta
A clinician is considering ulcerative colitis. Which finding adds the most support?
Resposta
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
Targeta 156
Pregunta
In a patient younger than 16, which diagnosis fits persistent joint swelling, limited motion, or morning stiffness after other causes are excluded?
Resposta
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
Targeta 157
Pregunta
Which bedside pattern best points to primary adrenal insufficiency?
Resposta
Weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia suggest primary adrenal failure.

Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26
Targeta 158
Pregunta
When can confidential information be shared with another treating clinician without a separate HIPAA authorization?
Resposta
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
Targeta 159
Pregunta
In a child aged 6 months or older, which bedside pattern best points to acute otitis media?
Resposta
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
Targeta 160
Pregunta
Which pathophysiologic process drives heart failure with reduced ejection fraction?
Resposta
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
Targeta 161
Pregunta
In a child, typically 6 months to 3 years, what immediate plan is appropriate for croup?
Resposta
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
Targeta 162
Pregunta
What drug class or regimen fits cellulitis?
Resposta
Use an agent active against streptococci for nonpurulent disease; add MRSA coverage when risk or purulence warrants it.

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26
Targeta 163
Pregunta
What is the key first diagnostic step for testicular torsion?
Resposta
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
Targeta 164
Pregunta
What counseling point helps reduce harm from Parkinson disease?
Resposta
Exercise, fall-risk reduction, medication review, and driving and swallowing assessment reduce complications.

Parkinson’s Disease in Adults · reviewed 2026-08-26
Targeta 165
Pregunta
How should a clinician initially manage hyperkalemia?
Resposta
With ECG changes or severe elevation, stabilize the myocardium, shift potassium intracellularly, and remove it from the body.

Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26
Targeta 166
Pregunta
What counseling point helps reduce harm from gonococcal urethritis or cervicitis?
Resposta
Condom use, routine screening by risk, and partner treatment reduce reinfection and complications.

Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26
Targeta 167
Pregunta
Which history or examination finding most strongly supports acute pericarditis?
Resposta
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
Targeta 168
Pregunta
What counseling point helps reduce harm from menopause vasomotor symptoms?
Resposta
Cooling strategies and avoiding individual triggers can reduce symptom burden; assess bone and cardiovascular risk separately.

The Menopause Years · reviewed 2026-08-26
Targeta 169
Pregunta
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?
Resposta
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
Targeta 170
Pregunta
What counseling point helps reduce harm from alcohol withdrawal?
Resposta
Treat alcohol-use disorder, plan medically supported withdrawal for high-risk patients, and provide thiamine when nutrition is poor.

The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26
Targeta 171
Pregunta
What diagnostic approach is most appropriate when acute compartment syndrome is suspected?
Resposta
Diagnosis is clinical; compartment-pressure measurement helps when the examination is unreliable or equivocal.

Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 172
Pregunta
In a child or adolescent with sickle cell disease, which pain pattern supports an acute vaso-occlusive episode?
Resposta
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
Targeta 173
Pregunta
What diagnostic approach is most appropriate when thyroid storm is suspected?
Resposta
Diagnosis is clinical; obtain thyroid tests and evaluate the trigger without delaying treatment.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26
Targeta 174
Pregunta
A clinician is considering acute respiratory distress syndrome. Which finding adds the most support?
Resposta
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
Targeta 175
Pregunta
How should medication be used in sudden sensorineural hearing loss?
Resposta
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
Targeta 176
Pregunta
What is the HIPAA minimum-necessary rule?
Resposta
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
Targeta 177
Pregunta
For surgical decision-making, hypotension, elevated jugular venous pressure, tachycardia, muffled heart sounds, and pulsus paradoxus indicate which diagnosis?
Resposta
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
Targeta 178
Pregunta
In a child or adolescent, what diagnostic approach is most appropriate when acute appendicitis is suspected?
Resposta
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
Targeta 179
Pregunta
For surgical decision-making, sudden focal weakness, facial droop, speech change, gaze deviation, neglect, or ataxia indicate which time-critical diagnosis?
Resposta
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
Targeta 180
Pregunta
A clinician is considering gout flare. Which finding adds the most support?
Resposta
Abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint, suggests gout.

Gout · reviewed 2026-08-26
Targeta 181
Pregunta
Which diagnosis best fits new cough, fever, dyspnea, pleuritic pain, and focal crackles when an infiltrate is confirmed?
Resposta
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
Targeta 182
Pregunta
In a child aged 6–11 years or an adolescent, what medication strategy is appropriate for asthma?
Resposta
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
Targeta 183
Pregunta
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?
Resposta
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
Targeta 184
Pregunta
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?
Resposta
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
Targeta 185
Pregunta
Which preventive measure belongs in care for atrial fibrillation?
Resposta
Address hypertension, obesity, sleep apnea, alcohol excess, and other modifiable drivers.

2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26
Targeta 186
Pregunta
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.
Resposta
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
Targeta 187
Pregunta
Which bedside pattern best points to hyperkalemia?
Resposta
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
Targeta 188
Pregunta
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.
Resposta
Ureteral stone. Sudden colicky flank pain radiating to the groin with hematuria and restlessness is typical.

EAU Guidelines on Urolithiasis · reviewed 2026-08-26
Targeta 189
Pregunta
In a child or adolescent, how should a clinician initially manage sickle cell vaso-occlusive crisis?
Resposta
Provide rapid individualized analgesia, assess oxygenation and hydration, and evaluate acute chest syndrome or infection.

ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26
Targeta 190
Pregunta
How should medication be used in primary hyperparathyroidism?
Resposta
Cinacalcet can lower calcium when surgery is not possible; antiresorptive therapy targets low bone density.

Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26
Targeta 191
Pregunta
What diagnostic approach is most appropriate when acute bacterial rhinosinusitis is suspected?
Resposta
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
Targeta 192
Pregunta
What should a clinician do before discussing a patient in a public or semipublic area?
Resposta
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
Targeta 193
Pregunta
A clinician is considering Parkinson disease. Which finding adds the most support?
Resposta
Bradykinesia plus rest tremor or rigidity, with reduced arm swing and shuffling gait, supports parkinsonism.

Parkinson’s Disease in Adults · reviewed 2026-08-26
Targeta 194
Pregunta
What immediate plan is appropriate for chronic hepatitis C?
Resposta
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
Targeta 195
Pregunta
A clinician is considering gonococcal urethritis or cervicitis. Which finding adds the most support?
Resposta
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
Targeta 196
Pregunta
In a child or adolescent, what immediate plan is appropriate for juvenile idiopathic arthritis?
Resposta
Refer to pediatric rheumatology early and treat to control inflammation and preserve function.

2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26
Targeta 197
Pregunta
A clinician is considering menopause vasomotor symptoms. Which finding adds the most support?
Resposta
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
Targeta 198
Pregunta
Which diagnosis best fits this presentation: Progressive exertional dyspnea, dry cough, bibasilar fine crackles, and clubbing in an older adult suggest fibrotic interstitial disease.
Resposta
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
Targeta 199
Pregunta
A clinician is considering alcohol withdrawal. Which finding adds the most support?
Resposta
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
Targeta 200
Pregunta
What is the priority management step for acute pericarditis?
Resposta
Assess immediately for tamponade or high-risk features that require admission.

2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26
Targeta 201
Pregunta
In complicated acute calculous cholecystitis, how should empiric antibiotics be selected?
Resposta
Base the regimen on likely biliary pathogens and local resistance patterns, with enteric gram-negative aerobes and anaerobes among the common targets.

2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26
Targeta 202
Pregunta
For surgical decision-making, what is the priority management step for pleural effusion?
Resposta
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
Targeta 203
Pregunta
In acute decompensated heart failure with fluid overload, which drug class is used first to relieve congestion?
Resposta
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
Targeta 204
Pregunta
For surgical decision-making, what immediate plan is appropriate for subarachnoid hemorrhage?
Resposta
Stabilize, control pressure carefully, give nimodipine, and obtain urgent neurovascular treatment of the aneurysm.

2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26
Targeta 205
Pregunta
What medication strategy is appropriate for hip fracture?
Resposta
Use multimodal analgesia and guideline-based VTE prophylaxis around surgery.

Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 206
Pregunta
In a child or adolescent, what immediate plan is appropriate for bacterial meningitis?
Resposta
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
Targeta 207
Pregunta
In a child or adolescent, which diagnosis fits hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status?
Resposta
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
Targeta 208
Pregunta
For surgical decision-making, what immediate plan is appropriate for preeclampsia with severe features?
Resposta
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
Targeta 209
Pregunta
For surgical decision-making, new flashes, floaters, and a curtain or shadow across the visual field indicate which diagnosis?
Resposta
Retinal detachment. New flashes, floaters, and a curtain or shadow across the visual field suggest detachment.

Retinal Detachment · reviewed 2026-08-26
Targeta 210
Pregunta
What immediate plan is appropriate for bipolar I mania?
Resposta
Hospitalize when danger, grave disability, or severe psychosis requires containment; stop antidepressant monotherapy.

Management of Bipolar Disorder in Adults · reviewed 2026-08-26
Targeta 211
Pregunta
May a clinician leave appointment information in a voicemail?
Resposta
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
Targeta 212
Pregunta
When is a loop diuretic appropriate in acute kidney injury?
Resposta
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
Targeta 213
Pregunta
How should a clinician initially manage plaque psoriasis?
Resposta
Assess body-surface area, special-site involvement, symptoms, and joint disease before selecting therapy.

Psoriasis Clinical Guidelines · reviewed 2026-08-26
Targeta 214
Pregunta
In a child or adolescent, how should medication be used in immune thrombocytopenia?
Resposta
Corticosteroids or IVIG are common initial treatments when therapy is needed; longer-term choices depend on response and duration.

American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26
Targeta 215
Pregunta
Which test or testing sequence best evaluates suspected ventricular fibrillation cardiac arrest?
Resposta
Use rhythm analysis during high-quality CPR without delaying compressions.

2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26
Targeta 216
Pregunta
Which drug class is first-line for erectile dysfunction when no contraindication such as nitrate use exists?
Resposta
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
Targeta 217
Pregunta
Which pathophysiologic process drives COPD?
Resposta
Small-airway disease and emphysematous parenchymal destruction cause persistent expiratory flow limitation.

2026 GOLD Report and Pocket Guide · reviewed 2026-08-26
Targeta 218
Pregunta
Which history or examination finding most strongly supports Crohn disease?
Resposta
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
Targeta 219
Pregunta
Which pathophysiologic process drives acute compartment syndrome?
Resposta
Rising pressure within a closed fascial space compromises capillary perfusion and causes muscle and nerve ischemia.

Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 220
Pregunta
What medication strategy is appropriate for migraine with aura?
Resposta
Use an NSAID or triptan for many acute attacks; select preventive therapy around comorbidities and patient preference.

AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26
Targeta 221
Pregunta
What clinical clue should raise suspicion for hypertensive emergency?
Resposta
Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 222
Pregunta
What medication strategy is appropriate for early syphilis?
Resposta
Benzathine penicillin G is preferred for early syphilis; penicillin is required in pregnancy.

Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26
Targeta 223
Pregunta
What counseling point helps reduce harm from Cushing syndrome?
Resposta
Limit avoidable exogenous glucocorticoid exposure and taper chronic therapy safely when appropriate.

Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26
Targeta 224
Pregunta
What medication strategy is appropriate for abnormal uterine bleeding from anovulation?
Resposta
Progestin or combined hormonal therapy can regulate bleeding; tranexamic acid reduces heavy bleeding in eligible patients.

Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women · reviewed 2026-08-26
Targeta 225
Pregunta
What counseling point helps reduce harm from peritonsillar abscess?
Resposta
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
Targeta 226
Pregunta
What medication strategy is appropriate for post-traumatic stress disorder?
Resposta
Sertraline, paroxetine, or venlafaxine can help; benzodiazepines are not recommended for PTSD treatment.

Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26
Targeta 227
Pregunta
When may protected health information be disclosed to prevent a serious threat?
Resposta
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
Targeta 228
Pregunta
In an infant aged 1–23 months, which history or examination finding most strongly supports bronchiolitis?
Resposta
An infant with viral prodrome followed by cough, wheeze or crackles, tachypnea, and feeding difficulty likely has bronchiolitis.

Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26
Targeta 229
Pregunta
Which diagnosis causes marked edema, heavy proteinuria, hypoalbuminemia, and hyperlipidemia?
Resposta
Nephrotic syndrome. Marked edema, heavy proteinuria, hypoalbuminemia, and hyperlipidemia define a nephrotic pattern.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 230
Pregunta
Which bedside pattern best points to herpes zoster?
Resposta
A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26
Targeta 231
Pregunta
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?
Resposta
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
Targeta 232
Pregunta
Which bedside pattern best points to testicular torsion?
Resposta
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
Targeta 233
Pregunta
For surgical decision-making, which diagnosis best fits hematemesis, coffee-ground emesis, or melena with orthostasis?
Resposta
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
Targeta 234
Pregunta
In a child or adolescent, what diagnostic approach is most appropriate when generalized tonic-clonic seizure is suspected?
Resposta
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
Targeta 235
Pregunta
Identify the condition from this pattern: Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.
Resposta
Stable chronic hypertension. Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 236
Pregunta
What diagnostic approach is most appropriate when sepsis is suspected?
Resposta
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
Targeta 237
Pregunta
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?
Resposta
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
Targeta 238
Pregunta
What diagnostic approach is most appropriate when pelvic inflammatory disease is suspected?
Resposta
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
Targeta 239
Pregunta
Which pharmacologic approach is preferred for COPD?
Resposta
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
Targeta 240
Pregunta
What diagnostic approach is most appropriate when schizophrenia is suspected?
Resposta
Diagnosis is clinical with medical, neurologic, and substance evaluation for first-episode psychosis.

Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26
Targeta 241
Pregunta
Which next action matters most in hypertensive emergency?
Resposta
Lower pressure with monitored IV therapy at a controlled rate tailored to the injured organ.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 242
Pregunta
How should an interpreter be used for a patient with limited English proficiency?
Resposta
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
Targeta 243
Pregunta
What immediate plan is appropriate for thyroid storm?
Resposta
Give a beta-blocker, block hormone synthesis, then block hormone release, add glucocorticoid, cool supportively, and treat the trigger.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26
Targeta 244
Pregunta
Which preventive measure belongs in care for ulcerative colitis?
Resposta
Use effective maintenance therapy and monitor symptoms together with objective inflammatory activity to reduce relapse and complications.

Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26
Targeta 245
Pregunta
What immediate plan is appropriate for acute bacterial rhinosinusitis?
Resposta
Assess orbital or intracranial red flags and arrange urgent evaluation when present.

Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26
Targeta 246
Pregunta
Which preventive measure belongs in care for gout flare?
Resposta
Weight management, limiting excess alcohol, reviewing urate-raising medicines, and long-term urate control reduce flares.

Gout · reviewed 2026-08-26
Targeta 247
Pregunta
What immediate plan is appropriate for hyponatremia due to SIADH?
Resposta
Treat severe neurologic symptoms with carefully dosed hypertonic saline and avoid overly rapid correction.

Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia · reviewed 2026-08-26
Targeta 248
Pregunta
In a child or adolescent, which pathophysiologic process drives immune thrombocytopenia?
Resposta
Autoantibodies accelerate platelet clearance and can impair platelet production.

American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26
Targeta 249
Pregunta
Which test or testing sequence best evaluates suspected COPD?
Resposta
Post-bronchodilator spirometry confirms persistent airflow obstruction.

2026 GOLD Report and Pocket Guide · reviewed 2026-08-26
Targeta 250
Pregunta
Why does atrial fibrillation produce its defining clinical pattern?
Resposta
Chaotic atrial activation eliminates coordinated atrial contraction and creates irregular AV nodal conduction.

2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26
Targeta 251
Pregunta
Which pathophysiologic process drives subarachnoid hemorrhage?
Resposta
Arterial blood entering the subarachnoid space raises intracranial pressure and can trigger vasospasm.

2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26
Targeta 252
Pregunta
In a child or adolescent, which pathophysiologic process drives bacterial meningitis?
Resposta
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
Targeta 253
Pregunta
Which pathophysiologic process drives preeclampsia with severe features?
Resposta
Abnormal placentation and systemic endothelial dysfunction produce vasoconstriction and multisystem injury.

Gestational Hypertension and Preeclampsia · reviewed 2026-08-26
Targeta 254
Pregunta
Which clinical feature defines bipolar I disorder?
Resposta
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
Targeta 255
Pregunta
For surgical decision-making, what is the priority management step for upper gastrointestinal bleeding?
Resposta
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
Targeta 256
Pregunta
Which history or examination finding most strongly supports rheumatoid arthritis?
Resposta
Symmetric inflammatory pain and prolonged morning stiffness in MCP, PIP, or wrist joints with synovitis suggest rheumatoid arthritis.

Rheumatoid Arthritis · reviewed 2026-08-26
Targeta 257
Pregunta
What is teach-back?
Resposta
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
Targeta 258
Pregunta
A clinician is considering primary hyperparathyroidism. Which finding adds the most support?
Resposta
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
Targeta 259
Pregunta
How can a clinician reduce avoidable harm related to aortic dissection?
Resposta
Long-term blood-pressure control and surveillance imaging reduce later aortic complications.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26
Targeta 260
Pregunta
A clinician is considering sudden sensorineural hearing loss. Which finding adds the most support?
Resposta
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
Targeta 261
Pregunta
Which preventive measure belongs in care for obstructive sleep apnea?
Resposta
Weight management, alcohol and sedative avoidance near bedtime, and treatment of nasal obstruction reduce severity.

Sleep Apnea Treatment · reviewed 2026-08-26
Targeta 262
Pregunta
In a child or adolescent, what diagnostic approach is most appropriate when atopic dermatitis is suspected?
Resposta
Diagnosis is clinical; testing is reserved for an alternative diagnosis or a specific suspected trigger.

Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26
Targeta 263
Pregunta
How should a clinician initially manage acute pyelonephritis?
Resposta
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
Targeta 264
Pregunta
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.
Resposta
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
Targeta 265
Pregunta
What diagnostic approach is most appropriate when hyperkalemia is suspected?
Resposta
Repeat a possibly hemolyzed sample while obtaining an ECG; assess kidney function, acid-base status, and contributing medicines.

Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26
Targeta 266
Pregunta
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.
Resposta
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
Targeta 267
Pregunta
What drug class or regimen fits stable chronic hypertension?
Resposta
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
Targeta 268
Pregunta
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.
Resposta
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
Targeta 269
Pregunta
Which pharmacologic approach is preferred for acute pancreatitis?
Resposta
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
Targeta 270
Pregunta
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.
Resposta
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
Targeta 271
Pregunta
For surgical decision-making, in a child or adolescent, what is the priority management step for septic arthritis?
Resposta
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
Targeta 272
Pregunta
In a child or adolescent, what diagnostic approach is most appropriate when sickle cell vaso-occlusive crisis is suspected?
Resposta
Use focused labs and imaging for the suspected complication; do not require a changed hemoglobin to validate pain.

ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26
Targeta 273
Pregunta
In a child or adolescent, which diagnosis causes variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers?
Resposta
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
Targeta 274
Pregunta
In a child or adolescent, which pathophysiologic process drives diabetic ketoacidosis?
Resposta
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
Targeta 275
Pregunta
How should a clinician respond to a patient requesting an unnecessary antibiotic?
Resposta
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
Targeta 276
Pregunta
Which pathophysiologic process drives retinal detachment?
Resposta
Fluid passing through a retinal break separates neurosensory retina from the pigment epithelium.

Retinal Detachment · reviewed 2026-08-26
Targeta 277
Pregunta
Which bedside pattern best points to peripheral artery disease?
Resposta
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
Targeta 278
Pregunta
Which preventive measure belongs in care for myasthenia gravis?
Resposta
Avoid medicines that worsen neuromuscular transmission and plan carefully for infection, surgery, and pregnancy.

International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26
Targeta 279
Pregunta
In a child or adolescent, which pathophysiologic process drives acute appendicitis?
Resposta
Luminal obstruction causes distention, ischemia, bacterial overgrowth, and eventual perforation.

Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26
Targeta 280
Pregunta
Which preventive measure belongs in care for Clostridioides difficile infection?
Resposta
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
Targeta 281
Pregunta
After an acute ACL tear, which nonprescription medicines may be used for symptom relief when safe?
Resposta
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
Targeta 282
Pregunta
Which preventive measure belongs in care for shoulder dystocia?
Resposta
Team drills, clear communication, and avoiding fundal pressure reduce preventable harm.

Shoulder Dystocia · reviewed 2026-08-26
Targeta 283
Pregunta
Which next action matters most in idiopathic pulmonary fibrosis?
Resposta
Assess oxygen need, comorbidity, transplant eligibility, and goals while monitoring progression.

Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26
Targeta 284
Pregunta
In a child or adolescent, which preventive measure belongs in care for attention-deficit/hyperactivity disorder?
Resposta
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
Targeta 285
Pregunta
Which diagnosis best fits unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border?
Resposta
Cellulitis. Unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border favor cellulitis.

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26
Targeta 286
Pregunta
A clinician is considering hyponatremia due to SIADH. Which finding adds the most support?
Resposta
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
Targeta 287
Pregunta
During a pulseless arrest, the monitor shows chaotic ventricular activity without organized QRS complexes. Which arrest rhythm is present?
Resposta
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
Targeta 288
Pregunta
A clinician is considering neutropenic fever. Which finding adds the most support?
Resposta
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
Targeta 289
Pregunta
A patient has this pattern: Progressive weak stream, hesitancy, incomplete emptying, nocturia, and frequency suggest bladder-outlet symptoms. What is the most likely diagnosis?
Resposta
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
Targeta 290
Pregunta
Which test or testing sequence best evaluates suspected primary adrenal insufficiency?
Resposta
Measure morning cortisol and ACTH, then confirm with cosyntropin testing when the patient is stable.

Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26
Targeta 291
Pregunta
What medication strategy is appropriate for peritonsillar abscess?
Resposta
Use antibiotics covering group A streptococci and oral anaerobes after drainage.

Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26
Targeta 292
Pregunta
What belongs in a safe handoff?
Resposta
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
Targeta 293
Pregunta
Which history or examination finding most strongly supports myasthenia gravis?
Resposta
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
Targeta 294
Pregunta
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.
Resposta
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
Targeta 295
Pregunta
Which history or examination finding most strongly supports Clostridioides difficile infection?
Resposta
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
Targeta 296
Pregunta
How should a clinician confirm or characterize acute coronary syndrome?
Resposta
Obtain a 12-lead ECG within 10 minutes and measure serial high-sensitivity troponin.

2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26
Targeta 297
Pregunta
Which history or examination finding most strongly supports shoulder dystocia?
Resposta
After delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicates dystocia.

Shoulder Dystocia · reviewed 2026-08-26
Targeta 298
Pregunta
In a child or adolescent, which history or examination finding most strongly supports attention-deficit/hyperactivity disorder?
Resposta
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
Targeta 299
Pregunta
What clinical clue should raise suspicion for cirrhosis with ascites?
Resposta
Increasing abdominal girth, shifting dullness, edema, jaundice, or stigmata of portal hypertension suggest decompensation.

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26
Targeta 300
Pregunta
In a child, typically 6 months to 3 years, what clinical clue should raise suspicion for croup?
Resposta
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
600 targetes
PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps
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Nibomo s'obre perquè puguis començar a estudiar.
Targeta 301
Pregunta
How should a clinician initially manage peripheral artery disease?
Resposta
Use supervised or structured exercise; evaluate revascularization for lifestyle-limiting symptoms despite therapy or limb threat.

2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26
Targeta 302
Pregunta
What drug class or regimen fits pulmonary embolism?
Resposta
Direct oral anticoagulants are preferred for many stable eligible patients; choose differently for pregnancy, severe renal disease, or specific cancer contexts.

ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26
Targeta 303
Pregunta
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.
Resposta
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
Targeta 304
Pregunta
Which test or testing sequence best evaluates suspected hip fracture?
Resposta
Obtain hip and pelvis radiographs; MRI detects an occult fracture when suspicion remains high.

Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 305
Pregunta
In a child or adolescent, what is the priority management step for generalized tonic-clonic seizure?
Resposta
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
Targeta 306
Pregunta
Which diagnosis causes fatigue, cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation?
Resposta
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
Targeta 307
Pregunta
What is the priority management step for sepsis?
Resposta
Start rapid resuscitation, broad empiric antimicrobials, and urgent source control.

2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26
Targeta 308
Pregunta
Which diagnosis best fits diffuse conjunctival injection with mucopurulent discharge and eyelids stuck on waking?
Resposta
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
Targeta 309
Pregunta
What is the priority management step for pelvic inflammatory disease?
Resposta
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
Targeta 310
Pregunta
What is closed-loop communication during an emergency?
Resposta
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
Targeta 311
Pregunta
What is the priority management step for schizophrenia?
Resposta
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
Targeta 312
Pregunta
What medication strategy is appropriate for nephrotic syndrome?
Resposta
Use renin-angiotensin system blockade to reduce proteinuria when appropriate; disease-specific immunotherapy depends on pathology.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 313
Pregunta
What immediate plan is appropriate for neutropenic fever?
Resposta
Give empiric antipseudomonal antibiotics rapidly and stratify for inpatient versus carefully selected outpatient care.

Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26
Targeta 314
Pregunta
What counseling point helps reduce harm from cellulitis?
Resposta
Treat tinea pedis, edema, skin breaks, and other portals of entry to reduce recurrence.

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26
Targeta 315
Pregunta
A clinician is considering cardiac tamponade. Which finding adds the most support?
Resposta
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
Targeta 316
Pregunta
What counseling point helps reduce harm from benign prostatic hyperplasia?
Resposta
Review fluid timing and medicines that worsen retention, and monitor complications.

EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26
Targeta 317
Pregunta
Which diagnosis best fits progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants?
Resposta
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
Targeta 318
Pregunta
Which test or testing sequence best evaluates suspected acute cholecystitis?
Resposta
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
Targeta 319
Pregunta
In a postmenopausal woman or man aged 50 or older, what clinical clue should raise suspicion for osteoporosis?
Resposta
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
Targeta 320
Pregunta
Which pharmacologic approach is preferred for Parkinson disease?
Resposta
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
Targeta 321
Pregunta
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?
Resposta
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
Targeta 322
Pregunta
Which pharmacologic approach is preferred for gonococcal urethritis or cervicitis?
Resposta
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
Targeta 323
Pregunta
In a child aged 6 months or older, which examination best evaluates suspected acute otitis media?
Resposta
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
Targeta 324
Pregunta
Which pharmacologic approach is preferred for menopause vasomotor symptoms?
Resposta
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
Targeta 325
Pregunta
How should a clinician handle an ambiguous verbal medication order?
Resposta
Stop and clarify the drug, dose, route, timing, and patient; read it back and do not guess.

TeamSTEPPS Communication Module · reviewed 2026-08-26
Targeta 326
Pregunta
Which pharmacologic approach is preferred for alcohol withdrawal?
Resposta
Benzodiazepines are first-line for clinically significant withdrawal; phenobarbital requires experienced protocols and monitoring.

The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26
Targeta 327
Pregunta
In a child or adolescent, how should a clinician initially manage asthma?
Resposta
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
Targeta 328
Pregunta
What medication strategy is appropriate for Cushing syndrome?
Resposta
Medical cortisol-lowering therapy can bridge or treat selected patients when definitive source control is delayed or unavailable.

Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26
Targeta 329
Pregunta
What counseling point helps reduce harm from acute kidney injury?
Resposta
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
Targeta 330
Pregunta
What medication strategy is appropriate for thrombotic thrombocytopenic purpura?
Resposta
Caplacizumab is added in many acute immune TTP protocols under specialist care.

ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26
Targeta 331
Pregunta
For surgical decision-making, in a child or adolescent, which next action matters most in acute appendicitis?
Resposta
Give fluids, analgesia, antibiotics, and obtain prompt surgical consultation.

Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26
Targeta 332
Pregunta
How should medication be used in ventricular fibrillation cardiac arrest?
Resposta
Give epinephrine during the arrest algorithm and consider amiodarone or lidocaine for refractory shockable rhythms.

2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26
Targeta 333
Pregunta
For surgical decision-making, which next action matters most in acute compartment syndrome?
Resposta
Remove constrictive material and obtain immediate surgical fasciotomy evaluation.

Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 334
Pregunta
In a child or adolescent, which diagnosis fits sudden loss of consciousness with bilateral tonic then clonic movements followed by confusion?
Resposta
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
Targeta 335
Pregunta
How should medication be used in herpes zoster?
Resposta
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
Targeta 336
Pregunta
Which diagnosis is defined by suspected infection with acute organ dysfunction and may include altered mentation, hypotension, tachypnea, or poor perfusion?
Resposta
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
Targeta 337
Pregunta
What medication strategy is appropriate for uncomplicated cystitis?
Resposta
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
Targeta 338
Pregunta
Which diagnosis warrants empiric treatment when lower abdominal pain occurs with cervical-motion, uterine, or adnexal tenderness in a patient at STI risk?
Resposta
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
Targeta 339
Pregunta
How should a clinician confirm or characterize pulmonary embolism?
Resposta
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
Targeta 340
Pregunta
Which diagnosis requires at least six months of illness with psychosis and functional decline, including at least one month of active symptoms, after exclusions?
Resposta
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
Targeta 341
Pregunta
Which prevention or risk-reduction step is important for infective endocarditis?
Resposta
Reserve antibiotic prophylaxis for defined high-risk cardiac conditions undergoing relevant dental procedures.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26
Targeta 342
Pregunta
What is the priority management step for primary adrenal insufficiency?
Resposta
Suspected adrenal crisis requires immediate glucocorticoid and isotonic fluid treatment before confirmatory results.

Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26
Targeta 343
Pregunta
What is the safest response to a critical test result that arrives after a patient leaves?
Resposta
Acknowledge it promptly, contact the patient or responsible team, document attempts and advice, and escalate until ownership is clear.

Quick Safety 52: Advancing Safety with Closed-loop Communication of Test Results · reviewed 2026-08-26
Targeta 344
Pregunta
In a child aged 6 months or older, what is the priority management step for acute otitis media?
Resposta
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
Targeta 345
Pregunta
When antibiotic susceptibility is unknown, which empiric regimen is preferred for most treatment-naive Helicobacter pylori infection?
Resposta
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
Targeta 346
Pregunta
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.
Resposta
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
Targeta 347
Pregunta
What drug class or regimen fits carpal tunnel syndrome?
Resposta
A local corticosteroid injection can provide relief; oral medicines do not correct the compression.

Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 348
Pregunta
In a child or adolescent, what counseling point helps reduce harm from immune thrombocytopenia?
Resposta
Avoid platelet-impairing medicines and counsel on bleeding precautions when counts are low.

American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26
Targeta 349
Pregunta
Which test or testing sequence best evaluates suspected bacterial brain abscess?
Resposta
Contrast-enhanced MRI is preferred; obtain blood cultures and avoid lumbar puncture when mass effect is possible.

ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26
Targeta 350
Pregunta
What physiologic disturbance underlies aortic dissection?
Resposta
An intimal tear lets blood split the aortic media, creating a false lumen.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26
Targeta 351
Pregunta
How can a clinician reduce avoidable harm related to acute respiratory distress syndrome?
Resposta
Use lung-protective ventilation in mechanically ventilated patients at risk for ARDS to reduce ventilator-induced injury.

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26
Targeta 352
Pregunta
Which test or testing sequence best evaluates suspected pulmonary tuberculosis?
Resposta
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
Targeta 353
Pregunta
Which test or testing sequence best evaluates suspected endometriosis?
Resposta
Diagnosis can be clinical with imaging for endometrioma or deep disease; laparoscopy is not mandatory before initial treatment.

Endometriosis · reviewed 2026-08-26
Targeta 354
Pregunta
Which test or testing sequence best evaluates suspected panic disorder?
Resposta
Diagnosis is clinical after considering cardiac, pulmonary, endocrine, neurologic, medication, and substance causes.

Panic Disorder: What You Need to Know · reviewed 2026-08-26
Targeta 355
Pregunta
How can a clinician reduce avoidable harm related to Crohn disease?
Resposta
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
Targeta 356
Pregunta
Which history or examination finding most strongly supports Cushing syndrome?
Resposta
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
Targeta 357
Pregunta
How can a clinician reduce avoidable harm related to rheumatoid arthritis?
Resposta
Keep indicated vaccines current and coordinate timing with immunosuppressive therapy to reduce preventable infection risk.

2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases · reviewed 2026-08-26
Targeta 358
Pregunta
Which history or examination finding most strongly supports peritonsillar abscess?
Resposta
Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26
Targeta 359
Pregunta
When should a safety event or near miss be reported?
Resposta
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
Targeta 360
Pregunta
For surgical decision-making, what immediate plan is appropriate for cardiac tamponade?
Resposta
Urgent pericardial drainage is the definitive step when tamponade causes hemodynamic compromise.

2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26
Targeta 361
Pregunta
Which bedside pattern best points to pleural effusion?
Resposta
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
Targeta 362
Pregunta
For surgical decision-making, what immediate plan is appropriate for melanoma?
Resposta
Prompt complete diagnostic excision and staging guide definitive surgical management.

Melanoma Clinical Guidelines · reviewed 2026-08-26
Targeta 363
Pregunta
A clinician is considering uncomplicated cystitis. Which finding adds the most support?
Resposta
Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 364
Pregunta
In a child or adolescent, which clinical sequence defines a generalized tonic-clonic seizure?
Resposta
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
Targeta 365
Pregunta
What is the priority management step for chronic kidney disease?
Resposta
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
Targeta 366
Pregunta
Why does sepsis produce its defining clinical pattern?
Resposta
A dysregulated host response causes endothelial injury, vasodilation, capillary leak, and organ dysfunction.

2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26
Targeta 367
Pregunta
Which history or examination finding most strongly supports stable chronic hypertension?
Resposta
Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 368
Pregunta
Why does pelvic inflammatory disease produce its defining clinical pattern?
Resposta
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
Targeta 369
Pregunta
Which bedside pattern best points to chronic hepatitis C?
Resposta
Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease.

Viral Hepatitis Clinical Care · reviewed 2026-08-26
Targeta 370
Pregunta
Which symptom domains should a clinician assess in schizophrenia?
Resposta
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
Targeta 371
Pregunta
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?
Resposta
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
Targeta 372
Pregunta
In pulmonary embolism with hemodynamic compromise and no prohibitive bleeding risk, which drug class should be considered for reperfusion?
Resposta
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
Targeta 373
Pregunta
Which diagnosis best fits this presentation: Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.
Resposta
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
Targeta 374
Pregunta
Which preventive measure belongs in care for type 2 diabetes mellitus?
Resposta
Weight-supportive nutrition, physical activity, tobacco avoidance, and cardiometabolic risk control prevent complications.

Standards of Care in Diabetes—2026 · reviewed 2026-08-26
Targeta 375
Pregunta
What is the first response when a colleague appears impaired while providing care?
Resposta
Protect patients immediately, remove the colleague from unsafe duties through the proper chain, and activate confidential professional-assistance procedures.

Physician Responsibilities to Colleagues with Illness, Disability or Impairment · reviewed 2026-08-26
Targeta 376
Pregunta
Which preventive measure belongs in care for acute angle-closure glaucoma?
Resposta
Definitive treatment of the fellow narrow-angle eye helps prevent a second attack.

Management of Angle-Closure Glaucoma · reviewed 2026-08-26
Targeta 377
Pregunta
Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, an S3, and an echocardiographic LVEF of 35% indicate which heart-failure phenotype?
Resposta
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
Targeta 378
Pregunta
What clinical clue should raise suspicion for multiple sclerosis relapse?
Resposta
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
Targeta 379
Pregunta
For surgical decision-making, which diagnosis best fits persistent right-upper-quadrant pain or tenderness, fever, leukocytosis, and a positive Murphy sign?
Resposta
Acute calculous cholecystitis. The combined clinical and inflammatory findings support the diagnosis; confirm it with imaging.

2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26
Targeta 380
Pregunta
What clinical clue should raise suspicion for HIV infection?
Resposta
Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

About HIV · reviewed 2026-08-26
Targeta 381
Pregunta
Why does hip fracture produce its defining clinical pattern?
Resposta
Osteoporotic bone can fail under low-energy load, and immobility rapidly adds medical risk.

Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 382
Pregunta
What clinical clue should raise suspicion for postpartum hemorrhage?
Resposta
Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

Postpartum Hemorrhage · reviewed 2026-08-26
Targeta 383
Pregunta
Why does pulmonary embolism produce its defining clinical pattern?
Resposta
Pulmonary embolism is venous thromboembolism obstructing the pulmonary arteries, which increases right-ventricular afterload.

ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26
Targeta 384
Pregunta
What clinical clue should raise suspicion for delirium?
Resposta
An acute fluctuating disturbance of attention and awareness with disorganized thinking suggests delirium.

Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26
Targeta 385
Pregunta
For surgical decision-making, what immediate plan is appropriate for ureteral stone?
Resposta
Provide analgesia, check for infection and kidney injury, and decompress urgently when obstruction is infected.

EAU Guidelines on Urolithiasis · reviewed 2026-08-26
Targeta 386
Pregunta
What is the key first diagnostic step for heart failure with reduced ejection fraction?
Resposta
Transthoracic echocardiography defines ejection fraction and structural disease.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26
Targeta 387
Pregunta
In a child or adolescent, a clinician is considering atopic dermatitis. Which finding adds the most support?
Resposta
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
Targeta 388
Pregunta
Which diagnosis causes fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in a patient with thyrotoxicosis?
Resposta
Thyroid storm. Fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in thyrotoxicosis suggest storm.

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis · reviewed 2026-08-26
Targeta 389
Pregunta
Which history or examination finding most strongly supports chronic kidney disease?
Resposta
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
Targeta 390
Pregunta
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.
Resposta
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
Targeta 391
Pregunta
Which history or examination finding most strongly supports iron-deficiency anemia?
Resposta
Fatigue, pica, restless legs, koilonychia, or chronic blood loss can accompany microcytic anemia.

British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26
Targeta 392
Pregunta
How should a clinician respond to a patient’s prejudiced request or discriminatory behavior?
Resposta
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
Targeta 393
Pregunta
For surgical decision-making, which next action matters most in bacterial brain abscess?
Resposta
Start IV antibiotics and obtain urgent neurosurgical consultation for aspiration or drainage when indicated.

ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26
Targeta 394
Pregunta
How should a clinician confirm or characterize acute pancreatitis?
Resposta
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
Targeta 395
Pregunta
Which next action matters most in pulmonary tuberculosis?
Resposta
Isolate suspected contagious disease and coordinate promptly with public health.

Tuberculosis Infection Control · reviewed 2026-08-26
Targeta 396
Pregunta
How should a clinician confirm or characterize anterior cruciate ligament tear?
Resposta
MRI confirms associated soft-tissue injury when it will guide management; radiographs assess fracture.

Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 397
Pregunta
For surgical decision-making, which next action matters most in endometriosis?
Resposta
Offer empiric symptom treatment or surgery based on severity, fertility goals, masses, and response.

Endometriosis · reviewed 2026-08-26
Targeta 398
Pregunta
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?
Resposta
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
Targeta 399
Pregunta
Which next action matters most in panic disorder?
Resposta
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
Targeta 400
Pregunta
What medication strategy is appropriate for acute coronary syndrome?
Resposta
Use dual antiplatelet therapy after ACS when indicated, balancing ischemic benefit against bleeding risk.

2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26
Targeta 401
Pregunta
What immediate plan is appropriate for COPD?
Resposta
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
Targeta 402
Pregunta
In a child or adolescent, which bedside pattern best points to juvenile idiopathic arthritis?
Resposta
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
Targeta 403
Pregunta
What is the priority management step for stable chronic hypertension?
Resposta
Estimate cardiovascular risk, assess target-organ damage, and set an individualized treatment plan.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 404
Pregunta
What drug class or regimen fits myasthenia gravis?
Resposta
Pyridostigmine treats symptoms; corticosteroid or other immunotherapy controls autoimmune activity.

International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26
Targeta 405
Pregunta
For surgical decision-making, how should a fit patient with acute calculous cholecystitis be managed initially?
Resposta
Give fluids and analgesia, prescribe antibiotics when indicated, and arrange early laparoscopic cholecystectomy as soon as possible.

2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26
Targeta 406
Pregunta
What drug class or regimen fits Clostridioides difficile infection?
Resposta
Oral fidaxomicin is preferred for many initial episodes; oral vancomycin remains an accepted alternative.

2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults · reviewed 2026-08-26
Targeta 407
Pregunta
How should a clinician confirm or characterize primary hyperparathyroidism?
Resposta
Confirm elevated albumin-corrected or ionized calcium with an inappropriately high PTH; assess kidneys and bone.

Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26
Targeta 408
Pregunta
Which medication prevents seizures in preeclampsia with severe features?
Resposta
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
Targeta 409
Pregunta
What is shared decision-making?
Resposta
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
Targeta 410
Pregunta
In a child aged 6 years or older or an adolescent, what drug class or regimen fits attention-deficit/hyperactivity disorder?
Resposta
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
Targeta 411
Pregunta
What is the priority management step for iron-deficiency anemia?
Resposta
Identify and control bleeding, then replace iron; investigate occult gastrointestinal loss when appropriate.

British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults · reviewed 2026-08-26
Targeta 412
Pregunta
Which pharmacologic approach is preferred for acute angle-closure glaucoma?
Resposta
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
Targeta 413
Pregunta
Which diagnosis best fits this presentation: A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.
Resposta
Herpes zoster. A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26
Targeta 414
Pregunta
In a child or adolescent, which pharmacologic approach is preferred for nephritic syndrome?
Resposta
Immunosuppression is disease-specific and should follow a supported diagnosis rather than empiric routine use.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 415
Pregunta
What counseling point helps reduce harm from symptomatic aortic stenosis?
Resposta
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
Targeta 416
Pregunta
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.
Resposta
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
Targeta 417
Pregunta
A clinician is considering idiopathic pulmonary fibrosis. Which finding adds the most support?
Resposta
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
Targeta 418
Pregunta
How should medication be used in ulcerative colitis?
Resposta
Use 5-aminosalicylates for many mild-to-moderate cases; advanced therapy is selected by severity and prior response.

Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26
Targeta 419
Pregunta
For surgical decision-making, how should a clinician initially manage hip fracture?
Resposta
Provide analgesia, optimize medical issues, and arrange timely operative management for most displaced fractures.

Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 420
Pregunta
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.
Resposta
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
Targeta 421
Pregunta
What clinical clue should raise suspicion for ventricular fibrillation cardiac arrest?
Resposta
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
Targeta 422
Pregunta
What condition should be suspected from this finding: Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.
Resposta
Pulmonary tuberculosis. Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26
Targeta 423
Pregunta
Which pharmacologic approach is preferred for type 2 diabetes mellitus?
Resposta
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
Targeta 424
Pregunta
For surgical decision-making, which diagnosis best fits cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility?
Resposta
Endometriosis. Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis.

Endometriosis · reviewed 2026-08-26
Targeta 425
Pregunta
How should a clinician confirm or characterize sudden sensorineural hearing loss?
Resposta
Differentiate sensorineural from conductive loss with bedside testing and urgent audiometry.

Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26
Targeta 426
Pregunta
Which diagnosis requires recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least one month?
Resposta
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
Targeta 427
Pregunta
How should uncertainty be communicated?
Resposta
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
Targeta 428
Pregunta
Which medication is FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity?
Resposta
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
Targeta 429
Pregunta
Which pathophysiologic process drives acute kidney injury?
Resposta
Abrupt loss of filtration disturbs volume, electrolytes, acid-base balance, and toxin clearance.

KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26
Targeta 430
Pregunta
Which pharmacologic approach is preferred for acute deep-vein thrombosis?
Resposta
A direct oral anticoagulant is preferred for many eligible patients; selection changes with pregnancy, cancer, renal function, and antiphospholipid syndrome.

ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26
Targeta 431
Pregunta
A clinician is considering upper gastrointestinal bleeding. Which finding adds the most support?
Resposta
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
Targeta 432
Pregunta
How should medication be used in gout flare?
Resposta
Use an NSAID, colchicine, or glucocorticoid based on comorbidity and timing; allopurinol is preferred long-term urate lowering for most.

2020 American College of Rheumatology Guideline for the Management of Gout · reviewed 2026-08-26
Targeta 433
Pregunta
Which diagnosis best fits an irregularly irregular pulse with palpitations, fatigue, or dyspnea?
Resposta
Atrial fibrillation. An irregularly irregular pulse with palpitations, fatigue, or dyspnea suggests atrial fibrillation.

2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26
Targeta 434
Pregunta
Which treatment should not be offered solely to treat multiple sclerosis?
Resposta
Do not offer vitamin D solely to treat multiple sclerosis.

Multiple Sclerosis in Adults: Management · reviewed 2026-08-26
Targeta 435
Pregunta
Which pathophysiologic process drives plaque psoriasis?
Resposta
IL-23 and Th17 pathway activation drives accelerated keratinocyte turnover.

Psoriasis Clinical Guidelines · reviewed 2026-08-26
Targeta 436
Pregunta
How can a clinician reduce avoidable harm related to HIV infection?
Resposta
PrEP, condoms, sterile injection equipment, perinatal treatment, and sustained viral suppression prevent transmission.

Preventing HIV · reviewed 2026-08-26
Targeta 437
Pregunta
Which pathophysiologic process drives acute pyelonephritis?
Resposta
Ascending infection reaches the renal pelvis and parenchyma, producing systemic illness.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 438
Pregunta
How can a clinician reduce avoidable harm related to postpartum hemorrhage?
Resposta
Antenatal anemia treatment, active management of the third stage, and hemorrhage protocols reduce morbidity.

Postpartum Hemorrhage · reviewed 2026-08-26
Targeta 439
Pregunta
What is the key first diagnostic step for tension pneumothorax?
Resposta
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
Targeta 440
Pregunta
How can a clinician reduce avoidable harm related to delirium?
Resposta
Orientation, mobility, sleep protection, hearing and vision aids, hydration, and medication review reduce hospital delirium.

Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26
Targeta 441
Pregunta
What core mechanism explains infective endocarditis?
Resposta
Microbial adherence to damaged endocardium or prosthetic material produces infected vegetations.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26
Targeta 442
Pregunta
For surgical decision-making, which next action matters most in primary hyperparathyroidism?
Resposta
Refer for parathyroidectomy when symptomatic or when guideline thresholds for calcium, kidney, bone, or age are met.

Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26
Targeta 443
Pregunta
What makes a useful return precaution?
Resposta
It names concrete symptoms or changes, states how urgently to act, and tells the patient where to seek help.

IDEAL Discharge Planning Overview, Process, and Checklist · reviewed 2026-08-26
Targeta 444
Pregunta
Which next action matters most in sudden sensorineural hearing loss?
Resposta
Arrange urgent otolaryngology evaluation and assess for retrocochlear pathology.

Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26
Targeta 445
Pregunta
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?
Resposta
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
Targeta 446
Pregunta
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?
Resposta
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
Targeta 447
Pregunta
Which bedside pattern best points to acute ischemic stroke?
Resposta
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
Targeta 448
Pregunta
Which electrolyte disorder may cause weakness, paresthesias, bradycardia, or ECG changes but can be dangerous even without symptoms?
Resposta
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
Targeta 449
Pregunta
Which bedside pattern best points to community-acquired pneumonia?
Resposta
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
Targeta 450
Pregunta
Which pharmacologic approach is preferred for heart failure with reduced ejection fraction?
Resposta
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
Targeta 451
Pregunta
For surgical decision-making, severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock indicate which diagnosis?
Resposta
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
Targeta 452
Pregunta
Which bedside pattern best points to ectopic pregnancy?
Resposta
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
Targeta 453
Pregunta
In a child with sickle cell disease, sudden severe limb or back pain matches prior vaso-occlusive episodes and no alternative cause is found. Which diagnosis best fits?
Resposta
Acute sickle cell vaso-occlusive pain episode.

ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26
Targeta 454
Pregunta
In a child or adolescent, which bedside pattern best points to major depressive disorder?
Resposta
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
Targeta 455
Pregunta
Which prevention or risk-reduction step is important for cirrhosis with ascites?
Resposta
Use sodium restriction, review medicines that can worsen kidney perfusion, and monitor weight, kidney function, and electrolytes.

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26
Targeta 456
Pregunta
What clinical clue should raise suspicion for type 2 diabetes mellitus?
Resposta
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
Targeta 457
Pregunta
In a postmenopausal woman or man aged 50 or older, which steps support bone health and reduce fracture risk?
Resposta
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
Targeta 458
Pregunta
What clinical clue should raise suspicion for acute angle-closure glaucoma?
Resposta
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
Targeta 459
Pregunta
How should a clinician respond to an incidental finding outside the visit’s main problem?
Resposta
Explain the finding and its uncertainty, recommend proportionate follow-up, assign ownership, and document the plan.

Catching Those Who Fall Through the Cracks: Follow-up for Incidental Radiologic Findings · reviewed 2026-08-26
Targeta 460
Pregunta
Which next action matters most in ventricular fibrillation cardiac arrest?
Resposta
Start high-quality CPR and defibrillate ventricular fibrillation or pulseless ventricular tachycardia as soon as possible.

2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26
Targeta 461
Pregunta
Which test or testing sequence best evaluates suspected plaque psoriasis?
Resposta
Diagnosis is usually clinical; biopsy is reserved for uncertain morphology.

Psoriasis Clinical Guidelines · reviewed 2026-08-26
Targeta 462
Pregunta
What is the priority management step for pulmonary embolism?
Resposta
Start anticoagulation for confirmed pulmonary embolism; consider thrombolysis for selected patients with hemodynamic compromise and acceptable bleeding risk.

ASH VTE Guidelines: Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26
Targeta 463
Pregunta
What diagnostic approach is most appropriate when uncomplicated cystitis is suspected?
Resposta
Urinalysis supports the diagnosis; culture is important for complicated, recurrent, resistant, pregnant, or atypical cases.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 464
Pregunta
How should a clinician initially manage migraine with aura?
Resposta
Treat early with an effective acute medicine and choose prevention when frequency or disability justifies it.

AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26
Targeta 465
Pregunta
Why does thrombotic thrombocytopenic purpura produce its defining clinical pattern?
Resposta
Severe ADAMTS13 deficiency permits ultra-large von Willebrand factor multimers to form platelet-rich microthrombi.

ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26
Targeta 466
Pregunta
How should a clinician initially manage early syphilis?
Resposta
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
Targeta 467
Pregunta
What diagnostic approach is most appropriate when atrial fibrillation is suspected?
Resposta
Confirm the rhythm with a 12-lead ECG and assess for structural disease and reversible triggers.

2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26
Targeta 468
Pregunta
How should a clinician initially manage abnormal uterine bleeding from anovulation?
Resposta
Stabilize acute heavy bleeding first, then protect the endometrium and control ongoing blood loss.

Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women · reviewed 2026-08-26
Targeta 469
Pregunta
Why does acute cholecystitis produce its defining clinical pattern?
Resposta
A gallstone can block bile flow, causing gallbladder pain and swelling (inflammation).

Cholecystectomy · reviewed 2026-08-26
Targeta 470
Pregunta
How should a clinician initially manage post-traumatic stress disorder?
Resposta
Offer individual trauma-focused psychotherapy as first-line treatment when available and acceptable.

Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26
Targeta 471
Pregunta
In a child or adolescent, a clinician is considering septic arthritis. Which finding adds the most support?
Resposta
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
Targeta 472
Pregunta
Which next action matters most in acute kidney injury?
Resposta
Treat the cause, restore perfusion without overload, stop nephrotoxins, and relieve obstruction.

KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26
Targeta 473
Pregunta
For an eligible infant or selected high-risk child aged 8–19 months, which immunization strategy reduces severe RSV disease?
Resposta
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
Targeta 474
Pregunta
Which diagnosis causes weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia?
Resposta
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
Targeta 475
Pregunta
What is the ethical approach to a learner performing a procedure?
Resposta
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
Targeta 476
Pregunta
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?
Resposta
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
Targeta 477
Pregunta
Which bedside pattern best points to acute coronary syndrome?
Resposta
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
Targeta 478
Pregunta
How should medication be used in multiple sclerosis relapse?
Resposta
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
Targeta 479
Pregunta
What immediate plan is appropriate for acute pancreatitis?
Resposta
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
Targeta 480
Pregunta
How should medication be used in HIV infection?
Resposta
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
Targeta 481
Pregunta
For surgical decision-making, what immediate plan is appropriate for anterior cruciate ligament tear?
Resposta
Control swelling, restore motion, begin rehabilitation, and individualize reconstruction by instability and activity goals.

Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 482
Pregunta
How should medication be used in postpartum hemorrhage?
Resposta
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
Targeta 483
Pregunta
In a child or adolescent, which history or examination finding most strongly supports asthma?
Resposta
Variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers suggests asthma.

2026 GINA Strategy Report · reviewed 2026-08-26
Targeta 484
Pregunta
How should medication be used in delirium?
Resposta
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
Targeta 485
Pregunta
Which preventive measure belongs in care for herpes zoster?
Resposta
Age-appropriate recombinant zoster vaccination lowers zoster and postherpetic-neuralgia risk.

Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26
Targeta 486
Pregunta
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.
Resposta
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
Targeta 487
Pregunta
Which preventive step is required during surgery for viable testicular torsion?
Resposta
Perform bilateral orchiopexy, fixing the affected and contralateral testes to reduce future torsion risk.

Testicular Torsion · reviewed 2026-08-26
Targeta 488
Pregunta
Which test or testing sequence best evaluates suspected hyponatremia due to SIADH?
Resposta
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
Targeta 489
Pregunta
Why does primary hypothyroidism produce its defining clinical pattern?
Resposta
Low thyroid hormone removes feedback inhibition, so TSH rises in primary gland failure.

Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26
Targeta 490
Pregunta
Which test or testing sequence best evaluates suspected neutropenic fever?
Resposta
Obtain blood cultures and targeted cultures or imaging, but do not delay empiric antibiotics.

Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26
Targeta 491
Pregunta
Why does bacterial conjunctivitis produce its defining clinical pattern?
Resposta
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
Targeta 492
Pregunta
When is a chaperone appropriate for an intimate examination?
Resposta
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
Targeta 493
Pregunta
Which diagnosis causes recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms?
Resposta
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
Targeta 494
Pregunta
What medication strategy is appropriate for Crohn disease?
Resposta
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
Targeta 495
Pregunta
Which diagnosis best fits a painless chancre or a diffuse rash involving the palms and soles with generalized lymphadenopathy?
Resposta
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
Targeta 496
Pregunta
What medication strategy is appropriate for rheumatoid arthritis?
Resposta
Methotrexate is a preferred anchor drug for many patients with moderate-to-high activity, with folate and safety monitoring.

2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis · reviewed 2026-08-26
Targeta 497
Pregunta
Which diagnosis best fits irregular, unpredictable uterine bleeding at reproductive extremes or with endocrine disruption?
Resposta
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
Targeta 498
Pregunta
Which medication class does the 2024 SCCM focused update suggest for an adult with acute respiratory distress syndrome?
Resposta
Use systemic corticosteroids in selected adults with ARDS; the guideline does not specify one best molecule, dose, or duration.

2024 Focused Update: Corticosteroids in Sepsis, ARDS, and Community-Acquired Pneumonia · reviewed 2026-08-26
Targeta 499
Pregunta
Which diagnosis requires intrusion, avoidance, negative mood or cognition, and hyperarousal lasting more than one month after trauma?
Resposta
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
Targeta 500
Pregunta
Which preventive measure belongs in care for acute pericarditis?
Resposta
Restrict strenuous activity until symptoms and inflammatory findings resolve.

2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26
Targeta 501
Pregunta
Which diagnosis best fits loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension?
Resposta
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
Targeta 502
Pregunta
What drug class or regimen fits atrial fibrillation?
Resposta
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
Targeta 503
Pregunta
In a child or adolescent, which history or examination finding most strongly supports acute appendicitis?
Resposta
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
Targeta 504
Pregunta
Which diagnosis best fits this presentation: Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.
Resposta
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
Targeta 505
Pregunta
In an adult with headaches consistent with migraine with aura and a normal neurologic examination, when is neuroimaging needed?
Resposta
Routine neuroimaging is unnecessary; consider it when the aura is unusual, prolonged, or persistent or when other atypical or red-flag features are present.

Neuroimaging for Migraine: The American Headache Society Systematic Review and Evidence-Based Guideline · reviewed 2026-08-26
Targeta 506
Pregunta
In a child or adolescent, how can a clinician reduce avoidable harm related to diabetic ketoacidosis?
Resposta
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
Targeta 507
Pregunta
How should a clinician confirm or characterize early syphilis?
Resposta
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
Targeta 508
Pregunta
How can a clinician reduce avoidable harm related to retinal detachment?
Resposta
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
Targeta 509
Pregunta
How should a clinician confirm or characterize abnormal uterine bleeding from anovulation?
Resposta
Exclude pregnancy, assess anemia, review medicines and systemic causes, and sample endometrium when age or risk warrants.

Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women · reviewed 2026-08-26
Targeta 510
Pregunta
How should social media be handled when a clinical story seems de-identified?
Resposta
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
Targeta 511
Pregunta
How should a clinician confirm or characterize post-traumatic stress disorder?
Resposta
Use a trauma-informed clinical assessment and a validated symptom measure while checking safety and comorbidity.

Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26
Targeta 512
Pregunta
Which preventive measure belongs in care for nephrotic syndrome?
Resposta
Vaccination, thrombosis-risk assessment, infection prevention, and cardiovascular-risk control reduce complications.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 513
Pregunta
In a child or adolescent, what medication strategy is appropriate for atopic dermatitis?
Resposta
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
Targeta 514
Pregunta
Which preventive measure belongs in care for thrombotic thrombocytopenic purpura?
Resposta
Recognize relapse symptoms early and maintain specialist follow-up after recovery.

ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26
Targeta 515
Pregunta
How should a clinician initially manage acute coronary syndrome?
Resposta
Give aspirin promptly when acute coronary syndrome is suspected and no contraindication exists; activate reperfusion pathways for STEMI.

2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26
Targeta 516
Pregunta
Which history or examination finding most strongly supports acute pyelonephritis?
Resposta
Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 517
Pregunta
For surgical decision-making, which next action matters most in tension pneumothorax?
Resposta
Perform immediate decompression followed by tube thoracostomy.

Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26
Targeta 518
Pregunta
Which diagnosis best fits this presentation: Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.
Resposta
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
Targeta 519
Pregunta
What physiologic disturbance underlies anterior cruciate ligament tear?
Resposta
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
Targeta 520
Pregunta
A clinician is considering heart failure with reduced ejection fraction. Which finding adds the most support?
Resposta
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
Targeta 521
Pregunta
What physiologic disturbance underlies bacterial brain abscess?
Resposta
Localized infection produces cerebritis and a capsule with surrounding edema and mass effect.

ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26
Targeta 522
Pregunta
What is the key first diagnostic step for Cushing syndrome?
Resposta
Use an accepted first-line screen such as late-night salivary cortisol, 24-hour urinary free cortisol, or overnight dexamethasone suppression.

Diagnosis of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26
Targeta 523
Pregunta
What physiologic disturbance underlies pulmonary tuberculosis?
Resposta
Mycobacteria survive in macrophages and drive granulomatous inflammation with latent or active disease.

Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26
Targeta 524
Pregunta
Which antibiotic is required for gonococcal conjunctivitis in an adult?
Resposta
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
Targeta 525
Pregunta
What physiologic disturbance underlies endometriosis?
Resposta
Estrogen-responsive ectopic endometrial-like tissue drives inflammation, fibrosis, and pain.

Endometriosis · reviewed 2026-08-26
Targeta 526
Pregunta
What should a clinician do after sending protected information to the wrong recipient?
Resposta
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
Targeta 527
Pregunta
Which clinical pattern defines a panic attack?
Resposta
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
Targeta 528
Pregunta
What clinical clue should raise suspicion for acute kidney injury?
Resposta
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
Targeta 529
Pregunta
What physiologic disturbance underlies tension pneumothorax?
Resposta
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
Targeta 530
Pregunta
In a child or adolescent, what clinical clue should raise suspicion for immune thrombocytopenia?
Resposta
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
Targeta 531
Pregunta
What is the key first diagnostic step for celiac disease?
Resposta
Order tissue-transglutaminase IgA with total IgA while the patient is eating gluten; confirm as guideline-directed.

ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26
Targeta 532
Pregunta
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?
Resposta
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
Targeta 533
Pregunta
What is the key first diagnostic step for carpal tunnel syndrome?
Resposta
Diagnosis is often clinical; electrodiagnostic testing helps when severe, atypical, or before selected surgery.

Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 534
Pregunta
Which prevention step is essential before oral intake in acute ischemic stroke?
Resposta
Screen swallowing before food, fluids, or oral medication to reduce aspiration risk.

2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26
Targeta 535
Pregunta
What is the priority management step for cellulitis?
Resposta
Mark the margin, assess for abscess or necrotizing infection, and escalate care for systemic toxicity.

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections · reviewed 2026-08-26
Targeta 536
Pregunta
Which prevention or risk-reduction step is important for community-acquired pneumonia?
Resposta
Keep age- and risk-appropriate pneumococcal vaccination current to reduce preventable pneumococcal pneumonia.

Pneumococcal Vaccine Recommendations · reviewed 2026-08-26
Targeta 537
Pregunta
For surgical decision-making, what is the priority management step for benign prostatic hyperplasia?
Resposta
Urgently catheterize acute urinary retention and evaluate infection, kidney injury, or severe hematuria.

EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26
Targeta 538
Pregunta
Which prevention or risk-reduction step is important for ectopic pregnancy?
Resposta
Early testing after a missed period and prompt evaluation of pain or bleeding reduce rupture morbidity.

Ectopic Pregnancy · reviewed 2026-08-26
Targeta 539
Pregunta
What diagnostic approach is most appropriate when obstructive sleep apnea is suspected?
Resposta
Confirm with polysomnography or an appropriate home sleep-apnea test in selected uncomplicated adults.

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea · reviewed 2026-08-26
Targeta 540
Pregunta
In a child or adolescent, which prevention or risk-reduction step is important for major depressive disorder?
Resposta
Monitor symptoms, suicidality, functioning, treatment adherence, and recurrence with a clear follow-up and safety plan.

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26
Targeta 541
Pregunta
Which pathophysiologic process drives symptomatic aortic stenosis?
Resposta
Calcific leaflet narrowing creates a fixed left-ventricular outflow obstruction and pressure overload.

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26
Targeta 542
Pregunta
In a child or adolescent, what drug class or regimen fits diabetic ketoacidosis?
Resposta
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
Targeta 543
Pregunta
What is the key first diagnostic step for peritonsillar abscess?
Resposta
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
Targeta 544
Pregunta
What does continuity require before ending a clinician-patient relationship?
Resposta
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
Targeta 545
Pregunta
What counseling point helps reduce harm from chronic hepatitis C?
Resposta
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
Targeta 546
Pregunta
What drug class or regimen fits hyperkalemia?
Resposta
IV calcium protects the heart; insulin with glucose shifts potassium, while diuresis, binders, or dialysis remove it.

Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26
Targeta 547
Pregunta
In a child or adolescent, what counseling point helps reduce harm from juvenile idiopathic arthritis?
Resposta
Vaccination, eye screening, activity, and growth monitoring reduce preventable morbidity.

2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26
Targeta 548
Pregunta
In a child or adolescent, which next action matters most in immune thrombocytopenia?
Resposta
Treat clinically important bleeding urgently; observation is appropriate for selected patients with minor symptoms.

American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26
Targeta 549
Pregunta
A clinician is considering subarachnoid hemorrhage. Which finding adds the most support?
Resposta
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
Targeta 550
Pregunta
Which test or testing sequence best evaluates suspected aortic dissection?
Resposta
CT angiography is the usual rapid definitive study in a stable patient; transesophageal echocardiography is useful when unstable.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26
Targeta 551
Pregunta
In a child, typically 6 months to 3 years, what counseling point helps reduce harm from croup?
Resposta
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
Targeta 552
Pregunta
In a child or adolescent, a clinician is considering bacterial meningitis. Which finding adds the most support?
Resposta
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
Targeta 553
Pregunta
A clinician is considering preeclampsia with severe features. Which finding adds the most support?
Resposta
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
Targeta 554
Pregunta
A clinician is considering bipolar I mania. Which finding adds the most support?
Resposta
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
Targeta 555
Pregunta
What is the priority management step for celiac disease?
Resposta
Do not start a gluten-free diet before completing diagnostic testing unless immediate clinical needs demand it.

ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26
Targeta 556
Pregunta
Which history or examination finding most strongly supports acute compartment syndrome?
Resposta
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
Targeta 557
Pregunta
For surgical decision-making, how should a clinician initially manage Cushing syndrome?
Resposta
Confirm hypercortisolism, identify whether it is ACTH dependent, and localize the source before definitive treatment.

Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26
Targeta 558
Pregunta
Which bedside pattern best points to retinal detachment?
Resposta
New flashes, floaters, and a curtain or shadow across the visual field suggest detachment.

Retinal Detachment · reviewed 2026-08-26
Targeta 559
Pregunta
How should a clinician respond when requested to falsify a work note or record?
Resposta
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
Targeta 560
Pregunta
How can a clinician reduce avoidable harm related to hypertensive emergency?
Resposta
Accurate home monitoring and sustained treatment adherence reduce progression to crisis.

2025 High Blood Pressure Guideline · reviewed 2026-08-26
Targeta 561
Pregunta
What clinical clue should raise suspicion for COPD?
Resposta
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
Targeta 562
Pregunta
Which pharmacologic approach is preferred for acute pyelonephritis?
Resposta
Select empiric therapy from local resistance and severity, then narrow to the culture.

EAU Guidelines on Urological Infections · reviewed 2026-08-26
Targeta 563
Pregunta
Which history or examination finding most strongly supports plaque psoriasis?
Resposta
Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis.

Psoriasis Clinical Guidelines · reviewed 2026-08-26
Targeta 564
Pregunta
What immediate plan is appropriate for Parkinson disease?
Resposta
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
Targeta 565
Pregunta
Which diagnosis best fits hypotonic euvolemic hyponatremia with inappropriately concentrated urine after thyroid, adrenal, renal, and diuretic causes are excluded?
Resposta
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
Targeta 566
Pregunta
What immediate plan is appropriate for gonococcal urethritis or cervicitis?
Resposta
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
Targeta 567
Pregunta
How should medication be used in aortic dissection?
Resposta
Use an IV beta-blocker first to reduce shear stress, then add a vasodilator if pressure remains high.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26
Targeta 568
Pregunta
What immediate plan is appropriate for menopause vasomotor symptoms?
Resposta
Match treatment to symptom burden, uterus status, contraindications, and patient preference.

Hormone Therapy for Menopause · reviewed 2026-08-26
Targeta 569
Pregunta
Which pharmacologic approach is preferred for cirrhosis with ascites?
Resposta
Spironolactone with furosemide is a common diuretic combination when renal function and electrolytes allow.

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26
Targeta 570
Pregunta
What immediate plan is appropriate for alcohol withdrawal?
Resposta
Stabilize, give thiamine, use symptom- or risk-guided withdrawal treatment, and admit high-risk patients.

The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26
Targeta 571
Pregunta
In a child or adolescent, what drug class or regimen fits sickle cell vaso-occlusive crisis?
Resposta
Use rapid individualized analgesia, with nonsteroidal anti-inflammatory drugs for selected mild pain and opioids for severe pain, followed by frequent reassessment.

ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26
Targeta 572
Pregunta
For surgical decision-making, what is the priority management step for carpal tunnel syndrome?
Resposta
Use neutral-position night splinting initially; refer for decompression with severe weakness, denervation, or persistent symptoms.

Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26
Targeta 573
Pregunta
In an infant aged 1–23 months, what drug class or regimen fits bronchiolitis?
Resposta
Routine salbutamol, corticosteroids, and antibiotics are not recommended; use antibiotics only when bacterial infection is evident or strongly suspected.

Bronchiolitis: Recommendations for Diagnosis, Monitoring and Management of Children One to 24 Months · reviewed 2026-08-26
Targeta 574
Pregunta
In a child or adolescent, which bedside pattern best points to diabetic ketoacidosis?
Resposta
Hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status suggests ketoacidosis.

Standards of Care in Diabetes—2026 · reviewed 2026-08-26
Targeta 575
Pregunta
For surgical decision-making, how should a clinician initially manage peritonsillar abscess?
Resposta
Assess the airway, drain the abscess, hydrate, and treat infection.

Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26
Targeta 576
Pregunta
Which factors determine a PA’s scope of practice?
Resposta
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
Targeta 577
Pregunta
What immediate plan is appropriate for heart failure with reduced ejection fraction?
Resposta
For acute pulmonary edema, support oxygenation and relieve congestion while identifying the trigger.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26
Targeta 578
Pregunta
What medication strategy is appropriate for acute ischemic stroke?
Resposta
Antiplatelet therapy is used after hemorrhage is excluded when thrombolysis timing and stroke mechanism allow.

2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26
Targeta 579
Pregunta
What combination of findings should raise suspicion for acute calculous cholecystitis?
Resposta
Right-upper-quadrant pain or tenderness, fever, leukocytosis, and a positive Murphy sign support the diagnosis when considered together.

2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26
Targeta 580
Pregunta
What medication strategy is appropriate for community-acquired pneumonia?
Resposta
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
Targeta 581
Pregunta
Which diagnosis is defined by acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult?
Resposta
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
Targeta 582
Pregunta
What medication strategy is appropriate for ectopic pregnancy?
Resposta
Methotrexate is an option for selected stable unruptured ectopic pregnancy without contraindications.

Ectopic Pregnancy · reviewed 2026-08-26
Targeta 583
Pregunta
In a child or adolescent, what medication strategy is appropriate for major depressive disorder?
Resposta
When medication is indicated for an adolescent, use an evidence-supported SSRI with close monitoring; combine it with psychotherapy according to severity and preference.

Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26
Targeta 584
Pregunta
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.
Resposta
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
Targeta 585
Pregunta
Which pharmacologic approach is preferred for a postmenopausal woman with osteoporosis at high fracture risk?
Resposta
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
Targeta 586
Pregunta
Which history or examination finding most strongly supports atrial fibrillation?
Resposta
An irregularly irregular pulse with palpitations, fatigue, or dyspnea suggests atrial fibrillation.

2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26
Targeta 587
Pregunta
Which diagnosis best fits dysuria and frequency without vaginal symptoms in an otherwise appropriate patient?
Resposta
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
Targeta 588
Pregunta
How should a clinician initially manage nephrotic syndrome?
Resposta
Manage edema and cause, and urgently evaluate thrombosis, infection, or severe volume compromise.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases with 2024 Chapter Updates · reviewed 2026-08-26
Targeta 589
Pregunta
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.
Resposta
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
Targeta 590
Pregunta
What is the purpose of root cause analysis after a serious patient-safety event?
Resposta
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
Targeta 591
Pregunta
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?
Resposta
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
Targeta 592
Pregunta
How should a clinician initially manage obstructive sleep apnea?
Resposta
Offer positive airway pressure for obstructive sleep apnea with excessive sleepiness and consider it for impaired sleep-related quality of life or comorbid hypertension.

Clinical Practice Guideline for Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure · reviewed 2026-08-26
Targeta 593
Pregunta
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?
Resposta
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
Targeta 594
Pregunta
Which diagnosis requires bradykinesia plus rest tremor or rigidity and often includes reduced arm swing or a shuffling gait?
Resposta
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
Targeta 595
Pregunta
Which diagnosis best fits purulent urethral discharge, dysuria, cervicitis, pelvic pain, or a relevant sexual exposure, although infection may be asymptomatic?
Resposta
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
Targeta 596
Pregunta
Which diagnosis best fits hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age?
Resposta
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
Targeta 597
Pregunta
Which diagnosis causes tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use?
Resposta
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
Targeta 598
Pregunta
Which diagnosis causes bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation?
Resposta
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
Targeta 599
Pregunta
Which diagnosis best fits abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint?
Resposta
Gout flare. Abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint, suggests gout.

Gout · reviewed 2026-08-26
Targeta 600
Pregunta
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.
Resposta
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 targetes