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

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

نوشتهٔ Flashcards Open Source App

دربارهٔ این دسته

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.

کارت‌های این دسته

  2. کارت ۲

    پرسش

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

    پاسخ

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

    Informed Consent · reviewed 2026-08-26

  3. کارت ۳

    پرسش

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

    پاسخ

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  8. کارت ۸

    پرسش

    What core mechanism explains ectopic pregnancy?

    پاسخ

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

    Ectopic Pregnancy · reviewed 2026-08-26

  10. کارت ۱۰

    پرسش

    What core mechanism explains type 2 diabetes mellitus?

    پاسخ

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

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

  11. کارت ۱۱

    پرسش

    What core mechanism explains acute angle-closure glaucoma?

    پاسخ

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

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

  13. کارت ۱۳

    پرسش

    What core mechanism explains chronic kidney disease?

    پاسخ

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

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

  16. کارت ۱۶

    پرسش

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

    پاسخ

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  18. کارت ۱۸

    پرسش

    What core mechanism explains uncomplicated cystitis?

    پاسخ

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

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

  19. کارت ۱۹

    پرسش

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

    پاسخ

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

    Rheumatoid Arthritis · reviewed 2026-08-26

  20. کارت ۲۰

    پرسش

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

    پاسخ

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

    Informed Consent · reviewed 2026-08-26

  21. کارت ۲۱

    پرسش

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

    پاسخ

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

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

  22. کارت ۲۲

    پرسش

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

    پاسخ

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

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

  23. کارت ۲۳

    پرسش

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

    پاسخ

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

    Shoulder Dystocia · reviewed 2026-08-26

  24. کارت ۲۴

    پرسش

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

    پاسخ

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

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

  25. کارت ۲۵

    پرسش

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

    پاسخ

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

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

  27. کارت ۲۷

    پرسش

    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.

    پاسخ

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

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

  28. کارت ۲۸

    پرسش

    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.

    پاسخ

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  30. کارت ۳۰

    پرسش

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

    پاسخ

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

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

  34. کارت ۳۴

    پرسش

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

    پاسخ

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

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

  35. کارت ۳۵

    پرسش

    What clinical clue should raise suspicion for pulmonary tuberculosis?

    پاسخ

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

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

  36. کارت ۳۶

    پرسش

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

    پاسخ

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  37. کارت ۳۷

    پرسش

    What clinical clue should raise suspicion for endometriosis?

    پاسخ

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

    Endometriosis · reviewed 2026-08-26

  38. کارت ۳۸

    پرسش

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

    پاسخ

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

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

  39. کارت ۳۹

    پرسش

    What clinical clue should raise suspicion for panic disorder?

    پاسخ

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

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

  41. کارت ۴۱

    پرسش

    What clinical clue should raise suspicion for tension pneumothorax?

    پاسخ

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

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

  42. کارت ۴۲

    پرسش

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

    پاسخ

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

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

  43. کارت ۴۳

    پرسش

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

    پاسخ

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

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

  44. کارت ۴۴

    پرسش

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

    پاسخ

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

    Retinal Detachment · reviewed 2026-08-26

  45. کارت ۴۵

    پرسش

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

    پاسخ

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

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

  46. کارت ۴۶

    پرسش

    Which next action matters most in Crohn disease?

    پاسخ

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

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

  48. کارت ۴۸

    پرسش

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

    پاسخ

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

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

  51. کارت ۵۱

    پرسش

    Which next action matters most in multiple sclerosis relapse?

    پاسخ

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

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

  52. کارت ۵۲

    پرسش

    Which next action matters most in HIV infection?

    پاسخ

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

    Initiation of Antiretroviral Therapy · reviewed 2026-08-26

  53. کارت ۵۳

    پرسش

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

    پاسخ

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  58. کارت ۵۸

    پرسش

    What clinical clue should raise suspicion for acute bacterial rhinosinusitis?

    پاسخ

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

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

  59. کارت ۵۹

    پرسش

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

    پاسخ

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

    Withholding Information from Patients · reviewed 2026-08-26

  61. کارت ۶۱

    پرسش

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

    پاسخ

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  65. کارت ۶۵

    پرسش

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

    پاسخ

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

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

  67. کارت ۶۷

    پرسش

    What drug class or regimen fits sepsis?

    پاسخ

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

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

  70. کارت ۷۰

    پرسش

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

    پاسخ

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

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

  71. کارت ۷۱

    پرسش

    What drug class or regimen fits schizophrenia?

    پاسخ

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

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

  73. کارت ۷۳

    پرسش

    What is the key first diagnostic step for primary hypothyroidism?

    پاسخ

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

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

  74. کارت ۷۴

    پرسش

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

    پاسخ

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

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

  76. کارت ۷۶

    پرسش

    What makes informed consent more than a signed form?

    پاسخ

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

    Informed Consent · reviewed 2026-08-26

  77. کارت ۷۷

    پرسش

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

    پاسخ

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

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

  79. کارت ۷۹

    پرسش

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

    پاسخ

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

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

  80. کارت ۸۰

    پرسش

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

    پاسخ

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

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

  82. کارت ۸۲

    پرسش

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

    پاسخ

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  83. کارت ۸۳

    پرسش

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

    پاسخ

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

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

  88. کارت ۸۸

    پرسش

    What drug class or regimen fits chronic kidney disease?

    پاسخ

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

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

  89. کارت ۸۹

    پرسش

    Which microbiologic test is essential when gonococcal conjunctivitis is suspected?

    پاسخ

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

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

  91. کارت ۹۱

    پرسش

    When may treatment proceed without prior consent in an emergency?

    پاسخ

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

    Informed Consent · reviewed 2026-08-26

  93. کارت ۹۳

    پرسش

    What is the key first diagnostic step for subarachnoid hemorrhage?

    پاسخ

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

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

  95. کارت ۹۵

    پرسش

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

    پاسخ

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

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

  96. کارت ۹۶

    پرسش

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

    پاسخ

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

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

  97. کارت ۹۷

    پرسش

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

    پاسخ

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  99. کارت ۹۹

    پرسش

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

    پاسخ

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

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

  100. کارت ۱۰۰

    پرسش

    How should medication be used in hypertensive emergency?

    پاسخ

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

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

  105. کارت ۱۰۵

    پرسش

    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?

    پاسخ

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

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

  107. کارت ۱۰۷

    پرسش

    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.

    پاسخ

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

    About HIV · reviewed 2026-08-26

  108. کارت ۱۰۸

    پرسش

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

    پاسخ

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

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

  109. کارت ۱۰۹

    پرسش

    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.

    پاسخ

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  110. کارت ۱۱۰

    پرسش

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

    پاسخ

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

    Promoting Patient Safety · reviewed 2026-08-26

  111. کارت ۱۱۱

    پرسش

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

    پاسخ

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

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

  113. کارت ۱۱۳

    پرسش

    Which next action matters most in uncomplicated cystitis?

    پاسخ

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

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

  116. کارت ۱۱۶

    پرسش

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

    پاسخ

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

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

  118. کارت ۱۱۸

    پرسش

    What is the key first diagnostic step for herpes zoster?

    پاسخ

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

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

  120. کارت ۱۲۰

    پرسش

    Which bedside pattern best points to migraine with aura?

    پاسخ

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

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

  121. کارت ۱۲۱

    پرسش

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

    پاسخ

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

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

  122. کارت ۱۲۲

    پرسش

    Which bedside pattern best points to early syphilis?

    پاسخ

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

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

  123. کارت ۱۲۳

    پرسش

    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.

    پاسخ

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

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

  124. کارت ۱۲۴

    پرسش

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

    پاسخ

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  125. کارت ۱۲۵

    پرسش

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

    پاسخ

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

    Gifts from Patients · reviewed 2026-08-26

  128. کارت ۱۲۸

    پرسش

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

    پاسخ

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  129. کارت ۱۲۹

    پرسش

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

    پاسخ

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

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

  132. کارت ۱۳۲

    پرسش

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

    پاسخ

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

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

  133. کارت ۱۳۳

    پرسش

    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?

    پاسخ

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

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

  135. کارت ۱۳۵

    پرسش

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

    پاسخ

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

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  137. کارت ۱۳۷

    پرسش

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

    پاسخ

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  138. کارت ۱۳۸

    پرسش

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

    پاسخ

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

    Ectopic Pregnancy · reviewed 2026-08-26

  139. کارت ۱۳۹

    پرسش

    What counseling point helps reduce harm from tension pneumothorax?

    پاسخ

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

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

  141. کارت ۱۴۱

    پرسش

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

    پاسخ

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

    Physician Exercise of Conscience · reviewed 2026-08-26

  144. کارت ۱۴۴

    پرسش

    How should a clinician initially manage primary hypothyroidism?

    پاسخ

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

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

  145. کارت ۱۴۵

    پرسش

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

    پاسخ

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

    Carpal Tunnel Syndrome · reviewed 2026-08-26

  146. کارت ۱۴۶

    پرسش

    How should a clinician initially manage bacterial conjunctivitis?

    پاسخ

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

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

  147. کارت ۱۴۷

    پرسش

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

    پاسخ

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

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

  149. کارت ۱۴۹

    پرسش

    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.

    پاسخ

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

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

  151. کارت ۱۵۱

    پرسش

    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?

    پاسخ

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

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

  152. کارت ۱۵۲

    پرسش

    How should medication be used in pulmonary tuberculosis?

    پاسخ

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

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

  153. کارت ۱۵۳

    پرسش

    How should medication be used in endometriosis?

    پاسخ

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

    Endometriosis · reviewed 2026-08-26

  154. کارت ۱۵۴

    پرسش

    How should medication be used in panic disorder?

    پاسخ

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

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

  156. کارت ۱۵۶

    پرسش

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

    پاسخ

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

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

  157. کارت ۱۵۷

    پرسش

    Which bedside pattern best points to primary adrenal insufficiency?

    پاسخ

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

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

  158. کارت ۱۵۸

    پرسش

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

    پاسخ

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

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

  160. کارت ۱۶۰

    پرسش

    Which pathophysiologic process drives heart failure with reduced ejection fraction?

    پاسخ

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

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

  161. کارت ۱۶۱

    پرسش

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

    پاسخ

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

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

  163. کارت ۱۶۳

    پرسش

    What is the key first diagnostic step for testicular torsion?

    پاسخ

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

    Testicular Torsion · reviewed 2026-08-26

  164. کارت ۱۶۴

    پرسش

    What counseling point helps reduce harm from Parkinson disease?

    پاسخ

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

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

  166. کارت ۱۶۶

    پرسش

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

    پاسخ

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

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

  168. کارت ۱۶۸

    پرسش

    What counseling point helps reduce harm from menopause vasomotor symptoms?

    پاسخ

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

    The Menopause Years · reviewed 2026-08-26

  169. کارت ۱۶۹

    پرسش

    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?

    پاسخ

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

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  172. کارت ۱۷۲

    پرسش

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

    پاسخ

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

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

  175. کارت ۱۷۵

    پرسش

    How should medication be used in sudden sensorineural hearing loss?

    پاسخ

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

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

  176. کارت ۱۷۶

    پرسش

    What is the HIPAA minimum-necessary rule?

    پاسخ

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

    Minimum Necessary Requirement · reviewed 2026-08-26

  177. کارت ۱۷۷

    پرسش

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

    پاسخ

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

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

  178. کارت ۱۷۸

    پرسش

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

    پاسخ

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

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

  179. کارت ۱۷۹

    پرسش

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

    پاسخ

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

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

  180. کارت ۱۸۰

    پرسش

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

    پاسخ

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

    Gout · reviewed 2026-08-26

  181. کارت ۱۸۱

    پرسش

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

    پاسخ

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

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

  182. کارت ۱۸۲

    پرسش

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

    پاسخ

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  183. کارت ۱۸۳

    پرسش

    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?

    پاسخ

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

    Ectopic Pregnancy · reviewed 2026-08-26

  184. کارت ۱۸۴

    پرسش

    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?

    پاسخ

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

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

  186. کارت ۱۸۶

    پرسش

    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.

    پاسخ

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

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  188. کارت ۱۸۸

    پرسش

    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.

    پاسخ

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  191. کارت ۱۹۱

    پرسش

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

    پاسخ

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

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

  192. کارت ۱۹۲

    پرسش

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

    پاسخ

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

    Incidental Uses and Disclosures · reviewed 2026-08-26

  193. کارت ۱۹۳

    پرسش

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

    پاسخ

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

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

  194. کارت ۱۹۴

    پرسش

    What immediate plan is appropriate for chronic hepatitis C?

    پاسخ

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

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  195. کارت ۱۹۵

    پرسش

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

    پاسخ

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

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

  196. کارت ۱۹۶

    پرسش

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

    پاسخ

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

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

  197. کارت ۱۹۷

    پرسش

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

    پاسخ

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

    The Menopause Years · reviewed 2026-08-26

  198. کارت ۱۹۸

    پرسش

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

    پاسخ

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

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

  199. کارت ۱۹۹

    پرسش

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

    پاسخ

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

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

  202. کارت ۲۰۲

    پرسش

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

    پاسخ

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

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

  203. کارت ۲۰۳

    پرسش

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

    پاسخ

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

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

  204. کارت ۲۰۴

    پرسش

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

    پاسخ

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

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

  206. کارت ۲۰۶

    پرسش

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

    پاسخ

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

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

  207. کارت ۲۰۷

    پرسش

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

    پاسخ

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

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

  208. کارت ۲۰۸

    پرسش

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

    پاسخ

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  209. کارت ۲۰۹

    پرسش

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

    پاسخ

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

    Retinal Detachment · reviewed 2026-08-26

  210. کارت ۲۱۰

    پرسش

    What immediate plan is appropriate for bipolar I mania?

    پاسخ

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

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

  211. کارت ۲۱۱

    پرسش

    May a clinician leave appointment information in a voicemail?

    پاسخ

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

    Incidental Uses and Disclosures · reviewed 2026-08-26

  212. کارت ۲۱۲

    پرسش

    When is a loop diuretic appropriate in acute kidney injury?

    پاسخ

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

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

  213. کارت ۲۱۳

    پرسش

    How should a clinician initially manage plaque psoriasis?

    پاسخ

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  216. کارت ۲۱۶

    پرسش

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

    پاسخ

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

    Erectile Dysfunction Guideline · reviewed 2026-08-26

  217. کارت ۲۱۷

    پرسش

    Which pathophysiologic process drives COPD?

    پاسخ

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

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

  218. کارت ۲۱۸

    پرسش

    Which history or examination finding most strongly supports Crohn disease?

    پاسخ

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

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

  221. کارت ۲۲۱

    پرسش

    What clinical clue should raise suspicion for hypertensive emergency?

    پاسخ

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

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

  225. کارت ۲۲۵

    پرسش

    What counseling point helps reduce harm from peritonsillar abscess?

    پاسخ

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  227. کارت ۲۲۷

    پرسش

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

    پاسخ

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

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

  230. کارت ۲۳۰

    پرسش

    Which bedside pattern best points to herpes zoster?

    پاسخ

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

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

  231. کارت ۲۳۱

    پرسش

    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?

    پاسخ

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

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

  232. کارت ۲۳۲

    پرسش

    Which bedside pattern best points to testicular torsion?

    پاسخ

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

    Testicular Torsion · reviewed 2026-08-26

  233. کارت ۲۳۳

    پرسش

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

    پاسخ

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

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

  234. کارت ۲۳۴

    پرسش

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

    پاسخ

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

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

  235. کارت ۲۳۵

    پرسش

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

    پاسخ

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

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

  236. کارت ۲۳۶

    پرسش

    What diagnostic approach is most appropriate when sepsis is suspected?

    پاسخ

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

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

  237. کارت ۲۳۷

    پرسش

    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?

    پاسخ

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

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

  238. کارت ۲۳۸

    پرسش

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

    پاسخ

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

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

  239. کارت ۲۳۹

    پرسش

    Which pharmacologic approach is preferred for COPD?

    پاسخ

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

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

  240. کارت ۲۴۰

    پرسش

    What diagnostic approach is most appropriate when schizophrenia is suspected?

    پاسخ

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

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

  241. کارت ۲۴۱

    پرسش

    Which next action matters most in hypertensive emergency?

    پاسخ

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

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

  242. کارت ۲۴۲

    پرسش

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

    پاسخ

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

    Limited English Proficiency Guidance · reviewed 2026-08-26

  245. کارت ۲۴۵

    پرسش

    What immediate plan is appropriate for acute bacterial rhinosinusitis?

    پاسخ

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

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

  246. کارت ۲۴۶

    پرسش

    Which preventive measure belongs in care for gout flare?

    پاسخ

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

    Gout · reviewed 2026-08-26

  249. کارت ۲۴۹

    پرسش

    Which test or testing sequence best evaluates suspected COPD?

    پاسخ

    Post-bronchodilator spirometry confirms persistent airflow obstruction.

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

  251. کارت ۲۵۱

    پرسش

    Which pathophysiologic process drives subarachnoid hemorrhage?

    پاسخ

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

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

  252. کارت ۲۵۲

    پرسش

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

    پاسخ

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

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

  253. کارت ۲۵۳

    پرسش

    Which pathophysiologic process drives preeclampsia with severe features?

    پاسخ

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  254. کارت ۲۵۴

    پرسش

    Which clinical feature defines bipolar I disorder?

    پاسخ

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

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

  255. کارت ۲۵۵

    پرسش

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

    پاسخ

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

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

  256. کارت ۲۵۶

    پرسش

    Which history or examination finding most strongly supports rheumatoid arthritis?

    پاسخ

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

    Rheumatoid Arthritis · reviewed 2026-08-26

  257. کارت ۲۵۷

    پرسش

    What is teach-back?

    پاسخ

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

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

  260. کارت ۲۶۰

    پرسش

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

    پاسخ

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

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

  261. کارت ۲۶۱

    پرسش

    Which preventive measure belongs in care for obstructive sleep apnea?

    پاسخ

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

    Sleep Apnea Treatment · reviewed 2026-08-26

  262. کارت ۲۶۲

    پرسش

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

    پاسخ

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

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  263. کارت ۲۶۳

    پرسش

    How should a clinician initially manage acute pyelonephritis?

    پاسخ

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

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

  264. کارت ۲۶۴

    پرسش

    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.

    پاسخ

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

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

  266. کارت ۲۶۶

    پرسش

    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.

    پاسخ

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

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

  267. کارت ۲۶۷

    پرسش

    What drug class or regimen fits stable chronic hypertension?

    پاسخ

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

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

  268. کارت ۲۶۸

    پرسش

    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.

    پاسخ

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  269. کارت ۲۶۹

    پرسش

    Which pharmacologic approach is preferred for acute pancreatitis?

    پاسخ

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

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

  270. کارت ۲۷۰

    پرسش

    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.

    پاسخ

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

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

  271. کارت ۲۷۱

    پرسش

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

    پاسخ

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

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

  273. کارت ۲۷۳

    پرسش

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

    پاسخ

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  274. کارت ۲۷۴

    پرسش

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

    پاسخ

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

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

  275. کارت ۲۷۵

    پرسش

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

    پاسخ

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

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

  276. کارت ۲۷۶

    پرسش

    Which pathophysiologic process drives retinal detachment?

    پاسخ

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

    Retinal Detachment · reviewed 2026-08-26

  279. کارت ۲۷۹

    پرسش

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

    پاسخ

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

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

  281. کارت ۲۸۱

    پرسش

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

    پاسخ

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

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

  282. کارت ۲۸۲

    پرسش

    Which preventive measure belongs in care for shoulder dystocia?

    پاسخ

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

    Shoulder Dystocia · reviewed 2026-08-26

  284. کارت ۲۸۴

    پرسش

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

    پاسخ

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

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

  287. کارت ۲۸۷

    پرسش

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

    پاسخ

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

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

  289. کارت ۲۸۹

    پرسش

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

    پاسخ

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

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

  290. کارت ۲۹۰

    پرسش

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

    پاسخ

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

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

  291. کارت ۲۹۱

    پرسش

    What medication strategy is appropriate for peritonsillar abscess?

    پاسخ

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  292. کارت ۲۹۲

    پرسش

    What belongs in a safe handoff?

    پاسخ

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

    TeamSTEPPS Communication Module · reviewed 2026-08-26

  294. کارت ۲۹۴

    پرسش

    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.

    پاسخ

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

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

  297. کارت ۲۹۷

    پرسش

    Which history or examination finding most strongly supports shoulder dystocia?

    پاسخ

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

    Shoulder Dystocia · reviewed 2026-08-26

  298. کارت ۲۹۸

    پرسش

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

    پاسخ

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

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

  300. کارت ۳۰۰

    پرسش

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

    پاسخ

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

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

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

    ۶۰۰ کارت

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

    این دسته را رایگان مطالعه کنید

    Nibomo باز می‌شود تا بتوانید مطالعه را شروع کنید.

  303. کارت ۳۰۳

    پرسش

    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.

    پاسخ

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

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

  305. کارت ۳۰۵

    پرسش

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

    پاسخ

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

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

  306. کارت ۳۰۶

    پرسش

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

    پاسخ

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

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

  308. کارت ۳۰۸

    پرسش

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

    پاسخ

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

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

  309. کارت ۳۰۹

    پرسش

    What is the priority management step for pelvic inflammatory disease?

    پاسخ

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

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

  310. کارت ۳۱۰

    پرسش

    What is closed-loop communication during an emergency?

    پاسخ

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

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

  311. کارت ۳۱۱

    پرسش

    What is the priority management step for schizophrenia?

    پاسخ

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

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

  317. کارت ۳۱۷

    پرسش

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

    پاسخ

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

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

  318. کارت ۳۱۸

    پرسش

    Which test or testing sequence best evaluates suspected acute cholecystitis?

    پاسخ

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

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

  319. کارت ۳۱۹

    پرسش

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

    پاسخ

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

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

  320. کارت ۳۲۰

    پرسش

    Which pharmacologic approach is preferred for Parkinson disease?

    پاسخ

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

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

  321. کارت ۳۲۱

    پرسش

    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?

    پاسخ

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

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

  322. کارت ۳۲۲

    پرسش

    Which pharmacologic approach is preferred for gonococcal urethritis or cervicitis?

    پاسخ

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

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

  323. کارت ۳۲۳

    پرسش

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

    پاسخ

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

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

  324. کارت ۳۲۴

    پرسش

    Which pharmacologic approach is preferred for menopause vasomotor symptoms?

    پاسخ

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

    Hormone Therapy for Menopause · reviewed 2026-08-26

  325. کارت ۳۲۵

    پرسش

    How should a clinician handle an ambiguous verbal medication order?

    پاسخ

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

    TeamSTEPPS Communication Module · reviewed 2026-08-26

  327. کارت ۳۲۷

    پرسش

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

    پاسخ

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  331. کارت ۳۳۱

    پرسش

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

    پاسخ

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

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

  334. کارت ۳۳۴

    پرسش

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

    پاسخ

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

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

  335. کارت ۳۳۵

    پرسش

    How should medication be used in herpes zoster?

    پاسخ

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

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

  336. کارت ۳۳۶

    پرسش

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

    پاسخ

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

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

  337. کارت ۳۳۷

    پرسش

    What medication strategy is appropriate for uncomplicated cystitis?

    پاسخ

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

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

  338. کارت ۳۳۸

    پرسش

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

    پاسخ

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

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

  339. کارت ۳۳۹

    پرسش

    How should a clinician confirm or characterize pulmonary embolism?

    پاسخ

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

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

  340. کارت ۳۴۰

    پرسش

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

    پاسخ

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

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

  342. کارت ۳۴۲

    پرسش

    What is the priority management step for primary adrenal insufficiency?

    پاسخ

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

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

  344. کارت ۳۴۴

    پرسش

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

    پاسخ

    Provide analgesia; treat severe illness promptly with antibiotics and use 24–48 hours of watchful waiting only for selected mildly ill children with reliable follow-up.

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

  345. کارت ۳۴۵

    پرسش

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

    پاسخ

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

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

  346. کارت ۳۴۶

    پرسش

    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.

    پاسخ

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

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

  352. کارت ۳۵۲

    پرسش

    Which test or testing sequence best evaluates suspected pulmonary tuberculosis?

    پاسخ

    Obtain chest imaging and multiple respiratory specimens for nucleic-acid testing, smear, and culture with susceptibility testing.

    Clinical and Laboratory Diagnosis for Tuberculosis · reviewed 2026-08-26

  353. کارت ۳۵۳

    پرسش

    Which test or testing sequence best evaluates suspected endometriosis?

    پاسخ

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

    Endometriosis · reviewed 2026-08-26

  354. کارت ۳۵۴

    پرسش

    Which test or testing sequence best evaluates suspected panic disorder?

    پاسخ

    Diagnosis is clinical after considering cardiac, pulmonary, endocrine, neurologic, medication, and substance causes.

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

  355. کارت ۳۵۵

    پرسش

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

    پاسخ

    Support smoking cessation and use effective maintenance therapy with objective monitoring to reduce relapse and complications.

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

  358. کارت ۳۵۸

    پرسش

    Which history or examination finding most strongly supports peritonsillar abscess?

    پاسخ

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  359. کارت ۳۵۹

    پرسش

    When should a safety event or near miss be reported?

    پاسخ

    Report it through the local safety system promptly, including near misses, so hazards can be corrected without waiting for patient harm.

    Reporting Patient Safety Events · reviewed 2026-08-26

  361. کارت ۳۶۱

    پرسش

    Which bedside pattern best points to pleural effusion?

    پاسخ

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

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

  362. کارت ۳۶۲

    پرسش

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

    پاسخ

    Prompt complete diagnostic excision and staging guide definitive surgical management.

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  363. کارت ۳۶۳

    پرسش

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

    پاسخ

    Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

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

  364. کارت ۳۶۴

    پرسش

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

    پاسخ

    Loss of consciousness with bilateral tonic stiffening followed by clonic jerking and a postictal period defines the typical sequence.

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

  365. کارت ۳۶۵

    پرسش

    What is the priority management step for chronic kidney disease?

    پاسخ

    Identify cause, quantify progression risk, treat complications, and refer for high-risk features or advanced disease.

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

  366. کارت ۳۶۶

    پرسش

    Why does sepsis produce its defining clinical pattern?

    پاسخ

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

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

  367. کارت ۳۶۷

    پرسش

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

    پاسخ

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

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

  368. کارت ۳۶۸

    پرسش

    Why does pelvic inflammatory disease produce its defining clinical pattern?

    پاسخ

    Ascending polymicrobial infection inflames endometrium and tubes, causing scarring and future ectopic or infertility risk.

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

  369. کارت ۳۶۹

    پرسش

    Which bedside pattern best points to chronic hepatitis C?

    پاسخ

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

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  370. کارت ۳۷۰

    پرسش

    Which symptom domains should a clinician assess in schizophrenia?

    پاسخ

    Assess positive, negative, cognitive, and mood symptoms together with substance use, functioning, and safety.

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

  371. کارت ۳۷۱

    پرسش

    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?

    پاسخ

    Hip fracture. An older adult after a fall with groin pain, inability to bear weight, and a shortened externally rotated leg likely has a hip fracture.

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

  372. کارت ۳۷۲

    پرسش

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

    پاسخ

    Use systemic thrombolytic therapy followed by anticoagulation; weigh the immediate bleeding risk and activate an advanced-reperfusion pathway.

    ASH 2020 Guidelines for Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

  373. کارت ۳۷۳

    پرسش

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

    پاسخ

    Acute deep-vein thrombosis. Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

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

  374. کارت ۳۷۴

    پرسش

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

    پاسخ

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

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

  376. کارت ۳۷۶

    پرسش

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

    پاسخ

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

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

  377. کارت ۳۷۷

    پرسش

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

    پاسخ

    Heart failure with reduced ejection fraction (HFrEF). The congestion findings establish heart failure, and an LVEF of 40% or less identifies the reduced-EF phenotype.

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

  378. کارت ۳۷۸

    پرسش

    What clinical clue should raise suspicion for multiple sclerosis relapse?

    پاسخ

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

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

  380. کارت ۳۸۰

    پرسش

    What clinical clue should raise suspicion for HIV infection?

    پاسخ

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

    About HIV · reviewed 2026-08-26

  382. کارت ۳۸۲

    پرسش

    What clinical clue should raise suspicion for postpartum hemorrhage?

    پاسخ

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  384. کارت ۳۸۴

    پرسش

    What clinical clue should raise suspicion for delirium?

    پاسخ

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

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

  385. کارت ۳۸۵

    پرسش

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

    پاسخ

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

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  387. کارت ۳۸۷

    پرسش

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

    پاسخ

    Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  389. کارت ۳۸۹

    پرسش

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

    پاسخ

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

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

  390. کارت ۳۹۰

    پرسش

    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.

    پاسخ

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

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

  392. کارت ۳۹۲

    پرسش

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

    پاسخ

    Address the behavior directly, explore its reasons, set limits that protect staff and other patients, and do not accommodate invidious discrimination; urgent care still takes priority.

    Discrimination and Disruptive Behavior by Patients · reviewed 2026-08-26

  394. کارت ۳۹۴

    پرسش

    How should a clinician confirm or characterize acute pancreatitis?

    پاسخ

    Diagnosis requires two of three: characteristic pain, lipase or amylase at least three times normal, or compatible imaging.

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

  395. کارت ۳۹۵

    پرسش

    Which next action matters most in pulmonary tuberculosis?

    پاسخ

    Isolate suspected contagious disease and coordinate promptly with public health.

    Tuberculosis Infection Control · reviewed 2026-08-26

  397. کارت ۳۹۷

    پرسش

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

    پاسخ

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

    Endometriosis · reviewed 2026-08-26

  398. کارت ۳۹۸

    پرسش

    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?

    پاسخ

    Pulmonary embolism. Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, hemoptysis, or syncope with VTE risk raises suspicion.

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

  399. کارت ۳۹۹

    پرسش

    Which next action matters most in panic disorder?

    پاسخ

    During an attack, ensure safety and exclude an emergency; for ongoing disorder, offer cognitive behavioral therapy and/or medication.

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

  401. کارت ۴۰۱

    پرسش

    What immediate plan is appropriate for COPD?

    پاسخ

    For an exacerbation, increase short-acting bronchodilation, use systemic steroids, add antibiotics when indicated, and support ventilation.

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

  402. کارت ۴۰۲

    پرسش

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

    پاسخ

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

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

  403. کارت ۴۰۳

    پرسش

    What is the priority management step for stable chronic hypertension?

    پاسخ

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

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

  408. کارت ۴۰۸

    پرسش

    Which medication prevents seizures in preeclampsia with severe features?

    پاسخ

    Use magnesium sulfate for seizure prophylaxis while controlling severe hypertension and planning delivery according to maternal and fetal status.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  409. کارت ۴۰۹

    پرسش

    What is shared decision-making?

    پاسخ

    The clinician presents reasonable options and evidence, elicits the patient’s goals and tradeoffs, and reaches a choice together when more than one path is reasonable.

    The SHARE Approach · reviewed 2026-08-26

  410. کارت ۴۱۰

    پرسش

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

    پاسخ

    Extended-release stimulants are first-line medication for most children and adolescents when combined with nonpharmacologic care and monitored for benefit and adverse effects.

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

  412. کارت ۴۱۲

    پرسش

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

    پاسخ

    Use pressure-lowering topical agents plus systemic acetazolamide when appropriate; pilocarpine is added after pressure begins to fall.

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

  413. کارت ۴۱۳

    پرسش

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

    پاسخ

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

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

  415. کارت ۴۱۵

    پرسش

    What counseling point helps reduce harm from symptomatic aortic stenosis?

    پاسخ

    Teach patients to report exertional dyspnea, angina, presyncope, or syncope promptly; new symptoms require timely reassessment, and severe symptomatic AS warrants valve-team evaluation rather than surveillance alone.

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

  416. کارت ۴۱۶

    پرسش

    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.

    پاسخ

    Testicular torsion. Sudden severe unilateral pain with nausea or vomiting, a high-riding transverse testis, and loss of the cremasteric reflex is the classic pattern.

    Testicular Torsion · reviewed 2026-08-26

  420. کارت ۴۲۰

    پرسش

    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.

    پاسخ

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

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

  422. کارت ۴۲۲

    پرسش

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

    پاسخ

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

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

  423. کارت ۴۲۳

    پرسش

    Which pharmacologic approach is preferred for type 2 diabetes mellitus?

    پاسخ

    Choose glucose-lowering therapy around comorbid ASCVD, heart failure, CKD, weight goals, hypoglycemia risk, and patient priorities; metformin remains appropriate for many.

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

  424. کارت ۴۲۴

    پرسش

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

    پاسخ

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

    Endometriosis · reviewed 2026-08-26

  425. کارت ۴۲۵

    پرسش

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

    پاسخ

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

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

  426. کارت ۴۲۶

    پرسش

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

    پاسخ

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

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

  427. کارت ۴۲۷

    پرسش

    How should uncertainty be communicated?

    پاسخ

    Name what is known and unknown, explain the leading possibilities and why, state the plan to reduce uncertainty, and give specific follow-up or return precautions.

    Why Does Clinical Uncertainty Matter? · reviewed 2026-08-26

  428. کارت ۴۲۸

    پرسش

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

    پاسخ

    Tirzepatide is approved for adults with obesity and moderate-to-severe obstructive sleep apnea, used with a reduced-calorie diet and increased physical activity.

    FDA Approves First Medication for Obstructive Sleep Apnea · reviewed 2026-08-26

  431. کارت ۴۳۱

    پرسش

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

    پاسخ

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

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

  434. کارت ۴۳۴

    پرسش

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

    پاسخ

    Do not offer vitamin D solely to treat multiple sclerosis.

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

  435. کارت ۴۳۵

    پرسش

    Which pathophysiologic process drives plaque psoriasis?

    پاسخ

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  436. کارت ۴۳۶

    پرسش

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

    پاسخ

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

    Preventing HIV · reviewed 2026-08-26

  437. کارت ۴۳۷

    پرسش

    Which pathophysiologic process drives acute pyelonephritis?

    پاسخ

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

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

  438. کارت ۴۳۸

    پرسش

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

    پاسخ

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

    Postpartum Hemorrhage · reviewed 2026-08-26

  439. کارت ۴۳۹

    پرسش

    What is the key first diagnostic step for tension pneumothorax?

    پاسخ

    Diagnosis is clinical in an unstable patient; bedside ultrasound can support it but imaging must not delay decompression.

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

  440. کارت ۴۴۰

    پرسش

    How can a clinician reduce avoidable harm related to delirium?

    پاسخ

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

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

  445. کارت ۴۴۵

    پرسش

    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?

    پاسخ

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

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

  446. کارت ۴۴۶

    پرسش

    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?

    پاسخ

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

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

  448. کارت ۴۴۸

    پرسش

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

    پاسخ

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

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

  450. کارت ۴۵۰

    پرسش

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

    پاسخ

    Foundational chronic therapy includes an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, an MRA, and an SGLT2 inhibitor when tolerated.

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

  451. کارت ۴۵۱

    پرسش

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

    پاسخ

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

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

  452. کارت ۴۵۲

    پرسش

    Which bedside pattern best points to ectopic pregnancy?

    پاسخ

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

    Ectopic Pregnancy · reviewed 2026-08-26

  456. کارت ۴۵۶

    پرسش

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

    پاسخ

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

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

  457. کارت ۴۵۷

    پرسش

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

    پاسخ

    Adequate calcium and vitamin D, weight-bearing and muscle-strengthening exercise, fall-risk reduction, tobacco cessation, and avoiding excess alcohol support bone health.

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

  458. کارت ۴۵۸

    پرسش

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

    پاسخ

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

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

  461. کارت ۴۶۱

    پرسش

    Which test or testing sequence best evaluates suspected plaque psoriasis?

    پاسخ

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  463. کارت ۴۶۳

    پرسش

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

    پاسخ

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

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

  466. کارت ۴۶۶

    پرسش

    How should a clinician initially manage early syphilis?

    پاسخ

    Treat the patient and ensure partner evaluation; urgent specialist evaluation is needed for ocular, otic, or neurologic disease.

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

  469. کارت ۴۶۹

    پرسش

    Why does acute cholecystitis produce its defining clinical pattern?

    پاسخ

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

    Cholecystectomy · reviewed 2026-08-26

  471. کارت ۴۷۱

    پرسش

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

    پاسخ

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

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

  473. کارت ۴۷۳

    پرسش

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

    پاسخ

    Use either maternal RSV vaccination or a recommended long-acting RSV antibody to protect infants; give nirsevimab to eligible high-risk children aged 8–19 months entering a second RSV season.

    RSV Immunization Guidance for Infants and Young Children · reviewed 2026-08-26

  474. کارت ۴۷۴

    پرسش

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

    پاسخ

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

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

  475. کارت ۴۷۵

    پرسش

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

    پاسخ

    Tell the patient who will participate, describe supervision, obtain voluntary agreement, and ensure refusal does not compromise care.

    Residents and Fellows: Patient Involvement in Self-Education · reviewed 2026-08-26

  476. کارت ۴۷۶

    پرسش

    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?

    پاسخ

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

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

  478. کارت ۴۷۸

    پرسش

    How should medication be used in multiple sclerosis relapse?

    پاسخ

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

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

  479. کارت ۴۷۹

    پرسش

    What immediate plan is appropriate for acute pancreatitis?

    پاسخ

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

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

  480. کارت ۴۸۰

    پرسش

    How should medication be used in HIV infection?

    پاسخ

    Use a recommended combination antiretroviral regimen selected for resistance, interactions, comorbidity, pregnancy potential, and patient preference.

    What to Start: Initial Combination Antiretroviral Regimens · reviewed 2026-08-26

  482. کارت ۴۸۲

    پرسش

    How should medication be used in postpartum hemorrhage?

    پاسخ

    Oxytocin is first-line for uterine atony; add other uterotonics according to contraindications and give tranexamic acid early when indicated.

    Postpartum Hemorrhage · reviewed 2026-08-26

  483. کارت ۴۸۳

    پرسش

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

    پاسخ

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

    2026 GINA Strategy Report · reviewed 2026-08-26

  484. کارت ۴۸۴

    پرسش

    How should medication be used in delirium?

    پاسخ

    Reserve short-term antipsychotic use for severe dangerous agitation after reversible causes and contraindications are addressed.

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

  485. کارت ۴۸۵

    پرسش

    Which preventive measure belongs in care for herpes zoster?

    پاسخ

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

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

  486. کارت ۴۸۶

    پرسش

    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.

    پاسخ

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

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

  487. کارت ۴۸۷

    پرسش

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

    پاسخ

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

    Testicular Torsion · reviewed 2026-08-26

  488. کارت ۴۸۸

    پرسش

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

    پاسخ

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

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

  489. کارت ۴۸۹

    پرسش

    Why does primary hypothyroidism produce its defining clinical pattern?

    پاسخ

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

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

  491. کارت ۴۹۱

    پرسش

    Why does bacterial conjunctivitis produce its defining clinical pattern?

    پاسخ

    Bacterial infection of the conjunctiva commonly produces red eye with purulent discharge that mats the eyelids.

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

  492. کارت ۴۹۲

    پرسش

    When is a chaperone appropriate for an intimate examination?

    پاسخ

    Offer a trained chaperone, respect patient preferences when safety permits, explain the examination, obtain consent, and document who was present.

    Use of Chaperones · reviewed 2026-08-26

  493. کارت ۴۹۳

    پرسش

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

    پاسخ

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

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

  494. کارت ۴۹۴

    پرسش

    What medication strategy is appropriate for Crohn disease?

    پاسخ

    Corticosteroids can induce remission but are not maintenance therapy; immunomodulator or biologic selection depends on risk and phenotype.

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

  495. کارت ۴۹۵

    پرسش

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

    پاسخ

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

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

  497. کارت ۴۹۷

    پرسش

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

    پاسخ

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

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  499. کارت ۴۹۹

    پرسش

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

    پاسخ

    Post-traumatic stress disorder. Intrusion, avoidance, negative mood or cognition, and hyperarousal lasting over a month after trauma suggest PTSD.

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

  502. کارت ۵۰۲

    پرسش

    What drug class or regimen fits atrial fibrillation?

    پاسخ

    Choose anticoagulation from validated thromboembolic-risk assessment; direct oral anticoagulants are preferred for most eligible patients without mechanical valves or moderate-to-severe rheumatic mitral stenosis.

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

  503. کارت ۵۰۳

    پرسش

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

    پاسخ

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

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

  504. کارت ۵۰۴

    پرسش

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

    پاسخ

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

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

  506. کارت ۵۰۶

    پرسش

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

    پاسخ

    Sick-day planning, continued basal insulin, ketone checks, and early contact for illness reduce recurrence.

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

  507. کارت ۵۰۷

    پرسش

    How should a clinician confirm or characterize early syphilis?

    پاسخ

    Use a nontreponemal test with a treponemal confirmatory test, or the reverse sequence; evaluate neurologic or ocular symptoms separately.

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

  508. کارت ۵۰۸

    پرسش

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

    پاسخ

    Assess sudden new floaters, flashes, or a curtain immediately; early treatment can prevent permanent vision loss. Dilated examination can find a small tear or detachment before vision is affected.

    Retinal Detachment · reviewed 2026-08-26

  510. کارت ۵۱۰

    پرسش

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

    پاسخ

    Do not post patient material without proper authorization; combinations of details can identify a person even when names are removed.

    Professionalism in the Use of Social Media · reviewed 2026-08-26

  513. کارت ۵۱۳

    پرسش

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

    پاسخ

    Topical corticosteroids are first-line for most flares; steroid-sparing topical agents help at sensitive sites or with maintenance.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  516. کارت ۵۱۶

    پرسش

    Which history or examination finding most strongly supports acute pyelonephritis?

    پاسخ

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

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

  517. کارت ۵۱۷

    پرسش

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

    پاسخ

    Perform immediate decompression followed by tube thoracostomy.

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

  518. کارت ۵۱۸

    پرسش

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

    پاسخ

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

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

  519. کارت ۵۱۹

    پرسش

    What physiologic disturbance underlies anterior cruciate ligament tear?

    پاسخ

    An ACL tear removes a primary restraint to anterior tibial translation and rotation, producing anterior and rotational instability.

    The Management of Anterior Cruciate Ligament Injuries · reviewed 2026-08-26

  520. کارت ۵۲۰

    پرسش

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

    پاسخ

    Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, and an S3 support volume-overloaded heart failure.

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

  523. کارت ۵۲۳

    پرسش

    What physiologic disturbance underlies pulmonary tuberculosis?

    پاسخ

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

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

  524. کارت ۵۲۴

    پرسش

    Which antibiotic is required for gonococcal conjunctivitis in an adult?

    پاسخ

    Give systemic ceftriaxone; consider one-time saline lavage and evaluate for chlamydial coinfection when it has not been excluded.

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

  525. کارت ۵۲۵

    پرسش

    What physiologic disturbance underlies endometriosis?

    پاسخ

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

    Endometriosis · reviewed 2026-08-26

  526. کارت ۵۲۶

    پرسش

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

    پاسخ

    Act immediately to limit further disclosure, notify the organization’s privacy or security process, document facts, and follow breach assessment requirements.

    Breach Notification Rule · reviewed 2026-08-26

  527. کارت ۵۲۷

    پرسش

    Which clinical pattern defines a panic attack?

    پاسخ

    An abrupt surge of intense fear or discomfort with physical and cognitive symptoms that peaks within minutes defines a panic attack.

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

  528. کارت ۵۲۸

    پرسش

    What clinical clue should raise suspicion for acute kidney injury?

    پاسخ

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

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

  529. کارت ۵۲۹

    پرسش

    What physiologic disturbance underlies tension pneumothorax?

    پاسخ

    A one-way pleural air leak raises intrathoracic pressure, collapses the lung, and impairs venous return.

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

  532. کارت ۵۳۲

    پرسش

    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?

    پاسخ

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

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

  536. کارت ۵۳۶

    پرسش

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

    پاسخ

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

    Pneumococcal Vaccine Recommendations · reviewed 2026-08-26

  538. کارت ۵۳۸

    پرسش

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

    پاسخ

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

    Ectopic Pregnancy · reviewed 2026-08-26

  542. کارت ۵۴۲

    پرسش

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

    پاسخ

    Use continuous IV regular insulin; add dextrose as glucose falls so ketone clearance can continue.

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

  543. کارت ۵۴۳

    پرسش

    What is the key first diagnostic step for peritonsillar abscess?

    پاسخ

    Diagnosis is usually clinical; ultrasound or CT helps when the diagnosis or deep-space extension is uncertain.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  544. کارت ۵۴۴

    پرسش

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

    پاسخ

    Give reasonable notice, provide urgent coverage during the transition, offer transfer resources, and make records available as permitted.

    Terminating a Patient-Physician Relationship · reviewed 2026-08-26

  545. کارت ۵۴۵

    پرسش

    What counseling point helps reduce harm from chronic hepatitis C?

    پاسخ

    Avoid blood exposure, do not share injection equipment, and screen all adults and each pregnancy as recommended.

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  547. کارت ۵۴۷

    پرسش

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

    پاسخ

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

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

  549. کارت ۵۴۹

    پرسش

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

    پاسخ

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

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

  551. کارت ۵۵۱

    پرسش

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

    پاسخ

    Caregivers should seek urgent assessment for stridor at rest, marked chest retractions, cyanosis, lethargy, or poor air entry.

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

  552. کارت ۵۵۲

    پرسش

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

    پاسخ

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

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

  553. کارت ۵۵۳

    پرسش

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

    پاسخ

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

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  554. کارت ۵۵۴

    پرسش

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

    پاسخ

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

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

  558. کارت ۵۵۸

    پرسش

    Which bedside pattern best points to retinal detachment?

    پاسخ

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

    Retinal Detachment · reviewed 2026-08-26

  559. کارت ۵۵۹

    پرسش

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

    پاسخ

    Decline, document objective facts accurately, explain what can truthfully be certified, and preserve the integrity of the record.

    Management of Medical Records · reviewed 2026-08-26

  560. کارت ۵۶۰

    پرسش

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

    پاسخ

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

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

  561. کارت ۵۶۱

    پرسش

    What clinical clue should raise suspicion for COPD?

    پاسخ

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

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

  562. کارت ۵۶۲

    پرسش

    Which pharmacologic approach is preferred for acute pyelonephritis?

    پاسخ

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

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

  563. کارت ۵۶۳

    پرسش

    Which history or examination finding most strongly supports plaque psoriasis?

    پاسخ

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

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  564. کارت ۵۶۴

    پرسش

    What immediate plan is appropriate for Parkinson disease?

    پاسخ

    Start multidisciplinary care and choose symptomatic treatment by functional impact, age, cognition, and adverse-effect risk.

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

  565. کارت ۵۶۵

    پرسش

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

    پاسخ

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

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

  566. کارت ۵۶۶

    پرسش

    What immediate plan is appropriate for gonococcal urethritis or cervicitis?

    پاسخ

    Treat promptly, test for other STIs, abstain until treatment criteria are met, and arrange partner services.

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

  568. کارت ۵۶۸

    پرسش

    What immediate plan is appropriate for menopause vasomotor symptoms?

    پاسخ

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

    Hormone Therapy for Menopause · reviewed 2026-08-26

  574. کارت ۵۷۴

    پرسش

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

    پاسخ

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

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

  575. کارت ۵۷۵

    پرسش

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

    پاسخ

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

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  576. کارت ۵۷۶

    پرسش

    Which factors determine a PA’s scope of practice?

    پاسخ

    A PA’s education and experience, state law, practice-setting policy and credentialing, and the care team’s arrangements together define the services the PA may provide.

    PA Scope of Practice · reviewed 2026-08-26

  581. کارت ۵۸۱

    پرسش

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

    پاسخ

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

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

  582. کارت ۵۸۲

    پرسش

    What medication strategy is appropriate for ectopic pregnancy?

    پاسخ

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

    Ectopic Pregnancy · reviewed 2026-08-26

  584. کارت ۵۸۴

    پرسش

    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.

    پاسخ

    Atopic dermatitis. Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  585. کارت ۵۸۵

    پرسش

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

    پاسخ

    Bisphosphonates are first-line for many postmenopausal women at high fracture risk; consider anabolic therapy for very high risk.

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

  587. کارت ۵۸۷

    پرسش

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

    پاسخ

    Uncomplicated cystitis. Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

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

  589. کارت ۵۸۹

    پرسش

    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.

    پاسخ

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

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

  590. کارت ۵۹۰

    پرسش

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

    پاسخ

    Identify active and latent system contributors, then design and track corrective actions that reduce recurrence rather than stopping at individual blame.

    Root Cause Analysis · reviewed 2026-08-26

  591. کارت ۵۹۱

    پرسش

    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?

    پاسخ

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

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

  593. کارت ۵۹۳

    پرسش

    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?

    پاسخ

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

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

  594. کارت ۵۹۴

    پرسش

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

    پاسخ

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

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

  595. کارت ۵۹۵

    پرسش

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

    پاسخ

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

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

  596. کارت ۵۹۶

    پرسش

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

    پاسخ

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

    The Menopause Years · reviewed 2026-08-26

  597. کارت ۵۹۷

    پرسش

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

    پاسخ

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

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

  598. کارت ۵۹۸

    پرسش

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

    پاسخ

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

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

  599. کارت ۵۹۹

    پرسش

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

    پاسخ

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

    Gout · reviewed 2026-08-26

  600. کارت ۶۰۰

    پرسش

    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.

    پاسخ

    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.

۶۰۰ کارت

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

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