What core mechanism explains acute coronary syndrome?

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

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

Confirm that the choice is informed and voluntary, explain material risks and alternatives, document the discussion, and respect the refusal. Informed Consent · reviewed 2026-08-26

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

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

What core mechanism explains upper gastrointestinal bleeding?

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

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

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

What core mechanism explains acute ischemic stroke?

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

What core mechanism explains community-acquired pneumonia?

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

What core mechanism explains ectopic pregnancy?

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

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

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

What core mechanism explains type 2 diabetes mellitus?

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

What core mechanism explains acute angle-closure glaucoma?

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

What clinical clue should raise suspicion for aortic dissection?

Abrupt severe chest or back pain, pulse or blood-pressure asymmetry, and a new aortic regurgitation murmur are high-risk clues. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

What core mechanism explains chronic kidney disease?

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

What core mechanism explains iron-deficiency anemia?

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

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

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

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

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

What clinical clue should raise suspicion for acute pancreatitis?

Severe persistent epigastric pain radiating to the back with nausea and vomiting is typical. ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

What core mechanism explains uncomplicated cystitis?

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

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

Rheumatoid arthritis. Symmetric inflammatory pain and prolonged morning stiffness in MCP, PIP, or wrist joints with synovitis suggest rheumatoid arthritis. Rheumatoid Arthritis · reviewed 2026-08-26

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

The patient must communicate a choice, understand relevant information, appreciate how it applies personally, and reason about the options. Informed Consent · reviewed 2026-08-26

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

Myasthenia gravis. Fluctuating fatigable ptosis, diplopia, dysarthria, dysphagia, or proximal weakness that worsens with use suggests myasthenia. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update · reviewed 2026-08-26

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

Clostridioides difficile infection. New clinically significant diarrhea after antibiotics or healthcare exposure, with abdominal pain or leukocytosis, suggests C. difficile. 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults · reviewed 2026-08-26

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

Shoulder dystocia. After delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicates dystocia. Shoulder Dystocia · reviewed 2026-08-26

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

Attention-deficit/hyperactivity disorder. Persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment suggests ADHD. ADHD in Children and Youth: Part 1—Etiology, Diagnosis, and Comorbidity · reviewed 2026-08-26

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

Acute pericarditis. Sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation support pericarditis. 2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

Which next action matters most in acute respiratory distress syndrome?

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

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

Cushing syndrome. Proximal weakness, easy bruising, facial plethora, wide violaceous striae, osteoporosis, or difficult diabetes and hypertension are discriminating clues. Diagnosis of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

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

Peritonsillar abscess. Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection. Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

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

A noncontact pivot, audible pop, immediate swelling, and instability with a positive Lachman test suggest an ACL tear. Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

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

Chronic kidney disease. CKD may be silent; edema, pruritus, anemia, hypertension, or abnormal urine testing often appears later. 2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

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

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

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

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

What clinical clue should raise suspicion for bacterial brain abscess?

Headache, fever, focal deficit, seizure, or signs of raised intracranial pressure after sinus, ear, dental, or bloodstream infection raise suspicion. ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

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

Crohn disease. Chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions support Crohn disease. Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

What clinical clue should raise suspicion for pulmonary tuberculosis?

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

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

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

What clinical clue should raise suspicion for endometriosis?

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

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

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

What clinical clue should raise suspicion for panic disorder?

Recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least a month suggests panic disorder. Panic Disorder: What You Need to Know · reviewed 2026-08-26

What drug class or regimen fits acute pericarditis?

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

What clinical clue should raise suspicion for tension pneumothorax?

Severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock suggest tension physiology. Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

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

Begin isotonic fluids, replace potassium according to the measured level, and start IV insulin once potassium is safe. Standards of Care in Diabetes—2026 · reviewed 2026-08-26

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

Use the legally authorized surrogate and guide decisions by the patient’s known wishes or, if unknown, best interests. Decisions for Adult Patients Who Lack Capacity · reviewed 2026-08-26

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

Send the patient to an eye doctor or emergency department immediately for retinal evaluation and treatment. Early treatment helps prevent permanent vision loss. Retinal Detachment · reviewed 2026-08-26

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

Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion. ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

Which next action matters most in Crohn disease?

Drain abscesses and involve surgery for obstruction, fistula complications, perforation, or refractory disease. Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

Which next action matters most in rheumatoid arthritis?

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

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

Start empiric antibiotics before culture results, covering likely organisms including anaerobes, then narrow therapy to microbiology and clinical context. British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

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

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

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

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

Which next action matters most in multiple sclerosis relapse?

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

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

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

โดยผู้สร้าง Flashcards Open Source App

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การ์ด: 600 การ์ด
เวอร์ชัน: 1
เผยแพร่เมื่อ: 26 สิงหาคม 2569
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สัญญาอนุญาต: Common knowledge · CC0 1.0
ภาษาของผู้เรียน: en
วิชา: Medicine
ระดับ: PANCE
แท็ก: pance-cardiovascular, task-foundations, pance-professional, task-professional, pance-pulmonary, pance-gi-nutrition, pance-musculoskeletal, pance-neurology, pance-infectious, pance-reproductive, pance-psychiatry, pance-endocrine, pance-eent, task-history-exam, pance-renal, pance-hematology, task-diagnosis, pance-dermatology, pance-genitourinary, task-intervention, task-pharmacotherapy, task-prevention, task-diagnostics

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เกี่ยวกับเด็คนี้

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.

การ์ดในเด็คนี้

การ์ด 1
คำถาม
What core mechanism explains acute coronary syndrome?
คำตอบ
Plaque disruption with superimposed coronary thrombosis causes most acute coronary syndromes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26
การ์ด 55
คำถาม
After successful endoscopic hemostasis of a high-risk bleeding peptic ulcer, what medication strategy is recommended?
คำตอบ
Give high-dose proton-pump inhibitor therapy continuously or intermittently for 3 days.

ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26
การ์ด 56
คำถาม
What clinical clue should raise suspicion for thyroid storm?
คำตอบ
Fever, marked tachycardia, agitation or delirium, gastrointestinal symptoms, and heart failure in thyrotoxicosis suggest storm.

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

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

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

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

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

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

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

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

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

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

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

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

AHS Consensus Statement: Integrating New Migraine Treatments into Clinical Practice · reviewed 2026-08-26
การ์ด 79
คำถาม
What is the key first diagnostic step for upper gastrointestinal bleeding?
คำตอบ
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
การ์ด 80
คำถาม
Which prevention or risk-reduction step is important for early syphilis?
คำตอบ
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
การ์ด 81
คำถาม
In a child or adolescent, what is the key first diagnostic step for septic arthritis?
คำตอบ
Perform urgent arthrocentesis for cell count, crystals, Gram stain, and culture; obtain blood cultures.

Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26
การ์ด 82
คำถาม
Which prevention or risk-reduction step is important for abnormal uterine bleeding from anovulation?
คำตอบ
Address reversible causes of ovulatory dysfunction, review medicines that worsen bleeding, and monitor for anemia.

Abnormal Uterine Bleeding · reviewed 2026-08-26
การ์ด 83
คำถาม
In a young child, which diagnosis best fits a barking cough, hoarseness, and inspiratory stridor after a viral prodrome?
คำตอบ
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
การ์ด 84
คำถาม
Which intervention is recommended to reduce later PTSD in an adult diagnosed with acute stress disorder?
คำตอบ
Offer individual trauma-focused cognitive behavioral psychotherapy with exposure and/or cognitive restructuring.

Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26
การ์ด 85
คำถาม
What clinical clue should raise suspicion for cellulitis?
คำตอบ
Unilateral expanding warmth, tenderness, erythema, and edema without a sharply raised border favor cellulitis.

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

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

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

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

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

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

Management of Bipolar Disorder in Adults · reviewed 2026-08-26
การ์ด 100
คำถาม
How should medication be used in hypertensive emergency?
คำตอบ
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
การ์ด 101
คำถาม
Which bedside pattern best points to obstructive sleep apnea?
คำตอบ
Loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension suggests OSA.

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea · reviewed 2026-08-26
การ์ด 102
คำถาม
What counseling point helps reduce harm from heart failure with reduced ejection fraction?
คำตอบ
Control blood pressure and coronary risk, and avoid medicines that worsen fluid retention.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26
การ์ด 280
คำถาม
Which preventive measure belongs in care for Clostridioides difficile infection?
คำตอบ
Isolate suspected or confirmed CDI with contact precautions, use C. difficile sporicidal agents for daily and terminal cleaning, and engage antibiotic stewardship.

Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities · reviewed 2026-08-26
การ์ด 281
คำถาม
After an acute ACL tear, which nonprescription medicines may be used for symptom relief when safe?
คำตอบ
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
การ์ด 282
คำถาม
Which preventive measure belongs in care for shoulder dystocia?
คำตอบ
Team drills, clear communication, and avoiding fundal pressure reduce preventable harm.

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

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

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

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

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

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

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

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome · reviewed 2026-08-26
การ์ด 300
คำถาม
In a child, typically 6 months to 3 years, what clinical clue should raise suspicion for croup?
คำตอบ
Barking cough, hoarseness, and inspiratory stridor after a viral prodrome in a young child suggests croup.

Acute Management of Croup in the Emergency Department · reviewed 2026-08-26
600 การ์ด
PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps
เรียนเด็คนี้ฟรี
Nibomo จะเปิดขึ้นเพื่อให้คุณเริ่มเรียนได้ทันที
การ์ด 301
คำถาม
How should a clinician initially manage peripheral artery disease?
คำตอบ
Use supervised or structured exercise; evaluate revascularization for lifestyle-limiting symptoms despite therapy or limb threat.

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

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

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

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

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

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

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

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

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

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

Treatment of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26
การ์ด 329
คำถาม
What counseling point helps reduce harm from acute kidney injury?
คำตอบ
Avoid unnecessary nephrotoxins, adjust medicine doses, maintain perfusion, and monitor high-risk patients.

KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26
การ์ด 330
คำถาม
What medication strategy is appropriate for thrombotic thrombocytopenic purpura?
คำตอบ
Caplacizumab is added in many acute immune TTP protocols under specialist care.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26
การ์ด 501
คำถาม
Which diagnosis best fits loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension?
คำตอบ
Obstructive sleep apnea. Loud snoring, witnessed apneas, gasping, daytime sleepiness, morning headache, or resistant hypertension suggests OSA.

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea · reviewed 2026-08-26
การ์ด 502
คำถาม
What drug class or regimen fits atrial fibrillation?
คำตอบ
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
การ์ด 503
คำถาม
In a child or adolescent, which history or examination finding most strongly supports acute appendicitis?
คำตอบ
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
การ์ด 504
คำถาม
Which diagnosis best fits this presentation: Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.
คำตอบ
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
การ์ด 505
คำถาม
In an adult with headaches consistent with migraine with aura and a normal neurologic examination, when is neuroimaging needed?
คำตอบ
Routine neuroimaging is unnecessary; consider it when the aura is unusual, prolonged, or persistent or when other atypical or red-flag features are present.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2020 World Society of Emergency Surgery Updated Guidelines for the Diagnosis and Treatment of Acute Calculous Cholecystitis · reviewed 2026-08-26
การ์ด 580
คำถาม
What medication strategy is appropriate for community-acquired pneumonia?
คำตอบ
Use guideline-concordant empiric antibiotics based on setting, comorbidity, and local resistance; narrow when microbiology permits.

Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26
การ์ด 581
คำถาม
Which diagnosis is defined by acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult?
คำตอบ
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
การ์ด 582
คำถาม
What medication strategy is appropriate for ectopic pregnancy?
คำตอบ
Methotrexate is an option for selected stable unruptured ectopic pregnancy without contraindications.

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

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

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

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

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

Gout · reviewed 2026-08-26
การ์ด 600
คำถาม
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.
คำตอบ
Symptomatic aortic stenosis. Exertional dyspnea, angina, or syncope with a harsh crescendo-decrescendo systolic murmur radiating to the carotids is typical.

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

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

600 การ์ด