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Answer: he should be referred to the emergency department
Two differential diagnosis that must be included with a complaint of sudden, severe scrotal pain are
testicular torsion and epididymitis. Historical findings suggestive of testicular torsion are pain following
groin trauma, age (adolescence), and sudden onset of symptoms. If testicular torsion is the cause of his
pain, immediate referral to the ER/hospital is paramount. Testicular torsion produces ischemia in the
affected testis. The viability of the testicle will become compromised if this persists beyond 4−6 hours.
Obtaining an ultrasound will delay treatment. A common assessment finding is a high riding testicle on
the affect side occurring secondary to shortening of the spermatic cord.
2. Answer: this can expose you to STDs
Sexual activity during pregnancy could cause exposure to an STD or precipitate preterm labor because
the lower uterine segment may be physically stimulated. Additionally, oxytocin is released, which may
precipitate preterm labor. However, in the absence of complications associated with the pregnancy,
sexual activity is not contraindicated. If vaginal discharge or bleeding occurs; or rupture of membranes
occurs, sexual intercourse should be avoided until assessed by the patient’s provider. STDs should be
screened for and treated.
3. Answer: temporal arteritis
Polymyalgia rheumatica (PMR) is chronic inflammatory condition that produces morning stiffness in the
neck, shoulders, and hips. Its peak incidence is 70−80 years old. PMR is commonly associated with
temporal arteritis, also known as giant cell arteritis. Temporal arteritis is a chronic vasculitis of the
medium and large vessels. Temporal arteritis is characterized by new onset of unilateral temporal
headache, abrupt onset of visual disturbances, elevated sedimentation rate, jaw claudication, and
unexplained fever. this is best diagnosed by temporal artery biopsy. She should be referred to neurology
for evaluation today.
4. Answer: distant vision
The snellen eye chart was named after Dr. Hermann Snellen. The Snellen fractions, 20/20, 20/30, etc.
Are measures of sharpness of distant vision. Acutally, 20/20 is not normal vision; it is a reference
standard. Average acuity in a population is 20/15 or 20/10 (hence the reason there are two lines
beneath the 20/20 vision line). When visual acuity is assessed, each eye is covered and assessed
independently, this is termed monocular.
5. Answer: improves urine flow
Saw palmetto is an extract of fruit of the American dwarf tree. It is commonly used to treat benign
prostatic hypertrophy (BPH) but there is no objective data supporting its use. It is available over the
counter and is purchased by men for BPH. It has an unknown mechanism of action, but men with BPH
report a subjective increase in urine flow rate when taking saw palmetto
6. Answer: pantoprazole
If a patient has been diagnosed with GERD and he is symptomatic on an H2 blocker like ranitidine, a PPI
should be considerd. AN example of PPI is pantoprazole. Relief of symptoms after using a PPI does not
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