Nonpalpable thyroid nodules are commonly found on sonograms, with a low risk of malignancy (<5%). These nodules do not require biopsy and further thyroid studies are not necessary if the TSH level is normal. Therefore, small purely cystic thyroid nodules can be safely managed without biopsy.

Cancer patients frequently face side effects as a result of their treatment (nausea, vomiting, anemia, leukopenia, thrombocytopenia, gastrointestinal effects, pain, depression, tumor lysis syndrome). Controlling these consequences increases one’s quality of life.Pain should be anticipated and dealt with aggressively. When compared to single drug classes, numerous drug classes may give superior pain control with fewer or less severe side effects. Opioids are the mainstay of treatment, administered 24 hours a day in typically effective levels, with additional doses administered for severe pain on rare occasions.Fentanyl is delivered transdermally if the oral route is not accessible.In patients with thrombocytopenia, NSAIDs should be avoided.→ Gabapentin can be used to alleviate neuropathic pain. A tricyclic antidepressant (e.g., nortriptyline) is another option.Non Pharmaceutical pain treatments include focused radiation therapy, nerve blocking, and surgery.

Based on the history and clinical examination, this is the case of Ewing sarcoma. It is the second most common malignant bone tumor (after osteosarcoma). It tends to peak between 10-20 years of age. Symptoms typically include pain and swelling, usually involving the midshaft of long bones, flat bones of the ribs and pelvis. Constitutional symptoms or signs, such as fever, fatigue, weight loss, or anemia, are present in about 10 to 20 percent of patients at presentation. Radiograph studies have typical features of multiple layers of periosteum around the tumor site described as an onion-skinning pattern.- Osteosarcoma does not typically present with systemic symptoms and radiographs typically show a sunburst pattern (soft tissue mass with radial calcifications).- Osteoid osteoma on plain radiographs, osteoid osteoma appears as a small, round lucency (nidus) with a sclerotic margin.- In Chondroblastoma small, well-defined lesions with a sclerotic border that may cross the physis (growth plate) is seen on plain X-ray.- Nonossifying fibroma appears as small, well-defined, eccentric, expansile, lytic lesions located in the metaphysis with scalloped sclerotic borders.

Heparin therapy followed by oral anticoagulation for 3 months is the correct answer. Patients with an uncomplicated calf deep vein thrombosis (DVT) have a significant risk of further clot extension without anticoagulation, and this may result in acute pulmonary embolism or recurrence of the thrombus. There is also a risk of late complications such as the post-thrombotic syndrome or chronic thromboembolic hypertension. Therefore, repeat ultrasonography to monitor a DVT by is not a good option unless there are contraindications to anticoagulation like active bleeding, recent surgery, hemorrhagic stroke, or heparin-induced thrombocytopenia.The treatment that is recommended for DVT is heparin which can be intravenous unfractionated or subcutaneous low molecular weight. This is followed by oral anticoagulation with warfarin once a therapeutic INR is achieved. A first episode of DVT due to an idiopathic cause or transient risk factor, such as short-term immobilization, should be treated for 3-6 months. The benefit-to-risk ratio declines after 6 months except if the patient has a recurrent DVT or a known chronic risk factor, like a thrombophilic condition or cancer.For patients with life-threatening pulmonary embolism, thrombolytic therapy with intravenous tissue plasminogen activator (tPA), urokinase, or streptokinase is used. Inferior vena cava filters are used in patients who have a contraindication to anticoagulant therapy, recurrent venous thromboembolism despite adequate anticoagulation, or such limited pulmonary vascular reserve that survival of additional thromboemboli is doubtful.Heparin therapy followed by oral anticoagulation for 3 months

– Common cause of pharyngitis is viral- Centor criteria/McIsaac decision rule used to diagnose streptococcal pharyngitis- Age plays a role in diagnosis- Modified criteria adds/subtracts points based on age- Symptomatic treatment recommended for this patient- Rapid antigen test and throat culture for streptococcal pharyngitis if patient has 2-3 points on Centor criteria/McIsaac decision rule- Treat empirically for streptococcal pharyngitis if Centor criteria/McIsaac score ≥ 4- Chest X-ray unnecessary for uncomplicated upper respiratory infection

Seborrhoeic dermatitis is a skin condition that primarily affects the scalp and skin folds of infants up to 12 months old. It is commonly referred to as cradle cap and is characterized by greasy, yellow plaques on the scalp. Treatment may include frequent shampooing with baby shampoo, applying an emollient to the scalp, and gentle scalp massage. If these measures are not effective, mild topical corticosteroids or antifungal shampoos may be prescribed.

An ectopic pregnancy is characterized by implantation of the blastocyst outside the endometrium, but most commonly in the fallopian tube 95%, particularly in the ampulla 70%). Fewer tubal pregnancies occur in the isthmus 12% and fimbriae 11%. Rarely, it occurs in the cervix < 1%) or abdomen 1%, or on the ovary 3%. The incidence is 2% of all pregnancies. Some of the risk factors include: 1. The most well known risk factor is a previous ectopic pregnancy. 2. Acquired tubal damage from pelvic inflammatory disease3. Previous tubal surgery or congenital tubal dysfunction.4. Genital surgery, endometriosis, and dysmenorrhea are significant risk factors.5. Intrauterine contraceptives devices.6. Infertility.7. Smoking impairs immunity, predisposed to PID and results in impaired motility of the tubes.8. Women with mental health disorders such as anxiety, depression, somatoform disorder and adjustment disorder have increased rates of infertility, endometriosis, chronic pelvic pain, and recurrent miscarriages. It is possible that the drugs disrupt the transport of embryo through the fallopian tube. More research is needed in this.Infertility is either primary or secondary. Primary infertility is the inability of a couple to conceive after one year of unprotected sex. The couple tried to conceive for three years, hence the diagnosis of infertility.

Current guidelines recommend that healthy adults engage in 30 minutes of moderate-intensity physical activity on 5 or more days per week. Exercise would help the index patient prevent or delay the onset of heart disease and hypertension, as well as manage his weight. Baseline EKG and rhythm strip did not respond to the patient’s question about starting an exercise program and is therefore not correct.Exercise stress testing is not indicated for this patient Sedentary patients should start light-intensity exercise programs. Jogging for 30 minutes every other day and weight training once weekly are not correct.

Molluscum contagiosum, also called water warts, is a benign condition of the skin. The skin lesions of molluscum contagiosum are called mollusca. The typical lesion appears dome-shaped, round, and pinkish-purple in color.A double-stranded DNA poxvirus called molluscum contagiosum virus (MCV) causes molluscum contagiosum. Molluscum contagiosum lesions are transmitted by direct skin-to-skin (including sexual) or indirect (towels, underclothes, toys, razor, tattoo supplies) contact. Molluscum contagiosum may also disseminate by autoinoculation to normal skin after mollusca scraping by the patients. Transmission from sharing swimming pools and other wet environments is possible but not fully proven. In utero and prepartum transmissions are occasionally reported, resulting in congenital molluscum contagiosum or skin lesions developing during the early months of life.Molluscum contagiosum causes mainly cosmetic concerns. Mollusca is usually asymptomatic but may be painful or itchy. The diagnosis of molluscum contagiosum is based on clinical examination. Lesions are firm, white to flesh-colored, dome-shaped, pearly papules, having a central umbilication from which one can express a cheesy material. Mollusca is usually one millimeter to one centimeter in diameter.In children, mollusca are located on the face, trunk, limbs, and axillary areas. Palms and soles are not involved. In sexually transmitted forms, lesions are mainly observed in the anogenital area, abdomen, and inner thighs. The treatment depends on the patient’s (or their parent’s) preferences. Because the condition is usually self-limiting, awaiting spontaneous resolution should be considered. However, the patients should be aware that the resolution of molluscum contagiosum may take several months. Even though many treatments had been proposed for molluscum contagiosum, none has proven its effectiveness. Current treatment options include physical removal of mollusca, topical medications, and systemic treatment.

Temporal arteritis is a form of systemic vasculitis that typically affects the superficial temporal arteries, but may also affect ophthalmic, occipital, vertebral, posterior ciliary, and proximal vertebral arteries. It is the most common form of systemic vasculitis in adults and can involve medium and large vessels, including the aorta and the carotid, subclavian, and iliac arteries. Symptoms include severe throbbing headache located only on the right side, accompanied by blurry vision, jaw claudication, and elevated ESR. If left untreated, it can lead to blindness or death from myocardial infarction, stroke, or dissecting aortic aneurysm. Diagnosis and treatment should be made as early as possible to prevent blindness. Treatment typically involves high dose corticosteroids, with temporal artery biopsy performed within 1 week.