Quiz 54

Question 1

A 40-year-old male with acute pancreatitis has an alanine transaminase (ALT) level that is five times normal. Which one of the following is the most likely diagnosis?   (check one)
 A. Gallstone pancreatitis 
 B. Pancreatic necrosis 
 C. Pancreatic pseudocyst 
 D. Hepatitis C 
 E. Alcohol-induced pancreatitis

Answer 1

In this setting, a threefold or greater elevation of alanine transaminase has a positive predictive value of 95% for acute gallstone pancreatitis. High levels of C-reactive protein are associated with pancreatic necrosis. Hepatitis C is identified by antibody detection or polymerase chain reaction testing.

Question 2

Klinefelter’s syndrome

Answer 2

Patients with Klinefelter’s syndrome usually have small testicles

Question 3

According to the U.S. Preventive Services Task Force, multivitamin supplements in the geriatric age group: (check one)
A. are not recommended for prevention of any disorder
B. should be prescribed to reduce elevated homocysteine levels
C. decrease coronary atherosclerosis
D. decrease the incidence of lung cancer
E. decrease the incidence of colon cancer

Answer 3

are not recommended for prevention of any disorder

Question 4

side effects of calcium channel blockers, such as amlodipine, are due to vasodilation.

Answer 4

One result of this may be peripheral edema, but it can also cause dizziness, nausea, hypotension, cough, and pulmonary edema. These problems may decrease with time, with reductions in dosage, or with the addition of a diuretic or second calcium antagonist.

Question 5

Behçet’s syndrome

Answer 5

This disease is also associated with cutaneous hypersensitivity; 60%–70% of patients will develop a sterile pustule with an erythematous margin within 48 hours of an aseptic needle prick.

recurring genital and oral ulcerations and relapsing uveitis.

affects primarily young adults

Question 6

A 40-year-old runner complains of gradually worsening pain on the lateral aspect of his foot. He runs on asphalt, and has increased his mileage from 2 miles/day to 5 miles/day over the last 2 weeks. Palpation causes pain over the lateral 5th metatarsal. The pain is also reproduced when he jumps on the affected leg. When you ask about his shoes he tells you he bought them several years ago.

Which one of the following is the most likely diagnosis?
(check one)
A. Ligamentous sprain of the arch
B. Stress fracture
C. Plantar fasciitis
D. Osteoarthritis of the metatarsal joint

Answer 6

Running injuries are primarily caused by overuse due to training errors. Runners should be instructed to increase their mileage gradually. A stress fracture causes localized tenderness and swelling in superficial bones, and the pain can be reproduced by having the patient jump on the affected leg. Plantar fasciitis causes burning pain in the heel and there is tenderness of the plantar fascia where it inserts onto the medial tubercle of the calcaneus.

Question 7

A 55-year-old male is brought to the emergency department because of confusion and seizures. He has a history of hypertension and obstructive sleep apnea due to obesity. He is not conscious and no other history is available. An examination shows no focal neurologic findings, but a general examination is limited because of his size. Breath sounds are diminished, and heart sounds are difficult to hear. He has venous insufficiency changes on his lower extremities, with brawny-type edema. Laboratory testing reveals a sodium level of 116 mmol/L (N 135–145), but normal renal and liver functions. A chest radiograph shows mild cardiomegaly. A BNP level is pending, but immediate treatment is felt to be indicated.

Which one of the following is the treatment of choice for this patient?

Answer 7

This patient has severe hyponatremia manifested by confusion and seizures, a life-threatening situation warranting urgent treatment with hypertonic (3%) saline.

The serum sodium level should be raised by only 1–2 mmol/L per hour

he arginine vasopressin antagonist conivaptan is approved for the treatment of euvolemic or hypervolemic hyponatremia, but not in patients who are obtunded or in a coma, or who are having seizures.

Question 8

A 14-year-old male with Tanner stage 1 pubic hair has prepubertal-size testes. His height is at the 3rd percentile. The physical examination is otherwise unremarkable.

Which one of the following additional findings would be most consistent with constitutional delay of growth and puberty?
  (check one)
 A. Impairment of the sense of smell 
 B. Delayed bone age 
 C. Elevated LH and FSH 
 D. Elevated thyrotropin 
 E. Elevated prolactin

Answer 8

Delayed bone age

Constitutional delay of growth and puberty (CDGP) tends to be inherited. Bone age is delayed, but growth potential is often normal. LH and FSH are elevated in hypergonadotropic hypogonadism, but this is not characteristic of CDGP. Thyrotropin is most often elevated in hypothyroidism, which can cause a secondary delay in growth and puberty. Anosmia is characteristic of Kallmann syndrome, but not CDGP. Puberty is also delayed in this form of hypogonadotropic hypogonadism. Prolactin is elevated in some pituitary tumors and by dopamine-blocking agents