Test 37

Question 1

Complementary and alternative medicine

Answer 1

Although there is some evidence for the efficacy of St. John’s wort in treating mild to moderate depression, issues regarding its safety should be discussed with the patient. These include potential for clinically significant drug interactions and the lack of herbal product standardization in the United States.

Question 2

Hepatitis b

Answer 2

Patients with an isolated elevation of anti-HBc should have hepatitis B serologies repeated to rule out a false positive result, followed by measurement of IgM anti-HBc and liver function tests to determine acuity of infection. IgM anti-HBc may be the only diagnostic marker for acute HBV infection during the “window period.”

Question 3

Hypoparathyroidism

Answer 3

Understand the long-term management of patients with chronic hypoparathyroidism: in patients with borderline low serum calcium and high urinary calcium, as seen in the patient described in the vignette, the addition of a thiazide diuretic will not only decrease the urinary calcium, but also increase serum calcium levels.

Question 4

Vitamin b12 deficiency

Answer 4

Vitamin b12 deficiency may cause erythroid hyperplasia and ineffective erythropoiesis in the bone marrow, which can result in markers of hemolytic anemia (elevated lactate dehydrogenase, low haptoglobin, indirect hyperbilirubinemia) and an absent reticulocyte response.