Test 47

Question 1

Pneumothorax

Answer 1

Bedside ultrasonography can be rapidly performed and has high sensitivity and specificity for pneumothorax. It has become the test of choice for evaluation of tension pneumothorax in the acute setting (trauma bay, ICU).

Question 2

ALS

Answer 2

Riuzole is a glutamate inhibitor that is currently approved for the management of ALS. Prolongs survival and delays need for tracheostomy.

Question 3

Gout

Answer 3

The risk of gout is increased following renal transplant in patients taking cyclosporine, which decreases uric acid excretion. The diagnosis is confirmed on synovial fluid analysis, which shows an inflammatory effusion and negatively birefringent, needle-shaped urate crystals.

Question 4

Gout

Answer 4

Treatment options for acute gout in patients to with a history of renal transplant include low-dose colchicine and systemic and intra-articulate glucocorticoids. Cyclosporine can cause delayed clearance of colchicine, leading to increased toxicity.

Question 5

Hypothyroidism

Answer 5

Subclinical hypothyroidism is an elevated serum TSH level with a normal free thyroxine. Treatment is warranted for most patients with significant elevations in TSH, goiter, or convincing hypothyroid symptoms. For asymptomatic patients with mild elevations in TSH, an elevated antithyroid peroxide antibody titer increases the likelihood of progression to overt hypothyroidism and can identify patients who are likely to benefit from treatment.

Question 6

Hypothyroidism

Answer 6

Subclinical hypothyroidism is associated with an increased risk for a number of pregnancy complications, including recurrent miscarriages, severe preeclampsia, preterm birth, low birth weight, and placental abruption.

Question 7

Thyroid cancer

Answer 7

Ultrasound of the neck and cervical lymph nodes is the primary modality for initial staging of thyroid cancer. Patients with a small (<1 cm) papillary thyroid tumor may be treated with thyroid lobectomy. Total thyroidectomy is recommended for tumors > than or equal to 1 cm in diameter, tumor extension outside of the thyroid, distant metastases, and in patients with a history of head or neck radiation exposure.

Question 8

HIV

Answer 8

HIV-associated thrombocytopenia can occur at any stage of the disease. The mainstay of therapy is antiretroviral therapy.