08-08-2007, 06:03 AM
hey guys, these r some of the questions from "remembered questions" posted by cjay sometime back...can anyone confirm the answers they've selected plz?
49. A 62-year-old man with metastatic prostate cancer
has a rising PSA level despite treatment with
leuprolide and flutamide. What should be the first
step in managing this asymptomatic man with hormone-
refractory disease?
A) Treat with aminoglutethimide
*B) Discontinue flutamide to attempt to obtain an
antiandrogen withdrawal response
C) Discontinue leuprolide
D) Treat with diethylstilbestrol
E) Perform an orchiectomy
38. A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
*d) total thyroidectomy with removal of enlarged nodes
48.A 65 year old female who had a stroke a year back and is bed-ridden for almost 15 hours a day due to severe paresis presents to the ER with abdominal distension and pain in the left leg (calf). She could not get up to pick up the phone and 911 was called when the home nurse came to her in the morning. SHe has been having the distension for almost 2-3 weeks but now she finds it intolerable and hurts when she breathes.
PE:
Abd: Ascites +++, Liver enlarged +++, Spleen enlarged ++, no spider angiomata present.
Leg: Left foot has no edema, left leg - calf is extremely tender and DOppler confirms DVT. Right leg has no edema, No vulvar edema
CVS: Right lung bas has minimal rales , no pain, (no chest pain in the HPI), NO JVD, NO neck vein distension
Temp - normal, Pulse - 94, RR - 30
THE CAUSE OF ASCITES IS:
a).Congestive cardiac failure
b).Pulmonary Embolism and Right HF
c).DVT moving into the systemic circulation
*d).Protein C deficiency
e).Atherosclerosis
f).Nephrotic syndrome
g).Cirrhosis secondary to HCV infection
Exclusion:
JVD is not raised - this alone excludes - CCF, Pulmonary embolism causing an acute Right heart failure and all other causes of increased pre load with congestion
There is no lower limb edema and no anasarca. This proves that there is no decreased albumin in the blood.That rules out Nephrotic syndrome. Also in Cirrhosis, the edema is mainly ascites due to portal hyper tension. If Generalized edema develops, it is due to decreased albumin production by the diseased liver. So this also rules out Cirrhosis to some extent. Also in Cirrhosis - liver is not palpable ( liver is palpable only in acute non-fulminant hepatitis. But they do not raise Portal pressure so much to cause dyspnoea)
USMLE gives hints in the questionas here. The guy has DVT ( no hx that the person had a prior episode of DVT or not).
Embolus going into circulation can causae an IVC clot and that causes pedal edema FIRST and later the pressure mounts inn the hepatic veins.
Another condition that can show like this is Acute alcoholic hepatitis - but no alcohol history.
49. A 62-year-old man with metastatic prostate cancer
has a rising PSA level despite treatment with
leuprolide and flutamide. What should be the first
step in managing this asymptomatic man with hormone-
refractory disease?
A) Treat with aminoglutethimide
*B) Discontinue flutamide to attempt to obtain an
antiandrogen withdrawal response
C) Discontinue leuprolide
D) Treat with diethylstilbestrol
E) Perform an orchiectomy
38. A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
*d) total thyroidectomy with removal of enlarged nodes
48.A 65 year old female who had a stroke a year back and is bed-ridden for almost 15 hours a day due to severe paresis presents to the ER with abdominal distension and pain in the left leg (calf). She could not get up to pick up the phone and 911 was called when the home nurse came to her in the morning. SHe has been having the distension for almost 2-3 weeks but now she finds it intolerable and hurts when she breathes.
PE:
Abd: Ascites +++, Liver enlarged +++, Spleen enlarged ++, no spider angiomata present.
Leg: Left foot has no edema, left leg - calf is extremely tender and DOppler confirms DVT. Right leg has no edema, No vulvar edema
CVS: Right lung bas has minimal rales , no pain, (no chest pain in the HPI), NO JVD, NO neck vein distension
Temp - normal, Pulse - 94, RR - 30
THE CAUSE OF ASCITES IS:
a).Congestive cardiac failure
b).Pulmonary Embolism and Right HF
c).DVT moving into the systemic circulation
*d).Protein C deficiency
e).Atherosclerosis
f).Nephrotic syndrome
g).Cirrhosis secondary to HCV infection
Exclusion:
JVD is not raised - this alone excludes - CCF, Pulmonary embolism causing an acute Right heart failure and all other causes of increased pre load with congestion
There is no lower limb edema and no anasarca. This proves that there is no decreased albumin in the blood.That rules out Nephrotic syndrome. Also in Cirrhosis, the edema is mainly ascites due to portal hyper tension. If Generalized edema develops, it is due to decreased albumin production by the diseased liver. So this also rules out Cirrhosis to some extent. Also in Cirrhosis - liver is not palpable ( liver is palpable only in acute non-fulminant hepatitis. But they do not raise Portal pressure so much to cause dyspnoea)
USMLE gives hints in the questionas here. The guy has DVT ( no hx that the person had a prior episode of DVT or not).
Embolus going into circulation can causae an IVC clot and that causes pedal edema FIRST and later the pressure mounts inn the hepatic veins.
Another condition that can show like this is Acute alcoholic hepatitis - but no alcohol history.