Common queries:: Will post the answer for dinner. - shess

[ArchivalUser]

1. What is the main contributor to the resting energy expenditure of an individual?
A. Adipose tissue
B. Exercise level
C. Lean body mass
D. Resting heart rate
E. None of the above

2. You are seeing a 19-year-old female in the university health clinic who returned 1 week ago from spring break, during which she went to the Caribbean with friends. She reports persistent redness over the face, shoulders, and arms without itching. Past medical history is notable for systemic lupus erythematosus and acne. Examination confirms the patient's report. There are no papules, and the rash spares the underarms and buttocks. Her current medications are ciprofloxacin, which was recently prescribed for a urinary tract infection, hydroxychloroquine, and minocycline. Which of the following is the likely cause of the skin eruption?
A. Ciprofloxacin
B. Hydroxychloroquine
C. Minocycline
D. A and B
E. A and C

3. A 50-year-old male is seen in the clinic for atrial fibrillation. He was diagnosed with this condition several months ago. Past medical history includes hypertension and ischemic heart disease. Current medications include atenolol, aspirin, losartan, warfarin, and simvastatin. It is recommended that the patient begin therapy with amiodarone. Amiodarone can be expected to interfere with the metabolism of which of his current medications?
A. Warfarin
B. Warfarin and losartan
C. Losartan and simvastatin
D. Warfarin and simvastatin
E. Warfarin, losartan, and simvastatin

4. A 24-year-old female is diagnosed with anorexia nervosa. Which of the following criteria would identify the patient as being at risk for malnutrition?
A. Body mass index less than 18.5
B. Body weight less than 90% of ideal for height
C. Unintentional weight loss of more than 10% of usual body weight in the preceding 3 months
D. A and B
E. All of the above

5. Which of the following provides the largest percentage of calories in standard enteral and parenteral nutritional support in hospitalized patients?
A. Carbohydrates
B. Medium-chain triglycerides
C. Polyunsaturated vegetable oils
D. Protein

[ArchivalUser]

1. C.
2. E.
3. E ?
4. E.
5. A.

[ArchivalUser]

dcdda

[ArchivalUser]

c c d d a

[ArchivalUser]

I can post the explanation only tomorrow but TH as usual you hit the jack pot. I cannot agree more. Good job.

[ArchivalUser]

c c e e a

[ArchivalUser]

1)A
2)E
3)E?
4)A
5)A

[ArchivalUser]

1. The answer is C.

To keep body weight stable, energy intake must match energy output. Energy output has two main determinants: resting energy expenditure and physical activity. Other, less clinically important determinants include energy expenditure to digest food and thermogenesis from shivering. Resting energy expenditure can be calculated and is 900 + 10w (where w = weight) in males and 700 + 7w in females. This calculation is then modified for physical activity level. The main determinant of resting energy expenditure is lean body mass.

2. The answer is E.

This patient presents with classic photosensitivity with erythema in sun-exposed areas. Although the patient is at risk for photoaggravation with classic malar rash from her systemic lupus erythematosis, the current eruption is in a larger distribution of sun-exposed skin, including the arms and shoulders, and suggests photosensitivity. Her most likely risk factor for photosensitivity is medications. Medications commonly associated with this disorder are flouroquinolones, furosemide, phenothiazines, sulfonamides, retinoids, tetracyclines, and amiodarone. A more extensive list can be found in the table. Hydroxychloroquine has not been associated with light eruptions.

3. The answer is E.

Medication interactions and errors are increasingly being recognized as a serious source of morbidity and even mortality not only in hospital inpatients but also in the outpatient population. A handful of drugs account for the majority of the adverse events, including nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, digoxin, anticoagulants, diuretics, antimicrobials, glucocorticoids, antineoplastics, and hypoglycemics. When prescribing new medications to patients, physicians must review the preexisting drug list and evaluate any potential interactions. A common offender for changes in drug metabolism is amiodarone. This medication inhibits CYP3A and CYP2C9. CYP3A is important in the degradation of calcium channel blockers, antiarrhythmics, HMG-CoA reductase inhibitors, cyclosporine, tacrolimus, indinavir, saquinavir, and ritonavir. In this patient amiodarone would inhibit the metabolism of simvastatin by this mechanism. CYP2C9 degrades warfarin, phenytoin, glipizide, and losartan. Subsequently, losartan and warfarin levels would be altered (see Table 3-1 in Harrison's 16/e, for further information regarding moleculary pathways affecting drug metabolism). Additional information regarding drug-drug interactions and adverse drug reactions can be obtained from a number of websites.

4. The answer is E.

Both inpatients and outpatients can be considered to be at risk for malnutrition if they meet one or more of the criteria listed in the question. The critieria for diagnosing a patient at risk for malnutrition are (1) unintentional weight loss of >10% of usual body weight in the preceding 3 months, (2) body weight