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USMLE forum Jeoprady Game! - pepsi00
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07-06-2008, 09:59 PM
19) PSS
arteriolar vasculitis causu=ing hyperplastic arteriolosclerosis in the glomeruli, Infarctions causing malignant hypertension I believe E should be the answer
07-06-2008, 10:05 PM
Gud Job!
19.)E) She has diffuse systemic sclerosis (i.e., sclero- derma). The small arteries of the kidney are involved with a hyperplastic arteriolosclerosis, which can be complicated by very high blood pressure and renal failure. Meningitis and adrenal failure are not typical features of autoimmune diseases. With scleroderma, the gastrointestinal tract under- goes fibrosis, without any tendency to perforation or ulcer- ation. Glomerulonephritis is a more typical complication for SLE.
07-06-2008, 10:10 PM
20.)
A 79ear-old white man visits a physician in the outpatient clinic for the first time. Over the past 5 months, he reports increasing lethargy, weight loss, and crying "for no reason." The patient had always been an optimistic person, but today he feels "detached from everything." He describes his mood "as if there was a pane of glass between me and the rest of the world and l don't think I'm going to make it. My family and friends are like cardboard cutouts." His speech is slow and methodicaI, punctuated by frequent sighs. The patient has also lost interest in watching movies, which had been his favorite pastime. He also admits that his drinking has become a problem over the past few weeks, and he currently consumes a bottle of white wine every evening. He recently lost his job and is currently filing for divorce, which would end a seventeen-year marriage. His son has attention-deficit disorder, for which he is prescribed amphetamine. The patient was hospitalized for major depression three years ago. The patient's previous doctor had started him on a medication, but he is unable to recall the name or anything about it except that he is not supposed to eat cheese, aged meats, or chocolate while taking it. On physical examination, the patient appears emaciated. His abdomen is very distended, with hepatomegaly 3 cm below the right costal margin. He also has a slight tremor. His gait is normaI. His latest calcium level is 10.3 mg/dL. Which of the following is the most likely diagnosis at this time? A. Acute stress disorder B. Adjustment disorder C. AIcohol abuse D. Bipolar disorder E. Hypercalcemia F. Unipolar disorder Which of the following medications is the patient most likely currently taking? A. Amitriptyline B. Chlorpromazine C. FIuoxetine D. Lorazepam E. Phenelzine To gather more details about the patient's current state of mind, which of the following questions would be most appropriate for the physician to ask at this time? A. " Are you taking your antidepressant medications as your previous doctor instructed?" B. " Have you ever made plans to kill yourself?" C. " Is there any history of depression in your family?" D. " On a depression scale of one to ten, how depressed do think you feel right now?" E. " On average, how much alcohol do you drink in one day?" Should this particular patient commit suicide, the likeliest method of suicide is which of the following? A. A drug overdose B. By running his car in a closed garage for an extended period of time C. Cutting his wrists D. Hanging himself E. With a firearm
07-06-2008, 10:30 PM
??? F) Another episode of major depression ?? Unipolar E ) phenelzine MAOI A} to establish compliance, though B also looks crucial at this point in time B] This guy has no energy to carry out all those other moves since he's too depressed- my opinion Cheers
07-06-2008, 10:49 PM
20.he correct answer is F. The patient's symptoms of weight loss, lethargy, tearfulness, hopelessness ("I'm not going to make it"), and depersonalization ("world through a pane of glass; family and friends are like cardboard cutouts") for at least one month meet the criteria for unipolar disorder (major depression). Even more specific are his loss of interest in favorite activities, as well as the feelings of sadness. The symptoms have been going on for at least two weeks and represent a change from previous functioning, which defines depression. Three stressors in his life are job loss, the upcoming divorce. and his son's attention-deficit disorder. The lifetime rate of major depression in men in the US is about 10%.
for second one The correct answer is E. Monoamine oxidase inhibitors (MAOIs) include phenelzine and tranylcypromine. MAOIs have the potential for severe side effects when taken with sympathomimetic medications or tyramine-containing foods (e.g., cheeses, red wines, beers, meats, fruits, beans, liver, yeast extracts) because they can cause a hypertensive crisis. MAOIs can also cause orthostatic hypotension, nausea, insomnia, and sexual dysfunction. third one The correct answer is B. At this stage, it is crucial to ask a direct question about suicidal ideation, particularly because this is the first time the physician is meeting the patient. In addition, the patient is a white male over the age of 50 who has already been hospitalized once for major unipolar depression, which places him at a greater risk for suicide. The suicide rate among people who have been hospitalized at least once for unipolar depression has been estimated to be 15%. A physician is the last person patients have seen before taking their own life in 10% of suicides. Asking this question as part of the mental status examination also gives information on how severe the depression is. If the patient has a plan about how they will take their own life, then this suggests that they are more likely to follow through with their plan. The correct answer is E. Firearms were the commonest method of suicide used by persons aged 65 years or older representing 71% of suicides. In 1998, firearms were the most common method of suicide by both males and females, accounting for 78% of male and 35% of female suicides in this age group.
07-06-2008, 10:58 PM
thks dude
u still not disclosing ua source gd qns though helped me get back 2 studying cheers |
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