clinical mastery Q - dr_toffee

[ArchivalUser]

43. A 37-year-old woman comes to the physician for a follow-up examination after her blood pressure at a health fair was 152/110 mm Hg. She has mild asthma treated with an albuterol
metered-dose inhaler as needed. She has a levonorgestrei iUD in place. There is no family history of cardiovascular disease or hypertension. She does not use illicit drugs. She is
173 em (5 ft 8 in) tall and weighs 66 kg (145 1b); BMI is 22 kgfm2. Her blood pressure is 155/108 mm Hg in the right upper extremity and 154/106 mm Hg in the left upper extremity.
Examination shows no other abnormalities. Serum studies show:
Na•
K•
CIHC0
3-
Mg2•
Urea nitrogen
Glucose
Creatinine
Which of the following is the most likely mechanism of this patient's increased blood pressure?
A) Adverse effect of levonorgestrel
® B) Cortisol excess
C) Focal areas of renal ischemia
D) Mi neralocorti coi d excess
E) Norepinephrine, epinephrine, and dopamine excess
Na= 143 mEq/L
K=3.1 mEq/L
Cl=106 mEq/L
HCO3=28 mEq/L
Mg=0.8 mEq/L
Urea Nitrogen=8 mg/dl
Glucose=72 mg/dl
Cr=0.8 mg

[ArchivalUser]

I think the answer is excess mineralocorticoid because of low level K,
not cortisol because no other signs of cushing (hyperglycemia, stria,etc) and not A, because it appear in wrong answers for someone took it. what do you think ??

[ArchivalUser]

A 25-year-old man who is HIV positive comes to the physician because of a 3-week history of cough and wheezing. He stopped taking his antiretroviral therapy 6 months ago because of
adverse effects, and he has had an increasing plasma HIV viral load since then. He has required treatment with prednisone for immune thrombocytopenia over the past 2 months with
improvement of his platelet count from 25,000/mm3to 1 OO,OOO/mm3. His temperature is 38.9•c (1 02.F), pulse is 95/min, respirations are 30/min, and blood pressure is 100/60 mm Hg.
Examination shows shotty bilateral cervical adenopathy. There is dullness to percussion over the left upper posterior thorax, and rhonchi are heard over the same area. Laboratory studies
show:
leukocyte count 10,000
segmented neutrophils 70%
eosinophils 10%

An x-ray of the chest shows a nodular density in the left upper lung field posteriorly. Which of the following is most likely to confirm the diagnosis?

A) Examination of duodenal aspirate
B) Examination of the stool for ova and parasites
C) Toxoplasmosis titers
D) Blood cultures
E) Biopsy and culture of the lung mass
F) Lymph node biopsy

answer is not F. what do you think ?? explain pls

[ArchivalUser]

For each patient with jaundice, select the most likely diagnosis.
A) Acute hepatitis
B) a1-Antitrypsin deficiency
C) Biliary atresia
D) Cholangiocarcinoma
E) Choledocholithiasis
F) Gi I bert syndrome
® G) Glucose 6-phosphate dehydrogenase deficiency
H) Liver abscess
I) Peptic ulcer disease
1. Two days after undergoing surgical repair of a torn anterior cruciate ligament, a 24-year-old man develops jaundice. He has not had fever, nausea, vomiting, or abdominal pain.
Examination shows no abnormalities except for mild scleral icterus. Laboratory studies show:
Hemoglobin 16 g/dL
Serum 3.5 mg/dL
Bili rubin, total 4.2 mg/dL
Direct 3.6
Alkaline phosphatase 120
AST 350
ALT 280
Lactate dehydrogenase 410



the answer is not G6PD , what do you think ?? I go with hepatitis

[ArchivalUser]

For your 1st Q what's 2nd mf cause of stenosis of renal A? K low ( think) elevation plasma or renal vein to what?

[ArchivalUser]

For your 2nd Q HIV pat you should biopsy & culture of the lung mass

[ArchivalUser]

@ cardio69 I did not understand you. what do you think is the answer ??

[ArchivalUser]

for the HIV patient I option F appeared with the wrong answers

[ArchivalUser]

Fibromuscular dysplasia/renin. So your D should be correct.
D/s nodular densities can be many things TB/...PJ BAL but.. You do the biopsy/culture of the mass in lung. so E correct here "confirm the diagnosis"

[ArchivalUser]

Hard to read your Q for the last one I think constitutional hepatic dysf/F.