PACKRAT Family Med Exam Graded A+ (Comprehensive Solutions)

A 52 year-old female comes to the office because of black stools for the past 3 days. She is afebrile and she has no pertinent physical examination abnormalities. Which of the following is the most appropriate initial diagnostic study? A. Stool for occult blood B. Stool cultures C. Sigmoidoscopy D. Abdominal CT scan - ANSWER (c) A. Occult bleeding, as evidenced by the patient's history of black stools, is initially verified by a positive fecal occult blood test. Which of the following is considered a risk factor for the development of malignant melanoma? A. male gender B. inability to tan C. Japanese ethnicity D. brown-haired individuals - ANSWER c) B. Inability to tan and propensity to burn are risk factors for developing malignant melanoma. A 43 year-old data entry clerk presents with a one-month history of pain and tingling in the right thumb, index finger, and middle finger. Tinel's sign and Phalen's maneuver are positive. The most appropriate intervention at this time is A. methylprednisolone (Medrol) dose pack. B. splint in neutral position. C. observation. D. surgery - ANSWER (c) B. Splinting in neutral position relieves impingement of the median nerve, thus improving symptoms of carpal tunnel. 7. Which of the following is a cause of prerenal azotemia? A. Infection B. Renal toxins C. Poor renal perfusion D. Urinary tract obstruction - ANSWER (c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be rapidly reversible when renal blood flow and glomerular ultrafiltration pressure are restored. Which of the following is the most common cause of secondary hypertension? A. Renal parenchymal disease B. Primary aldosteronism C. Oral contraceptive use D. Cushing's syndrome - ANSWER (c) A. Renal parenchymal disease is the most common cause of secondary hypertension. (u) B. Primary aldosteronism can cause secondary hypertension, but it is not the most common cause. Progesterone influence on the breast tissue prior to menstruation causes A. proliferation of the mammary ducts. B. growth of the lobules and alveoli. C. proliferation of Cooper's ligaments. D. increase in the number of glands of Montgomery - ANSWER (u) A. Proliferation of the mammary ducts is under the influence of estrogen. (c) B. Growth of the lobules and alveoli is under the influence of progesterone. Prior to menses, the breast swelling that women notice is a result of the progesterone which is secreted from the corpus luteum. During menses, the swelling subsides A patient presents with chronic back pain. On physical examination testing, the patient is found to have abnormalities of proprioception and vibration discrimination. Which of the following portions of the spinal column are most likely affected? A. Lateral spinothalamic tract B. Ventral spinothalamic tract C. Posterior column D. Transection of the cord - ANSWER (u) A. The lateral spinothalamic tract affects pain and temperature sensation. (u) B. The ventral spinothalamic tract affects pressures and touch sensations. (c) C. The posterior column affects proprioception (position sense) and vibration sense. A 65 year-old patient with steroid-dependent chronic obstructive lung disease presents with a headache that has been increasing in severity over the past week, accompanied by nausea and vomiting. He denies fever, but has had photophobia and a stiff neck. Which of the following is the most likely diagnosis? A. Transient ischemic attack B. Bacterial meningitis C. Migraine headache D. Cryptococcosis - ANSWER (a) B. Bacterial meningitis is typically acute in onset and causes fever, but immunocompromised patients may have a slower onset and no fever. A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing shortness of breath for 2 days. Her asthma has been well-controlled until 2 days ago. Since yesterday, she has been using her albuterol inhaler every 4 to 6 hours. She is normally very active, however yesterday she did not complete her 30 minute exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries, or use of oral contraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment? A. Chest x-ray B. Sputum gram stain C. Peak flow D. Ventilation-perfusion scan - ANSWER (c) C. A peak flow reading will help you to gauge her current extent of airflow obstruction and is helpful in monitoring the effectiveness of any treatment interventions. Which of the following medication classes is the treatment of choice in a patient with variant or Prinzmetal's angina? A. Calcium channel blockers B. ACE inhibitors C. Beta blockers D. Angiotensin II receptor blockers - ANSWER (c) A. Calcium channel blockers are effective prophylactically to treat coronary vasospasm associated with variant or Prinzmetal's angina. Which of the following is an indication for vaccination against hepatitis A? A. Illicit drug users B. Health care workers C. Renal dialysis patients D. Routine vaccination starting at birth - ANSWER (c) A. Hepatitis A vaccine is recommended for illicit drug users, anyone living or traveling to endemic areas, sewage workers, food handlers, homosexual and bisexual men, animal handlers, patients with a history of chronic liver disease or a clotting factor disease as well as children and workers in day care settings and institutions. (u) B. Health care workers, renal dialysis patients and routine vaccination starting at birth are some of the recommendations for vaccination against hepatitis B, not hepatitis A A 53 year-old female status post abdominal hysterectomy 3 days ago suddenly develops pleuritic chest pain and dyspnea. On exam, she is tachycardic and tachypneic with rales in the left lower lobe. A chest x-ray is unremarkable and an EKG reveals sinus tachycardia. Which of the following is the most likely diagnosis? A. Atelectasis B. Pneumothorax C. Pulmonary embolism D. Myocardial infarction - ANSWER (c) C. This patient's risk factors for pulmonary embolism include advanced age, surgery, and prolonged bedrest. While the diagnosis of pulmonary embolism is difficult to make due to nonspecific clinical findings, the most common symptoms include pleuritic chest pain and dyspnea associated with tachypnea. Chest x-ray and EKG are usually normal. A 34 year-old female with a history of asthma presents with complaints of increasing asthma attacks. The patient states she has been well-controlled on albuterol inhaler until one month ago. Since that time she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime use averaging about three episodes in the past month. Spirometry reveals greater than 85% predicted value. Which of the following is the most appropriate intervention at this time? A. Oral prednisone B. Oral theophylline (Theo-Dur) C. Salmeterol (Serevent) inhaler D. Beclomethasone (Qvar)inhaler - ANSWER (c) D. This patient has progressed to mild persistent asthma. In addition to her inhaled beta2-agonist (albuterol), she should be started on an anti-inflammatory agent. Inhaled corticosteroids, such as beclomethasone, are preferred for long-term control. Which of the following mechanisms leads to a primary pneumothorax? A. Penetrating or blunt trauma forces B. Underlying lung cancer C. Pressure of air in the pleural space exceeds room air pressure D. Rupture of subpleural apical blebs due to high negative intrapleural pressures - ANSWER (u) C. When pressure of air in the pleural space exceeds room air pressure, it leads to a tension pneumothorax. (c) D. A primary spontaneous pneumothorax is thought to result from a rupture of subpleural apical blebs secondary to high negative intrapleural pressures A patient presents with eye pain and blurred vision. Snellen testing reveals vision of 20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals the presence of a dendritic ulcer. Which of the following is the most likely diagnosis? A. Viral keratitis B. Fungal corneal ulcer C. Acanthamoeba keratitis D. Bacterial corneal ulcer - ANSWER (c) A. Herpes Simplex virus is a common cause of dendritic ulceration noted on fluorescein staining. Clinical Therapeutics/Cardiology A 63 year-old female with history of diabetes mellitus presents for blood pressure follow-up. At her last two visits her blood pressure was 150/92 and 152/96. Today in the office her blood pressure is 146/92. Recent blood work shows a Sodium 140 mEq/L, Potassium 4.2 mEq/L, BUN of 23 mg/dL, and Creatinine of 1.1 mg/dL. Which of the following is the most appropriate initial medication in this patient? A. Terazosin (Hytrin) B. Atenolol (Tenormin) C. Lisinopril (Zestril) D. Hydrochlorothiazide (HCTZ - ANSWER (c) C. ACE inhibitors should be part of the initial treatment of hypertension in diabetics because of beneficial effects in diabetic nephropathy and is the most appropriate initial medication What is the EKG manifestation of cardiac end-organ damage due to hypertension? A. Right bundle branch block B. Left ventricular hypertrophy C. Right ventricular hypertrophy D. ST segment elevation in lateral precordial leads - ANSWER (c) B. Long-standing hypertension can lead to left ventricular hypertrophy with characteristic changes noted on EKG Scientific Concepts/Orthopedics/Rheumatology In adults and intravenous drug abusers, which of the following bones is most commonly affected with acute osteomyelitis? A. Femur B. Humerus C. Vertebral spine D. Tibia - ANSWER (c) C. The bones of the vertebral spine are most commonly affected in a patient with osteomyelitis. Diagnostic Studies/Endocrinology A 43 year-old asymptomatic diabetic female is found to have an elevated total calcium level of 12.4 mg/dL. Which of the following tests must be assessed in order to evaluate this laboratory abnormality? A. Intact parathyroid hormone B. Serum albumin C. 24 hour urine calcium level D. Complete blood count - ANSWER (c) B. Since approximately 50% of calcium is protein bound, total calcium levels should be interpreted relative to albumin levels. . History & Physical/Cardiology Which of the following conditions would cause a positive Kussmaul's sign on physical examination? A. Left ventricular failure B. Pulmonary edema C. Coarctation of the aorta D. Constrictive pericarditis - ANSWER (c) D. Kussmaul's sign is an increase rather than the normal decrease in the CVP during inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction. Which of the following physical exam findings is consistent with moderate emphysema? A. Increased tactile fremitus B. Dullness to percussion C. Distant heart sounds D. Deviated trachea - ANSWER (u) A. Physical examination findings in emphysema include a midline trachea, diffuse hyperresonant to percussion, and decreased tactile fremitus. (u) B. See A for explanation. (c) C. Distant heart sounds are common in emphysema patients due to hyperinflation of the lungs. . Health Maintenance/Obstetrics/Gynecology Patient education for a 23 year-old using oral contraceptives should include which of the following? A. Rifampin may decrease the effectiveness of the oral contraceptives. B. Acetaminophen may decrease the effectiveness of the oral contraceptives. C. Oral contraceptives may provide some protection from coronary artery disease. D. Changing to the "minipill" (progestin only) will inhibit ovulation more consistently than combination oral contraceptives - ANSWER (c) A. Rifampin may interfere with the efficacy of the oral contraceptives. (u) B. Acetaminophen levels or effects may be decreased by oral contraceptive Clinical Therapeutics/Orthopedics/Rheumatology Which of the following medications is the treatment of choice for patients with chronic gout to prevent recurrence of symptoms during its quiescent phase? A. Probenecid (Benemid) B. Allopurinol (Zyloprim) C. Colchicine D. Indomethacin (Indocin - ANSWER (c) B. Allopurinol is the best drug to lower serum urate in overproducers, stone formers, and patients with advanced renal failure. It is a xanthine oxidase inhibitor that is used to prevent the formation of uric acid. Diagnosis/Endocrinology A 64 year-old male presents complaining of new onset of fatigue, weight gain, constipation, erectile dysfunction, and loss of body hair. Laboratory investigation demonstrates: TSH less than 0.5 microunits/mL (normal range 0.5-5.0 microU/mL); Thyroxine (T4) 2 mcg/dL (normal range 5-12 mcg/dL); Prolactin 10 nanograms/ml A. Primary hypothyroidism B. Excessive dosing of levothyroxine (Synthroid) C. Hypopituitarism D. Subacute thyroiditi - ANSWER (c) C. The low trophic and target hormone levels combined with symptoms of hypogonadism indicate this patient has hypopituitarism Diagnostic Studies/Hematology An 18 year-old woman presents to the clinic complaining of fatigue. She reports a past history of lifelong frequent nosebleeds and bleeding gums. She also has menorrhagia. Her mother and maternal grandfather have a similar bleeding history. Initial lab results are as follows: WBC 9,500/mm3, Hgb 10.9 g/dL, HCT 33%, MCV 69 fL, MCHC 26 pg and platelets 284,000/mm3. Which of the following tests should be ordered to evaluate this patient's diagnosis? A. Hemoglobin electrophoresis B. Bleeding time and platelet aggregometry C. Bone marrow aspiration D. PT and aPTT - ANSWER (c) B. The patient's presentation is consistent with a congential qualitative platelet disorder, most likely von Willebrand's Disease, necessitating a bleeding time and evaluation of platelet function. Clinical Therapeutics/ENT/Ophthalmology A 35 year-old patient has recurrent seasonal rhinitis and a history of mild asthma. Which of the following should be included for first-line management? A. Immunotherapy B. Decongestants C. Corticosteroid inhalers D. Cromolyn sodium (Intal - ANSWER (c) C. Regular use of corticosteroid nasal spray and oral inhalers prior to the allergy season is among the best means of preventing allergies. Scientific Concepts/ENT/Ophthalmology Small grayish vesicles and punched-out ulcers in the posterior pharynx in a child with pharyngitis is representative of which organism - ANSWER (c) C. Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx. Health Maintenance/Neurology A 53 year-old female has a diagnosis of migraine headaches. She had been using sumatriptan (Imitrex) to abort her headaches, but she is now having one or two headaches per week. The most appropriate preventive therapy is A. zolmitriptan (Zomig). B. promethazine (Phenergan). C. propranolol (Inderal). D. fluoxetine (Prozac). - ANSWER (c) C. Propanolol is useful in preventing migraine headaches and may be maintained indefinitely. Which of the following drugs is first-line therapy for schizophrenia? A. Chlorpromazine (Thorazine) B. Clozapine (Clozaril) C. Haloperidol (Haldol) D. Olanzapine (Zyprexa - ANSWER (c) D. Initial pharmacologic therapy of schizophrenia should begin with one of the newer, "atypical" antipsychotic drugs, such as olanzapine, risperidone, quetiapine, ziprasidone, and clozapine because their side effect profile is significantly better than the older drugs, and they may be more effective for negative psychotic symptoms. Health Maintenance/ENT/Ophthalmology A patient with type 2 diabetes mellitus presents for a yearly eye exam. Ophthalmoscopic exam reveals neovascularization. Which of the following is the most likely complication related to this finding? - ANSWER (c) C. Proliferative retinopathy, as evidenced by neovascularization, is associated with an increased risk of vitreous hemorrhage. 23 year-old male presents with syncope. On physical examination you note a medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining. Which of the following is the most likely diagnosis? A. Hypertrophic cardiomyopathy B. Aortic stenosis C. Mitral regurgitation D. Pulmonic stenosis - ANSWER (c) A. Hypertrophic cardiomyopathy is characterized by a medium- pitched, mid-systolic murmur that decreases with squatting and increases with straining A 28 year-old female, who has experienced occasional painful migratory arthralgias, complains now of a tender, swollen, and hot left ankle. The joint was aspirated and the synovial fluid showed 55,000 WBCs, 75% polymorphonuclear lymphocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis? - ANSWER (c) B. Septic arthritis presents with a large number of WBCs, predominantly polymorphonuclear, and with glucose levels much lower than serum levels. History & Physical/Dermatology Erythema nodosum is characterized by A. subcutaneous red tender nodules. B. brown pigmentation on the lower extremities. C. tender lymph nodes in the groin. D. scaling red macules. - ANSWER (c) A. Erythema nodosum produces erythematous red tender nodules, especially on the shins. (u) B. Brown pigmentation on the lower extremities is a feature of chronic venous insufficiency. (u)C. Lymphovenereum granuloma is likely to produce tender lymph nodes in the groin as can acute infection in the lower extremities. (u) D. Scaling red macules are a feature of tinea corporis. Clinical Therapeutics/ENT/Ophthalmology Use of systemic corticosteroids can cause which of the following adverse effects in the eye? A. Cortical blindness B. Optic atrophy C. Glaucoma D. Papilledema - ANSWER (c) C. Glaucoma can be caused by the long-term use of steroids (u) A. Cortical blindness is a rare adverse effect when prescribing salicylates. (u) B. Optic atrophy can occur as an adverse effect with lead compounds, amebicides, and MAO inhibitors. Best screening test for SLE - ANSWER c) D. ANA's are the best screening test used in the evaluation for SLE. Clinical Therapeutics/Cardiology Acute rebound hypertensive episodes have been reported to occur with the sudden withdrawal of A. verapamil (Calan). B. lisinopril (Prinivil). C. clonidine (Catapres). D. hydrochlorothiazide (HCTZ) - ANSWER (c) C. Clonidine (Catapres) is a central alpha agonist and abrupt withdrawal may produce a rebound hypertensive crisis. Diagnosis/Obstetrics/Gynecology A 30 year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is A. placenta abruptio. B. ectopic pregnancy. C. pelvic inflammatory disease. D. ruptured ovarian cyst. - ANSWER (c) B. Infertility increases the risk of developing ectopic pregnancy. The onset of vaginal bleeding, pelvic pain, and formation of an adnexal mass makes this the most likely diagnosis. (u) C. Pelvic inflammatory disease typically presents with fever, abdominal pain, purulent vaginal discharge, and cervical motion tenderness. (u) D. Acute pelvic pain may occur secondary to bleeding from the rupture of a hemorrhagic ovarian cyst, but no adnexal mass would be palpable on pelvic examination. History & Physical/Gastrointestinal/Nutritional A patient presents complaining of periumbilical pain. Which of the following anatomical sites is this finding associated with? A. Bladder B. Stomach C. Pancreas D. Small bowel - ANSWER (u) A. Pain from the bladder, uterus, or colon causes hypogastric pain. (u) B. Pain from the stomach, duodenum, or pancreas causes epigastric pain. (u) C. See B for explanation. (c) D. Pain from the small intestine, appendix, or proximal colon causes periumbilical pain. Diagnosis/Orthopedics/Rheumatology A 53 year-old patient presents with severe pain at the base of the thumb and no other finger involvement. The pain is worse with activity and lasts a short period of time following rest. There is no specific history of trauma to the thumb but the patient admits working with her hands as a typist. Which of the following is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Hemochromatosis D. Pseudogou - ANSWER (u) A. Rheumatoid arthritis typically involves the MCP and PIP joints of the digits for the second through fifth fingers. The thumb is classically spared. (c) B. The base of the thumb is typically involved with osteoarthritis as are the DIP joints of the other fingers. (u) C. Hemochromatosis classically involves the MCP joints of the second through fifth fingers. (u) D. Pseudogout joint involvement is typically the MCP joints of the second through fifth fingers. History & Physical/Endocrinology Which of the following findings is usually associated with Addison's disease? A. Weight gain B. Hypertension C. Increased pigmentation D. High plasma cortisol levels - ANSWER (u) A. Patients with Addison's disease tend to have anorexia and weight loss. (u) B. Patients with Addison's disease tend to have hypotension. (c) C. Patients with Addison's disease have diffuse tanning over nonexposed and exposed skin due to increased melanocytic factor that is released with adrenocorticotropic hormone. (u) D. Patients with Addison's disease tend to have low plasma cortisol levels. Diagnosis/Hematology A 60 year-old male presents with a normochromic, normocytic anemia and splenomegaly. His past history reveals several episodes of bacterial pneumonia in the past year. The WBC count is 43,000 mm3 with 25% segmented neutrophils, 3% blasts, 70% mature lymphocytes, 1% basophils, and 1% eosinophils. This most likely represents A. myelodysplastic syndrome. B. acute lymphocytic leukemia. C. chronic lymphocytic leukemia. D. chronic myelogenous leukemia. - ANSWER (c) C. Chronic lymphocytic leukemia usually occurs after the age of 50 presenting with lymphocytosis 20,000 mm3 and lymphocytes that appear mature. Which of the following is the chief adverse effect of thiazide diuretics? A. Hypokalemia B. Hypernatremia C. Hypocalcemia D. Hypermagnesemia - ANSWER (c) A. Thiazide diuretics can induce electrolyte changes. Principle among those is hypokalemia. (u) B. Hyponatremia, not hypernatremia may be a complication of thiazide diuretics Clinical Therapeutics/Pulmonology An immunocompromised patient presents with signs and symptoms consistent with Legionella pneumophila who has not responded to initial antibiotic therapy with a macrolide. Which of the following should be added? A. Clarithromycin (Biaxin) B. Rifampin (Rifadin) C. Levofloxacin (Levaquin) D. Amoxicillin-clavulanate (Augmentin - ANSWER (c) B. Rifampin should be used as an adjunct in patients with either a macrolide or quinolone antibiotic, who have failed therapy, are immunocompromised or have severe illness. . Clinical Intervention/Orthopedics/Rheumatology Which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius? A. Open reduction and internal fixation B. Ace wrap or anterior splinting C. Closed reduction and casting D. Corticosteroid injection followed by splinting - ANSWER (c) B. A torus or buckle fracture occurs after a minor fall on the hand. These fractures are very stable and are not as painful as unstable fractures. They heal uneventfully in 3-4 weeks Clinical Therapeutics/Urology/Renal Which of the following can be used to treat chronic bacterial prostatitis? A. Penicillin B. Cephalexin (Keflex) C. Nitrofurantoin (Macrobid) D. Levofloxacin (Levaquin) - ANSWER (c) D. Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate. Scientific Concepts/Pulmonology Which of the following pathophysiological processes is associated with chronic bronchitis? A. Destruction of the lung parenchyma B. Mucous gland enlargement and goblet cell hyperplasia C. Smooth muscle hypertrophy in the large airways D. Increased mucus adhesion secondary to reduction in the salt and water content of the mucus - ANSWER (c) B. Chronic bronchitis results from the enlargement of mucous glands and goblet cell hypertrophy in the large airways. Scientific Concepts/Gastrointestinal/Nutritional Gallstones usually result in biliary symptoms by causing inflammation or obstruction following migration into the common bile duct or A. cystic duct. B. pancreatic duct. C. duodenal ampulla. D. common hepatic duct - ANSWER (c) A. Obstruction of the cystic duct by gallstones causes the typical symptom of biliary colic. Once obstructed the gallbladder distends and becomes edematous and inflamed. Gallstones can also migrate into the common bile duct through the cystic duct leading to a condition known as choledocholithiasis. Health Maintenance/Pulmonology A 65 year-old with COPD receiving their first pneumococcal conjugate vaccination should be revaccinated in A. 1 year. B. 3 years. C. 5 years. D. 10 years - ANSWER (c) C. A single revaccination for a person over the age of 65 is recommended if it has been more than 5 years since they received their first vaccination. Clinical Therapeutics/Orthopedics/Rheumatology An 80 year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with osteoporotic compression fracture. Which of the following treatment modalities has the potential to cause analgesia of the fracture site with its use? A. Calcitonin (Miacalcin) nasal spray B. Alendronate (Fosamax) C. Raloxifene (Evista) D. Combined estrogen and progesterone (Prempro) therapy - ANSWER (c) A. Calcitonin has the ability to cause analgesia when used for acute compression fracture of the vertebral body. . Clinical Therapeutics/Neurology Which of the following side effects is associated with long-term administration of phenytoin (Dilantin)? A. Ataxia B. Hypotension C. Osteomalacia D. Cardiac dysrhythmia - ANSWER (c) C. Osteomalacia, or demineralization of bone, is a side effect of phenytoin that may occur after chronic administration. History & Physical/ENT/Ophthalmology Hairy leukoplakia has the greatest prevalence of distribution on the 52 A. palate. B. floor of the mouth. C. lateral tongue. D. gingiva - ANSWER (c) C. The lateral border of the tongue is where hairy leukoplakia is commonly seen Shy-Drager Syndrome - ANSWER Shy-Drager syndrome is due to autonomic degeneration and typically presents with orthostatic hypotension Clinical Therapeutics/Dermatology A 45 year-old female presents to the emergency department with generalized, hot, erythema of the skin. Physical exam reveals an oral temperature of 102 degrees Fahrenheit, purulent conjunctivitis, and mucosal erosions. Her skin is painful and separates from the dermis with touch. Which of the following is the most likely cause for this condition? A. Ampicillin B. Prednisolone C. Aspirin D. Hydrochlorothiazide (HCTZ) - ANSWER (c) A. Medications are most frequently implicated in toxic epidermal necrolysis. These usually include, analgesics (NSAIDs), antibiotics (Ampicillin) and anticonvulsants (Carbamazepine). Diagnosis/Endocrinology A 7-year-old child with a history of type 1 diabetes mellitus for 3 years presents for routine follow-up. The mother states that the child has been having nightmares and night sweats. Additionally, his average morning glucose readings have risen from an average of 100 mg/dL to 145 mg/dL over the past week. This child is most likely experiencing A. a growth spurt. B. emotional problems. C. the Somogyi effect. D. the dawn phenomenon. - ANSWER (c) C. This refers to nocturnal hypoglycemia, which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia. (u) D. This refers to an early morning rise in plasma glucose due to reduced tissue sensitivity to insulin between 5 AM and 8 AM. It is not associated with nightmares and night sweats. Clinical Intervention/Hematology A 29 year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient? A. Aspirin B. Intravenous immunoglobulin C. Danazol (Danocrine) D. Splenectomy - ANSWER (c) D. Persistently low platelet counts ( 20,000) require effective long-term treatment, and splenectomy is the treatment of choice. A patient presents for a follow-up visit for chronic hypertension. Which of the following findings may be noted on the fundoscopic examination of this patient?