|
Q 1. Which of the following pairs of association is incorrect?
The most appropriate answer is choice 4. Steroids are specifically not meant for PREVENTION of UC flares. They are great for the TREATMENT of a flare. Prevention is best done using Sulfasalazine. Choice 5 is very true and has appeared in many exams that I have taken. The fact is important because the patient with Wegener's would present with such URI/Sinusitis type symptoms and a doctor would most likely prescribe Bactrim and see mild improvement. This convinces the doctor and patient that this is sinusitis BUT not really. In a medical practice, this is the way a Wegener's patient is likely to present. SO BEWARE of that response to Bactrim. Choice 3 is correct as Homocystinemia is now treated using high doses of Vitamins Folic acid and B6 (Pyridoxine) which help reduce the levels. Patients with high levels of Homocysteine have arteries that get very advanced atherosclerosis at very young ages. Choice 2 suggests Glaucoma and tonometry is appropriate. I once had such a patient who had a chief complaint of slight blurring of vision. He had an oval pupil. That is the only time I saw this finding in my life. I asked the patient to go and get tonometry done immediately. He had no more money than to pay me so he could not go see anyone else. I did not charge him and said that this way he will have some money to pay the ophthalmologist/optometrist. He went. The next day he called back. He did see the Ophthalmologist who confirmed the diagnosis. The patient was a mason by profession. He has made several attempts to pay me again - without success. He now has an open offer to build my office for me - whenever I go on my own. Lesson - have good Karma - your reward is never lost. Q 2. A 70 year old female patient comes to you with confusion and vomiting. You check her BUN and creatinine. They are markedly elevated. Which of the following would be the best indicator that this is a chronic problem (chronic renal failure)?
The correct answer is choice 3. I could accept choice 3 as one of the correct answers too. Broad casts are extremely specific for the diagnosis of Chronic renal failure. They signify that the remaining few tubules have dilated extensively. On occasion the exam might want to know the protein that causes the formation of casts - Tamm Horsfal protein. It is secreted in the tubules and is normal component. Exams also sometimes ask what the Bence Jones protein is in myeloma. They are Light chains - Either Kappa or Lambda. Granular casts suggest pyelonephritis. Isosthenuria is seen in acute and chronic failure - both. Anemia has a lot of causes but in a case wit elevated BUN/Cr, it is a fair indicator of the chronicity of the problem. Corneal opacities are present in patients with hypercalcemia and also in those with idiopathic hypoparathyroidism. Not much to do with renal failure chronicity.
|